My health equity journey can be summed-up in the expression, “I am my sister’s (brother’s) keeper.” This phrase characterizes both the privileges and responsibilities that I hold, which are foundational to my leadership style and role as a nurse. As a Black woman, nurse scientist, and educator, my personal experiences surrounding racial and systemic inequities drive my commitment to change. My worldview is informed by an intersectional perspective, underscored by an intrinsic appreciation for differences among all people. Consistent and intentional reflection of the ways that I “show-up” in the world are inherent to my identity, rooted in a duality of both privilege as a nurse scientist and educator and oppression as a woman of color.

However, if I can speak truthfully, this duality has at times made me question my role in the nursing profession. While working in a profession that I wholeheartedly love, I have had to wrestle with the reckoning of what it means to be a nurse serving in a space that is at times mired with the medicalization and stigmatization of the human condition. This is where the practice of reflection becomes so important for me. In such moments, I reflect on my “why” and the important roles of nurse leaders and health equity advocates.

“What made you want to become a nurse?” It is a common question for those in our field and often shapes the ways in which we choose to apply our passion. Nursing had always been on my radar as a career option, but as a teenager, nursing became a calling. In 2008, the PBS network premiered the documentary series Unnatural Causes…. Is Inequality Making Us Sick. The entire documentary was impactful, but it was the segment, When the Bough Breaks, that really struck a chord with my teenage self. In this segment, the documentarians examine the factors that contribute to the maternal and infant mortality gaps between Black and White Americans, then considered a public health mystery. While in the documentary, they broke down many of the contributing factors to the disparity, including social determinates of health (SDoH), I still had a difficult time comprehending why those disparities existed based on race alone. It frustrated me to hear that as a Black woman, regardless of how much education I attained, I am more likely to die during the perinatal period and my child would be more likely to die than our White counterparts.

So, what made this issue clearer to me? Racism. The concept of racism was an issue that was very clear to me. Growing up in a diverse, military city exposed me to various perspectives, but racism was still pervasive in my small town. There are experiences of racism that will live in my memory forever.

When the concept of racism was discussed in the documentary as a precursor to structural violence, or the proliferation of less optimal SDoH, and as a contributor to disparate maternal and infant mortality rates, it sparked my consideration of how I might be able to help reduce the disparities that I had become so passionate about. It was then that I affirmed that I wanted to become a nurse. I firmly believed, and still do, that nurses have the power to reduce and eliminate health disparities across populations. However, as I eventually grew in my role as a nurse, I quickly learned that nurses also have the power to uphold and contribute to the same disparities I wanted so badly to decimate.

Nurses have always been leaders in healthcare. We stand uniquely positioned to either take an active role in working toward health equity and supporting those with historically marginalized identities or remain silent and contribute to the health disparities plaguing our society. In exploring the history of nursing, I learned that as both a profession and as individuals, we have always had to work to resist bias and stigma, often in opposition to the larger societal context. For example, over the last few decades, nurses have played a crucial role in reducing the stigma related to HIV/AIDS, contributing to improvements in care. In contrast, we have yet to adequately reckon with our participation in some of the biggest health atrocities in the United States, including the unwanted or unconsented sterilization procedures forced upon Black and Brown women in the 20th century.

While we cannot go back and change the past, we can work to ensure that the future of nursing continues to grow not only in number but more importantly in the culture of care that we hold so dear. The only way to upend these behaviors is to acknowledge our history and recognize that even some of our current practices, policies, and mindsets as providers and organizations are rooted in principles of paternalism and colonization, or the act of subjugating another group. To achieve health equity, we must explore issues that cause structural violence, or harm rooted in racism, classism, genderism, and other forms of discrimination, within ourselves and our systems and communities. A few practices that I intentionally center include:

1. Continually assessing my own assumptions and challenging my own biases, with knowledge that failing to do so can have lasting implications on the health and wellbeing of the people that I serve.
2. Upholding the self-practice of accountability, wherein I can acknowledge the potential impact my actions or words can have on someone, regardless of my intent.
3. Mentoring and collaborating with students from diverse backgrounds, with the intent to provide students with positive and welcoming experiences in nursing practice and science. I believe feeling welcomed as their whole self is the first step in the students empowering our patients to feel the same way about their healthcare experience.

As we consider the role that nurses play in contributing to the current and ongoing maternal and infant health crisis, we must come to terms with the history of the field and consciously choose not to perpetuate it. Otherwise, we risk jeopardizing not only our profession but more importantly, the lives we strive to care for every day. We must strengthen our resolve by pushing one another to reorient ourselves toward pursuing equity and justice in health and health care. We must continue the self-reflective work of examining who is omitted, ignored, erased, silenced, and harmed by our practice and recommit ourselves to more inclusive endeavors.

Kelly McGlothen-Bell, PhD, RN, FAWHONN, is an Assistant Professor at UT Health San Antonio, School of Nursing and the recipient of the 2023 Equity-Minded Nurse Rising Star Award, which was co-sponsored by the National League for Nursing.

_{^{Lead photo credit: (c) GETTY IMAGES: FilippoBacci}}

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The post How Closely Do Texas’ RN Graduates Reflect the State’s Diversity? appeared first on Campaign for Action.

The Texas State Capitol Building

Texas has signed into law legislation that removes some red tape that will help people have better access to care provided by advanced practice registered nurses (APRNs).

