In the consensus report of the National Academies of Sciences, Engineering, and Medicine, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, 9 recommendations were offered to bring about changes throughout the country to improve the quality and equity of healthcare for all citizens. It is my opinion that all the recommendations would be of great benefit to the healthcare system. There are a few recommendations that I believe to be most effective because of their national impact, some of which I have experienced first-hand.
According to the report, the committee’s recommendations are a call for change at individual and system levels (The National Academies Press, 2021). The recommendations that execute change at both of those levels are first Recommendation 1, that all national nursing organizations should develop a shared agenda for addressing social determinants of health (SDOH) and achieving fair healthcare for all. This recommendation stands out because of the impact it has on several populations. The action item proposed is to analyze diversity, equity, and inclusion (DEI) and remove any policies that do not align with DEI. Systematic racism, biases, discrimination, mistreatment are all targeted and discarded of with this recommendation. I have seen recommendations put to action in my organization. All staff were educated on the importance of DEI through online learning modules and breakout huddles. In addition, the organization offered free 15-minute DEI webinars to attend for those interested in learning more. As it relates, the organization now acknowledges more cultural and religious holidays/ traditions. For example, during Ramadan specialized menu items are provided at various locations within the hospital.
Recommendation 2, which suggests that the nursing workforce should be made able to address SDOH regardless of practice setting (The National Academies Press, 2021) also has action items that have potential to make significant impact on the healthcare system. Most notably, increasing the number of nurses practicing in specialized areas experiencing shortages, investing in nurses’ education statewide, prioritizing community-based learning, and supporting academic progression of students from disadvantaged backgrounds. Collectively, the impact of these actions would change entire communities. When the nation, or state invests in underserved communities by providing health care education to citizens, investing in the youth’s education, especially regarding healthcare, a shift will eventually occur, and more than the community will benefit from the progress.
Lastly, I believe that recommendation 3 is of immense importance. In short, the recommendation suggests that nursing education programs, leaders, employers, and organizations promote nurses’ health and well-being as they assume greater responsibility in advanced roles (The National Academies Press, 2021). As a bedside nurse during and following the COVID pandemic, I witnessed many nurses with tenures from a few years to decades leave the bedside from burnout. I listened to the concerns of my peers, as we battled running out of personal protective equipment, reusing n-95 masks for entire shifts and sometimes days. The toll that a nurse’s mental health takes on their body and consequently their care of patients is not to be underestimated. The steps suggested for recommendation 3 are all in favor of nurse wellness. The key steps that I identified that will make momentous improvements within healthcare organizations across the country are, ensure that nurses have sufficient resources, establishing a culture of safety within the workplace, and protection against retaliation.
As the report states, nurses will need to continue to be adaptable to the changes that come and respond to new health challenges at the individual and community levels. I agree that nurses will remain at the forefront of change within healthcare, and the responsibly of nurses will only increase with time. Although it has only been two years since the report was published, many of these action items are live today. I am certain that in the years to come we will see nurses in advanced roles continue to evolve and provide equitable care for patients of all communities.
DQ 2: Identify recommendations for nursing education you believe will be most effective or radical in creating change within the industry.
NUR 513 Topic 1 DQ 2
Refer to the consensus report of the National Academies of Sciences, Engineering, and Medicine, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, provided in the topic Resources. Identify recommendations for nursing education you believe will be most effective or radical in creating change within the industry. Provide rationale based on your experience in practice. Do you agree or disagree with how the report describes the evolution of the advanced practice registered nurse role? Why or why not?
REPLY TO DISCUSSION
According to the consensus report of the National Academies of Sciences, Engineering, and Medicine, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, “The authoring committee produced a set of recommendations for the field of nursing and it provided a blueprint for improving n
urse education; ensuring that nurses can practice to the full extent of their education and training; providing opportunities for nurses to assume leadership positions; and improving data collection for policymaking and workforce planning.” Out of the nine key recommendations the consensus report has addressed, the two main ones that I consider to be on the top level of importance within my community and organizations involve the nurse’s health and wellbeing and the inequities surrounding public health emergencies.
Recommendation 3: By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence-based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity.
Recommendation 8: To enable nurses to address inequities within communities, federal agencies and other key stakeholders within and outside the nursing profession should strengthen and protect the nursing workforce during the response to such public health emergencies as the COVID-19 pandemic and natural disasters, including those related to climate change.
