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Future of Nursing Report Calls for Greater Health Equity, Diversity


2020 was one of the most challenging years for nurses in generations. The COVID-19 pandemic exposed serious inequities in the nation's healthcare system, with front-line healthcare workers often lacking the necessary PPE and other equipment to safely and effectively do their jobs. And the social justice movement that followed the death of George Floyd shined a spotlight on the structural racism that still exists in the workplace and society at large. [caption id="attachment_84260" align="alignleft" width="208"] Susan Hassmiller, RN[/caption] In the wake of these many challenges, a new Future of Nursing report by the National Academy of Medicine entitled, "The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity," outlines key issues and goals for the nursing profession over the next 10 years, with a particular focus on reducing healthcare inequities and improving health outcomes. The report was originally scheduled for release in December 2020 but was delayed until May to incorporate lessons learned from the COVID-19 crisis and the racial and social justice issues that have occurred over the past year, according to Susan Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation and senior scholar-in-residence for the National Academy of Medicine. Regina Cunningham, PhD, RN, NEA-BC, FAAN, who served on the committee that helped draft the Future of Nursing report, said COVID-19 exposed many disparities that exist within the nation's healthcare delivery system, as low-income and minority communities were particularly hard hit by the pandemic.

"COVID-19 didn't cause these things, but it showed us where a lot of the health disparities exist," said Cunningham. "It was devastating but incredibly clear."

Hassmiller gave a presentation on the report during a June 2 webinar hosted by the Columbia University School of Nursing. The webinar was also attended by other nursing leaders and experts. She remarked that the need for greater health equity in the U.S. and a more diverse nursing workforce were central themes of the report. Hassmiller also said the report produced a total of 54 specific recommendations, but the key takeaways fall into four major areas:

1. Permanently remove nurse practice barriers

This includes removing regulatory barriers to nursing like legislation to give full practice authority to APRNs and ending restrictive workplace policies or practices that prevent nurses from practicing to the full extent of their education and training.

2. Value nurses' contributions

This includes establishing sustainable and flexible payment mechanisms to support nurses in healthcare, including public health and school nurses, in advancing health equity.

3. Prepare nurses to tackle and understand health equity

This includes addressing systemic racism in the workplace, increasing the ranks of minority students in schools of nursing, and caring for the needs of an aging and diverse population.

4. Fully support nurses

This includes implementing systems, structures, and evidence-based interventions to promote nurses' health and well-being.

Diversifying the Workforce

Hassmiller said the need for greater diversity in the nursing workforce is really woven throughout the Future of Nursing report. Currently, she said, the nursing workforce remains predominantly white and female, and about 90% of the nursing leaders in the U.S. are white. Those numbers do not adequately reflect the current demographic makeup of the country.

"We need to understand that historically black and brown people have been treated differently," she said.

[caption id="attachment_84265" align="alignright" width="213"] Regina Cunningham, RN[/caption] The report also took a bold stance on the need to eliminate structural and institutional racism in nursing. "The fact that this report calls out racism in nursing and says we need to dismantle it is very important for nurses of color," Cunningham said. "It's time to address this." Cunningham, who is CEO of the Hospital of the University of Pennsylvania and an adjunct professor and assistant dean at the University of Pennsylvania School of Nursing, said there has been some progress in recent years in increasing the numbers of minority and male nurses. In 2018, African American nurses made up about 12% of the nursing workforce, Hispanic nurses 7.4%, and Asian nurses 9.1%, all of which are increases from 20 years earlier. Still, the report found that 69% of registered nurses were still white and more than 87% are women.

"We have made some progress, but we haven't made enough and we haven't made it fast enough," she said.

The report makes several recommendations for increasing diversity in nursing, including calling on schools of nursing to increase representation of minority students and faculty. It also calls for mentoring and educational bridge programs to help minority students considering careers in nursing and urges health systems to promote more minority nurses to leadership positions. [caption id="attachment_84267" align="alignleft" width="225"] Catherine Georges, RN[/caption] Catherine Georges, EdD, RN, FAAN, professor and chair of the Department of Nursing at Lehman College in New York, one of the speakers at the Columbia University webinar who has done research on healthcare disparities, said the report has many excellent goals, but it's essential that the report's actions be implemented. "This is not just about advocacy, we have got to take action," she said. "Nursing still remains predominantly white in this country, predominantly female. Where is the next generation of nurses going to come from? Why aren't there more nurses sitting on the boards of hospitals? I think nursing is in a unique position to take the lead on these issues."

A New Generation of Nurses

The next decade is expected to present unique challenges to the nursing profession, with many baby boomer nurses aging out of their roles. The need for more highly trained nurses will be critical. Georges, who was the past national volunteer president of the AARP, said it's estimated that by 2030, more than one million people in the U.S. will be over the age of 100, and more nurses will be required to address the needs of this aging population. On a positive note, Georges said there has been a significant increase in nursing school enrollment in the past year, but those nurses also need to be properly trained to reflect the diversity of the communities they serve.

"It's not just about younger nurses," she said. "It's about better-prepared nurses. We need a different workforce. We need a well-educated workforce that reflects the communities they serve and provide care to."

Promoting Community-Based Nursing

With an aging population, Georges said there will be a greater need for more nurses who work directly in communities to improve healthcare outcomes, particularly in low-income and communities that are marginalized. That means greater investment in school and public health nursing. Hassmiller said school and public health nurses are often undervalued for the work they do. "School and public health nurses are not paid as well as hospital nurses, or nursing faculty, and yet the work they do is just as important," she said. The Future of Nursing report calls on nursing to expand its focus on the social determinants of health to address health inequities in underserved communities such as lack of access to health care and food insecurity. While doing research for the report, Cunningham said committee members visited several cities including Chicago, Seattle, and Philadelphia where nurses were doing innovative things to promote health equity in their communities. In one example in Chicago, a nurse practitioner and nursing students set up a health clinic in a housing project to provide needed health care to low-income residents. In another, nurses developed a program within a high school to provide health care and education to pregnant teens and new mothers. "These are incredible examples of how nurses are working to address social determinants of health and health equity," Cunningham said. Hassmiller believes the millennial and other younger generations of nurses are very socially conscious and ready to tackle many of the health equity issues identified in the Future of Nursing report. "I honestly think this younger generation of nurses may be more attuned to learning about and understanding health equity because they grew up in a more diverse society," she said.

Take these courses to learn more about diversity, health equity, and cultural competence:

Harmonize Diversity and Improve Health Outcomes (1 contact hr) Positive and productive relationships depend on personal and team awareness of various personality types across the continuum of their partners and their willingness to bridge the gaps among those differences to create a harmonic work climate. This module introduces the concept of personality sensitivity and gives examples of how personality-sensitivity training can improve performance, satisfaction, and outcomes.

Cultural Differences Impact Interpersonal Communication (1 contact hr) Transcultural healthcare workers are sensitive to these differences and strive to determine the most appropriate and effective ways to interact with diverse colleagues. When you communicate and collaborate productively with your colleagues, you are much more likely to deliver culturally relevant care to your patients and improve the overall patient experience.

Mind Your Manners ... Multiculturally (1 contact hr) As the nursing workforce increasingly reflects the changing U.S. population, nurses have many opportunities to collaborate and interact with other nurses from around the world. These experiences afford all nurses a chance to gain cultural knowledge and understanding that will ultimately enhance the delivery of culturally competent patient care. Working cross-culturally requires nurses to appreciate the impact cultural differences have on interpersonal communication.