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In October 2025, the Australian Nursing and Midwifery Federation (ANMF) formally launched its Nurses and Midwives for Peace campaign.¹ Following the launch of this campaign, the ANMF emailed its members nationwide inviting them to add their names to an online petition calling on the Australian Government to take urgent, decisive action to protect frontline healthcare workers, hospitals, and humanitarian workers in conflict zones across the globe. Clarifying the purpose of the petition, the ANMF outlined five specific points of action it sought the Australian Government to take, notably to:
 

1. Publicly condemn all attacks on healthcare facilities and healthcare workers, and demand accountability for perpetrators. 
2. Support stronger enforcement of international humanitarian law, including at the United Nations and other global forums. 
3. Increase humanitarian aid and medical assistance to affected regions, ensuring essential supplies and personnel can safely reach those in need. 
4. Work with international partners to investigate and prosecute those responsible for war crimes targeting healthcare. 
5. Demand a global commitment that healthcare must never be a target.¹

Like other members of the ANMF, I was a recipient of the nationwide email inviting me to sign the online petition. Proud that the ANMF was not only taking a stance, but taking action –something I immediately felt I could and should support– I opened the link to the petition embedded in the email and started to populate the boxes: First Name > Last name >Email >Post Code >Country>Occupation > Confirmation of Union membership>phone number.

And then, at the bottom of the petition, I came to a prominent blue box with the word SIGN written in bold white capital letters and, for some inexplicable reason, I hesitated to pass my cursor over that word and ‘click’.

My hesitation both shocked and surprised me. It was not at all clear why, at that moment, when I felt so strongly about supporting the #nursesforpeace campaign – and indeed had authored articles encouraging nurses to do so^2-4 – I was reluctant to activate the SIGN link and submit my digital signature. And yet, I equivocated. Later, when reflecting on my hesitancy, I wondered whether other nurses experienced a similar reluctance to sign the petition and if so, why?

Engagement, advocacy and activism

The nursing profession has a rich and distinctive history of individual nurse leaders and professional nursing organisations engaging in social and political activism.^5-7 Examples include British nurse Florence Nightingale (1820-1910), who, although not perceiving her work as ‘political activism’, nonetheless succeeded in informing the public about the unsanitary conditions of military hospitals in Crimea and achieved reforms that improved health outcomes; less well celebrated is Nightingale’s establishment of workhouse reforms and her continued opposition to the 19th-century British Contagious Diseases Acts which allowed police to arrest suspected sex workers and force them to undergo invasive vaginal examinations.⁸  Other notable examples include American nurse and humanitarian Lillian Wald (1867-1940), founder of American community nursing, and regarded as one of the most influential and respected social reformers of the 20th century; American nurse, feminist, writer, pioneer in nursing education and social activist Lavinia Dock  (1858-1956); and  American nurse Margaret Sanger (1879-1966), activist for women’s reproductive rights, who in 1916 opened the first birth control clinic in the United States, founded Planned Parenthood, and was instrumental in the development of the first contraception pill.^5-7,9 As Florell^7(p135) notes, these early nurse leaders ‘believed not only in the concept of activism, but in the importance of identifying issues and taking action to facilitate change.’

‘Rank and file’ nurses, however, have been more reticent when it comes to activism per se. Whereas advocacy (and in particular patient advocacy) has been accepted for decades as a professional norm within nursing, nurses have generally been reluctant to accept ‘capital-P’ political activism as a legitimate role.^7,10 Certainly, since the removal of  ‘no strike’ clauses from nursing codes of conduct in the early 1980s, nurses have increasingly participated in political rallies calling for safe staffing ratios, fair pay, and better working conditions. And during the COVID-19 pandemic nurses were active in joining other frontline workers protesting against severe shortages of personal protective equipment (PPE), chronic understaffing, unsafe working conditions, and burnout.  

Driven by a professional commitment to human rights, advocacy, and public health, nurses have also participated in marches highlighting humanitarian concerns such as racism (e.g. Black Lives Matter rallies), climate change, Palm Sunday rallies for refugee rights, International Women’s Day, and rallies calling for the end of conflict in Gaza. Whether nurse participation in such rallies constitutes bona fide ‘activism’, however, requires clarification.

