Nurses Are Key to Health Equity
By Susan B. Hassmiller
The year 2020 has been devastating ─ from the COVID-19 pandemic to racial injustice to wildfires and hurricanes. Nearly all of us are struggling. Many of us have lost jobs and face economic hardship and hunger. If you’re a parent, you’re likely attempting to provide child care, oversee remote learning, and work simultaneously. If you live alone, you may be experiencing profound loneliness from social distancing. If you live with family members, you may be noticing rising tensions in your home from spending a lot of time together. While all of us have been affected by the pandemic, we have not been affected equally: Black, Indigenous and Latinos have been disproportionately affected by the virus compared with whites, with higher infection, hospitalization, and death rates. They are dying from COVID-19 at disproportionate rates because they are more likely to rely on public transportation, lack basic resources such as food and clean water, live in crowded housing with multigenerational families, be essential workers who cannot work from home, and lack access to health insurance.
These health inequities – coupled with the murder of George Floyd at the hands of Minneapolis police and the failure of authorities to press charges against the three police officers who killed Breonna Taylor while she was sleeping in her own home -- have forced us into a reckoning over racial injustice. We’re also increasingly forced to grapple with the realities of climate change, as wildfires ravage communities on the West Coast and hurricanes ruin homes and lives in the South and on the East Coast.
In the midst of seemingly endless despair, it can seem futile to wonder what one person--or one profession--can do to create a more just path moving forward. But it is only when enough of us come together to recognize our shared humanity and commit to changing the present situation that we can create a more just world.
Nurses have the potential to offer much needed solutions to the problems facing our country: We make up the largest segment of health professionals, we are repeatedly ranked the most trusted profession overall, and we are the first point of contact for most people seeking health care. You probably know a nurse, and you may even be friends with one that you call for advice when your child has a cut or a fever. But you may not have a good sense of who we are, what we do, and how we are well positioned to take on larger roles in tackling the many problems facing our country. The way that we think about nurses is the way that we need to think about health care if we are to address the rampant inequities that are plaguing our country.
The Nursing Myth vs. The Nursing Truth
One of the barriers to nurses taking on a more pronounced role in addressing health equity is that relatively few people have an accurate idea of what nurses do. We are largely absent from media stories about health care, and portrayals of us on television are often stereotypical or inaccurate. While we have gotten involved in policy-making, more of us should be invited to sit at leadership tables and advocate for those invitations. By gaining a full understanding of the role that nurses can play in addressing health equity, we can start to reimagine a better and more just world. Let’s debunk a few of the pervasive myths about nurses:
Myth: Nurses are physicians’ personal assistants.
Truth: Nurses are professionals in their own right.
Nurses are educated to see you in the context of your life, with all of the factors that impact your life and well-being, whereas medicine has focused principally on disease. This holistic approach to health promotion recognizes your experiences and your relationships with family and community members in the context of your whole life. Nurses are educated to consider health issues within a broad context that includes all of the social and economic factors that affect health. We know that if you don’t have a grocery store in your community or reliable transportation to a medical appointment, you will have difficulty staying healthy. Our chief responsibilities include educating you about how to stay healthy and prevent disease, and advocating for you, your family, and your community ─ skills critical to tackling health inequities.
Myth: Nurses practice in hospitals and clinics.
Truth: Nurses practice everywhere.
Many of you probably picture nurses working in hospitals and doctors’ clinics, but you may be less likely to think of us practicing at your child’s school; your office, church, community center, or home; or in all branches of the U.S. military. But we practice in all of those places. Most of what determines your health happens outside a health care facility, including whether you have access to a good job that pays a living wage, safe housing without mold or lead poisoning, reliable transportation, walkable neighborhoods, fresh food, clean water, and adequate green spaces to exercise. This understanding of health is already built into the nursing profession.
For example, an exciting nurse-led program that improves the health of new mothers and babies is the Nurse-Family Partnership. Highly trained nurses regularly visit young, first-time moms-to-be, beginning early in the pregnancy and continuing through the child’s second birthday. During these visits, nurses help to ensure that expectant moms receive good prenatal care and any needed treatment for pregnancy-related complications. After the baby is born, the nurse focuses on ensuring the child stays healthy by supporting the mother in providing responsible and competent care during early childhood. The program enhances educational and employment opportunities for parents and gives advice on how to plan future pregnancies.
Because nurses work in a wide variety of settings, you probably know a nurse in your community. You may even have a nurse that you go to when you have questions about your health or your loved one’s health. Nurses are the connective tissue between the broader community and the health care system. Don’t be afraid to ask a nurse to advocate for better health for you, your family, and your community.
Myth: Nurses are selfless heroes.
Truth: Nurses are citizens like you, and we’re feeling the same stresses that you’re feeling.
While health systems continually praise nurses as heroes during this pandemic, many of us are not getting adequate support to feel safe at work and to maintain our own health and well-being. We are experiencing unprecedented stress during the pandemic ─ caring for multiple critically ill patients without always having enough masks and other protective equipment to protect ourselves, our patients, and our loved ones. Some of us have been fired for speaking out about unsafe working conditions. We are sometimes the only person present when patients die. Many have also had to “float” to other units and care for patients without adequate training.
We’re also feeling the same stresses that you’re feeling, whether it’s difficulty finding child care while we’re working, financial hardship for those of us who were furloughed during the economic shutdown last spring, or despair during the pandemic. It’s been unbelievably hard, and a smile, kind words, and patience when you see us can go a long way.
By understanding what nurses do and supporting us, you can elevate our skills and expertise so that we can take on larger roles in addressing health equity. Nurses are everywhere, we care about everything, and we want you to see that we have solutions for addressing the challenges facing our country. We have enormous potential to help to give everyone a fair and just opportunity for health, and we are a crucial component to creating a more just world.