On episode 339 of The Nurse Keith Show nursing and healthcare career podcast, Keith interviews nurse philosopher and healthcare system design expert Dr. John Silver regarding his brilliant model of the future of American healthcare as a public utility.
Political Philosopher and Healthcare System Design Expert
Dr. John Silver received his Associate degree in nursing in 1984 from Palm Beach Community College, his BSN from Florida Atlantic University (FAU) in 1998 and his Master’s Degree from FAU in 2000. He earned the Public Intellectual Ph.D. in Comparative Studies from FAU in 2010.
Dr. Silver started in healthcare in 1974 and became a Respiratory Therapist in 1978. After receiving his ADN nursing degree in 1984, he worked extensively in critical care, including medical and surgical ICUs, trauma units, burn units, and neurological ICUs. He spent the last 8 years of practice in emergency rooms while attaining his degrees, and then transitioned to academia.
Dr. Silver writes and speaks about political issues in nursing and healthcare. He has presented at multidisciplinary conferences both nationally and internationally on health policy, the restructuring of healthcare systems using the Public Utility Model, and the role of nursing in that process. He has also spoken to a variety of nurse practitioner groups on political tactics for prescriptive authority and independent practice. In 2004, he led Spectrum’s international online chat prior to the election. He also studied nursing theory, nursing leadership and has a particular interest in the political fracturing of nursing. In 2013, he published his book on political empowerment “just a union…of nurses.
Declaration of Independence for Nursing
When in the course of human events, it becomes necessary for one profession to dissolve the bands which have connected them with another, and to assume among the great powers of the professions, the separate and equal station to which the Laws of nature and training entitle them, a decent respect to the opinions of mankind requires that they declare the causes which impel them to the separation.
We hold these truths to be self-evident, that the profession of Nursing has earned the trust and respect of their countrymen. That the profession has demonstrated since its inception that we are dedicated to the prevention of disease, the treatment of disease with other professionals, and the quality and humanity of healthcare for our patients, our communities, our states, and the nation. That whenever any institution becomes destructive of these ends, it is the Right of Nursing to publicly recommend to our fellow citizens the need to alter or to abolish it, and to institute a new system, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect the Safety and Health of our fellow citizens. Prudence, indeed, will dictate that systems long established should not be changed for light and transient causes; and accordingly all experience has shown, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.
But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them to suffer, it is their right, it is their duty, to throw off such systems, and to provide new Guards for their future security. Such has been the patient sufferance of Nursing; and such is now the necessity which empowers them to recommend altering the former Systems of relationships. The history of Healthcare over the last 100 years is a history of repeated injuries and usurpations of Nursing and too many of the American Public, all having in direct object the evolution of a dysfunctional and profit focused “system”. To prove this, let Facts be submitted to a candid world.
- Whereas Healthcare in the United States has evolved into a disease-focused and profit-centered endeavor at the expense of prevention and social health, and the exclusion of many geographical regions and populations.
- Whereas This dysfunctional system has allowed serious healthcare risks to continue whether environmental, preventable, or practice related, and placed an undue financial burden on states, counties, cities, companies, corporations, individuals, and the Federal Government.
- Whereas Hospital administrations have denigrated and constrained the profession of Nursing for over a century from controlling their professional practice environments by being the sole discretionary force in determining institutional nursing leadership, and thus relegated safe practice decisions to financial officers.
- Whereas The profession of Medicine has spent an enormous amount of money and effort over the last 70 years to block the natural progression of training and thus practice capabilities of Nursing professionals to help meet the healthcare demands in our country.
- Whereas The American Nursing Association has been unable or unwilling to protect the profession from abuse, and yet pretends to speak politically for all nurses when they only represent 4 to 5 percent of nurses.
- Whereas Nursing leadership organizations are allied with the American Hospital Association, long known to be opposed to safety and safe practice initiatives for nurses, and thus patient care.
- Whereas The profession of Medicine has tolerated and participated in an abusive facility environment and “military” subjugation of the Profession of Nursing for a century.
- Whereas The political establishment has responded to the increasing crisis of healthcare and the dysfunction of the system by only considering the interests of those who finance them, and long relegated Nursing to a non-entity when major healthcare decisions are made.
- Whereas Healthcare facilities have refused to take accountability for the health of the communities they serve, and determined the allocation of resources based only on profitability.
