Shortly after National Nurses Week in May 2005, a provocative op-ed piece published in the New York Times by Teri Mills, a nurse educator and NP from Portland, Oregon, called on readers to "dethrone the surgeon general and appoint a National Nurse." Mills said that because the surgeon general seems unable to connect with the general public, nurses should be given the opportunity to do so. (See In the News, December 2006, for more information.)

Since then a small group composed of Mills as president and other supporters advocating a national nurse has become the National Nursing Network Organization (NNNO). Support for the movement has been growing, with politicians, state governments, local and national nursing organizations, physician organizations, and labor unions (including the national arm of the American Federation of Teachers, which represents 40,000 nurses) endorsing the idea. The initiative received a huge boost when U.S. Representative Lois Capps (D-CA) introduced a bill to establish the post in March 2006. However, despite receiving bipartisan support from 42 cosponsors, the bill languished and was not reintroduced, perhaps because the support of some key players is lacking.

The nursing establishment declines to endorse. A number of nursing and public health organizations have declined to endorse the concept of an Office of the National Nurse. Among them is the Tri-Council for Nursing, an umbrella organization representing the American Association of Colleges of Nursing (AACN), the American Nurses Association (ANA), the American Organization of Nurse Executives, and the National League for Nursing (NLN).

"The Tri-Council has been very clear that we don't need to put resources into creating a brand new office when we already have a chief nurse officer of the United States Public Health Service (USPHS)," said M. Elaine Tagliareni, president of the NLN. "Everyone wants to improve the quality of care and the public health service, but there's an infrastructure already in place. We need to focus on elevating the position of the chief nurse officer, not create another one, and we need to address other issues that are pertinent to the nursing community."

In the fall of 2007, the ANA and other organizations set out their reasons for opposing the establishment of the Office of the National Nurse:

* the programs proposed for oversight by the national nurse would be redundant because existing public health bodies already direct them.

* funding for existing programs is already strained, making new ones impractical.

* the proposal's public health-education efforts are limited to simple messages and do not incorporate proven, evidence-based interventions.

But Mills objected to these characterizations, saying that they have been addressed as the idea has developed. "The biggest obstacle to implementing the national nurse initiative is the continued misinformation about what it is," she said. "For the facts, go to http://nationalnurse.org."

The role of the National Nurse. "Our goal is to elevate and enhance the position of the chief nurse officer of the USPHS so it becomes a full-time position within the Office of the Surgeon General, and to make the position's official title the national nurse for prevention," says Mills. "Having a full-time, recognizable public health nursing leader at the federal level is necessary to a culture of health promotion and disease prevention."

NNNO board member Susan Sullivan told AJN that creating a national nurse position could also help unify the nursing workforce. "Having a prominent nurse who is visible and familiar to the public could provide an identifiable contact point for communication on nursing issues," she said. "The size of the nursing workforce is nearly 3 million, yet there is no unifying body that unites all nurses and truly speaks for all nurses. Only a very small percentage of nurses [some estimates put the figure at about 6%] belong to the ANA.

"However, recruitment may be enhanced once young people understand the different roles for nurses and see nurses involved in the community as well as in hospitals," Sullivan added.

It's still no. But in a July 2008 letter to Mills, Jeanette Lancaster, president of the AACN, writing for the Tri-Council for Nursing, confirmed that the group remains "in opposition to the creation of an Office of the National Nurse, whether independent or through re-titling the position of the Chief Nursing Officer of the United States Public Health Service," citing concern over diverting scarce resources from critical issues like nursing education and improving quality of care. Mills's response: "There's room for both types of advocacy."

Roxanne Nelson, BSN, RN