Remarks as prepared; not a transcript.

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

Keynote Address at National Student Nurses Association Conference

Wednesday, April 6, 2005
5 p.m.
Salt Lake City, Utah

"The Future of Nursing"

Thank you, Mark, for that terrific introduction. [Mark Ariizumi, nursing student]

It's great to be here with so many colleagues and friends.

My boss Secretary of Health and Human Services Mike Leavitt has a special place in his heart for the great state of Utah. As governor of Utah, Mike Leavitt was actually our nation's longest-serving governor.

When I told Secretary Leavitt that I was going to be in his home state, he told me that Salt Lake City was a place of tremendous hospitality and friendliness. Well, you know what? He's right. And when you bring in 3,000 nurses from throughout the nation, it becomes not only a friendly place, but a healthier and safer city.

You're making Salt Lake City an even better city through your visits this week to schools and your blood drive this Friday. Today, I am calling on all health and healthcare organizations to follow your lead. I challenge every group of healthcare professionals that visits a city for a conference to hold a blood drive for that city.

Of course it's our student nurses that are leading the way in this great donation effort. You are creative and practical at the same time. You see a challenge not as a problem but as an opportunity. You are leaders - you shape the destiny of others.

One of the reasons that President Bush nominated me to be Surgeon General was because he had heard that I was a former nurse. Of course I had to tell him that he'd been given some incorrect information. I said, "Sir, there's no such thing as a 'former nurse.' I am a nurse. Once a nurse, always a nurse!"

As a nurse, I am very interested in the past, present, and future of our profession. I also have an added motivation to help make sure that your work on behalf of patients is recognized and supported: My oldest daughter is a trauma nurse, and I know that she's looking over my shoulder today and every day.

It's a tremendous honor to serve in the position of Surgeon General, and to travel the world speaking with people who are shaping the future of healthcare and education, the future of government and business. As nursing leaders, you are shaping all these areas, and more. You are truly shaping the future of life.

The reality is that we don't ever know what the future holds. We don't in our lives, and we certainly don't in nursing. That is why we must keep innovating and improving nursing with fresh ideas and a fundamental commitment to serving humanity. I want to thank all of you for being here, for your commitment to nursing, and your commitment to improving the health and well-being of all Americans. Your mission is my mission.


When President Bush nominated me to be Surgeon General, he asked me to focus on three priorities. I'm fortunate to work with a leader who understands the importance of health, who insists that evidence and the best science always guide our policies and what I do. All three of my priorities are very strongly evidence-based. They are:

  • First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.

  • Second is Public Health Preparedness. We are investing resources at the federal, state, and local levels to prevent, mitigate, and respond to all-hazards emergencies. For decades our nation's public health infrastructure deteriorated through neglect. Now, with the nearly $5 billion invested over the past four years in our nation's hospitals and state public health systems, we're finally catching up to where we should be.

    Not only have we increased the national pharmaceutical stockpile and our response mechanisms, we've improved communications, education, laboratory capabilities, and hospital capacity. And if there's any doubt, let me assure you that nurses are absolutely critical to our nation's security.

    After graduation, you will have the opportunity to volunteer in case of a public health emergency. Your country needs you to be prepared. There are many opportunities to respond, including the National Disaster Medical System's Disaster Medical Assistance Teams, the Medical Reserve Corps, the American Red Cross, or your state nursing association's alert system.

    Our response efforts will be successful because nurses are always the first to ask, "What can I do to help?"

    Nurses have definitely stepped forward to in Medical Reserve Corps units throughout the nation. The Medical Reserve Corps is the specialized health component of President Bush's volunteer effort known as the Citizen Corps, and the one I lead as Surgeon General. These units, based at the local level, are made up of volunteers - nurses, dentists, doctors, paramedics, and other professionals. MRC units could be called upon to staff triage and decontamination sites, casualty collection centers, or mass immunization sites. I urge you to join or start a Medical Reserve Corps in your community.

    The good news is that we are more prepared than ever before in our nation's history to respond to these threats. But we cannot rest. I want to thank the Chief Nurse of our Public Health Service Commissioned Corps, Rear Admiral Mary Pat Couig, and her colleagues for their excellent work establishing the International Nursing Coalition for Mass Casualty Education. It's that sort of professional and community leadership that makes nursing the best profession in healthcare today.

  • The third priority I'm focusing on relentlessly is Eliminating Health Disparities. I am so proud that President Bush charged me with working with him and all of you to eliminate health disparities. Notice that he didn't just charge me with reducing health disparities. He said we will eliminate health disparities.

Health Literacy

Woven through these three priorities is the issue of health literacy. It is the currency for success in everything that we are doing in the Office of the Surgeon General.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

As nurses, you are on the front lines of improving health literacy. The nursing profession was making strides and - let's face it - making waves, in improving health literacy before other professions ever heard of it. You didn't always call it health literacy, because it was part of your overall effort to help patients and their families. But you are the original health literacy advocates. I'm just picking up the flag and carrying it forward using this bully pulpit I now have as the first nurse to serve as United States Surgeon General.

