Health Equity And The Future Of Nursing, Post-COVID-19

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A National Academy of Medicine (NAM) panel clearly conveyed that the nursing field must be socially and politically engaged in advocacy efforts to address the health inequities laid bare by the COVID-19 pandemic.

“As the most trusted among all health professionals, I can think of…no group better equipped to advance health equity,” said panelist Lisa Cooper, a professor at Johns Hopkins University and director of the Johns Hopkins Center for Health Equity. Panelist Kristine Qureshi, a professor at the University of Hawaii at Manoa, agreed. “Systemic inequities require policy change,” she said. “It is incumbent that nursing views that as one of their essential roles.”

Cooper and Qureshi spoke on August 30, 2020, during a NAM webinar that I moderated. It sought to gather input about the nation’s pandemic response, as well as how nurses, specifically, have responded.

Information from the webinar will be included in a second Future of Nursing report, which will chart a path for the profession to help our nation build a culture of health, reduce health disparities, and improve the health and well-being of the US population. The report, underwritten by the Robert Wood Johnson Foundation, will be released in the spring of 2021.

There is growing consensus that cross-sector alignment of health care, public health, and social service systems can promote population health and the efficient use of resources. The NAM report will help to determine how nurses can best be utilized to assess and meet social needs in health care and conduct case management for vulnerable populations to promote health equity.

Extensive Health Inequities

Cooper underscored the urgency for health policy makers to prioritize the extensive health inequities that have been exposed and intensified by the COVID-19 pandemic. Black, Latino, indigenous, and Asian populations are disproportionately affected by this virus, with significantly higher infection and death rates compared to those for Whites.

COVID-19’s disproportionate effect on people of color is because of a myriad of factors stemming from structural racism. People of color are more likely to rely on public transportation, lack basic resources such as food and water, live in crowded housing with multigenerational family members, be essential workers, and lack access to health insurance.

The disproportionate toll from COVID extends to immigrants and people of color who are employed as health care workers and are more likely to care for Blacks and Latinos and nursing home residents. About 40 percent of total COVID deaths have occurred in nursing homes.

Comprehensive And Coordinated Investments

Cooper called for a “systemic, comprehensive, and coordinated long-term set of investments” to address the social and economic factors that affect health—a proposal that she and David Williams, a professor at Harvard University and cochair of the NAM Committee on the Future of Nursing, floated in May 2020 in a Journal of the American Medical Association editorial.

She named three broad ways to address health inequities: (1) tackling the social and economic factors that affect health through efforts such as early-childhood education programs and raising the minimum wage; (2) building more health into health care to prioritize preventive health and primary care, and diversifying the health care workforce to reflect the racial and ethnic composition of the US population; and (3) raising awareness of inequities so as to build political will to address them.

How Nurses Can Be Involved

Cooper said that nurses can play roles in all three categories mentioned above. She urged the nursing profession to diversify, noting that Whites comprise 60 percent of the population but make up 80 percent of registered nurses.

More nurses should be involved in assessing and integrating social needs in health care and advocating for community-based resources and case management to better assist vulnerable populations. Cooper added that the topic of health equity should be woven throughout the nursing curriculum.

Qureshi agreed that incorporating health equity into the curriculum would enable nursing to develop a “cadre of leaders” devoted to tackling inequities.

Lessons Learned From COVID-19

Nursing must prepare its workforce for an increase in future pandemics because of urbanization, mass travel and transit, and increased population density, Qureshi stressed. She said that undergraduate curricula should include more content and clinical experiences in emergency, critical care, and public health nursing; disaster preparedness; and basic principles of epidemiology. Continuing education for nurses should cover those topics as well.

Qureshi recommended convening a national task force to develop a model for implementing surge capacity for the disaster nursing workforce because of a shortage of nurses with critical care skills in cardiac and respiratory care that was seen in hospitals with large numbers of COVID-19 patients.

Panelist Frank Baez, a cardiovascular intensive care unit staff nurse at New York University Langone Health, described a harrowing experience of caring for multiple critically ill patients without always having enough personal protective equipment (PPE) and often being the only person present when patients died. Because of the patient surge at that time, many nurses who worked on nonemergency floors quickly switched, often without adequate training, to units filled with COVID-19 patients. “It was physically, mentally, and spiritually exhausting for a lot of us,” Baez noted.

Among his recommendations, he called for a plan to provide mental health support to nurses—a need acknowledged by NAM President Victor Dzau during the webinar. “Nurses are shouldering heavy burdens and are deserving of our strong support,” Dzau said.

Baez called for policies to make nurses “feel safer at work and not feel they will be reprimanded if they speak up”—a reference to the unacceptable firing of nurses who have publicized a lack of PPE, which unbelievably still continues seven months into the pandemic.

As the nation grapples with the pandemic’s devastation, it’s clear to me that nursing leaders must prioritize health equity. They need to activate nurses at all levels and give them straightforward tools to make it easier for them to address the many social and economic factors that affect health. Leaders must also support the emotional health of nurses, so they can experience greater well-being and continue to care for others. Let’s make this the decade where the nursing field focuses on health equity.

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