The Role of Nurses in Countering Environmental Racism

The Role of Nurses in Countering Environmental Racism

Nurses are integral to every community, and not just from the perspective of simply providing critical medical services. Your field experiences have likely made it clear to you that you impact patients’ lives through your empathy, social sensitivity, and hard-earned knowledge.

One of the often overlooked areas in which nurses are influential is helping to address injustice, even environmental racism. Given how urgent and potentially destructive the climate crisis is, it’s important to understand better this issue and how nurses can help counter it.

The Consequences of Climate Change

Environmental racism occurs when Black and other traditionally marginalized communities are disproportionately affected by climate change, pollution, and other environmental issues. This counters the traditional concept of environmentalism, which states that everyone is affected by ecological disasters. However, more evidence indicates that marginalized communities get the brunt of these disasters due to systemic injustices, which may affect the public health of these communities.

For instance, fossil fuel companies primarily tend to set up shops near minority communities, with 68% of African Americans living within 30 miles of a coal-fired power plant. Emissions from these plants can result in community exposure to respiratory and other health issues.

However, such wellness challenges are not limited to the better-known respiratory and cardiovascular risks. The climate can impact vision and eye health, too. People living in neighborhoods exposed to pollution can be more likely to experience glaucoma. Indoor pollution is also an issue, with those who may be unable to invest in adequate filtration systems at risk of experiencing long-term eye damage due to exposure to small particulate matter.

Even with these exacerbated health issues, marginalized communities may not receive proper treatment. One recent Pew Research study reported that 63% of Black Americans polled believe that their diminished access to quality medical is one of the reasons behind poorer health outcomes. Even if specific communities have access to medical care, the plethora of climate change-related health concerns places a greater demand on the healthcare system already underserving these communities.

Community Education and Outreach

The consequences of climate change concerning environmental racism are concerning. Indeed, such systemic issues can feel so large that it’s often difficult to see what individuals can do to help. Yet, as a nurse, you can powerfully impact the communities you serve.

One of the most important forms of assistance you can provide is improvements in relevant health literacy for minority communities. Once community members know the impacts of climate change on their health, they can be more empowered to make informed decisions surrounding their care and day-to-day preventative measures. Therefore, it’s essential to ensure patients have data about local negative environmental influences, the potential impacts, and steps they can take to safeguard their health.

This may involve working with local public health services to find the right literature addressing your community’s concerns. You might also consider engaging with community outreach programs. Spending time at community centers, workplaces, schools, and universities can be helpful to forums for education, where you can answer questions concerning this issue.

Collaboration on Change

Unfortunately, health literacy is unlikely sufficient to counter environmental racism alone. As with so many forms of social injustice, meaningful change happens at a systemic level. Your perspectives and insights as a nurse in minority communities can be a powerful contribution if you collaborate with initiatives that reduce ecological inequality.

This may be most effective on a regional level. You can identify local organizations that are dedicated to taking action to address environmental justice. These actions may involve coordinating efforts to provide qualitative data and testimony as supporting evidence of climate-related illness to present to governmental agencies tasked with assigning public health budgets, planning facilities, and creating healthcare policies.

Alternatively, you can offer insights as a medical professional to organizations dedicated to blocking the local introduction of new hazardous industrial businesses. Grassroots organizations like the Mothers of East L.A. have proven successful here. Your assistance can be invaluable as efficacy tends to rely on research and expert testimony.

This isn’t just effective concerning budget assignment and healthcare policy but also in encouraging the adoption of other resources that directly and indirectly affect the environmental connection to health.

For instance, the rise of the digital age has seen the emergence of inventions that can help combat climate change. If local or state governments adopt ambient carbon capture technology to remove carbon dioxide from the air or invest in distributed energy resources (DERs), there’s a chance to mitigate the health issues that disproportionately impact minority communities. As a nurse, you could play an influential role in representing the medical importance of these tools to local government decision-makers. Advocate for how climate-protecting technology makes a difference in community health and could reduce pressure on care resources.