Activism in the context of nursing has been described as ‘the use of action to achieve results or bring about change, especially political or social change’.^6(p52) The kind of action being referred to here is not of an ‘ordinary’ everyday kind, however.  Rather, it is a very deliberate kind of action that ‘speaks truth to power’ – that is, it is action aimed at challenging those in power (e.g., individuals, authority figures, institutions, or government) and confronting an injustice, propaganda, or other issues of public concern. Unlike ordinary action, activism requires courage on the part of activists since their actions can result in retaliation and alienation. In other words, bona fide activism encompasses a courageous act by an individual or group aimed at challenging those in power to change the status quo even when doing so poses significant personal and professional risks. As Florell^7(p139) puts it, nursing activism ‘is being present “at the sharp end of the spear”’, the place where the most difficult and intimate work takes place.

As suggested above, ‘true activism’ involves much more than routine advocacy (speaking up on behalf of another/pleading another’s case), or engagement (establishing a meaningful connection with someone or thing).^7(p136) While each of these behaviours are important in nurse-lead campaigns aimed at challenging and changing the status quo, they are nonetheless distinct and should not be conflated or treated as being synonymous with activism per se. For example, a nurse could ‘engage’ with or ‘advocate’ a particular stance on an issue –and even join a rally– without significant personal risk of retaliation or alienation.  In such cases, their advocacy is neither courageous nor risky, since it is within the realm of normative behaviour. Moreover, by blending into a peaceful and lawful rallying crowd, an individual nurse can join a march with a relative degree of anonymity and hence be protected from being personally identified and subjected to a targeted backlash: whereas a crowd (e.g. thousands marching down a street) certainly stands out, individuals making up the crowd generally do not (conceding however that AI facial recognition technology may change that).

Here the question arises of whether signing peace petitions—such as those authorised by the ANMF and ICN—is a politically risky act of ‘speaking truth to power,’ or is it instead a convivial, low-risk advocacy-driven gesture of ‘paper diplomacy.’

Peace petitions and anti-war activism

Petitions have an instructive history dating back thousands of years and to this day serve as a primary mechanism for everyday citizens to communicate complaints and protests to those in power without retaliation.¹¹ Defined by change.org (the world’s largest online petition platform) as ‘a formal written request to a person in authority, elected official, or organization with demonstrated public support in the form of signatures’,¹² petitions are along-established fundamental right of citizens in many countries and, significantly, the only direct means by which an individual or group can ask a Parliament to take action.

Peace petitions similarly are a mechanism for mobilising civilian support and offers citizens a democratic avenue for opposing war, advocating disarmament, and demanding diplomatic solutions for achieving peace. Although peace diplomacy occurred in ancient times,¹¹ prominent peace activism today is a modern phenomenon that emerged primarily in response to the devastation of the first world war and has continued in response to later wars (e.g., the Second World War 1939-1945, the Vietnam War in the late1960s and early 1970s,  the Ukraine war following its full-scale invasion in 2022, and the Gaza War since 2023).

The primary objective of peace activism has always been and continues to be to prevent and end violent conflict.¹³ Methods used to achieve this objective have included nonviolent resistance, vigils, diplomacy, exposing war crimes or conspiracies to create wars, demonstrations, and political lobbying, as well as addressing the root causes of warfare such as structural inequality, militarism, and human rights abuses.¹³  Peace petitions launched by the ICN, and the European Federation of Nurses Associations and the ANMF in cooperation with the ICN, align directly with the core objectives of peace activism.  Moreover, the stance of peace advocacy taken by these organisations falls squarely within the nursing domain, reinforcing the profession’s mandate to promote health, prevent illness, restore well-being, and alleviate suffering—all of which are severely exacerbated by armed conflict, and inevitably results in catastrophic ‘delayed mortality’.^14(p33)

Despite the obvious relevance of the peace petitions which professional nursing organisations have called upon their members to sign, response rates have been low. For example, at the time of writing (seven months since the ANMF first launched its online petition in 2025), only 1,393 signatures had been received, representing less than 4% of the ANMF’s reported 356,000 members nationwide. The disappointing response to ANMF calls for nurses to sign its online petition is not an isolated outcome. The International Council of Nurses (ICN), which has memberships from over 140 national nurses association representing over 30 million nurses worldwide, likewise has had a similar disappointing result.  In  March 2023, the  International Council of Nurses (ICN)  launched its #nursesforpeace campaign in response to the war in Ukraine. Within two weeks, the campaign had reportedly reached over 95 million viewers, attracted  670K internet ‘likes and shares’, yet only 2,500 signatures from organisations representing more than 400K nurses. This low response perhaps accounts for why the ICN subsequently expanded its campaign from a solely online static petition to a campaign that included fundraising, solidarity messages, and practical support.¹⁵

In April 2026, the ICN renewed its call for nurses, National Nursing Associations (NNAs), and global partners to support its #peacefornurses campaign, demonstrating its enduring commitment to peace advocacy. Joining other national nursing organisations in cooperation with the ICN the ANMF has consistently responded to such calls.

