"Everything we shut our eyes to, everything we run away from, everything we deny, denigrate, or despise, serves to defeat us in the end." So said Henry Miller, as quoted by Connie Barden, immediate past president of the American Association of Critical-Care Nurses (AACN), at the association's annual National Teaching Institute (NTI) May 19, in San Antonio, Texas.

I'm writing this after an extraordinary morning at the NTI. I must disclose that I received an award from AACN, but I feel no obligation to promote the association in return. Rather, I write because I was moved by Barden's opening address, delivered to more than 6,000 nurses. She urged her colleagues to make three commitments: to be led by their purpose, to develop and use a bold voice, and to be responsible for the future of nursing. I extend that challenge to all nurses.

She elicited laughter when she claimed she's an introvert. "I really am," she said. But she also said she has a sense of purpose that "propels me past my fears of speaking and acting boldly." She appears to be in the minority. Nurses seem to me to be numb to work environments that are abusive to them and unsafe for patients. As Barden noted, remaining silent under these circumstances is unethical. And I would add that a complaint without action is tantamount to sanction of such unacceptable working conditions.

For a number of years, I periodically met with a nurse colleague who invariably told me how awful things were at work-her colleagues were unsupportive, her patients too acutely ill, the care they received too poor. When I suggested she find another job, she said she didn't want to lose seniority and the accompanying benefits. So I proposed she speak out about the working conditions and team up with coworkers to find solutions. She said, "It's no use. Nothing will change." She had no excuse for this passivity: she was represented in her facility for collective bargaining by a strong state nurses association, which afforded her some protection from being fired for speaking out.

I no longer see this woman. I often left our dinners despairing about the future of nursing and health care. I learned long ago that chronic complaining is a sign of powerlessness that can be contagious. She believed she was powerless, she acted as though she were powerless, and that in turn meant she was powerless. Such a cycle can be destructive to nurses, both individually and collectively.

"A bold voice," said Barden, "isn't a blaming voice or a whining voice. It doesn't argue about who is right or wrong or about whose fault it is that we are faced with challenges. A bold voice moves past complaints to look for solutions, which will be found if we work with others and take the time, give the thought, and have the patience to create the changes needed."

Barden asked each nurse at the NTI to take three pledges:

* "I will identify the most pressing challenge in my immediate work environment."

* "I will initiate dialogue with my colleagues to find solutions to this problem."

* "I will remain actively involved in the solutions until they're working."

I have taken these pledges. One way I hope to fulfill it is through AJN 's annual retreat, where staff members discuss work together. Ground rules include that no one will be fired for what is said and that we speak to one another respectfully, even when angry. I'm dedicated to doing whatever I can to support my colleagues, encourage their creativity in their work, and solve problems collaboratively.

I ask you to take these pledges and ask your colleagues to do so too. Read Barden's full speech on the AACN Web site, http://www.aacn.org, and make your own pledge. AACN intends to track and report on the results.

What are you waiting for?