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.”
The nursing industry has dozens of professional associations devoted to the art and science of nursing care and nursing specialties. And while many nurses know they exist, they may need to realize the depth of what associations do and how the skills and connections developed through membership can advance a career in ways they never expected.
American Nurses Association (ANA) president Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, says joining an association is an excellent professional move, and membership carries personal benefits that are just as critical. “Many people don’t consider that when they join the ANA or an association of another specialty, that they are advocating for the profession,” she says. “We are protecting our profession or specialty.”
“We grow in the ability to influence. So even if you feel like being a member isn’t an active form of involvement, it is; you are being counted when association leaders are advocating for change. We represent you, and you count.”
Be an Active Member
If you want to get the most from any professional association membership, active participation helps you and the organization. Even if your busy schedule leaves little time to devote, you can find something that will fit your schedule. Sign up for any newsletters and read them. Attend webinars, seminars, and conferences as you are able. “NAHN doesn’t have a chapter in every state yet, so if you don’t have a local chapter, I would encourage you to reach out to the national organization and connect with other members who live in your area,” says Nava. “Our national organization also has national committees, and volunteering for a committee is another way to become engaged.”
With so many nursing professional associations out there, it’s not hard to find the most appealing one. “Review the organization’s mission, vision, values, and goals to determine which organization may best fit your professional needs,” says Nava.” Do these align with your values and goals? If so, this organization may be a good fit, and you will find other nurses to collaborate with to meet those goals and stay engaged.”
There are many opportunities to get involved, but not all involve nursing skills. Associations need you to reach out to legislators or members of Congress, help produce newsletters, or advance fundraising efforts. “When you’re in an organization, it’s about the organization as a whole, and it’s not nursing specific,” says Kennedy.
All Nurses Are Welcome and Needed
Associations don’t require years of nursing experience for membership. Nurses across the entire career spectrum can learn from each other. “I often hear from students that they are too busy to join an association,” says Ann Kriebel-Gasparro, DrNP, FNP, GNP, FAANP, and president-elect of the Gerontological Advanced Practice Nurses Association (GAPNA). “And yet, this is the best time to join. Membership fees are often lower, there are opportunities for growth, and later on in your career trajectory, you may want to run for a state or national office in that organization. The opportunities are many–most associations/organizations offer scholarships, travel, and speaking opportunities, and networking connections are especially important.”
“A misconception is that novice nurses have nothing to contribute, which is a myth,” Kim Regis, DNP, RN, NEA-BC, CPNP-PC, BCC, and a member ofthe American Academy of Ambulatory Care Nursing (AAACN). “The voices of all generations must be at the table so that policies, practices, and standards reflect everyone working in the profession and the communities we serve.”
Regardless of where you are in your career, Kennedy says that mentoring plays a big role in many nursing associations. Whether you are a new nurse looking for guidance from a mentor or a more experienced nurse who can share your expertise and mentor someone else, a nursing association offers excellent opportunities to do both.
All the skills you acquire, and your work in an organization will also help advance your career. You may have yet to gain formal management experience, but if you have led an education campaign, board member, or committee in your organization, that gives you hands-on experience.
Nurses can also add to their knowledge and grow into leadership roles within an association. “Joining a nursing organization is a great way to expand your skill set within leadership, advocacy, research, and clinical practice,” says Nava.
The personal connections you’ll form in an association membership are also professionally valuable. “This is how you learn of job opportunities, fellowships, and academic opportunities,” says Nava. “Also, members and leaders within organizations, through your engaged involvement, will end up being the people who mentor you, or sponsor you, or write letters of recommendation for you, to advance your career.”
Nurses also know the opportunities they find through an association membership are often the kind they would not have found any other way. “As a new member [of AAACN], I had many doors opened to get involved in various committees and task forces,” says Andrea Petrovanie-Green CAPT(Ret), NC, USN, RN, MSN, AMB-BC, and a member of the leadership team supporting AAACN. “These experiences helped hone my leadership, management, and clinical acumen. As a result, I authored a white paper that established the first Specialty Leader in Ambulatory Care Nursing for the Navy Nurse Corps. Another unique opportunity I am grateful for was co-chairing the Tri-Service Military annual symposium. During networking events, I was introduced to several influential and inspiring leaders who mentored me to pursue additional opportunities. I subsequently served as a member of the nominating committee and currently as a director.”
Both Nava and Kennedy credit their association memberships with advancing their careers.
“I joined my first association because my aunt encouraged me to join with her our local Illinois Chapter of NAHN when I was a first-year nurse,” says Nava, noting the small chapter gave her opportunities to take on leadership roles including, eventually, president. “My ability to work with others and build a team, something I learned early on, has helped me grow and become the leader I am today as the national president of NAHN.”