- Whereas Too many Americans lose their wealth, face bankruptcy, or lose their livelihoods and futures related to acute, chronic, and long-term healthcare costs or healthcare conditions.
- Whereas Health outcomes in the United States are a global embarrassment in too many categories and for too many people.
- Whereas There is a lack of equitable access appropriate to community needs, and a lack of equitable, targeted, and evidence-based distribution of healthcare resources.
- Whereas There is a lack of social accountability by current systems to the communities they do serve, and a blind eye to the communities they don’t.
- Whereas Nursing leadership has failed to heed the call for critical reflexivity regarding the empowerment of Nursing as a political force.
- Whereas Nursing has lost its philosophical bearing in health care, and lost touch with its socially active roots in practice due to the systemic design.
Nor have we been wanting in our attentions and efforts with our partners in healthcare. We have warned them from time to time of their unwarrantable jurisdiction over us. We have reminded them of our history and ethical imperatives. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common missions to disavow these usurpations. They have been deaf to the voice of justice and consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, either allies or foes.
We further commit ourselves to the following goals for healthcare:
- Equitable access appropriate to the communities needs
- Quality evidence-based care
- Equitable, targeted, and evidence-based distribution of resources
- Interdisciplinary practitioner-led administration so that the system is congruent with their values
- Equitable and positive outcomes
- Cost efficiency, and Social accountability and a mandate for direct public reporting.
We pledge ourselves to achieve this goal: To offer to the American Public a new vision for healthcare, administered by Nursing, working inclusively with all our partners in practice, and firmly committed to offering cost-constrained, equitable, and accessible healthcare to ALL Americans.
We pledge ourselves to achieve independent practice at every level of service to better serve the American Public.
We pledge ourselves to remain true to our calling of service to our patients, communities, states, and nation.
We pledge ourselves to confront those forces that work against public health, regardless of their political connections.
We pledge ourselves to publicly report directly to our regions on a regular basis regarding the health status of our communities.
We pledge ourselves to respect and value this social contract with the American Public.
We pledge ourselves to remain true to who we are and to avoid the trappings of hubris and greed.
And for the support of this declaration, and with a firm reliance on providence and a belief in Justice, we pledge ourselves as nurses.
Connect with Dr. Silver and Nurses Transforming Healthcare: http://nursestransforminghealthcare.org
- International Council of Nurses (ICN) podium invitee | Helsinki, Finland, October 2014. “Proactive media Utilization for international nursing”
- 1st European Sigma Theta Tau conference, Podium Presentation, Cardiff, Wales, August 2013. “The merging of U.S. and European healthcare systems: Where is the balance?”
- UCLA Conference on Technology, Knowledge, and Society, Podium Presentation | Los Angeles, California, January 2012. “Electronic Health Records: The Devil’s advocate”
- Master’s essential conference | Orlando, FL, Poster presentation, 2012. “What do we MEAN by faculty practice?”
- Drexel University Simulation Conference | Orlando, Florida, 2011
- Invited Speaker- 3rd International Conference on Design Principles and Practice | Berlin, Germany, 2009. “The Philosophical, Social, and Structural Design Requirements for a Successful Healthcare System.”
- Luncheon host, 35th Annual National Conference on Professional Nursing Education & Development, 2008. “The Role of Politics in Nursing Education: Moving from Nurse to Nursing”
- SFONE oral presentation, 2007. “Crossing the Great Divide -The Fractured Field of Nursing”
- Simulation Conference NLN | Baltimore, Maryland Nov, 2006. SMUG meeting Univ. Of Md.
- Invited keynote speaker – Michigan Council of Nurse Practitioners | Dearborn, MI, 2006. “Prescriptive Authority: Myth or Reality? ”
- NPR WLRN Miami, “Topical Currents”, 2005. ”Restructuring the Healthcare System”.
- Nursing Spectrum National Chat host, 2004. “The Politics of Nursing”
- Invited speaker, Michigan Council of Nurse Practitioners | Dearborn, MI, 2005. “Policymaking and Nursing”
- 5th Annual Southeastern Seaboard Emergency Nursing Symposium |Tampa, FL, 2004. “Nursing and Policy”
- “Malpractice Tip of Healthcare Crisis”, (Op-ed ). Sun-Sentinel, 6/25/03.
- Silver J., Winland-Brown J. Power asymmetry and patient autonomy. J Crit Care 2000 Oct 01; 9(5):360-361
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