Nurses may not always think about environmental racism in their daily routines, but it’s a hidden undercurrent in the healthcare system. Nurses have a profound potential to stop this injustice before it worsens.

It’s essential to be mindful of taking everything on your shoulders. Nurses already face a lot of pressure and often unrealistic expectations. When engaging in this social issue, seek support from colleagues, administrators, and community leaders.

Rita And Alex Hillman Foundation Awards Innovation Dissemination Grant to TeamBirth

Rita And Alex Hillman Foundation Awards Innovation Dissemination Grant to TeamBirth

Affirming its commitment to scaling evidence-based, nursing-driven interventions that provide equitable, person-centered, and trustworthy care, The Rita and Alex Hillman Foundation today announced a $200,000 Hillman Innovation Dissemination (HID) grant to TeamBirth.rita-and-alex-hillman-foundation-announce-grant-to-teambirth

“At a time when one in five pregnant people experience mistreatment during childbirth, and up to 40 percent of Black and multiracial patients report discrimination while receiving maternity care, it is imperative that interventions like TeamBirth are made widely available,” says Ahrin Mishan, Executive Director of The Rita and Alex Hillman Foundation. “We are proud to support the expansion of this important intervention.”

Developed by Ariadne Labs – a joint center for health systems innovation at Brigham and Women’s Hospital and Harvard’s T.H. Chan School of Public Health – TeamBirth is a care process innovation that ensures people giving birth and the clinicians who are caring for them have shared input and understanding into decisions during labor and delivery. Using such easy-to-implement components as team huddles and a patient-facing whiteboard, patients and clinicians alike have credited TeamBirth with making the labor and delivery process more person-centered and, most importantly, safer.

After an initial feasibility trial at four sites in 2018, TeamBirth is on track to be integrated into more than 100 U.S. hospitals by the end of this year. Building on this momentum and a growing evidence base, HID funds will enable Ariadne Labs to pursue innovative strategies for maximizing the reach and impact of TeamBirth.

“Funding from The Rita and Alex Hillman Foundation comes at a critical time,” says Amber Weiseth, DNP, MSN, RN, Director of the Ariadne Labs’ Delivery Decisions Initiative and the principal investigator of the HID grant. “This partnership and support will be vital in ensuring that more parents-to-be have access to dignified, equitable, and safe birthing experiences.”

The Hillman Innovation Dissemination program, established in 2017, amplifies the scaling efforts of successful interventions with proven outcomes that target the needs of marginalized populations. See a roster of previous HID grant recipients here.

Educating About Health Equity

Educating About Health Equity

Nursing has always held health equity as a critical value in many ways. Nurses strive to deliver the best care to all patients, independent of socioeconomic status, gender, race, or other factors.

Health equity arguably gets even more attention than in the past. And that attention also occurs in nursing schools, where nurses are presented with the concept of health equity.

In this article, we examine how various schools teach health equity. But first, let’s define the term.


“Fair and Just Opportunity”

Health equity, according to the Centers for Disease Control and Prevention (CDC), “is the state in which everyone has a fair and just opportunity to attain their highest level of health.” Educator Jessica Alicea-Planas, PhD, MPH, RN, of the Egan School of Nursing and Health Studies at Fairfield University in Fairfield, Connecticut, echoes that sentiment, defining health equity as “ensuring that everyone has an opportunity to live whatever they feel their healthiest life should be.”

“Equity should mean that people have the opportunity to get what they need when they need it,” notes Alicea-Planas, associate professor of nursing at Egan and practicing nurse at a community health center in Bridgeport, CT. “That’s something that has historically been lacking for certain communities within our healthcare system.”

Health equity means that “everyone has the ability and opportunity to be healthy and to access healthcare to help them maintain health,” says Latina Brooks, PhD, CNP, FAANP, associate professor at Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Brooks also directs the MSN and DNP programs at Frances Payne.

