During 2020 the world faced the challenge of COVID-19, which required the nursing profession to rapidly assume new or additional routines to address a health crisis that was alarming, and initially seemed insurmountable. The pandemic was outside of any experiences in most of our lifetimes, yet nurses demonstrated their agility as they used their knowledge and abilities to swiftly change course or trouble shoot strategies for managing the virus—but it was exhausting. Many inequities present in society and in healthcare were highlighted during the COVID-19 pandemic that will require nurse's knowledge and problem solving capacity to resolve.
Eileen
Sullivan-Marx, 2020
, the president of the American Academy of Nursing, shared in an AAN statement entitled: Racism Affects Health and Wellness and It Must be Addressed that “violence, discrimination, and racism have a direct impact on determinants of health, exacerbate health inequities, and can lead to long-term trauma” (Sullivan-Marx, 2020
, para 1). Similarly, the Centers for Disease Control and Prevention 2021
has reported that communities of color have been subject to systemic racism, which negatively affects the health of individuals, both physically and mentally, and leads to health inequities. The American Academy of Nursing as well as professional nursing organizations around the country are stepping up in a myriad of ways to address issues of violence, racism, and health inequities.Currently The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (
National Academies of Sciences, Engineering and Medicine 2021
) highlights challenges that nursing as a discipline must address. According to the committee, nursing needs to continue to explore a path towards addressing health inequities by working together to eliminate violence, discrimination, and racism. Further, the nursing profession, regardless of whether nurses are working at the bedside, in the classroom, administration or within a nursing community partnership, are encouraged to work aggressively towards that goal.Health equity is a broad and complex issue, which appears to be an insurmountable task for nurses to address all at once. As the discipline is considering The Future of Nursing 2020-2030 report, it is important to contemplate how best to chart the path towards health equity. One overarching goal discussed in the Consensus Study Report Highlights is for the “achievement of health equity in the United States built on strengthened nursing capacity and expertise” (
National Academies of Sciences, Engineering and Medicine 2021
, May, para 2). Strengthening nursing capacity and expertise requires nurses to also be “aware of social injustices and the systemic racism that exist in much of nursing” (Moorley et al., 2020
, p. 2450). Social injustices and racism affect nursing and are a nursing workforce issue, which continue to emerge regarding retention of a diverse workforce (Carthon et al., 2021
; Clary-Muronda and Hawkins, 2021
).Effectively addressing health equity requires nurses to strive to eliminate inequities within the discipline. According to
Clary-Muronda and Hawkins, 2021
the health of the workplace is instrumental in reducing inequalities amongst nurses, which ultimately leads to greater diversity in the workplace. The authors suggest that a diverse workforce can increase patients’ positive health outcomes. Strategies are needed to reduce inequities in nursing and thereby promote a diverse workforce to strengthen “nursing capacity and expertise” (National Academies of Sciences, Engineering and Medicine 2021
, May, para2).Strategies for reducing inequities in nursing must start with the recruitment of students, and using a holistic process to increase equitable admissions of students in nursing programs around the U.S. Academic environments and opportunities within nursing programs, including financial aid, need to be equitable for the success of all students. Curriculums in nursing should include content threaded throughout that addresses ending social injustices and systemic racism. However, addressing social injustices and systemic racism cannot be limited to educational programs, as novice nurses must be integrated into equitable practice arenas.
Establishing an equitable and healthy work environment in practice is a strategy that needs to start with the orientation process. The orientation process is foundational for nurses beginning a new role (
Jakubik et al., 2017
; Regan et al., 2017
). According to - Regan S.
- Wong C.
- Laschinger H.K.
- Cummings G.
- Leiter M.
- MacPhee M.
- Rheaume A.
- Ritchie J.A.
- Wolff A.C.
- Jeffs L.
- Young-Ritchie C.
- Grinspun D.
- Gurnham M.E.
- Foster B.
- Huckstep S.
- Ruggolo M.
- Shamian J.
- Burkoski V.
- Wood K.
- Read E.
Starting out: Qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.
