I very much admire AJN 's courage in publishing "Learning the Bones," a poem that may well draw criticism from those who prefer poetry to be safe and sentimental. But as the poet Jack Gilbert wrote, "Propriety is exactly what we should not ask of poetry." He calls good poems a "disturbance of the peace," and I agree. Those of us who work with patients are always close to such disturbances-birth and death, suffering and grief. Our work is intimate.

Good poems, like this one, stimulate discussion and raise moral and ethical questions, taking as their subjects love, death, passion, evil, and as Gilbert has written, "the major issues of life," just what we nurses deal with daily. Good poems also use metaphor to deepen meaning. The narrator of this poem (whose actions, by the way, should not be confused with those of the poet) is truly a student, not one who is learning just about the bones that hold the body together but also about the real-life moments-those that get under our skin-that either save us or fracture us emotionally. Being used by her lover, the narrator is left disjointed, not knowing where love begins and where it ends, what is distal and what is proximal. I hope nurses discuss this poem, debate it, delve into it, dissect it, asking what it might teach them about being human and vulnerable, about how we love or fail to love-all things critical to caregiving and living.

I am proud to see that AJN is drawing submissions to Art of Nursing from nonnurse writers who are attracted to the journal because of its excellent poetry and arts pages. AJN is now among the few clinical magazines accepting and publishing poems. Poems like this one put AJN alongside the Annals of Internal Medicine, the Journal of American Medical Association, and the Lancet, journals that regularly publish very good poems.

Cortney Davis, ANP, RN,C

Redding, CT

I am writing to express the concerns of the American Nurses Association regarding the publication of "Learning the Bones." The ANA has received a number of complaints from nurses about the publication of this poem.

While we do not question AJN 's right to publish this poem, we do question the judgment of the editorial staff in choosing to do so. The poem does not have any clear link to nursing, and the author is not an RN. At a time when we are all working to promote the profession's image, as evidenced by AJN 's continued championing of the Center for Nurse Advocacy, the publication of this poem seems to contradict that goal. While art is subjective, a poem that deals with adultery has no place in a professional nursing journal, particularly when there's no explanation of the link between it and nursing.

Because of the ANA's partnership with AJN and the fact that it's billed as "the official journal of the American Nurses Association," the publication of this poem reflects poorly on our organization as well. The ANA and its members have worked tirelessly to promote the nursing profession in the eyes of the public, the media, and state and federal policymakers and lawmakers. By publishing a poem that addresses adultery in a graphic manner with no clear context, AJN has undermined our credibility. In fact, readers may perceive the author to be a nurse or nursing student, an unfortunate conclusion that could perpetuate the negative image of nurses as promiscuous-something AJN has decried in the media.

Barbara A. Blakeney, MS, APRN, BC, ANP

ANA president

The content of this poem is not appropriate for the official journal of an organization that touts a lust for professionalism. Descriptions of adultery and graphic sexual language have no place in AJN unless they are included in articles on counseling or sexual issues.

Amanda D. Boring, MSN, RN

Austin, TX

Multiple methods of learning may be the message of this poem, but any content that makes adultery mainstream is inappropriate and should not be included in a professional publication. Although the adultery is portrayed as less than satisfying (and that may be part of the message), I find no virtue or value in the publication of this poem, which does nothing to elevate or support the stature of the nursing profession.

Nancy K. Lowe, PhD, CNM, FACNM, FAAN

Portland, OR

I often refer students to AJN, but I found this poem to be so offensive that I now wonder about the appropriateness of offering this journal to students who are forming their opinions and loyalty to our profession.

Jean Storey, MNSc, RN

Texarkana, AK

What do readers find most outrageous about this poem? That a student would have a textbook around while having sex? That a student of anatomy would have a functioning body herself? That a student of nursing might have sex outside of a mutually monogamous lifetime relationship? That professional nurses would read about a woman who has made different choices than they have? That reading a poem would require a different process of thought and analysis than reading other editorial matter in professional publications?

I believe Art of Nursing is intended to push my mind in directions other than those I might be inclined to take. Keep on pushing!!

Kristine Gebbie, DrPH, RN, FAAN

New York, NY

I thought we were finally past the days when nurses were thought to parade around in spiked heels and short, cleavage-bearing uniforms, looking for a man in need of a sponge bath.

Sallie Gilbertson, RN

Houston, TX

We should be so proud of our profession that only poetry written by nurses be included in Art of Nursing.

Valarie Petersen, MN, APRN,CS,BC

Simpsonville, SC

"Learning the Bones" was very provocative. You took a risk, and it's a wonderful piece.