Beyond Accessibility

The CDC notes that achieving health equity requires ongoing efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Health equity isn’t just about access to healthcare, notes Elaine Foster, PhD, MSN, RN, vice president of nursing, Education Affiliates. It can also relate to whether a diabetic patient, for instance, knows what to get checked. “I think sometimes we’ve put a very narrow description on health equity, and I think if you were to flesh it out, it goes beyond that accessibility,” Foster notes.

“You can even take health equity that next step and say, Do you have an advocate or do you have someone who knows to push the envelope?” says Foster. “We have to be active participants in our healthcare these days to get what we need.”

Besides accessing resources, health equity involves “understanding how to navigate our healthcare system,” says Alicea-Planas. “It is understanding the information that’s being provided to us by healthcare providers and being able to use it for patients to do well on their health and wellness journey.”

Teaching Equity

At various schools, health equity is integrated throughout the course of study. For instance, at Adelphi University College of Nursing and Public Health, Long Island, New York, health equity is threaded throughout the undergraduate and graduate curriculum in various courses, notes Deborah Hunt, PhD, RN, Dr. Betty L. Forest dean and professor. For example, in the school’s community health course, there is a focus on vulnerable and underserved populations. In the childbearing course, Hunt notes, there is a focus on health disparities and maternal and infant mortality.

Foster notes that health equity is threaded into the curriculum at the 21 nursing schools within the Education Affiliates system. Likewise, at Frances Payne Bolton, health equity is integrated into courses. However, Brooks notes that some courses go more in-depth, such as discussing health equity in vulnerable populations.

At Egan, introductory courses talk a lot about health equity and social determinants of health, notes Alicea-Planas, as do clinical courses. “I think a big part of understanding health equity is also understanding social determinants of health,” says Alicea-Planas. “I am super excited that now in the nursing curriculum, we have lots of conversations around those social determinants of health and how they influence people’s ability to attain their highest level of health.”

The Takeaways

One crucial learning that Alicea-Planas hopes students take away is that for students who haven’t been exposed to many people from different backgrounds, it’s essential “to understand how historically our healthcare system has treated certain communities of color. That factors into people’s feelings about how doctors or nurses treat them, influencing their ability to seek care.”

Alicea-Planas notes that students wanting to explore the topic of implicit bias can take a test on the Project Implicit website. In addition, the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University offers online modules on implicit bias.

Foster hopes that students learn that no matter what the patient’s background, “Everyone is entitled to good, nonjudgmental care within the healthcare system.” Students must learn “not to impose our beliefs, our judgment on someone. Because until we get rid of that type of judgment, we will never overcome issues with health equity because we’ve got to first check our beliefs and opinions at the door and say I’m going to give the best care possible to these patients.”

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SWAT RNs: Supporting Bedside Leaders with Clinical Judgment

SWAT RNs: Supporting Bedside Leaders with Clinical Judgment

SWAT RNs serve as expert consultants and mentors to nurses working as bedside leaders in various clinical settings. With clinical practice experience of five or more years in the areas of critical care, emergency nursing, and flight nursing, these nurses enjoy the adrenaline rush that comes with quickly assessing patients at risk for condition deterioration.


The role of the Specialized Workforce for Acute Transport Registered Nurse (SWAT RN) has evolved in national healthcare organizations. Early detection of patients experiencing physical decline is the hallmark of the SWAT RN role. Having identified an early condition decline, bedside nurse leaders working in various clinical settings collaboratively work with SWAT RNs to promptly stabilize and prevent patient injury and death. 

Susan Dresser, Cynthia Teel, and Jill Peltzer, in their 2023 article entitled, Frontline Nurses’ Clinical Judgment in Recognizing, Understanding, and Responding to Patient Deterioration: A Qualitative Study, noted that nurses who work at the bedside are essential in the recognition of patients’ decline and initiating contact with the SWAT RN. Hence, the SWAT RN is a nursing role that is instrumental in the promotion of the nursing process and the National Council of State Boards of Nursing’s 2019 Clinical Judgment Measurement Model within the acute care setting, as they work collaboratively with bedside nurse leaders to facilitate positive patient outcomes.