Journal of Nursing Management. 2017; 25: 246-255
Bastian, 2019
“equity is all about recognizing that everyone has had different opportunities and barriers in their lives, and then doing the work to provide people with what they need to be successful.” (para 2). Nurse leaders must review the structure and curriculum of orientation to ensure that it is crafted to assess the goals of each orientee. The assessments can be utilized to equitably assign each nurse to the activities/ opportunities and resources they need to be successful.Ensuring nurses experience equitable opportunities for their professional advancement should not end upon completion of orientation. As a newly employed nurse or continuing colleague, maintaining an emphasis on professional goals (
Bastian, 2019
) should be ongoing – at least annually- to encourage successful outcomes. Nursing organizations, including the AAN and Sigma, have developed leadership initiatives, which can be instrumental in facilitating each nurse's professional growth and advancement. Professional development opportunities should be funded in Department of Nursing budgets as essential resources.Mentoring is another strategy that has been effective in nursing practice (Jakubik, Weese, Eliades, & Huth, 2017) and can be used for alleviating inequities (
Bastian, 2019
). Working with a mentor enables nurses to develop greater competence in their clinical judgement and increase autonomy in practice. Rao et al., 2017
suggest that autonomy is essential to a good work environment, while at the same time increasing satisfaction in practice (Carthon et al., 2021
) which can lead to greater retention of diversity in nursing and improved patient outcomes. Additionally, mentors can facilitate the mentees navigation of their career, including goal development, educational opportunities, and engagement in decision-making within the organization.Individual nurses should also consider reducing inequities in the discipline by becoming a sponsor for a novice or junior nurse. Sponsorship is a process that goes beyond mentoring, and focuses by assisting the protégé to expand their skills, make connections and being a professional advocate for them (Bastian, 2021;
Hewlett, 2011
; Schawbel and Hewlett, 2013
, Hewlett, 2019
). Sponsorship is an effective way to promote professional growth and equitable outcomes (Hewlett, 2011
; Schawbel and Hewlett, 2013
). This is especially important for underrepresented nurses as “for many underrepresented identities, there is an unfortunate shortage of people who look like them in the roles that they might aspire to” (Bastian, 2019
, para 3). Becoming a sponsor is beneficial for the protégé, while also enabling the sponsor to continue with their professional advancement and job satisfaction (Schawbel and Hewlett, 2013
; Hewlett, 2019
).Engagement of nurses in an organization needs a process that ensures diversity, equity and inclusion, which can be effective through shared governance. Shared governance processes and structures of committees may vary across organizations, including equitable procedures for engagement, time allotted to participation, and leadership opportunities. Participation by all in shared governance allows nurses voices to be heard, and nurses should strive to hear all voices as they take part in decision-making and responsibility for their practice (
O'Grady and Clavelle, 2021
; Kutney-Lee et al., 2016
).An alternative to consider for equitable engagement of nurses within an organization is to review the shared governance committees available for membership or leadership roles. In academe, faculty might want to consider identifying all colleagues who are eligible and qualified to participate on each shared governance committee. Obtain each faculty members preferences for service and leadership, and instead of holding elections, randomly select committee members. And then have leaders or their mentors personally talk with nurses who are hesitant to step forward and encourage them to participate. Faculty governance can enact a process for establishing mentors to support committee members and leaders as they rotate through and learn their varying roles. Leadership on a committee could advance through a predetermined rotation of governance roles such as member, co-chair, the chair role, with the leader rotating off becoming the mentor for the new chair.
Education continues to be foundational to the discipline of nursing. Across venues within nursing, book clubs involve educating nurses on a range of topics including diversity, equity, inclusion, social justice and racism, which affect health inequities in the U.S. The nature of the book clubs can vary, though many have incorporated reading a selected text and then spending time dialoguing with colleagues in an effort to learn from each other, and expand their knowledge of factors contributing to health inequities. Given the increasing access to online platforms for meetings, colleagues within and across institutions can engage in discussion sessions. Discussions and open dialogues that emerge from book clubs can be uncomfortable, challenging, enlightening, and sometimes discouraging. However, ongoing dialogue is an important opportunity, even when it is uncomfortable for individuals as they share their views and insights, while learning from others perspectives. At one nursing program, the faculty and students were very creative and had graduate students facilitating the book club dialogues, and incorporated that process into their DNP project (C. Klingbeil, personal communication, June 10, 2021).
As nursing continues to examine The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, there are multiple paths that lead towards health equity. One path leading towards health equity entails reducing inequities in nursing in order to promote the growth of a diverse workforce that will strengthen nursing's capacity and expertise. Establishing that path will require nurses to examine all avenues within the discipline for ensuring diversity, equity, and inclusion. Arriving on the path will require each and every one of us to identify the most effective strategies for promoting equity in nursing. Not only are strategies needed, but nurses must make sure they are not only implemented, but evaluated for effectiveness in continuing to strengthen nursing's capacity and expertise.
References
- How mentorship can make workplaces more equitable.Forbes. 2019, August 26;
- Disparities in Nurse Job Dissatisfaction and Intent to Leave Implications for Retaining a Diverse Workforce.Journal of Nursing Administration. 2021; 51: 310-317https://doi.org/10.1097/NNA.0000000000001019
- Racism and Health.Office of Minority Health & Health Equity. 2021;
- Global Impact: Workplaces can change the world.Nursing Centered. 2021, April 8;
- The Real Benefit of Finding a Sponsor.Harvard Business Review. 2011, January 26; : 2-4
- The sponsorship effect: How to be a better leader by investing in others.Harvard Business Review Press, 2019
- Mentoring in the career continuum of a nurse: Clarifying purpose and timing.Pediatric Nursing. 2017; 43 (ISSN: 0097-9805): 149-152
- Nurse engagement in shared governance and patient and nurse outcomes.Journal of Nursing Administration. 2016; 46: 605-612https://doi.org/10.1097/NNA.0000000000000412
- Dismantling structural racism: Nursing must not be caught on the wrong side of history.Journal of Advanced Nursing. 2020; 76: 2450-2453https://doi.org/10.1111/jan.14469
- The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.The National Academies Press, Washington, D. C.2021https://doi.org/10.17226/25982
- Consensus Study Report Highlights.The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. 2021, May
- Transforming shared governance toward professional governance for nursing.Journal of Nursing Administration. 2021; 51: 206-211https://doi.org/10.1097/NNA.0000000000000999
- Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue.Journal of Nursing Scholarship. 2017; 49: 73-79https://doi.org/10.1111/jnu.12267
- Starting out: Qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.Journal of Nursing Management. 2017; 25: 246-255
- Sylvia Ann Hewlett: Find A Sponsor Instead Of A Mentor.Forbes. 2013, September 10;
- Racism affects health and wellness and it must be addressed.American Academy of Nursing. 2020, June 1
Article info
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
