The structural racism and unequal treatment in our nation’s health care system is widely known and results in deep inequities in the delivery of health care. Minority patients — especially Black patients — have higher rates of cancer, heart disease, diabetes and other serious illnesses. The mortality rates of Black people are 24% higher than whites in the 30 largest U.S. cities based on research at the Sinai Urban Health Institute (SUHI) which examined almost 26.3 million death records between 2009 and 2018. Left decontextualized, these startling statistics could perpetuate inequities.
Studies have shown that patient-provider race concordance (a patient having a primary care physician or specialist of the same race) leads to better patient experiences and clinical outcomes. While medical and nursing schools are receiving larger amounts of applications from diverse students, the fact remains that only 5% of physicians in the United States identify as Black and Black nurses represent only 6.2% of the Registered Nurse (RN) workforce (as of 2017). In clinical settings and in our culture this underscores the need for health systems to address issues that undermine efforts to support racial diversity.
But there is good news. As an educator and health equity leader, I strongly believe nurses can facilitate race-related conversations and work to influence and inspire change in policy and practice.
First, we must ask ourselves: Why do these inequities exist? And when moving forward, we should realize there is no panacea, no quick fix for everything that contributes to inequities as this is part of a much broader and deeper dynamic. However, we can examine biases related to color and language that are rooted in a false belief of intellectual inferiority and result in practices that contribute to disparities in access and quality of care. Individually, we can pay more attention to and reconcile the subliminal biases we carry, which shape our automatic responses to patients and colleagues. When we are aware and able to discuss, we are better positioned to align our professional values with our actions and deliver high quality care to all. Bottom line: we need to embody a humanistic approach that views all individuals as worthy.
Nurses can inspire change
As part of our education for nurses, we have adopted a social mission lens to strengthen the capacity of nursing schools to graduate future nurses who are prepared to deliver the highest quality of health care for all communities. We can do this by creating a more diverse and inclusive nursing pipeline.
At Chamberlain we strive to be crystal clear in our commitment to advance health equity in everything we do from admissions and faculty hiring policies, to curriculum development, the extent of community-based experiential learning, and ultimately how we measure our graduates' success in treating patients. We recently released the Social Determinants of Learning framework which further enables us and other institutions to identify physical, social, economic, and psychosocial obstacles to educational success and provide solutions to overcome those barriers – leading to better student outcomes.
Creating an educational Renaissance to advance racial and social justice
This education should be inspired by programs like the NLN’s Taking Aim Against Racism or the strategic plan authored by the AMA’s Center for Health Equity which values people equally and treats them equitably. In our multicultural society, cultural humility is critically important in eliminating healthcare disparities and social disadvantages for every patient, regardless of ethnicity or race.
Learning how to deliver culturally responsive care and wanting to understand each patient’s sociocultural background should be part of nursing education. We need to address the nuances and appreciate how our biases impact how we care for patients. This involves a high level of self-awareness and emotional intelligence and requires a humanistic approach to health care. Nurses need to take this approach: I value who you are. I see your goodness and I am focusing on you and your health with dignity. As health care providers, we need to be held accountable. To move forward, listening and integrating the voices of people in communities experiencing injustice is paramount. We can only effectively lead when we are informed by the voices of those who have been historically excluded and deprived of their chance to achieve health equity.