Kennedy says she was starting her PhD when she first heard of the ANA. One of her classmates was the executive director of the Arizona ANA and asked Kennedy if she was a member. “I joined that day,” she says with a laugh, eventually becoming president of the Arizona ANA. As needs arose, she helped out and got involved, learning new skills along the way and developing close personal connections. “That’s what helped me most in my career,” she says, joining an association. “We need new individuals to carry on the profession. They must be involved to keep our profession and specialties strong.”
Kriebel-Gasparro says membership in an organization gives nurses leverage on areas they care deeply about. “This is why I belong to the Nurses of PA organization and offer my time to advocate for safe staffing and other issues,” she says.
Associations know policymakers without nursing experience are making critical, industry-impacting decisions. It takes nurses with lived experience and a passion for excellent nursing practice to move into roles where they can make those decisions.
“With over four million nurses in the United States and greater than 80 percent of those employed in the field, it is imperative that a unified voice, with a unified message, is brought forth on many of the issues that impact practice and the health of our communities in which we work,” says Regis. “The bottom line: there is a professional organization for everyone to find a home where they belong. If a nurse has not found a good fit where they are, it is almost guaranteed that there is one out there somewhere that will pour into them with mentorship and development. Don’t miss your opportunity to take your career to the highest level.”
Nurses with disabilities find the nursing industry offers excellent career paths that help them fulfill their goals, regardless of disability. Whether nurses have a disability before they enter the workforce or become disabled after their licensure, they are needed to fill jobs and help broaden the diversity of the nursing workforce, says Karen McCulloh RN, BS, co-founder and co-director of the National Organization of Nurses with Disabilities (NOND).
Working with a disability might require accommodations to help you perform your job better or an open approach to different specialties. “Being honest with yourself regarding your strengths and weaknesses will go a long way toward facilitating success,” says Donna C. Maheady, EdD, APRN-BC, founder of ExceptionalNurse.com.
McCulloh, who lost her vision over a 24-hour span, says her nursing skills were enhanced. “We’ve found
that nurses with disabilities have a sense of compassion for patients and what they are going through because they’ve been there,” she says. But for nurses who become disabled while already working as a nurse, McCulloh says there’s often an adjustment phase. “You think about, ‘who am I now? What about my self-esteem, self-identity, self-worth, and self-confidence? Am I still the same person?’”
Every Path Is Different
Sandra Nosek, MSN, RN, has been a nurse for over 30 years with experience in management, staff development, QA wound care, long-term critical acute care, hospice, and skilled nursing facilities. She had a hearing aid in her right ear but woke up with sudden bilateral deafness in 2015. “It rocked my world and was very scary,” she says. Navigating without her hearing proved exceedingly challenging.
Nosek thought she’d have surgery and be able to return to work quickly, but her path proved challenging. She obtained her MSN in nursing education (with a 4.0 GPA) in 2019 and, after receiving improved Bluetooth processors in 2021, sent out more than 400 applications with little result.
She landed a job at a skilled nursing facility that restored some of her self-confidence lost in the job search process, and she eventually began working in hospice, a nursing specialty she loves. She recently obtained an RN case manager position with a small hospice in her community. “To other nurses with disabilities, don’t give up,” she says. “Continue to pursue options in your career.”
Kim Hickman, DNP, APRN, Adult PMHNP-BC, works as an adult psychiatric mental health nurse practitioner with the VA Health Care System and has more than 36 years of nursing experience, including in the Army Nurse Corp, as a lieutenant stationed at Walter Reed Army Medical Center (three years on active duty), and roles in medical surgical nursing, home health nursing, occupational health nursing, and volunteer work as a faith community nurse. But Hickman, who has a speech impediment of a stutter/stammer, almost didn’t pursue this career.
“I was unsure if I would be an effective nurse,” she says. “I shared my concerns with my mother, an ICU nurse at the VA then. My mother paused for a few minutes before answering. She looked at me and said, ‘Remember, it’s more important what you say than how you say it.’ Her confidence in me encouraged me to continue pursuing my nursing degree. From that point on, I focused on the content of my speech, making sure the information was accurate and relevant.”
Hickman says her stutter/stammer can fluctuate depending on the situation and her stress level. “Learning to be patient with myself has been a tremendous achievement. I am learning to accept that my stutter/stammer is a part of who I am,” she says, noting that it has positive impacts. “Stutter/stammering has allowed me to actively listen to others, to be patient with others, to be present, and to be compassionate and empathetic toward the suffering of others. It has also helped me recognize and value words’ power and importance. It has given me a chance to pause and decide if I want to say what I intended and time to decide if my comments add value or take away value to the conversation.”