A Hypothetical Case Study

The following hypothetical case study provides an opportunity to explore the SWAT RN role and examine how this role collaborates with bedside leaders to improve patient outcomes.

Case Presentation

Bernard Salzo is a 38-year-old male employed as a carpenter and painter. Unable to sleep and experiencing restlessness accompanied by shortness of breath for the last two days, Mr. Salzo presents to the emergency department (ED) at 3:00 a.m. with difficulty breathing. The triage nurse obtains his vital signs: blood pressure 134/82 mm Hg, respirations 30 breaths per minute, heart rate 102 bpm, temperature 99.8 F, and oxygen saturation on room air, 94%. The patient appears anxious and restless, requiring redirection as the triage nurse processes him. The patient states, “I have not been sleeping that well. I kind of feel discombobulated.”

History and Assessment 

Mr. Salzo’s medical history is significant for childhood asthma and hypertension. His hypertension is managed with an ACE Inhibitor, Lisinopril 15 mg PO daily, and diuretic Furosemide 10 mg PO daily. Prescribed Montelukast sodium 10 mg PO once daily and a Proventil HFA inhaler twice daily and as needed for asthmatic symptoms. Mr. Salzo’s asthma has been stable for the past ten years. Mr. Salzo is a nonsmoker and abstains from alcohol.

Mr. Salzo is triaged, assessed by an ED nurse, examined by an ED provider, and admitted to a Medical-Surgical Unit. The nurse in the Medical-Surgical Unit suspects worsening respiratory distress, noticing that Mr. Salzo has become increasingly anxious and is moving about restlessly in bed during the admission assessment. Oxygen therapy via nasal cannula 2 L O2 is placed on the patient, and the nurse contacts the SWAT RN, who arrives in less than 5 minutes.

The SWAT RN provides a rapid assessment of the patient and reports their findings to the patient’s healthcare provider and bedside nurse leader.

  • Alert and anxious, use of accessory muscles of respiration, respiratory distress
  • RR- 32 breaths per minute and labored, BP- 143/88 mm Hg, T- 100.3 F (temporal), oxygen saturation- 90% on room air (sitting)
  • Peak flow- 185

HEENT, Skin, Neck

  • No bruits, nor thyromegaly or adenopathy
  • Bilateral tearing of the eyes noted with conjunctivae that are edematous and inflamed
  • Pharynx with clear postnasal drainage; nasal mucosa edematous with clear discharge
  • Fundi without lesions
  • Skin is supple, diaphoretic, pink, and flushed


  • No egophony or fine crackles (rales); scattered coarse crackles present
  • Expiratory phase is prolonged with wheezes auscultated bilaterally
  • Diaphragm percusses low in the posterior chest with 2 cm; chest expansion is limited


  • No clicks or gallops
  • Tachycardia, regular
  • Notable slight systolic ejection murmur (SEM) at the left lower sternal border (LLSB) without radiation

Abdomen, Extremities, Neurologic

  • Capillary refill at 3 seconds, no clubbing, no edema; extremities clammy
  • Bowel sounds present, no hyperactivity; abdomen non distended
  • Liver percusses 2.5 cm below the right costal margin, but overall size 8 cm, no tenderness or masses
  • Cranial nerves intact; DTR 2 + and symmetric; sensory intact; strength 5/5 throughout

Preliminary Laboratory Results

  • pH- 7.48; PaO2- 70; PaCO2- 33 mm Hg
  • HCT- 33.0% and HgB- 7.2 g/dL
  • WBC- 7,680
  • PLTS- 246,000

Bedside Nurse Leader and SWAT RN Collaboration

The SWAT RN maintains closed-loop communication with the bedside nurse leader assigned as the primary care nurse for Mr. Salzo. The bedside nurse leader and SWAT RN discuss the patient’s time of initial decline, treatment approaches that were effective, and next steps. The SWAT nurse respectfully acknowledges the bedside nurse’s prior knowledge about the patient’s health history and recent health status change while modeling clinical judgment in managing the clinical case scenario.

