The creators of the Million Nurse March share a common vision: a huge but united group of nurses and allied health professionals amassed in Washington, D.C., for two days of public gatherings and lobbying, with the hope of improving work conditions and patient care.

"Our ultimate goal is to march on the Mall," said Ron Phelps, RN, the march’s executive director and Webmaster. Phelps, who grew up in the mining town of Keystone, W.Va., and often accompanied his coal miner father to picket lines during wildcat strikes, is well aware of the power such a gathering could communicate.

But as Phelps is quick to note, such an undertaking requires money—and with the year already half over, the march’s coffers hold only about $1,000, he said. That’s nowhere near the minimum $100,000 he believes is required to organize the event.

"These people are notoriously hard to motivate," Phelps said of his colleagues and their willingness to donate to the cause.

Phelps, who runs the effort out of his home in Newport News, Va., has tried a variety of fund-raising ideas, including selling T-shirts and mugs embossed with the Million Nurse March logo. He even has contacted pharmaceutical manufacturers to solicit a potential corporate sponsorship.

But he admitted that persuading them to sponsor an initiative that could offend their largest clients—hospitals—is an uphill battle.

So, dreams of reaching the nation’s capital have been pushed back from May 2002 to a non-specific date in the fall, and could be delayed even further. Instead, a potential series of smaller public rallies will be scheduled to try to gather momentum. The first is planned for Aug. 11 in Cleveland.

Building momentum for the Million Nurse March isn’t the only challenge that Phelps faces.

He and the two other individuals in charge of the day-to-day operations of the march—state coordinator Teri Sulewski, LPN, and media coordinator Louise Garcia, RN—are at odds with some of the former directors of the Delaware-based nonprofit.

They quit in April over potential conflicts of interest, objections to including non-nurses in the march and how the march’s funds were being handled.

Michele Jansen, RN, a Jacksonville, Fla., long-term care nurse who takes credit for the Million Nurse March concept—inspired by dialogues between nurses on Internet bulletin boards—was among those who resigned. She claims she has reported Phelps’ money-management techniques to the IRS. Phelps countered that Jansen and the other organizers resigned because they didn’t want to do the hard work involved with organizing such an event.

Helen Cook, RN, a long-term care nurse in Nashville, Mich., and another of the directors who resigned, denied the charge.

"We left because we weren’t getting the answers we wanted to the questions we had," she said.

Cook and Jansen claim that Phelps had created a conflict of interest by having Sulewski’s firm manufacture the march’s paraphernalia without receiving other competitive bids and by accepting free table spaces at conferences without reporting it to the IRS. Phelps denied the charges.

Despite the darts being hurled, those involved with the march in the past and present share common interests. They either have burned out on nursing or are so concerned about the stresses the job entails that they’re pushing for change. Staffing ratios, personnel retention and encouraging more people to go to nursing school are the march’s primary agenda items, organizers say.

Cook, 37, became involved in September after receiving a mass e-mail from the march’s initial organizers. Her father had just died of melanoma in a Memphis, Tenn., hospital, where he was one of 14 patients being cared for by a single nurse. Cook was so concerned about the care he was receiving that she traveled to Tennessee to assist.

Phelps, 52, worked for more than 20 years as a concrete finisher around the country before moving from Seattle to New Orleans in 1986 so that his wife, a nurse, could pursue a job opportunity. Phelps couldn’t find work in construction, so he decided to become a nurse himself, drawn to the prospect of working indoors and confident that his rapport with older people would prove useful.

He graduated from Nicholls State University in Thibodaux, La., in 1994 with a four-year nursing degree, and has worked in hospitals in New Orleans and Virginia. Phelps, who runs several nurse-related bulletin boards, got involved in the Million Nurse March when he was approached by Jansen to design a Web site.

Although Phelps likes nursing, he often has been overwhelmed by the environment. "There are times when the floor isn’t adequately staffed, when you can’t take a lunch break or go to the bathroom," he said. "In that way, nursing is a lot harder than concrete finishing. It requires all of your physical, emotional and intellectual strength."

The strains eventually proved too much for Sulewski, also a resident of Newport News. After a 17-year career working for a series of hospitals in Ohio and Virginia, she quit in 1999 to run a silk-screening business. In addition to being the Million Nurse March state coordinator, Sulewski provides the organization with its T-shirts, mugs and other promotional items. To date, she says march organizers are set up in about 20 states, most in the Northeast.

Sulewski’s speciality was maternity nursing, a task she found more daunting as the years went by and staffing ratios dropped. "It’s difficult to give one-on-one care to three mothers at a time, especially when one is joyful because she just gave birth and another is mournful because she could lose the baby, and you have to be appropriate to both of them," she said.

The realities were fairly far removed from Sulewski’s childhood dream of becoming a nurse, the chosen profession of her mother and grandmother.

Family ties also were a big factor in 35-year-old Louise Garcia’s decision to become a nurse. Her mother is a nurse and a nurse educator, as are several other members of her family.

Garcia, who works in the Cleveland area, graduated from Cuyahoga Community College with a nursing degree in 1996 and was licensed the next year. Although warned about the realities of the profession by her mother, she still was caught off guard by the persistent demands to work mandatory overtime—even on days off—and lack of support from her colleagues.

She believes tight staffing not only harms patient care, but turns nurses on one another. "They eat their young," she said.

Like many of the other march organizers, she became involved through mass e-mailings that the organization disseminated.

Phelps, Garcia and Sulewski still are devoted to making a march materialize, even though it may not happen anytime soon. "Things fall into place when they fall into place," Phelps said. "All you can do is work toward that end."

Meanwhile, Jansen and Cook are considering starting a new organization that would directly address staff ratios, protections for whistleblower nurses who report work conditions that may harm patients and the abolishment of mandatory overtime.

At first, Cook and Jansen jokingly referred to the new movement as the "National Nurse Liberation Organization." But as time goes on, the name seems less of a joke.

"It gives it a little bit of militancy," Cook said.