Lois Taurman (who has a nursing degree, national certification as a poison information specialist, a master’s in educational counseling, a jurist doctorate, and also represented the United States as a wheelchair athlete in the Paralympics Games in Seoul) had plans to work in the Navy as a nurse or as a pediatric nurse when a fall from a ladder just before graduation paralyzed her (she can move her arms, but has no finger movement). Taurman, who now works in America’s Poison Centers, a poison specialist in the Kentucky Poison Control Center of Norton Children’s Hospital, says that while she isn’t doing hands-on nursing, her work fulfills her drive to help children.
That doesn’t mean the role was anywhere on Taurman’s radar. “I didn’t know poison center nursing even existed,” she says. “This is a blessing for my career, but also to feel like I have valuable nursing skills.” Her employer has made adjustments and accommodations so Taurman can work, including adaptive technology and spaces. Still, she knows not all nurses have such proactive employers and may feel like they can’t reach their dreams. “Be persistent in looking for jobs,” she advises. “Your skills may differ, but you can show them how to accomplish the job. It may not be how you envisioned it, but it is still possible. Disability isn’t something that should hinder someone.”
PoisonCenters.org is available for all health care professionals to access assistance during a poisoning emergency, and nurses can also find job opportunities there. Always keep the Poison Help number 1-800-222-1222 with you.
Work Options
Nurses must assess their interests and how they work when thinking about a nursing path. Consider the specialties you enjoy working in, determine how fast you can work or prefer, and what accommodations you’ll need to know what’s possible.
According to Maheady, the career options available for nurses with disabilities are very wide and include the following partial list:
Technology is changing the options available to nurses with disabilities. Some apps help nurses with color blindness, and assistive technology will read out information for those who can’t see it.
Accommodations
As a nurse with a disability, the Americans with Disabilities Act protects you from having to disclose your disability, but if you need accommodations, then you will need to disclose. Nurses with visible disabilities (such as amputation or paralysis) will likely address their needs earlier in a job search than those with invisible disabilities (such as anxiety or fibromyalgia). Nurses who an organization already employs could become disabled and will need to determine the next steps.
Despite the tendency for some nurses to not want to reveal any disability for fear it could impact their job, Maheady says sometimes that approach backfires. “Undisclosed invisible disabilities can provide a privacy shelter for some nurses,” she says. “However, it may not serve the nurse or institution well.” Colleagues and supervisors might not know about the disability and could make hurtful comments about not looking sick or faking symptoms to struggling nurses.
So, when is a good time? McCulloh says once you have a job offer, you should consider the need for any accommodations. But before that even happens, you’ll want to think about precisely what you’ll need to do the job best. Even the most accommodating human resources department can’t guess your needs, so having a detailed plan will help get you what you need and help human resources make the best plan.
When you have the job offer, approach the topic with your natural enthusiasm for the position, the new opportunity, and the skills you’ll bring. And then relay having a disability and needing specific accommodations to perform the job. Put everything in writing, says Maheady. See this Sample Language for Accommodation Request Letters from JAN – Job Accommodation Network.
Work with HR
The more specific you can be and the more resources and examples you can offer, the better your chances for getting the accommodations you need, says Maheady. “Do you need a sign language interpreter? If so, provide your employer with a list of resources in your community that provide sign language interpreters,” she says. “Offer to start a sign language club for staff to help staff learn basic sign language to work better with you and patients with hearing loss.”
She says that if you need frequent breaks, be specific about how often you need a break and for how long. Suggest to your employer ways you could be covered for breaks specific to your clinical setting/area of practice.
Nurses with mobility issues might need a scooter to navigate long hallways, so they can help their employer by providing resources for purchasing new and used scooters. “Show the cost-benefit of purchasing a scooter compared to the cost of hiring a new nurse or travel nurse for your position,” says Maheady.
Despite awareness around nurses working with disabilities and the protections of the ADA, not all employers are receptive. “If you are met with a negative response, don’t take no for an answer,” says Maheady. “Ask, ‘Who else can I talk to?’ ‘What else can I provide you with to help me be successful?’”
Role Modeling
Nurses with disabilities also reflect the diversity in a patient population and can show people that their life doesn’t stop after a disability. Nurses can share resources with patients and act as important mentors to other nurses. “I can share in an hour what took me ten years to learn,” says McCulloh.