As noted earlier, in 2025, the ANMF launched its online petition, which was emailed nationwide to members. The ANMF explicitly intended to present this petition directly to the Australian Federal Government in the hope of making the collective moral voice of nurses heard.¹⁶ Given this intention, it is puzzling why, to date, only a minority of nurses have signed the petition.

Barriers to political activism 

There are several reasons why nurses may hesitate to sign a peace petition or engage in more robust actions such as joining a politically controversial peace rally or joining an international flotilla heading to a conflict zone to break a naval blockade and deliver life-saving humanitarian aid. Various studies have suggested that nurses may hesitate to engage in actions they perceive to be ‘political’ due to:

• personal values that give precedence to patient-focused care and prioritising local pressing workplace issues over political activism (some may believe that any form of political involvement, even signing a peace petition, distracts from their clinical and local workplace duties)
• concerns about the possible politicisation of their role (some may worry that signing a peace petition may compromise their espoused professional neutrality)
• fear of workplace retaliation (some may fear that their visible political activity could  have negative consequences for both them and their employing organisation – e.g., lead to ostracisation by fellow workers and have negative consequences for their ongoing employment; result in a backlash from an ‘offended community’)
• frank disagreement with the petition’s specific geopolitical framing – particularly if implicating specific conflicts, governments or policies
• feeling powerless and cynical about whether their signatures will make a difference
• controversy about the idea that political activism is a legitimate part of the nurse’s role
• a personal aversion to politics and lack of interest and time.^{6,9-10, 17-20}

It is understandable that in light of these concerns many nurses may have misgivings about taking a stand, even when urged to do so by their representative professional organisations. The perceived reticence by nurses is also understandable given:

• political activism in nursing is a contested notion¹⁷
• nursing codes and regulatory documents lack specific clarification on the role and responsibility of nurses to engage in activism ‘beyond the bedside’ and what counts as ‘acceptable activism’^10,21 and
• the lack of education informing and inspiring nurses about political activism and triggers for their personal and professional engagement.^17,19

Even so, in a world that is being increasingly devastated by protracted conflicts – the harmful consequences of which are reverberating across the globe – there comes a point when not speaking out or not taking a stand ‘translates to endorsement of the status quo’.^22(p2)  Such endorsement is unconscionable and underscores why activism by nurses is not only permissible but essential.  

While some nurses may seek to avoid ‘becoming involved’, the reality is that politics in nursing is unavoidable. As Chinn and Kennedy^6(p57) point out, ‘Not acting, or failure to take a position on a major political issues, is in fact a political act’.  

To sign or not to sign

We are living in a time of reckoning. Reflecting on ‘the vitriolic confrontations’ that are posing a fundamental threat to human welfare and wellbeing, I agree with Chinn and Kennedy^22(p5) that it is time for the nursing legacy of activism to be renewed.

In writing this commentary I am mindful that it is beyond individual nurses alone to tackle the politics of war and peace. Nonetheless, they can lend their voices in gentle ways, if not in a roar to support the initiatives of representative nursing organisations and their allies. How much more significant – how much more poignant and morally potent – would it have been had the ANMF been able to submit a petition to the Australian Government containing 139,300 signature instead of just 1,393 – how much more powerful our collective moral voice would have been.  How much more transformative and ethically resonant would the ICN campaign have been if 2,500,000 signatures had been collected instead of just 2500. And how much more supported might our fellow nurses in conflict zones feel, knowing that the madness and mayhem that is confronting them every single day is being kept before the public across the world in a manner that is speaking truth to power.

Postscript

I, of course, signed the petition. Why? Because, quite simply, it was the right thing to do.