Recommendation 8 hits close to home on so many levels. I have been a nurse for 3 years, and the pandemic took me by surprise. I had been working as a nurse for about a year when Covid started. The amount of stress and distrust myself and my coworkers felt navigating around the everchanging policies and procedures associated with the pandemics CDC instruction was unnecessary. Unfortunately, I experienced the blatant disregard our organization had for our health and wellbeing by withholding and rationing vitally needed supplies when they were readily available for us to use. It was infuriating at the time, because this was a whole new ballgame for even the most seasoned nurses, and it caused a significant number of employees to resign. Management never came on the unit anymore like they used too and we felt abandoned. Bringing up the concerns with our director and management at staff meetings was futile and our concerns would be triumphed over with CDC recommendations and the organizations rationales based on fear and lack of knowledge. The COVID pandemic was an eyeopener to the world in terms of high-level planning and preparation for patient and provider safety.
Also Check Out: DQ 1: Describe how the role of advanced registered nurse transformed over time
I agree with how the report describes the evolution of the advanced practice registered nurse role. The solution the report proposes states, “The committee recommends that all relevant state, federal and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality, and value.” Advanced practice nurses can help curb disparities and positively influence communities’ health and wellbeing by letting the ever evolving career of nursing take the front seat with the physicians and other specialty roles. As nurses we are in the frontlines and are the eyes and ears for our physicians. We may not be as educated in medicine as the physicians are but we are strong in our assessment, implementation and evaluation skills. We are a golden asset to the care team and as APNs, we can have a deeper impact within our patients lives and communities with the right education and support.
National Academies of Sciences, Engineering, and Medicine. 2021. The future of nursing 2020–2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982
REPLY
Well stated and described . Recommendation #8 stands out for all of us to be able to learn from our mistakes as a community. The amount of burnout and disparities seen during the pandemic among nurses and other health care professionals is unexplainable. Words cannot to do justice about the experiences many went through with Covid 19. Not one organization or industry is to blame as I have not encountered such a worldwide phenomenon of a pandemic as this in my life.
Recommendation #3 is apt in the light of #8 of how very important it to guide and guard the well being of a nurse no matter the setting where they work or study in. We have not reached a post pandemic state, thus it is yet to see how federal agencies , stakeholders and private organizations are responding to new work environments for nurses being in telehealth, working remotely and creating jobs within the nursing profession to allow for a better work life balance
REPLY
One phrase that stood out to me while reading The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report was “cultural humility” (National Academies of Sciences, Engineering, and Medicine, 2021). This phrase was new and intriguing to me. What exactly is cultural humility and how do we include the concept into nursing education since, according to the authors of the report, it is “essential” to accomplishing the goal of delivering person centered care and education to diverse populations (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206)? The report states that the concept of cultural humility is so important that it should be included in nursing education “as a thread throughout the curriculum.” (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206)
Shamaila Khan, PhD states that the phrase “cultural humility” is a “dynamic and lifelong process focusing on self-reflection and personal critique, acknowledging one’s own biases” (Khan, 2021). This phrase struck me as radical, when I read it for the first time in the report. Although I do view the concept of cultural humility as a drastic shift from the previous and current approaches to addressing culture in healthcare, it is a very appropriate change in the right direction. Khan makes a profound statement that part of being culturally humble is to realize “that even in sameness there is difference” (Khan, 2021). This concept speaks to the foundation of providing the “person-centered care” that the report has deemed necessary to achieve the goal of healthcare equality (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206)
I have personally witnessed situations where individuals within the healthcare system treat certain patients differently, based on their race, culture, or socioeconomic status. In each of these experiences, I was amazed at how oblivious the person was to the inappropriateness of their actions. While I agree that nursing education should include courses on cultural humility and biases, if we are going to see the change in the industry that is needed, every discipline within the healthcare system needs to be educated on cultural humility training, not just nurses.