General Outcome

Mr. Salzo complains of chest tightness. Intravenous access via Mr. Salzo’s right arm in the cephalic vein was secured. The bedside nurse leader inquires about potential allergen exposure and the use of methylprednisolone (Solu-Medrol) intravenously. The SWAT RN and team decided to assess the patient’s response to a bronchodilator. The SWAT RN administers Albuterol nebulizer treatments. An electrocardiogram (ECG) reveals sinus tachycardia (Figure 2.). The elevated white blood cell count (WBC) is suggestive of infection. A chest x-ray shows a large area of opacity in the right lung. A sputum sample is obtained and sent for culture and sensitivity. Blood cultures were obtained as well.

Admitted to the Medical-Surgical Unit with the primary diagnosis of asthma exacerbation and pneumonia, Mr. Salzo starts the intravenous (IV) antibiotic ceftriaxone (Rocephin) 1 gm twice daily. On day 2 of antibiotic therapy, a repeat chest x-ray reveals the presence of a mass in the right lung. Further diagnostic tests reveal that the mass is a malignant neoplasm. Mr. Salzo was diagnosed with lung cancer adenocarcinoma.


The unknown or atypical presentations are the driving factors in bedside nurse leaders utilizing clinical judgment in the decision-making process to ramp patient assessment to the level of consultation before rapid patient deterioration occurs. Mr. Salzo’s diagnostic presentation appeared typical for asthma. However, his elevated WBCs suggested infection was present. The resolving pneumonia treated with IV antibiotic therapy revealed a malignant tumor mass, adenocarcinoma.

Adenocarcinomas typically proliferate within the cells that line the alveoli. According to the Centers for Disease Control and Prevention (CDC), in 2022, 50% to 60% of lung cancers were diagnosed in patients with no smoking history. The CDC noted in 2022 that 10% to 20% of nonsmoker cancers are squamous cell carcinomas and 6% to 8% small cell lung cancers. The CDC also noted that risk factors associated with lung cancer include family history, pipe smoking, cigarette and cigar smoking, beta-carotene supplements in heavy smokers, human immunodeficiency virus (HIV), and environmental risk factors. Mr. Salzo’s dual occupation as a carpenter and painter, both environmental risk factors, likely placed him at risk for the development of lung cancer. Wood dust can be inhaled and enter the airway and lung tissues, causing scarring and irritation. The paint contains benzene solvents that, inhaled, can lead to oral and lung cancers.

The National Council of State Boards of Nursing Clinical Judgment Measurement Model provides the nursing profession with a roadmap for enhancing critical thinking, clinical decision-making, and clinical judgment within the clinical setting. SWAT RNs, because of their advanced clinical practice experience and knowledge, effectively role model closed-loop communication and evidenced-based practice clinical interventions and provide clinical expertise “in live-time” to bedside nurse leaders during emergent patient cases.


Mr. Salzo, transferred to an oncology unit, begins cancer treatment. The bedside nurse leader provides him with education about his new diagnosis. His clinical presentation to the ED for an asthmatic exacerbation and the combined efforts of all healthcare team members have contributed to Mr. Salzo’s diagnosis and current implementation of treatment for lung cancer. The early involvement of SWAT RNs is instrumental in supporting bedside nurse leaders (and nurses in other settings) with the provision of rapid assessments and necessary diagnostics in ensuring the consistent delivery of evidence-based practice care for patients entering healthcare systems. In the 2020 article, Using Benner’s Model of Clinical Competency to Promote Leadership, Barry Quinn discusses the novice to expert level nurse in clinical practice. Because the SWAT RN is an expert level nurse, their role is essential in developing leadership and competency of bedside nurse leaders in recognizing patients with rapidly declining physiological problems. Hence, SWAT RNs’ roles are beneficial in promoting clinical judgment in bedside leaders at all practice levels (e.g., novice to expert).

How Nurses Can Spot and Support Patients Suffering from Lipedema

How Nurses Can Spot and Support Patients Suffering from Lipedema

Despite being first identified in medical literature in the 1940s and impacting 5-12% of women annually, medical professionals rarely diagnose Lipedema due to the lack of training and awareness to recognize the disease.