People of all ages, races, incomes, and education levels are challenged by low health literacy. Even the seemingly simple things that we can all do to stay healthy and safe, such as getting regular medical check-ups and eating healthy foods, can be struggles for many people. The reality is that to be able to do these things, we must have a basic infrastructure and understanding of why these choices are important.

Comprehensive health programs must clearly communicate health information to populations across our diverse nation.


Nurses have always played a major role in the health and health literacy of our nation, training community health workers and working directly with patients and families, as well as stepping in when doctors don't always take the time to communicate clearly.

Today your role is rapidly expanding, as it should. You care for patients in hospitals, clinics, schools, doctor's offices, residential care facilities, and even in homes. You provide 'round-the-clock assessment, and you use your voice to communicate the needs of your patients. Your voice protects the safety, dignity, and best interests of all people. Your voice is large, your voice is loud, and your voice matters.

Challenges Nurses Face Today

You have become advocates in the face of the current nursing shortage. It's no surprise that this shortage affects your patients' health, as well as your own health. Nurses across the country are speaking up on behalf of their patients and themselves, calling for solutions to this problem. I'm proud of the nurses who are working through this shortage, giving their patients the best care possible. You are making a difference.

This shortage requires all of us to work together to recruit new nurses into the profession. The image you portray as someone who cares and as someone who can meet the challenges of healthcare will inspire more people to consider nursing. At the same time, we must look at retention issues. We cannot afford to lose highly talented nurses.

One answer is the National Student Nurses Association program "Breakthrough to Nursing" project. In its proud 40-year history, this program has successfully integrated nontraditional applicants into our profession. So many of you are here today because of the Breakthrough to Nursing program, and I want to congratulate all of you for working to ensure that the nursing profession mirrors the population of our great nation.

The Bush Administration is also responding to the nursing shortage through a number of nursing recruitment and retention initiatives at the Department of Health and Human Services. Our Health Resources and Services Administration manages several programs to support the nursing profession. Their 2005 budget includes $151 million devoted to nurse training programs. That is funding that's being invested in hospitals, universities, and communities across America for recruitment of nurses, and for ongoing nurse education and retention.

Evolution of the Nursing Profession

Today you find nurses in all aspects of public health, including research, clinical, communications, and policy-setting work. Your knowledge and experience are crucial in these arenas.

Keeping up with technology has created other specialties for nurses, including health IT. Schools of nursing and healthcare facilities are recognizing that in the future, electronic health records and telemedicine will be standard. At HHS, we are working with healthcare organizations and leaders throughout the nation to help implement the President's vision of a seamless healthcare IT infrastructure. This is one of the most exciting aspects of health and healthcare today.

Nurses are also taking an active part in biomedical and behavioral research. Our own National Institute of Nursing Research, part of HHS' National Institutes of Health, is paving the way.

Another HHS agency, the Agency for Healthcare Research and Quality, is also funding nursing research. Current nurse-led studies are examining how staffing, fatigue, stress, sleep deprivation, organizational culture, and shift work can lead to problems for nurses and patients, including medical errors.

All of these aspects of nursing, from behavioral research to clinical care and nurse education, are key to building a healthier America.

The Year of the Healthy Child

I will also need your help with my 2005 agenda: "The Year of the Healthy Child." To help today's children grow to be healthy and self-sufficient members of society, we need nurses from every specialty and every background to work together to promote good health in all its forms - mental, physical, and spiritual.

The good news is that 82 percent of our nation's 70 million children are in very good or excellent health. Childhood immunization rates are at an all-time high. Our children are less likely to smoke and less likely to give birth as teenagers.

These are important gains in pediatric health. But we still have some troubling problems. That is why this year I will be taking a hard look at ways to improve the health of children both domestically and internationally.

By improving the holistic health of our children, we can ensure a healthier population for the next generation. "The Year of The Healthy Child" is the most comprehensive agenda ever set forward by a U.S. Surgeon General for a single year. It includes all aspects of a child's life - body, mind, and spirit - starting with prenatal care and going through the developmental stages of childhood and adolescence.

A healthy child begins before birth, so we are highlighting steps that women should take to keep themselves healthy, especially when they are considering becoming pregnant. This includes a healthful diet, exercise, and eliminating tobacco and alcohol use. We are also highlighting the contributions and the role of fathers. Every person has to come to the table to ensure the health and well-being of every child.

We are focusing attention this year on every aspect of a child's life. We are addressing - among other things - breastfeeding, on-time immunizations, oral health, prevention of drug and alcohol use and smoking, youth violence prevention, safe teen driving, child injury, childhood obesity, child abuse and maltreatment, mental health, and healthy indoor environment.

