Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

Policy Brief: R. Gonzalez-Guarda, E.B. Dowdell, M.A. Marino, J.C. Anderson, K. Laughon (2018). American Academy of Nursing on Policy: Recommendations in Response to Mass Shootings Policy Brief. Nursing Outlook, Volume 66, Issue 3, 333 – 336.

When Americans attend large events in public places or when children go to school to learn or families go to church to pray, they should feel safe and not afraid. The mass shootings and rampant gun violence in this nation has reached unthinkable records. It has affected us deeply and we need to stop offering our thoughts and prayers to survivors and families, but to garner the public support to take steps toward addressing the incomprehensible actions that are perpetrated by individuals without remorse. The national debate has been loud and public. Our nursing organizations are poised for positive change. Our profession cares about the health of people collectively and with resolve, and we have taken to the stage with policy recommendations to reduce gun violence published in Nursing Outlook (American Academy of Nursing on policy: Recommendations in response to mass shootings – 2018) with our leadership speaking out on the federal policy stage.

On September 26, American Academy of Nursing President Karen Cox spoke at the House of Representatives “Gun Violence Prevention Task Force” press conference, hosted by Representatives Lauren Underwood (D-IL), Mike Thompson (D-CA, Chair), Lucy McBath (D-GA), and Jahana Hayes (D-CT). She listed the 7 evidence-based recommendations that included:

  • Creating a universal system for background checks designed to highlight an applicant’s history of dangerousness and require that all purchasers of firearms complete a background check.
  • Strengthening laws to assure that high-risk individuals, including those with emergency, temporary, or permanent protective or restraining orders or those with convictions for family violence, domestic violence and/or stalking, are prohibited from purchasing firearms.
  • Banning the future sale, importation, manufacture, or transfer of assault weapons, and calling for a more carefully crafted definition of the term “semiautomatic assault weapon” to reduce the risk that the law can be evaded.
  • Ensuring that health care professionals are unencumbered and fully permitted to fulfill their role in preventing firearm injuries through health screening, patient counseling, and referral to mental health services of individuals with high-risk danger behaviors.
  • Focusing federal restrictions of gun purchase for persons on the dangerousness of the individual and fully funding federal incentives for states to provide information about dangerous histories to the National Instant Check System for gun buyers.
  • Supporting enriched training of health care professionals to assume a greater role in preventing firearm injuries through health screening.
  • Researching the causes of and solutions to firearm violence. (https://doi.org/10.1016/j.outlook.2018.04.010)

Dr. Cox thanked the Violence Prevention Expert Panel for its prompt preparation of the policy brief that further describes the issue of gun violence and presents the evidence behind the seven recommendations published in this issue. This timely response by our collective voices is critical as we work to craft policies with the potential to have a national impact.

We interviewed Dr. Kathryn Laughon, one of the authors of the policy brief, to discuss the issue of mass shootings and speak about key policy aspects to reduce gun violence using our 3-Questions format. Dr. Laughon, a forensic nurse examiner and associate professor at the University of Virginia, School of Nursing, has focused her work on a range of issues related to intimate partner violence and its impact on women and children. She offers us insight into the raging epidemic of gun violence and offers ways that nurses can advocate for change.

We invite commentary that is thoughtful and provocative! Join the online dialogue!


The policy brief authors would also like to acknowledge the contributions of Gordon Lee Gillespie, PhD, DNP, RN, CEN, CNE, CPEN, PHCNS-BC, FAEN, FAAN, Rachell A. Ekroos, PhD, APRN, FNP-BC, AFN-BC, FAAN, Annie Lewis O’Connor, PhD, NP-BC, MPH, FAAN, Eileen M. Sullivan-Marx, PhD, RN, FAAN, and the members of the American Academy of Nursing Violence Expert Panel for reviewing and providing suggestions for this policy brief.

Veronica D. Feeg, PhD, RN, FAAN

Kathryn Laughon

Kathryn Laughon, PhD, RN, FAAN





Question 1. How does your 2018 policy recommendations relate to the recent mass shootings? What did we know then that we know now? Do you think anything has changed?


I think our recommendations basically still stand. There have not been major legislative changes in the past 18 months since these recommendations first came out. What we know from the point of view of the evidence is that reducing access to firearms absolutely reduces mortality from firearm homicides and that’s of individuals and mass shootings as well.