Nurses have the most face time with patients, so nurses must understand what Lipedema is and how to recognize the signs.

We spoke with Ana Pozzoli, PT, CLT, National Lymphedema Network expert clinician, about how nurses can play a pivotal role in helping women receive care and treatment for Lipedema. What follows is our interview, edited for length and clarity.


Ana Pozzoli is a licensed physical therapist and certified lymphedema therapist with over thirty years of experience in orthopedics and lymphatic disorders. The focus of her work is a mix of orthopedics and mostly lymphatic disorders. She and her husband own Omnitherapy Center, LLC.

What is Lipedema?

Lipedema is a chronic medical condition involving loose connective tissue. Lipedema is characterized by symmetric enlargement of the legs due to deposits of fat beneath the skin. It is predominantly diagnosed in women. The cause of Lipedema is unknown; however, there is evidence of hormonal and hereditary influences. It is identified by increased nodular and fibrotic adipose tissue in the gynoid areas, the buttocks, hips, thighs, lower abdomen, and limbs. Many believe these changes start at different hormonal stages in a female’s life, such as puberty, pregnancy, pre-menopause, and menopause. It is a common condition but underrecognized. The hallmark of Lipedema is tissue inflammation. This often painful medical condition usually worsens gradually. Few physicians recognize the constellation of signs and symptoms to diagnose it properly.

How many people suffer from this condition? Are they generally women?

Though comprehensive epidemiology data is lacking, Lipedema impacts 5-12% of women.

What is the prognosis for women with lipedema?

With a Lipedema diagnosis, it is believed the different hormonal stages of a female’s life can worsen the condition. It is a gradual worsening of the adiposity in the legs, though some individuals develop Lipedema that stabilizes. In the early stages of Lipedema, most females have a normal appearance above their waist. The upper extremities, chest, torso, and abdomen can also enlarge. Physicians underrecognize it; if left untreated, it can progress, causing mobility and disability issues.

Why is it rarely diagnosed or misdiagnosed? 

Lipedema was first diagnosed in the 1940s at the Mayo Clinic by Allen and Hines. The pathophysiology of Lipedema needs to be better understood and routinely included in medical school curricula. There is currently no specific test to identify Lipedema. Imaging studies like ultrasound, MRI, lymphoscintigraphy, and lymphangiogram may be helpful, although test results may appear normal in the earlier stages.

The medical community often confuses lipedema with obesity and lymphedema. Other similar disorders are Lipohypertrophy (no pain and edema), Chronic venous insufficiency, and other idiopathic edemas. Misdiagnosis in patients with Lipedema is concerning, as it can delay appropriate management of the condition and allow the progression of the condition.

What are the physical signs and symptoms and genetic markers for diagnosing Lipedema? 

Lipedema signs and symptoms vary from person to person, including abnormal adiposity in both legs, extending from buttocks to ankles. These may include the tendency to bruise easily, pain sensation in the legs, having knee (Genu) valgus, smaller waist in relation to the hips, hypermobility of the joints, pes planus, cuff sign at the ankles, and is generally resistant to dietary and exercise interventions. General fatigue and physical impairment are often observed. There is swelling with symmetrical enlargement of the lower limbs due to abnormal adiposity. Some manifestations to watch for may indicate weight loss has been non-respondent to exercise; elevation does not tend to help; absent or minor pitting edema; vascular fragility; tenderness in the affected areas; and negative stemmer signs. 

Many clinicians and patients reference Stages of Lipedema. You can read more about staging here. For more comprehensive guidelines on diagnosis, you can reference the Standard of Care.

What are the treatment options available for Lipedema?

There is no one effective treatment approach for treating Lipedema. Management to prevent progression and alleviate symptoms is the therapy goal. Current guidelines recommend conservative therapies such as specialized compression garments and manual lymphatic drainage (MLD).