It may surprise you to learn that one in five schools in America has indoor air quality problems. In January, I convened the first-ever Surgeon General's Workshop on Healthy Indoor Environment and began collaborations with engineers, designers, architects, and builders to improve the air in schools and other buildings across America. I was very pleased to hear that the Salt Lake City School District was recognized by the Environmental Protection Agency for implementing an exemplary indoor air quality management program. Salt Lake City is a leader in EPA's Tools for Schools Clean Indoor Air Initiative. This morning I visited Hawthorne Elementary School here in Salt Lake City as part of my "50 Schools in 50 States" Initiative. It was a fun visit, and it was all the more fun because I knew that the kids at Hawthorne didn't have to worry that their school is one of the schools with indoor air problems.

As part of "The Year of the Healthy Child," we are also encouraging more students, especially minorities, to focus on excelling in math and in the hard sciences, areas in which the United States is falling behind. I am grateful to the National Student Nurses Association for your commitment to diversity and for all you are doing to encourage young people of color, who have traditionally been underrepresented in our field, to study and excel in nursing.

The final area that we will focus on during "The Year of the Healthy Child" is spirit. The enthusiasm of children and teens is often overlooked in their communities. We must work to harness their energy and partner them with local and national organizations to promote volunteerism, civic responsibility, and patriotism. Like the blood drive that you are holding this Friday, civic duty should be a part of each of our lives, and children love to help others. We have to find more ways to give them those opportunities.

Together, with your help, we can ensure the best possible health, and the greatest productivity and independence for every child. I hope that you will join us in making "The Year of the Healthy Child" a success. We need you - your expertise, your experience, and your passion.

U.S. Public Health Service Commissioned Corps

I want to also encourage you to consider a career in the United States Public Health Service Commissioned Corps. We are one of the United States' seven uniformed services, like the Army, Navy, and Air Force. We are a Corps of public health professionals, dedicated to our mission of promoting, protecting, and advancing the health and safety of the nation.

Our nurse officers work in their communities, and are sometimes deployed to national and international disaster locations and Special National Security Events. But not only do they deploy - our nurse officers lead. Let me give you some examples of some nurse leaders - some nurse heroes:

  • Our Chief Nurse Officer, Rear Admiral Mary Pat Couig is working with the Chief Nurses of the Air Force, Army, Navy, Veteran's Administration, and American Red Cross to strengthen federal nursing and public health preparedness.
  • President Bush charged the Department of Health and Human Services with rebuilding the maternal and child health capacity in Afghanistan. A Public Health Service nurse from the Centers for Disease Control and Prevention - Captain Kitty MacFarlane - has been traveling back and forth to Afghanistan for 18 months, leading very important this effort at a hospital in Kabul.
  • After the first anthrax attack at the U.S. Capitol Building, the Commissioned Corps response was led by a nurse. The response to the second anthrax attack at the Washington, D.C. Brentwood Postal Facility - was led by another nurse.
  • When the Commissioned Corps sent 700 officers to Florida in September and October 2005 to respond after the four hurricanes that hit that state, the entire medical operation was coordinated by a Nurse - Captain Clara Cobb.
  • After the December 2004 tsunami in the Indian Ocean, the Public Health Service deployed a medical and public health team to U.S. Naval Ship Mercy - one of our nations' two floating hospital ships. That team of Commissioned Corps officers was led by a nurse.
  • The two officers that are responsible for organizing all emergency deployments of officers through the Office of the Surgeon General - are nurses.
  • The administrative head of our entire Public Health Service Commissioned Corps - who reports directly to me - is Captain Denise Canton - a nurse.

Nurses can do just about anything in the U.S. Public Health Service. Join the USPHS and help me improve the health of all people, across the globe. Join the USPHS and unleash your leadership capabilities.

The Commissioned Corps is a tremendous career opportunity for any healthcare professional, and it's especially gratifying because of the level of support that we receive from our Commander in Chief. Take the opportunity at this conference to speak with Captain Regena Dale at the Indian Health Service booth. You will be glad you did.

Charge and Closing

In closing, I want to thank you for the wonderful work you do. And if you ever doubt whether your work matters, consider this: the cost of failing to prevent illness and injury is about much more than dollars and cents. It's about a mother who can no longer provide for her children. It's about a child who can no longer ask a father for advice.

It's about real human costs: millions of American lives lost each year to smoking-related and obesity-related diseases, families devastated by alcohol abuse, and children whose lives are cut tragically short because of completely preventable illnesses and injuries.

Secretary Leavitt shared something with me recently that I think you will all appreciate. An entrepreneur he respects once told him that in an atmosphere of change and transformation, there are three ways you can respond: You can fight it and die. You can accept it and survive. Or you can lead it and prosper.

Now is the time for nurses to lead!

Let's continue working together to advance prevention and preparedness; continue fighting for the best nursing care for all patients; and improve health literacy to give all Americans - especially our children - a chance for longer, happier lives.

Looking around this room I know that through your individual efforts; your work with the National Student Nurses Association; and through your partnerships with President Bush, Secretary Leavitt, and me - we can make this a reality.

Thank you for your dedication. I stand ready to work with you on any effort that is important to nurses and nursing.


Last revised: January 8, 2007