At a point in my career, a devastating event deeply affected me. One of my former nursing students, a vibrant young Black woman, tragically lost her life and the life of her newborn during childbirth. Despite access to healthcare, she fell victim to maternal complications that ended in her untimely death. This loss was not an isolated incident but rather indicative of a more significant crisis facing Black mothers in the United States – one that is not just a healthcare issue but rather a matter of social justice and equity.
In recognition of National Nurses Week, it’s crucial to reflect on nurses’ profound impact on healthcare, particularly in addressing health disparities. This year’s theme, “Nurses Make the Difference,” resonates deeply with me, as I have dedicated my career to advocating for improved maternal health outcomes for Black women and preparing nurses for careers in healthcare aimed at advancing health equity.
Every maternal death is a devastating tragedy that leaves a hole in families – representing a forever-altered dynamic. Perhaps even worse, statistics from the Centers for Disease Control and Prevention show that most maternal deaths are preventable.
This staggering data also demonstrates that Black women are nearly three times more likely to die from pregnancy-related complications than white women. Morbid racial disparities such as these do not have a place in the 21st century. Still, they are exacerbated by socioeconomic factors, a shortage of providers, and a lack of access to quality healthcare.
Central to this work is the recognition of the lived experiences of Black women. Factors such as poverty, barriers to healthcare access, and lifestyle choices are frequently used to explain the disparity in Black maternal health; however, these factors alone are inadequate to explain the problem. Healthcare providers often fail to see their patients as individuals with unique needs and concerns. Implicit bias and cultural incompetence compound these disparities, leading to substandard care and poor outcomes.
To effect meaningful change, we must address these root causes head-on. This includes increasing access to quality healthcare, fostering diversity and inclusivity in healthcare practices, and educating healthcare workers to be culturally competent and understand the social determinants of health.
Increasing access to quality healthcare is essential, and addressing the nursing shortage is a top priority when it comes to Black maternal health. By creating new programs and expanding existing ones that reach future healthcare workers, we can help prepare the next generation of diverse nurses who can reduce the burden on the current population of healthcare workers and meet the evolving needs of society – especially Black women.
As a nurse educator with over 18 years of experience in higher education, I believe education is integral to creating positive, sustainable change. At Walden University, where I serve as the associate dean for the BSN program, our online curriculum emphasizes the social determinants of health and the role of nurses in addressing health disparities. I am particularly excited about a new course we launched this spring, “Advocating for Diversity, Equity, and Inclusion in Healthcare.” This course, among others at institutions like Columbia and Frontier Universities, challenges students to confront their biases and privilege while equipping them with the tools to advocate for inclusive and equitable care. Our focus areas include implicit bias, systemic racism, microaggressions, health disparities, the healthcare ecosystem, and advocacy strategies to improve healthcare outcomes. These programs, which establish a better understanding of the unique experiences of our diverse population, are just a part of the solution. Patient outcomes can also be significantly improved by changing the face of those who deliver it. With minority populations experiencing disproportionate rates of disease and death, it is clear we need to create pathways to the nursing profession for all, regardless of ethnic, religious, or financial factors.
One way to do this is by providing educational access to those who may not yet have had the opportunity, which can mean emphasizing online education programs. This approach enables students to earn their degrees from where they live and encourages the development of nurses who practice within their communities, reflecting the communities they serve. This is a proven way to improve the healthcare outcomes of minorities, and it has the additional benefit of combatting the nursing shortage, particularly in rural areas.
Nurses, educators, policymakers, and advocates must join forces to dismantle the systemic barriers perpetuating healthcare inequality. Our industry has a unique opportunity to drive change and promote health equity by elevating the voices of marginalized communities, challenging implicit biases, and advocating for policies that prioritize equity and justice.
As we celebrate National Nurses Week, let us recommit ourselves to compassion, advocacy, and equity principles. Together, we can make a difference in the lives of Black mothers and ensure that every woman receives the quality care she deserves with the understanding she needs.
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.
“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.”
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.”
Diversity, equity, and inclusion (DEI) are hot topics in the healthcare world, but including a DEI module in our yearly education isn’t enough to address these issues. Policy is a valuable tool, but actual change needs to come from a more personal level, from each and every staff member.
Before we can have a meaningful conversation about DEI that might lead us toward significant change, we need to understand the meaning of diversity, equity, and inclusion and why it is important in healthcare.
First, the issues often relate to our biases, especially those so deeply ingrained in our life circumstances that we aren’t aware of them. We can’t advocate for what we don’t understand, and if we don’t advocate for change, we will stay in our “safe” silos, which only strengthens the idea that we are separate and different.