Nurses are needed to help guide policy, and the information is particularly validating to listeners when it comes from a nurse with a disability. “Nurses with disabilities are transforming healthcare and patient care practices,” says McCulloh. “The priority with every nurse is to ensure patient safety. And because of the critical eye toward us, we have direct awareness of that requirement.”
Nosek, who eventually found a role in a specialty that is meaningful to her, says that all nurses must realize that no one is protected from having or developing a disability. “To all nurses, I strongly suggest obtaining some experience in an office-type position at some point in your career to be able to fall back on if you were to become disabled,” she says, noting that her extensive education and management experience wasn’t enough of a buffer to prevent roadblocks in her path to finding a job that would fit her needs.
“There should be more care and compassion by healthcare administrators to ensure healthcare staff can continue to work no matter their disability,” she says, noting industry-wide changes for additional skills training and compassion from health care administration when faced with a nurse’s disability are needed. “I would have gone right back to work had I had the support and training to do another job within nursing,” says Nosek.
Hickman advises nurses to embrace their differences, acknowledge their strengths, work on their weaknesses, and not hide behind a disability. “You are more than your stutter/stammer or any other disability you may have,” she says. “Above all, love, respect, and be patient with yourself and teach others to love, respect, and be patient with you. You truly are unique! You inspire and motivate someone because you have decided to be courageous, present, and speak up!”
If you’ve seen an increase in your paycheck in the past few years––and hopefully you have––you are part of an overall trend of increases in salaries for nurses. And, as you might expect, some of that has to do with the effects of the COVID pandemic.
“We’ve seen an increase in nursing salaries, particularly since the pandemic,” says Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, director of nursing programs and co-lead for Project Firstline at the American Nurses Association (ANA).
Registered Nurses (RNs) earned a median salary of $81,220 in May 2022, according to the Occupational Employment and Wage Statistics (OEWS) program from the Bureau of Labor Statistics (BLS). That’s up from a median salary of $77,600 in 2021. The mean (as opposed to median) annual wage for RNs as of May 2022 was $89,010.
Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, is the director of nursing programs and co-lead for Project Firstline at the American Nurses Association (ANA)
Nurses on the West Coast and Northeast generally enjoy higher salaries than nurses in other areas of the country, with an annual mean wage of $87,990 to $133,340. The top-paying states for RNs included California, Hawaii, Oregon, Massachusetts, and Alaska. The lowest salaries were clustered in the middle of the country, where the annual mean wage of $37,360 to $74,330 was indicated for nurses in states such as South Dakota, Missouri, Tennessee, and South Carolina.
Some 46% of surveyed nurses earned a salary between $80,000 and $139,999, according to the2022 Nursing Trends and Salary Survey Results published in American Nurse, the official journal of the ANA. Those figures were up from 39% in 2021 and 41% in 2020. Nearly half (47%), notes the report, earn less than $80,000, but 62% reported that their salary was higher than the prior year.
Pandemic Effects
Before the pandemic, healthcare organizations were moving away from merit increases for nurses and shifting more toward bonuses and cost of living increases, according to Boston-Leary. But that has been problematic, she notes, because a great deal of data indicates that, to a certain degree, nurses live barely above livable wage in some markets. As a result, some nurses work overtime or take on second jobs.
The pandemic encouraged nurses to feel justified in asking for fair compensation. “It’s important to recognize also that, culturally, it has been taboo for nurses to raise the salary issue because the thinking around nursing has always been that it’s altruistic. It’s about serving others. It’s not about money. It’s true. Many of us didn’t get into nursing to get rich. But you hope you’ll get compensated appropriately, and it’s always been a struggle for nurses to advocate for what they deserve in terms of their salaries. So I think some of that broke through with the pandemic.”
Not only were nurses who were incumbents in organizations making less than the staff they were training, notes Boston-Leary, but also agency nurses were making a lot more than they were. “That created this untenable situation where many nurses rallied,” some striking or entering new bargaining agreements.
“Now we’re in this place where there’s a reckoning point, and there is some making up that’s happening,” says Boston-Leary.
Minority Challenges
Nurses of color face challenges when it comes to salaries. “The difference is that many nurses of color don’t get the opportunities to climb the career ladders as quickly as their white counterparts,” says Boston-Leary. “That in itself presents a salary discrepancy. And there are many more minoritized nurses with multiple degrees and academic achievements that are not in leadership roles compared to their white counterparts with lesser credentials.”
Organizations have had the reluctance to track such data as turnover for nurses of color and nurse satisfaction by race, notes Boston-Leary. “There’s been an unwillingness over the years to look at that because when you look at it, you must deal with it. That is starting to change, but we’re still not fully there.”
