What Would Nurses Do With Families at the Border?

The “Nuremberg defense” was used by Nazi war criminals, who claimed that they were “just following orders” when they tortured and murdered 6 million Jews and countless others, including children with disabilities, gays and lesbians. Our country is better than that — or at least that is what we learned in nursing school.

It seems, however, that terms such as “land of immigrants,” “land of opportunity,” and “melting pot” that welcome people from all backgrounds have simply become vacuous phrases. Last week, the United States was in the midst of a humanitarian crisis. How could it be humane to separate children from their parents in any situation? And what about today’s refugee crisis, where families are fleeing war-torn, violent countries?

Lady Liberty, America’s welcoming statue at the entrance to Ellis Island, where refugees sought asylum a century ago, has these words engraved: “Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door!” 

This is the heart of what the United States represents, but recently children were being separated from their parents because they are seeking asylum, and border guards were being told to separate families and confine their children in cell-like conditions. The border guards were just following orders.

Members of the Trump administration said that this practice of separating children from their parents would be a deterrent to further “illegal” immigration. Since when is seeking asylum from war, domestic violence or gang violence illegal?

But Attorney General Jeff Sessions determined that this was our policy. We were just supposed to follow orders. Secretary of Homeland Security Kirstjen Nielsen supported this practice, as well, saying that letting parents and their children into the United States is like giving out “get-out-of-jail-free cards.” In other words, we must follow the orders because this is the law.

If a nurse believes that orders given to him or her by a physician do not follow hospital policy or put the patient at risk, how does the nurse resolve the conflict? First, nurses must voice their opinion to the physician and try to persuade the physician. However, if an action will obviously harm a patient, then nurses refuse to follow the order, even if they will face retaliation from the physician. As nurses, we know that doing or saying nothing when action is required may be the worst offense of a nurse on duty.  

That is why over 33 nursing organizations — representing a cross-section of nursing education, research, practice and regulation — called on the Department of Homeland Security and the overall administration to stop the unethical order of separating children from their patients because this practice was harming people, particularly children. This was not simply a difference of opinion of what strategy was best; it was a matter of doing what is right, what is ethical and what prevents harm.

Just as nurses have an obligation to say “no” to practices that are simply wrong, to resist, to not follow orders blindly, our government officials have a similar obligation. “Just following orders” is not a reason to act against the interests of our fellow human beings.

This response by nursing organizations across the country was encouraging, and we, as nurses, need to continue to make our voices heard. The Woodhull Study, originally published in 1998, found that nurses represented 4 percent of all sources for media related to health issues. A new Woodhull study is in process, with preliminary results indicating that nursing still has much work to do to be represented in the media.

Standing up to inhumane and immoral government policies is one very important reason for nurses’ voices to be represented. Despite this new executive order by President Donald Trump to end the practice of separating families at the border, we must keep up our vigilance to “not just follow orders” if these orders are unethical, and cause harm.


Ellen Olshansky, Ph.D., RN, is a professor and chair of the Department of Nursing at the Suzanne Dworak-Peck School of Social Work and professor emerita at the University of California, Irvine Sue & Bill Gross School of Nursing.

Sarah Oerther, MSN, RN, is the communications chair of the Public Health Nurse Section of the American Public Health Association.

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