Understanding that we are separate and different and what that means is the first step in making diversity, equity, and inclusion a part of our workspace and nurse recruitment.
Diversity
Diversity is simply including people with different backgrounds. For example, when healthcare systems conduct nurse staffing while considering different cultural, gender, religious, sexual orientation, and socioeconomic backgrounds, the staff benefits from exposure to differences among coworkers, and patients feel more comfortable knowing they aren’t alone.
Our healthcare system has been lacking in diversity from the beginning, and although we’ve seen a lot of progress since the days when only white males could practice medicine, we are far from diverse.
In one study, over 56% of physicians identified as White and 64% as male, according to the Association of American Medical Colleges (AAMC). According to Minority Nurse, about 75% of RNs identify as White, and 91% are female. So if most doctors and nurses are white, most doctors are male, and most nurses are female, who are we really serving?
When we don’t have a common background, it’s easy to make the mistake of seeing the patient through our own lens instead of their reality. Our lenses place them where we want them to be—fully able and capable of taking the steps we want them to take for their health. The outcomes we desire assume the tools, processes, and understanding are within their reach and that they have the same goals we do.
Textbook knowledge can never make up for the lack of diversity in our own lives. And our lack of understanding of our patients’ reality can lead to misunderstanding or errors in care, creating inequity. Hiring a diverse workforce promotes understanding and creates a more comfortable environment for patients and coworkers alike.
Equity
Equity is a concept that often gets confused with equality. In healthcare, equality means giving everybody the same resource or opportunity to achieve their health goals. Equity is recognizing that each person has different circumstances and honoring that by allocating opportunities and resources to allow them to reach an equal outcome.
Simply giving someone an opportunity isn’t enough if they don’t have the means to use it. Equity can only be achieved when nobody is allowed to be disadvantaged due to age, race, ethnicity, nationality, gender identity, sexual orientation, geographical background, or socioeconomic status.
Access to life-saving medication is an example of inequity we see every day. A medication that costs hundreds of dollars every month may not be out of reach for someone with superb insurance coverage and a large bank account. For someone whose job doesn’t offer prescription coverage or who doesn’t make a living wage, that life-saving medication is technically available but far out of their reach. Far too many patients fail to fill the prescriptions they need for this reason.
Healthcare policy can promote equity, but we can also change how we treat and educate patients. In our medication example, we could address a patient’s ability to obtain a prescription before they leave the office or hospital. No patient should walk out the door with a prescription they can’t fill.
Inclusion
Inclusion is about deliberately creating a respectful and safe environment for all staff and patients. Inclusion means giving patients and staff a voice in giving and receiving care and encouraging diversity. Healthcare isn’t the place for a one-size-fits-all approach. We must all strive to embrace diversity and promote equity.
Nurses Are Uniquely Positioned to Champion DEI
Nurses may have little say in enacting policy within their healthcare systems but are very likely the first and last staff member a patient sees and the role they interact with most frequently. That close relationship with our patients makes nurses the most important role to champion diversity, equity, and inclusion with our patients, in nursing education, and within our own workspaces.
One of the most essential directives we learned in nursing school may have been to meet patients where they’re at. Let’s add and coworkers to that and, together, we can create a more effective healthcare system that serves all people.
Gina S. Brown, dean for the College of Nursing and Allied Health Sciences at Howard University (left) and Eileen Sullivan-Marx, dean of NYU Meyers (right)
Howard University’s College of Nursing and Allied Health Sciences and New York University’s Rory Meyers College of Nursing have formed an educational and research partnership to work together to have a greater impact on improving health and health equity in urban areas and global communities.
“We are ecstatic to be in partnership with such a prestigious educational institution as NYU Meyers at such a critical time within our nation’s health care cataclysm,” said Gina S. Brown, PhD, MSA, RN, FAAN, dean for the College of Nursing and Allied Health Sciences at Howard University. “The potential collaborations are endless.”
The new partnership will enable nursing researchers at Howard and NYU to collaborate on existing research projects and jointly apply for grant funding for new projects. The schools are in the process of applying for funding to develop a mentoring and education program to encourage African-American nurses to obtain specialty nursing certifications. In addition, faculty will be invited to attend research seminars and professional development opportunities at both schools.
“We are thrilled to build new ties to Howard University, one of the country’s top HBCUs, and to work closely with its expert nursing faculty,” said Eileen Sullivan-Marx, PhD, RN, FAAN, dean and Erline Perkins McGriff professor at NYU Rory Meyers College of Nursing. “By formally establishing this partnership, we can develop unique opportunities for cross-school collaborations that address health inequities and increase our impact on improving care for the patients and communities we serve.”