Carolyn D. Holmes, BSN, RN,C

Springfield, IL

I was surprised to read the poem "Learning the Bones" in AJN-pleasantly so!! It spoke to me on many different levels, both as a nurse and as a woman. And I enjoyed its satirical nature, especially the use of "fibula" in the paragraph in which the man lies to his wife.

Mary Jo Koschel, MSN

Greeley, CO

I had been pleased to see the creation of Art of Nursing, which facilitates creativity within the profession. But when I began to read "Learning the Bones," I gasped in shock and disbelief. The reader is left with the impression that a nurse has just had kinky intercourse with a married man.

This kind of stereotyping is the reason why I (and hundreds of nurses like me) have decided to call it quits. For years I attempted to fight the stereotypical image of nurses that people like you have created. On a daily basis, I was harassed, belittled, humiliated, and bullied by physicians on ego trips that were fueled by the support of the facility's administration.

Julie Adair, RN

Rockwall, TX

Shame, shame, shame on you for publishing this poem in our professional journal. This is not to discredit Ms. Germain's work, which was creative. Indeed, if I had read it in Cosmopolitan, I would most likely have enjoyed it. But in "the Official Journal of the American Nurses Association"?

Kimberly Catania, MSN, RN, CNP, OCN

Columbus, OH

Although I may not agree with the lifestyle of the woman described in this poem, it's not unlike those of many of my coworkers. I work in a large university medical center's adult ICU, and my coworkers and I share all kinds of personal information. I am familiar with the intimate details of many of their lives, more so than I ever needed to be. I would not do many of the things they describe, but I listen and try not to be judgmental, much as I do with my patients.

Personal lives aside, most of my fellow nurses provide good care to their patients. At a time when there aren't enough nurses, that is what's most important to me.

Cheryl Johnson, BSN, RN

Ann Arbor, MI

This poem is a well-crafted work of literature with a subject that draws the reader in and thereby creates a strong response. This is what art (and learning) is all about. Art should cleverly stir us and help us to think creatively, take sides, form opinions, and remember things, like the names of bones. My only regret-I wish the author was a nurse.

Thank you for the high quality of this wonderful department.

Judy Schaefer, MA, RN,C

Harrisburg, PA

How can we blame the general media for depicting nurses in an unprofessional way when this occurs in the pages of AJN?

Janet M. Rentko, RN

Omaha, NE

How is one woman's sex life relevant to caring for the sick and injured? There is no caring, it's certainly not art, and the poem isn't even about nursing.

Cathy Melter, MSN, RN, CS, CWOCN

Vacaville, CA

Although we appreciate literary talent, we do not expect to see such crude and vulgar content in our nursing journals. Artistic endeavors may be a very valid part of the expression of the nursing profession, but we would expect those expressions to be affirmative.

Aside from the tasteless content, the tone of the poem downplays the necessity of being diligent in learning.

Faye M. Sigman, MSN, RN

Kelley C. Burg, MSN, RN

Dawn Chalk, MSN, RN,BC

Marjorie Champion, MSN, RN

Patsy E. Crihfield, MSN, RN, CCRN, APRN,BC

Patricia Warren, MSN, RN,C

Dyersburg, TN

Shanna R. Germain's "Learning the Bones" is an expression of intimacy that will undoubtedly scandalize some readers, who will accuse you of promoting promiscuity. But I would like to applaud AJN 's courage in publishing it.

As the former executive editor of Alternative Therapies in Health and Medicine, a peer-reviewed medical journal, and author of several books examining the scientific evidence of prayer's effectiveness in healing, I have learned firsthand about intolerance. For example, the many controlled studies that examine the connections between prayer and healing show clearly that religious affiliation has no correlation with the effect of prayer. The prayers of Buddhists, Jews, Hindus, and Muslims achieve positive results in these studies. This conclusion, based on many controlled clinical studies, has horrified some Christian health care professionals and those unwilling to acknowledge the validity of any religion's prayer.

Good poetry gives a voice to the magnificent spectrum of life. This inevitably means that it won't please everyone. Germain is not selling sex and promiscuity, any more than Matisse or Picasso endorsed the abandonment of clothing by painting nudes. Neither are the AJN editors promoting premarital or extramarital sex.

If we allow ourselves to be swamped by moral outrage when offended by art and literature, we fall prey to censorious behaviors-as when a church congregation in my state of New Mexico recently burned Harry Potter books and videos in a public bonfire, along with the works of Shakespeare.

Both nursing and medicine have always benefited from more tolerance, not less.

Larry Dossey, MD

Santa Fe, NM