The Honorable Robert F. Kennedy Jr., Secretary of Health and Human Services U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201

Dear Mr. Kennedy,

I am writing to you as a psychiatric nurse with nearly 20 years of dedicated service, representing a collective of 4.5 million nurses... Registered Nurses, Licensed Practical and Vocational Nurses, Nurse Practitioners, alongside doctors, allied healthcare workers, and every citizen of the United States... who share a profound commitment to healing. Our work is often hailed as heroic, yet we stand at a breaking point, watching our careers and lives erode under a bureaucracy that prioritizes profit over people. As you lead the Department of Health with your “Make America Healthy Again” vision, I implore you to hear our voices and spearhead a transformation that honors both the patients we serve and the nurses who sustain them. This system, dominated by the Joint Commission (JCAHO) and, to a lesser extent, the American Nurses Association (ANA), has become a monopoly of misery, fear, and outdated control... and it must stop.

For two decades, I’ve cared for patients across states like Iowa, California, Vermont, Ohio, Tennessee, and South Carolina, often as a travel nurse balancing 9-month explorations with 3-month stints to fund my passion. Recently, I took a 6-month break to recharge... scuba diving, grieving a family loss, and addressing my own mental health after years of relentless duty. This respite was not a luxury but a necessity; the Centers for Disease Control and Prevention (CDC) reported in 2024 that nurse suicide rates are double the national average, a stark indicator of our mental health crisis. Yet, upon returning, I’ve faced insurmountable barriers to re-enter my profession. Despite a robust resume from top-tier facilities, the Joint Commission’s rigid credentialing standards, demanding continuous employment with no tolerance for gaps, have effectively blacklisted me. This isn’t an isolated incident; a 2024 Nursing Solutions Inc. (NSI) report highlights a 27% nursing turnover rate, with bureaucracy like JCAHO’s re-credentialing cited as a top reason nurses leave or struggle to return.

The Joint Commission, a private, non-profit entity, wields outsized influence without direct congressional or presidential authority. Instead, its power stems from a delegation by the Centers for Medicare and Medicaid Services (CMS), which ties hospital accreditation to Medicare reimbursements... accounting for 80% of hospital revenue, per 2023 CMS data. Hospitals pay between $10,000 and $100,000 annually for this accreditation, contributing to JCAHO’s $300 million yearly revenue, as reported in its 2023 IRS 990 filing. As a tax-exempt 501(c)(3), JCAHO reinvests this into operations, but the system feels less like quality assurance and more like a pay-to-play scheme. A 2019 Annals of Internal Medicine study found no significant correlation between JCAHO accreditation and reduced patient mortality or errors, suggesting its inspections... often a week-long “circus” of polished charts and temporary protocol heightening... are more performative than transformative. This fear-based adherence, unchanged since the DSM-5 update in 2022 for psychiatric care, doesn’t enhance safety; it exhausts us.

The ANA, with its 4.5 million members, should be our advocate, but it too often aligns with institutional interests. While it lobbies for initiatives like the 2023 Safe Staffing Act, its focus on patient outcomes over nurse well-being leaves us vulnerable. Patient-nurse ratios are a glaring example: in psychiatric units, I’ve managed 20 patients single-handedly, far exceeding safe limits, as California’s 5:1 RN-to-patient ratio (often ignored elsewhere) suggests. The 2023 American Nurses Association survey revealed 31% of nurses plan to leave within a year, driven by burnout and inadequate support... issues JCAHO and ANA fail to address. We’re deemed “essential,” forced into mandatory shifts, yet lack a nationwide felony for assaulting healthcare workers; it remains a state-by-state misdemeanor, leaving us unprotected amid rising violence.

This crisis is compounded by systemic strains. Emergency Medical Treatment and Labor Act (EMTALA, 1986) mandates care for all, including undocumented immigrants, leading to a 20% increase in ER visits in border states, per the 2024 Government Accountability Office (GAO) report. This adds pressure to already stretched ratios, but the burden falls on nurses without corresponding resources. We understand the need for care, but without addressing our conditions, the system collapses. My own story reflects this: after 20 years, I can’t find work because a 6-month break... taken to survive the “constant droll of society”... is deemed a liability by JCAHO’s antiquated rules. This isn’t just my struggle; it’s a nationwide exodus of talent.

Nurses are the backbone of healthcare, touching every patient in America. We’re as vital as police, yet treated as afterthoughts. The Joint Commission’s monopoly... voluntary in name but mandatory in practice... creates a reversed union, shielding hospitals while we pay the price through fees and constraints. The ANA’s dues ($200–$400 annually) fund lobbying, but its silence on our assault protections and burnout is deafening. We’re dropping out not because we don’t love nursing, but because the system doesn’t love us back. A 2024 AMN Healthcare survey pegged turnover at 62%, with many citing bureaucratic hurdles over pay alone.

Mr. Kennedy, your platform against big pharma and corporate overreach aligns with our fight. We need actionable change: mandate safe ratios (5:1 RN-to-patient nationwide, including psych), establish a federal felony for assaulting healthcare workers, reform JCAHO to make accreditation optional... not a chokehold... and fund re-entry programs for nurses taking mental health or family breaks. These steps would retain our 4.5 million-strong workforce, the largest in healthcare, and ensure patients receive the care they deserve.

I offer myself as your ally... ready to testify, rally, or meet with you to amplify this cause. This isn’t just my profession; it’s my life’s work, now imperiled by a system that values paperwork over people. Let’s build a healthcare model that empowers nurses and patients alike, free from the misery of monopolies and fear. The time is now... please, act with us.

Sincerely, Brady, all nurses in the Great United States of America, and any other healtcare worker, allied healtcare worker, doctor, and patient and also, NurseNirvana.com  a social network for nurses and anyone affected by subpar care resulting from outdated policies, nurse burnout, and systemic safety failures that are driving healthcare quality down across the country.  #WEAreALLPatients