I agree that the advanced practice registered nurse role has evolved to include more autonomy and prominence within the healthcare system since the growth and changes in healthcare delivery methods, such as retail clinics. I also agree that APRNs could have a greater positive impact on promoting equality of healthcare access if certain political barriers were removed. (National Academies of Sciences, Engineering, and Medicine, 2021)
In order to radically change nursing industry and provision of nursing practice to patients and populations, I believe the biggest contributor will be two things: education and embrace of technology and an expansion of education for social determinants of health (SDOH). As a nurse who works in the intersection of public health, education, and patient care/coordination, I have a unique perspective of how changes, additions, or disruptions to a system can contribute to the health or unhealth of individuals. Most, if not all, nurses who worked and continue to work through the COVID pandemic can attest to the blatant disparities of populations and how they were affected by not only the disease process of COVID but the effects of public health policy that were put into place.
Technology within nursing, like using, data analytics” …to analyze trends, identify disparities, and guide policy decisions” (National Academies of Sciences, Engineering, and Medicine, 2021, p. 210) uses the foundation of the nursing process: assessment. As technology advances, nurses need to be well prepared to use these technologies in the spectrum of opportunities to gather data from bedside to population to policy. One such way I use technology in my practice is to look at the health of my population of students via vaccination reports. It is Minnnesota State Law that students be up to date (or documented exempted) with their vaccination records. I would not be able to see trends in where there are holes in vaccinations if I were not versed in how to run vaccination reports. One such trend that I am seeing is a down tick in varicella vaccinations in incoming kindergarteners, a trend that is true across our district and in neighboring districts.
Technology will not only be a tool in itself for nurses to learn but its application to SDOH .As for education nurses on social determinants of health, one such example I have seen in my own practice is obvious through the COVID pandemic. from a disease process standpoint, there were many that understood that COVID had a more severe disease process for individuals within the BIPOC community. But unless you were working in public health, what one didn’t see was how COVID affected the community themselves, the family systems, and the trickledown effects of COVID of those within the family.
One such highlight of how there were disparities in these populations of people was not just that they were at greater risk of severe illness but people in these communities were at higher risk of exposure; they typically did not hold jobs where they could work from home, they lived in cramped or overcrowded multi-family housing; the access to education was lessened compared to other populations; access to technology for those that were school age was limited or completely unavailable whether because there was no internet or no device to access schoolwork. This population was also at greater financial risk because if the primary bread winner were to become ill, it was two weeks of isolation or quarantine without pay and if a decision needed to be made on whether to pay for rent or for internet, one can guess what would be the priority.
As students returned to the classroom, the impact of the disparity was clear: low income, BIPOC, and special education students were farther behind academically and socially than their peers. Although technology has been a boon to those who can access it, it can also “exacerbate the existing disparities” (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206) in health and education as seen in my experience with my student population.
A common theme that I see within this report is education specifically to SDOH. I completely agree that this is a direction nursing education, and the role of Advanced Practiced Nursing, needs to go in order to meet the needs of patients and populations. I was drawn to public health nursing with the idea of root cause analysis: why is this happening? It is one thing to notice that low income and BIPOC individuals were at greater risk for severe illness and to treat them as they showed up in the hospital but it is another thing to recognize the why behind it and remedy the underserved and vulnerable population to prevent it from happening therefore preventing a trickledown of mutli-faceted negative health and educational outcomes to the individual, their family, and their community.
References
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. (M. K. Wakefield, D. R. Williams, S. Le Menestrel, & J. L. Flaubert, Eds.). The National Academies Press. https://doi.org/10.17226/25982
Evidence based practices have proven that Health promotion had enabled people to increase control over, and to improve, their health (WHO, 2023). It focuses on individual behavior towards a wide range of social and environmental , emphasizing preventive measures and lifestyle choices. Promoting these measures encompasses education, awareness, and initiatives that empower people to make informed decisions for their well-being, fostering a proactive approach to health rather than merely treating illnesses. Effective health promotion addresses various factors such as nutrition, physical activity, mental health, and environmental influences, aiming to create a supportive and conducive context for individuals and communities to thrive. I believe health promotion is very important and should be initiated from the primary schools, churches, camps and other places, helping people who smoke and willing to quit, disease control and management, access to healthy foods and physical activity. Basic education on hand washing has proven to eradicate a lot of illness and disease around us especially those living in rural or underdeveloped countries. I can relate to lifestyle in Ghana , citizens in our villages were encouraged to boil water before drinking and wash hands when not only dirty through health promotion. This was very helpful to reduces incidence like cholera and other diseases.
World Health Organization(2023) /www.who.int › programmesHealth Promotion