There is, I believe, major public support for the idea of reasonable restrictions on access to firearms, so that individuals who have been adjudicated to be dangerous through protective orders in the case of domestic violence (several states now are passing “red flag” laws that allow individuals to be identified as perhaps being a danger) and having then, their access to firearms restricted. These laws absolutely work! So we’ve seen that on country levels and we see that in the United States at the state levels – states that enact stricter laws see a drop in their firearm related homicides, and that states that loosen these laws, see an increase.

Question 2. What are the key policy aspects that need to continue to be addressed in this area (i.e. Risk factors? Access to firearms? Missed opportunities?)

So I would put the policy issues in a couple of bins. One is this idea of limiting access to firearms, and limiting access to the type of firearms that individuals can buy, sell, trade, possess. We know that folks who have been adjudicated as dangerous – at the federal level, domestic abusers (I believe is the federal term) may not possess firearms. Those laws exist at the state level as well. There are a number of loop holes in those laws so they typically don’t come into effect until a permanent protective order has been obtained, for example, (and the protective order process is a three stage process) so it’s not until you get to the third stage. It is very difficult in most states to remove firearms. So if a person has a protective order and they are not allowed to possess a firearm, it is difficult to actively remove the firearm. We just have to rely on the individual to not use the firearm, and that is obviously a problem.

When we talk about mass shootings, let’s be clear there are several definitions out there, but the most usual definition of a mass shooting is four or more individuals are killed, not including the shooter, and most of those happen in private homes and among family members.  And while it’s the large mass shootings in public places that get a lot our attention, most of the gun homicides happen in these smaller settings among people who know each other. And so there is a real danger to these guns being possessed in the home by people who have already been adjudicated to be too dangerous to have them.

There are loopholes in these laws so that boyfriends, we often call it the boyfriend loophole, so that boyfriends and girlfriends – people who have not been married – are not covered by the federal law and they are not covered by many state laws.   Additionally we know and we see it now when we look at some of the mass shootings is that these shooters have often a history of violence against women, but perhaps not have a history of violence against a domestic partner. So they may have a history of abusing their mothers, for example, and we have seen that in some of the shootings where the shooter has killed his mother before going on (I believe that was in Sandy Hook) to enact that shooting. So “red flag” laws that would allow for individuals like the shooter in the Parkland shooting – who many people had recognized was a danger but had no legal mechanism to prevent him from processing firearms – these “red flag” laws would help provide additional tools.  So there are some states that have passed “red flag” laws – there is a move right now at a the federal level that the Extreme Risk Protection Order Act is working its way through the Senate right now.


The other issue that we have not talked as much about, but that is becoming clearer and clearer is the intersection between white supremacy, violence against women and mass shootings.  And we have now seen a number of mass shootings that fairly clearly have a white supremacist intent have been enacted by people who also have a history of violence against women, and I think we need to be paying more attention to this. So that’s one of sort of bin  of laws of being able to identify individuals who are at risk and insuring that they don’t have access to firearms, or  if they have firearms, that they have those firearms removed. 

Question 3. What role(s) have you played in your own research and advocacy work that can influence other nurses to follow your lead? What can nurses do?

So I think that there really are two roles for nurses in addressing firearm violence. One is in our scope of practice: as nurses we ought to be talking to people about firearms and about firearm safety. And there are a number of toolkits out there to help guide nurses in various settings, but when dealing with pediatric populations, we should be talking to parents about safe firearm storage. Firearms need to be stored in locked gun cabinets with ammunition stored separately, and children should not have access to these firearms. The number of shootings by children of children because they have had access to a firearm that they shouldn’t have had access to is heart breaking. And that is 100 % preventable, when parents practice good solid gun safety that all gun owners should endorse.

We know that most women who are murdered by a partner have been seen in a healthcare setting and have not had a screening for intimate partner violence.  So that again is something that nurses – it’s within our nursing scope of practice – we should be talking to women, asking them about their history of intimate partner violence – and referring them to experts (either social workers with in their own systems or to their state and local and national hotlines) to help connect women to safety planning, so that they can take action to stay safer. So that’s all within the nursing scope of practice.

I think that nurses are also amazing advocates for legislative change. We are credible; people believe us; we have clinical experience; we have stories to tell; and we have the training to read the research and synthesize it and tell our legislators what we want. So as nurses, we ought to be speaking to our members of Congress at the federal level, to our state legislators, and lobbying them to make changes in laws that will keep people safer. This is a matter of public health and something that all nurses should feel strongly about, I think. I think we need to be using our collective power better than we have so far.