In addition to fostering faculty and research collaborations, nursing students at Howard and NYU Meyers will have the opportunity to attend new and established programming through educational exchanges. For instance, Howard nursing students will be encouraged to participate in NYU Meyers’ 10-week summer research program, designed to engage undergraduate and graduate students from underrepresented backgrounds in mentored research. The NIH-funded program aims to develop the next generation of cardiovascular disease researchers, and NYU and Howard hope that participation will encourage more nursing students of color to pursue research doctorates in nursing or related fields.
The Howard-NYU partnership was catalyzed by Brown and NYU Meyers’ Audrey Lyndon, PhD, FAAN, RNC, professor and assistant dean for clinical research. While on faculty at the University of California, San Francisco, Lyndon worked closely with Brown on educational exchanges; they look forward to building upon this collaboration to change the future of nursing.
About NYU Rory Meyers College of Nursing (@NYUNursing) NYU Rory Meyers College of Nursing is a global leader in nursing and health. Founded in 1932, the College offers B.S., M.S., DNP and Ph.D. degree programs providing the educational foundation to prepare the next generation of nursing leaders and researchers. NYU Meyers has several programs that are highly ranked by U.S. News & World Report and is among the top 10 nursing schools receiving NIH funding, thanks to its research mission and commitment to innovative approaches to health care worldwide.
About the Howard University College of Nursing and Allied Health Sciences
The College of Nursing and Allied Health Sciences is comprised of top-ranked educational programs that prepare health care professionals to be leaders and innovators in practice, education, research and service. Graduates are prepared to deliver patient-centered, interprofessional care and utilize cutting-edge technology and evidence-based practice to improve the health of all people with an emphasis on promoting health equity toward eliminating health disparities. Currently, the college offers degrees in the following accredited programs: bachelor’s degrees in clinical laboratory science, health management sciences, nursing, nutritional sciences and radiation therapy; master’s degrees in nursing, occupational therapy and physician assistant; a post-master’s certificate in nursing; a doctoral degree in physical therapy; and a master’s and doctoral degree in nutritional science in conjunction with the Howard University Graduate School. To learn more, visit cnahs.howard.edu/
My first experience with “minority health” came during my Master of Public Health degree program. I served as a member of the speakers’ committee for the annual Minority Health Conference at the University of North Carolina at Chapel Hill.
We sought to raise awareness about issues related to health disparities and how to take collaborative action across different professions. Our participants included academic scholars, researchers, public health practitioners, community leaders, human rights advocates and policy makers.
We often hear the terms “health disparities,” “health inequities” and “social determinants” as they relate to populations, locally, nationally and globally. So let’s start with a few basic definitions:
Health Equity
Health equity means achieving the highest level of health for all people. It requires valuing every human being equally with continuous efforts to address avoidable social and economic inequalities, historical and contemporary injustices. Health equity also seeks the elimination of health and healthcare disparities.
Health Disparities
Health disparities are defined as a particular type of health difference that is closely linked with one’s social or economic status. Health disparities negatively affect groups of people who have experienced greater social and/or economic obstacles to health due to characteristics historically linked to discrimination or exclusion. These characteristics include but are not limited to:
Racial or ethnic group
Religion
Socioeconomic status
Gender
Age
Mental health
Physical disability
Sexual orientation
Geographic location
Social Determinants of Health
Social determinants of health refers to environmental conditions in which people are born, live, work and play that affect a wide array of health and quality-of-life outcomes and risks.
Ways to Observe National Minority Health Month
There are several easy ways to participate in National Minority Health Month. This year’s theme is “Bridging Health Equity across Communities.” During April, consider doing the following activities:
Stay Informed
Learn more about your own family’s medical history and keep a good record of your health conditions and treatment plans.
Read, watch or listen to local news about emerging health conditions in your community.
Public Health Involving Minorities Is a Global Concern
National Minority Health Month recognizes health disparities in the United States, but coping with public health issues involving minorities remains both a local and a global problem. Fortunately, there are local public health events that address issues disproportionately affecting minorities, such as the Houston Heart Failure Management Conference, Save a Life and the Adult Congenital Heart Symposium.
In addition, international organizations have addressed global public health issues affecting minorities. The national ministries of health in the African region, the Centers for Disease Control and Prevention, and the World Health Organization/African Region are evaluating Ebola outbreak response capabilities, which have been strengthened through my collaboration.
The best way to teach more consumers about public health – and especially the health of minority groups – is through education. Staying informed, getting involved and getting connected are powerful ways to raise awareness and learn about the health problems affecting minorities.
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