  • Manual lymphatic drainage targets the extra fluid retention of the extremities in the later stages. It also helps with reducing pain sensation.
  • Compression therapy helps support the tissue and prevent increased fluid retention. The compression is selected according to the lipedema type and location in the body. It can be in leggings, Bolero for arms, Knee Highs, capri, and shorts. Flat knit or micro-massage materials tend to support the tender tissue where the adiposity is present. Circular knit garments tend to bind on the tissue and create more discomfort. In the later stages, bandaging may be applicable in their treatments. Each patient needs to be assessed individually for garment selection. A pneumatic compression device(pump) can be beneficial in self-management.
  • Exercises should also be individual to the patient’s needs. The focus should be on posture, strength, mobility, balance, joint hypermobility, and gait. Some tools that are implemented are aqua therapy, vibration plates, and exercise equipment. Some of the techniques used as exercise can range from yoga, tai chi, swimming, and Pilates. Exercise should not be aggressive because it may cause the body to produce inflammatory hormones during performance of, such as cortisol.
  • Skin care is critical at all stages of lipedema. Many patients consider dry brushing and moisturizing the skin as essential. The best way to care for the skin is to hydrate from within. Drinking water is vital.
  • Nutrition suggestions vary but can play a significant role in the inflammatory condition of Lipedema. Understanding the anti-inflammatory way of eating can be a part of self-management. Remember that the FDA does not test supplements, so there is no way to know possible side effects. Most diuretics do not help alleviate the swelling of Lipedema. Liposuction can be valuable for some people to manage pain and improve mobility. However, research is still evolving on the effectiveness of surgery. Surgeons have different approaches; there must be clear research to recommend one approach over another. We encourage you to research, and your decision should be made in partnership with a qualified medical professional.

How can Nurses communicate information about the disease with patients? 

Nurses can be a liaison in the care of a Lipedema patient. Many times, nurses are the first practitioner to see the patient. By recognizing the signs and symptoms, a differential diagnosis may be made instead of labeling the patient as obese. Since nurses are in direct communication with the physicians or the specialist in the medical team, noticing and documenting the criteria that classify the patient as Lipedema will initiate a dialogue about the patient’s condition.

What general facts and advice should nurses know about lipedema to help their patients?

The fact is that Lipedema is an actual chronic condition of loose connective tissue. If the patient fits the criteria profile, the patient should not be diagnosed as obese based solely on BMI.

Another fact is that Lipedema predominantly affects women.

There is an actual asymmetrical body composition, a smaller trunk compared to the lower portion of the body. The feet and hands are usually spared.

Lipedema is progressive if left untreated, and is common but misdiagnosed and underrecognized. This condition carries psychological morbidity.

Look for signs and symptoms if you think the patient may display Lipedema. Be compassionate with the patient, and do not judge. Guide the patient to the proper resources, such as the Lipedema Foundation.

What role do nurses play in helping patients (women) receive care and treatment for this ailment?

Nurses play a critical role in showing an understanding of the signs and symptoms that are involved in the diagnosis of Lipedema.

Discuss with your patients that there is help for them to manage the condition’s progression.

Show compassion when the patient tells you they have tried many things and that nothing works for them.

In addition, nurses are also health care providers who can become certified lymphedema therapists by the many certification institutions.

What can nurses do to help patients with this condition? 

Once Lipedema has been identified, reassure your patient that it’s not their fault that their body looks different.

Early recognition and functional limitations can enhance the ability of the patient to make lifestyle changes to improve the quality of life.

Guide the patients in the right direction with proper recommendations to the health care practitioners equipped to treat them.

Where can nurses go to become educated about lipedema?