References

1. Australian Nursing and Midwifery Federation (ANMF) Nurses and midwives for peace. [Cited May 23, 2026]. Available from: https://anmf.org.au/media/nurses-and-midwives-for-peace
2. Johnstone M-J. Bombing hospitals, destroying ambulances and the ethics of (un) just war. Australian Nursing and Midwifery Journal (ANMJ). Online. Available: https://anmj. org. au/bombing-hospitals-destroying-ambulancesand-the-ethics-of-unjust-war. 2023.
3. Johnstone M-J. Taking a stand against attacks on healthcare: A call to support ICN’s# nursesforpeace campaign. International Nursing Review. 2024 Jun 1;71(2).
4. Johnstone M-J. The failure of humanity and the moral obligation to take a stand: a nursing response to the Middle East conflict. Australian Nursing and Midwifery Journal (ANMJ). 2026; in press.
5. Attenborough J, Reynolds L, Nolan P. The nurses that roared: nurses from history who found their voices and challenged the status quo. Creative Nursing. 2019 Feb;25(1):67-73.
6. Chinn PL, Kennedy MS. Activism is an essential nursing role. AJN The American Journal of Nursing. 2023 Oct 1;123(10):52-8.
7.  Florell MC. Concept analysis of nursing activism. Nursing Forum 2021 Jan (Vol. 56, No. 1, pp. 134-140).
8. Wikipedia contributors. Contagious Diseases Acts. In Wikipedia, The Free Encyclopedia. [Cited May 21, 2026]. Available from:  https://en.wikipedia.org/w/index.php?title=Contagious_Diseases_Acts&oldid=1348566696
9.  Falk-Rafael A. Speaking truth to power: nursing’s legacy and moral imperative. Advances in Nursing Science. 2005 Jul 1;28(3):212-23.
10. Mainey L, Richardson S, Essex R, Dillard-Wright J. Nursing advocacy and activism: A critical analysis of regulatory documents. Nursing ethics. 2025 May;32(3):980-93.
11.  Connolly S. Petitioning in the ancient world. Medieval Petitions: Grace and Grievance. London: Boydell & Brewer. 2009:47-63.
12. Change.org. What is a petition? How it works and why it matters [Cited May 23, 2026]. Available from: (https://www.change.org/petition-guides/what-is-a-petition)
13. Wikipedia contributors. Peace movement. In Wikipedia, The Free Encyclopedia. Retrieved [Cited May 21, 2026]. Available from: https://en.wikipedia.org/w/index.php?title=Peace_movement&oldid=1345955775.
14. Boyle JS, Bunting SM. Horsemen of the Apocalypse: lessons from the Gulf War. Advances in Nursing Science. 1998 Dec 1;21(2):30-41.
15. International Council of Nurses. Nurses for peace update Dec 2025-Jan 2026. [Cited May 23, 2026]. Available from: https://www.icn.ch/how-we-do-it/campaigns/humanitarian-fund-nursesforpeace.
16. Australian Nursing and Midwifery Federation (ANMF) Staff. Stand up for the protection of healthcare in conflict zones. [Cited May 23, 2026]. Available from: https://anmj.org.au/stand-up-for-the-protection-of-health-care-in-conflict-zones/
17. Buck-McFadyen E, MacDonnell J. Contested practice: Political activism in nursing and implications for nursing education. International journal of nursing education scholarship. 2017 Jan 1;14(1).
18. Han NK, Kim GS. The Barriers and Facilitators Influencing Nurses’ Political Participation or Healthcare Policy Intervention: A Systematic Review and Qualitative Meta‐Synthesis. Journal of Nursing Management. 2024;2024(1):2606855.
19. Mundie C, Donelle L. Health activism as nursing practice: a scoping review. Journal of Advanced Nursing. 2022 Nov;78(11):3607-17.
20. Tschudin V, Schmitz C. The impact of conflict and war on international nursing and ethics. Nursing Ethics. 2003 Jul;10(4):354-67.
21.  O’Connor K. Nursing ethics and the 21st-century armed conflict: The example of Ciudad Juárez. Journal of transcultural nursing. 2017 Jan;28(1):6-14.
22. Chinn P, Kennedy S. Politics and professional nursing journals. Nurse Author & Editor. 2017 Dec;27(4):1-7.
    

Dr Megan-Jane Johnstone AO, independent scholar and Adjunct Professor in the School of Nursing and Midwifery, La Trobe University, Melbourne. She is also the author of the widely acclaimed text Bioethics: a nursing perspective, 8^th revised edition.