We all have our stories about why we, whether nurse or not, have chosen to work in the nursing space. 

In 2004, I was a professional philosopher, working at a small liberal arts college in Philadelphia. My brother called me. “Mom is in the hospital.” “Should I come?” I asked. We already knew she had Stage 4 colon cancer, but as laypeople, we didn’t really know what that meant. We didn’t know that she had a gene polymorphism that caused her to have severe diarrhea and neutropenia as a side effect of one of the chemotherapies she was receiving. Her hospital had no specialty care, not even an ICU. Eventually she was transfered to a hospital a hundred miles away. 

When I arrived, my three siblings and I asked to meet with her oncologist. We had a phone conversation with him while we were driving. It was on a flip phone that I held up in the middle of the car so my sister and brothers could hear. He said our mother had a “slim chance.” I heard “slim.” My siblings heard “chance.” When we got back to the ICU, the intensivist told us that it was time to put her on the ventilator. We knew that was a big step. We sat in a nearby consultation room discussing the difference between “slim chance” and “chance” when my mother’s nurse came in, sat down, and talked with us. I suspect it was her dinner break, for I now know that she would have had little time to give than her own. Patiently, kindly, she helped us realize that there was no coming back from this. We moved Mom to a nearby hospice, and two days later, she passed with us by her side.

That nurse profoundly transformed my life. She cared about my mother, and she cared about my family. After that encounter, I changed my life’s course, went back to school, and became an advanced practice cancer nurse. 

Whatever your story about why you find yourself here in this school, you now find yourself in the space of nursing. Something special happens in this space each time an act of care occurs. It is the something special that occurred between that ICU nurse and my family and me. Her act of care was what the contemporary British cognitive scientist Margaret Boden calls generative creativity. 

According to Boden, generative creativity maps, explores, and transforms. Generative creativity is not mere dreaming, hoping, or wishing. It is seeing what others do not see – and then doing it. It thinks and does the impossible. 

Leonardo Boff, a contemporary Brazilian philosopher, says that generative creativity is the ultimate form of care, which organized our universe’s creation. Boff says that, “if the original energies and the first elements had not been governed by…care,” the universe would not have existed. In other words, generative creativity – that is, ultimate care –  brought our universe into being. 

It is not only that we conduct research and that we practice in such a way that improves patient-, family-, and community-outcomes. It is, also, that our doing so is generative creativity. It maps, explores, and transforms people’s lives. We bring a new universe into being for people when we improve their health outcomes. 

I know this firsthand. That ICU nurse mapped and explored our options. And when the death of our mother, la matriarca que se alzaba grande, was upon us and we were struggling, that nurse, through her care, brought order to the chaos of our family and provided our mother a peaceful death.

A less private example is of our own school. From a certificate program in the 1990s, to a full-fledged program in 2007, to being a named school just five years ago, and soon to be inhabiting a state-of-the-art building: Is this not an example of caring to think what others could not think and of caring to do what they said was impossible at one of the country’s leading public universities? Those who cared — Ellen Lewis, Ellen Olshansky, Alison Holman, Suzanne Phillips, Susan Tiso, Dorothy Tu, and of course, the school’s founding dean, Adey Nyamathi, among others about whom I do not know — engaged in generative creativity.

This is the vision I bring with me to set the course for the next five years: a vision of us — as nursing community — transforming our society by caring to think and do the impossible. 

I have three specific areas in mind.

First is pandemic preparedness. Well over 5 million people have died from covid, mostly older adults and Black, Indigenous, and People of Color. This pandemic has put health disparities squarely on the front page. But these disparities are not new. Almost 37 million people have died from AIDS-related illnesses since the HIV pandemic began, and as you know, most of them were from vulnerable populations in the Global North and Black, Indigenous, and People of Color in the Global South. 

Let me tell you about a nurse in Botswana who met the HIV pandemic with generative creativity. At that pandemic’s height, Sheila Tlou was a community health nurse and a professor at the University of Botswana. In response to the devastation around her, she ran for political office in the early 2000’s and won. The president installed her as the country’s minister of health. And she put into place a national HIV program that included free antiretroviral therapy and depended largely on community-health nursing. Because of this program, today 92% of Batswana living with HIV know their status, of whom at least 90% are on treatment, and of those on treatment, 95% have no detectable viral load (UNAIDS, 2020). By comparison, as of the year 2020, in the United States, only New York City has met the UNAIDS 90-90-90 targets. In Botswana in response to a pandemic, nurses thought and did the impossible and transformed society.  

I know the school is conducting research and is practicing in this area. I ask us to grow this work to address future pandemics. After all, this pandemic age, which has been the age we have lived in for the last century, is not going away.

Second, the pandemic has shown us that we must care more than ever about health equity. 

We must care about Black, Indigenous, and People of Color, about the LGBTQ community, about people with different abilities, unhoused people, and older adults – about people who, because of the many discriminatory structures of society, are marginalized, and whose health, as a result, has borne the brunt. 

We must also care about health equity and nurses. During this pandemic, some nurses have died, mostly nurses of color. Others have given so much that they felt they had no choice but to leave the profession. We can call this moral distress. We can roll out interventions to bolster nurses’ resilience. But at the end of the day, the pandemic showed us what we all have known: the moral conditions of nurses’ work are inequitable. We must address this. We must also address the inequities in nurse practitioner authority in California, which is one of a handful of states that, sadly, restricts our practice, which in turn restricts underserved peoples’ access to care. 

I was drawn to UCI Nursing because of your compassionate response toward vulnerable populations in your teaching and learning, in your practice, and in your research and scholarship. I wish to advance this emphasis by inviting you to address equity issues not only in research, practice, and the curriculum but also by continuing to admit diverse students and hiring diverse faculty and staff. I invite us all to continue to address equity issues in our messaging, in our fundraising, and in how we administrate the school. If we create a society here, in our school, that practices radical equity, we will be a force that counters structural racism, in its many forms, in society at large. 

Pandemic preparedness and health equity are interrelated, but so is the third area I’d like us to address. The earth is sick with an illness that arises from how we who inhabit the Global North live. The effects of this illness largely fall upon Black, Indigenous, and People of Color here but more so in the Global South. Newer technologies may contribute to the solution to climate change, but they will not treat the underlying illness. The treatment is to change how we live and work. Let us, here at the school and within UCI Health, follow through on the COP26 commitment to developing climate-resilient and low-carbon health systems. Let us, as a nursing community, give Earth the same succor it gives us day in and day out.

Just as that nurse did for my family in that ICU consultation room almost 20 years ago, I ask us, over the next five years, to map, explore, and transform three great issues of our time — pandemic preparedness, health equity, and climate change. To use Boff’s phrase, let us create a universe governed by care, right here, right now, in our school. Thank you very much.