Rounds with Leadership: An End to Inequity

“Addressing inequities and improving the health of individuals in the nation’s most disadvantaged communities improves the quality of care for everyone and advances population health. Poor outcomes for minoritized communities lead to poor outcomes for everyone. It is not a zero-sum game.”

- Ending Unequal Treatment (NASEM, 2024, p.2)

On June 26, 2024, the National Academies of Science, Engineering, and Medicine (NASEM) released a new publication examining healthcare inequities that persist in the U.S. titled Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All. Flaws in our health system disproportionately affect members of marginalized communities, including stark racial and ethnic inequities in life expectancy, maternal and infant mortality, and many chronic diseases. This new report reviews the major drivers of healthcare disparities, provides insight into successful and unsuccessful interventions, identifies gaps in the evidence base, and makes recommendations to advance health equity.

Academic nursing has a pivotal role to play in stemming unequal treatment and preparing an equity-minded workforce. Collectively, we have the power to change direction and move toward the desired state where all people have a fair and just opportunity to attain optimal health regardless of race, ethnicity, or other factors (personal, social, economic, environmental) that impact individual and population health. Specific pathways we can take include:

Education: Developed to outline the core competency expectations for all professional nurses, AACN’s 2021 Essentials features a strong emphasis on preparing nurses to lead initiatives that address structural racism, systemic inequity, and discrimination with the understanding that “equitable healthcare better serves the needs of all individuals, populations, and communities” (p. 7).  Faculty can help to achieve this outcome by:

• Integrating content on the social determinants of health and health equity throughout students’ curriculum.
• Expanding education beyond the classroom to provide experiential learning opportunities in underserved communities and with marginalized populations.
• Cultivating inclusive learning environments that acknowledge and challenge racism in all aspects of nursing education and practice.

School administrators can lead in advancing change by recruiting, supporting, and mentoring both students and faculty from diverse backgrounds to ensure that the next generation of nurses reflects the communities we serve. Together, we should strive to create environments that recognize the value of diversity, equity, inclusion, and belonging to achieving excellence in teaching, learning, scholarship, and service.

Research: Uncovering the full impact of unequal treatment on patients and health systems is critical to building momentum for change. One of the five recommendations in the new NASEM report calls for investing in research and evidence generation to better identify and widely implement interventions that eliminate healthcare inequities. The authors call on federal and private funders to expand support for research on health disparities, structural racism, and health-related social needs, as well as to explore various approaches, strategies, and policies needed to eliminate inequities.

Nurse researchers have played a pivotal role in building the nation’s evidence base around health equity, but there is much more work to be done. Many research-intensive nursing schools have launched centers specifically focused on reducing health disparities, including the University of California San Francisco, University of Maryland, University of Texas at Austin, and University of Wisconsin Madison among others. We encourage schools to maintain a strong focus on addressing health inequities and unraveling the social determinants of health as key components of their research enterprise.
 
Advocacy: According to a recent study in Nursing Outlook, a policy pathway to achieving health equity is feasible as long as it “leverages nursing science, research, education, and practice in order to promote social justice within health and health care and to uphold health care as a human right” (Nickitas et al, 2022). Nurses collectively can influence the public discourse on health equity and help to advance legislation on Capitol Hill that serves the greater good. With the understanding that data drives change, a key component of AACN’s Federal Policy Agenda is to shape public policy by pursuing transformative research that investigates methods to improve public health and reduce health disparities. AACN is committed to providing the information, resources, and opportunities needed to engage nurse educators, students, and advocates in efforts to advance legislation and policy focused on health equity.

We encourage all nurses to use their position as a trusted healthcare providers and patient advocates to call for an end to unequal treatment. By joining voices with other nurses and interprofessional colleagues spanning education, research, practice, and policy, we can make a real difference in ensuring that our healthcare system provides just and equitable care for all.

Additional Resources

Webinar: Ending Unequal Treatment Report: Implications for Nursing Science
On August 27, 2024, from 12:00-1:30 p.m. (ET), Dr. Vincent Guilamo-Ramos, Executive Director of the Institute for Policy Solutions and Distinguished Professor at the Johns Hopkins School of Nursing, will join NINR to discuss the National Academies of Sciences, Engineering, and Medicine’s Ending Unequal Treatment report.

Campaign for Action’s Equity-Minded Nurse Initiative
This campaign spotlights nurses who recognize themselves as drivers of change who are uniquely poised to inform healthcare practice, policies, research, and educational standards. As part of this initiative, AACN sponsors the Equity-Minded Educator Award to recognize faculty focused on preparing nurses to champion health equity. 

Customized AACN Workshops
AACN staff are available to consult directly with member schools to help address key issues related to advancing health equity. On-site workshops can be arranged, including Creating an Inclusive Learning Environment; Fostering Success of Students from Diverse Backgrounds; and Recruitment, Hiring, and Retention of Nursing Faculty from Diverse Backgrounds. Contact cdowning@aacnnursing.org for more information.