  1. Amanda Oakley. Lipedema. DermNet NZ. 2008;
  2. Herbst KL, Kahn LA, Iker E, Ehrlich C, Wright T, McHutchison L, Schwartz J, Sleigh M, Donahue PM, Lisson KH, Faris T, Miller J, Lontok E, Schwartz MS, Dean SM, Bartholomew JR, Armour P, Correa-Perez M, Pennings N, Wallace EL, Larson E. Standard of care for lipedema in the United States. Phlebology. 2021 Dec;36(10):779-796. doi: 10.1177/02683555211015887. Epub 2021 May 28. PMID: 34049453; PMCID: PMC8652358.
  3. Bonetti G, Herbst KL, Dhuli K, Kiani AK, Michelini S, Michelini S, Ceccarini MR, Michelini S, Ricci M, Cestari M, Codini M, Beccari T, Bellinato F, Gisondi P, Bertelli M. Dietary supplements for lipedema. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl 3):E169-E173. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2758. PMID: 36479502; PMCID: PMC9710418.
  4. Okhovat JP, Alavi A. Lipedema: A Review of the Literature. Int J Low Extrem Wounds. 2015 Sep;14(3):262-7. doi: 10.1177/1534734614554284. Epub 2014 Oct 17. PMID: 25326446.
  5. Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016 Aug 11;8:389-95. doi: 10.2147/IJWH.S106227. PMID: 27570465; PMCID: PMC4986968.
The Howley Foundation’s $12 Million Gift to Double Number of Nurse Scholars at Cleveland Clinic

The Howley Foundation’s $12 Million Gift to Double Number of Nurse Scholars at Cleveland Clinic

Cleveland Clinic has received a gift of more than $12 million from The Howley Foundation to double the number of nurse scholars at Cleveland Clinic beginning in fall 2023.

In recognition of this new generous gift and the Foundation’s cumulative support, all programs within the ASPIRE initiative at Cleveland Clinic will be renamed to honor the Howley name, including the Howley ASPIRE Nurse Scholars Program.

The nursing program is for local high school and college students and seeks to increase diversity in healthcare, address opportunity gaps and reduce health disparities in the community.

“It’s essential that we diversify the pipeline of our future healthcare workforce, including nurses, to better represent our patients and the communities we serve,” says Tom Mihaljevic, M.D., CEO and President of Cleveland Clinic and the holder of the Morton L. Mandel CEO Chair. “We are grateful for the Howley’s continued support and passion for increasing diversity and equity in our next generation of caregivers.”

The gift will allow the nurse scholars program to double enrollment annually to approximately 50 students from Cleveland-area high schools.

Students enter the program as high school juniors and are taught an innovative curriculum that explores the nursing profession, socialization, and integration into healthcare. High school graduates then can earn a scholarship to pursue a bachelor of science degree in nursing from the Breen School of Nursing and Health Professions at Ursuline College.

Students work as patient care nursing assistants at Cleveland Clinic during the summer after high school graduation and throughout their college careers. They then can return to work as registered nurses at a Cleveland Clinic facility after college graduation and licensure.

“We feel strongly that a quality education is the best way to address social inequality and promote economic mobility,” says Nick Howley, chairman of The Howley Foundation and executive chairman and founder of Transdigm Group Inc. “We want students to be able to complete their nursing degrees poised for success.”

Launched in 2017, the program was the brainchild of Kelly Hancock, DNP, Chief Caregiver Officer of Cleveland Clinic, and the holder of the Rich Family Chief Caregiver Chair, and Lorie and Nick Howley. It has been sustained by The Howley Foundation’s generosity, which has committed more than 20 million dollars to date, and other donors, such as Beth E. Mooney and the KeyBank Foundation.

“We remain committed to cultivating a workplace that embraces diversity, inclusion and equity to better serve our patients,” says Dr. Hancock. “The Howley ASPIRE Program serves as a key element in supporting these efforts. This generous gift allows us to offer this wonderful opportunity to more nurse scholars in Northeast Ohio and increases public awareness about the vital role our nurses have in delivering high-quality healthcare.”

In December 2022, the nurse scholars program celebrated its first five graduates who are now employed as full-time registered nurses at Cleveland Clinic. More than 15 students are expected to graduate from Ursuline College with nursing degrees by 2024.

The Howley ASPIRE Program also offers additional pathways for other healthcare careers, including respiratory therapy, surgical technology, and sterile processing.

Cleveland Clinic is accepting nurse scholar applications from high school juniors through Oct. 1, 2023. To learn more and apply online, visit