The bill signed by Gov. Greg Abbott earlier this month lifts the need for face-to-face meetings between APRNs and physicians. That means that, although Texas still requires an APRN to hold a “prescriptive authority agreement” contract with a physician, nurses need not spend time driving. Now, the required communication can be exchanged by videoconference or whatever method the nurse practitioner and physician choose.

Each minute that a nurse does not have to spend driving miles through this largely rural state or through the state’s sprawling urban areas is one minute more that can be spent clinically caring for patients and supporting family caregivers. A strong Texas coalition, including AARP Texas, the state nursing association, and other sectors, was key to this effort. The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation, is committed to expanding access to care for all.

The post Texas Eases Restriction on Nurse Practitioners appeared first on Campaign for Action.

Texas Dashboard Indicator 2: Doctoral Degrees. Retrieved 12/18/2018.

Since the Future of Nursing: Campaign for Action began, it has measured the progress that nursing has made across the U.S. on a national data dashboard. Now at least four  states are creating their own dashboards, using as a yardstick—as does the Campaign—the goals laid out by the Institute of Medicine (now the Health and Medicine Division of the National Academies) in The Future of Nursing: Leading Change, Advancing Health report.

Texas

For example, scroll down the “about” page for the Texas Team: Using information from the Texas Board of Nursing and Texas Center for Nursing Workforce Studies, Texas reports in easy-to-understand graphics how close it’s coming to its 2020 goals in education. The Texas Team also depicts in a bemusing way the roadblocks it has overcome (and still faces) in changing the laws to increase the public’s access to nurse-provided health care.

Nebraska

Bringing the truth about nursing progress home for its residents, too, is Nebraska, which invites website visitors to take a spin through its successes on six indicators. For example, the national data dashboard posted by the Campaign shows the percentage of employed nurses with a baccalaureate (or higher) degree in nursing stands at 54 percent as of 2016. Nebraska’s close-up look shows its percentage as of 2016 stands at 64 percent. (Hooray  for all, but especially slide 3, which celebrates Nebraska’s becoming the 20th state to adopt full practice authority for nurse practitioners.)

Hawaii

Hawai’i has also honed in on its growth toward increasing the percentage of nurses with a bachelor’s or higher. Using data including the 2016-2017 Hawai’i State Nurse Education Capacity Survey, the state forecasts it will achieve the IOM goal of having an 80 percent BSN-prepared workforce more quickly than the nation as a whole.

Wisconsin

Wisconsin lays out its progress points on the Wisconsin Center for Nursing website, including the fact that the number of Badger State nurses with a BSN or higher is about 6 percent higher than the national average.

With strong visuals, leaders in these states can make the case for nursing more easily with information specific to their residents. Congratulations Texas, Nebraska, Hawai’i and Wisconsin for going the extra mile to translate the IOM’s national goals to the state level, making them more accessible for all.

If your state has created its own data dashboard, the Campaign would love to hear from you. Make sure to contact us.

The post A Dashboard of One’s Own: Four States Track Their Successes appeared first on Campaign for Action.

Group prayer and a buddy system helped nurses at CHRISTUS Southeast Texas St. Elizabeth Hospital cope with the disruption and loss that Hurricane Harvey brought to Beaumont, Texas. Photo courtesy of CHRISTUS Southeast Texas St. Elizabeth Hospital. 

When Hurricane Harvey hit the Gulf Coast in late August 2017, nearly 100 nurses and other licensed professionals who work for CHRISTUS Southeast Texas St. Elizabeth Hospital in Beaumont, Texas, were stranded at home. Yet St. Elizabeth remained open, having strengthened its disaster preparedness after years of practice and planning. That preparedness served the nurses and patients at St. Elizabeth well—and offers lessons for nurses and health care administrators as the incidence of climate-related natural disasters climbs.

Tener Goodwin Veenema, PhD, RN, FAAN, wants all nurses to be ready when disaster strikes.

“I truly believe that all practicing nurses need a minimum understanding of the disaster lifecycle: mitigation, preparation, response, and recovery,” says Tener Goodwin Veenema, PhD, RN, FAAN, Johns Hopkins School of Nursing Associate professor and an internationally recognized expert in disaster nursing and public health emergency preparedness.

CHRISTUS St. Elizabeth: An Exemplar of Resilience

Scholars use the term “resilient” to describe health systems that are ready to respond to crises such as hurricanes. Resilient health systems function in the face of unforeseen demands because they share these characteristics:

• Awareness of potential health threats and their system’s strengths and limitations
• Ability to draw on redundant capacity
• Established relationships and agreements with public health and community partners
• Strong and flexible leadership and organizational structures

Today St. Elizabeth is an exemplar of resilience, but that was not always so.

“Many of us have grown up in this area, and we have lived with hurricanes all our lives,” says St. Elizabeth’s Chief Nursing Executive Paul Guidroz, MSN, RN, CNOR.

After Hurricane Rita devastated the region in 2005, St. Elizabeth’s leadership realized they needed to be better prepared. They invested in a flood mitigation system, water wells, and hurricane-strength protective window film. Leaders also committed to regularly improving the hospital’s disaster response plan, efforts that paid off with Harvey.

Chief Nursing Executive Paul Guidroz, MSN, RN, CNOR, and others at St. Elizabeth Hospital use the time between hurricanes to hone their hospital’s response plan.

In the days leading up to the hurricane, the health system’s command center in Dallas held conference calls with leaders throughout the state. When Harvey’s rains reached Beaumont on Tuesday, August 29, the hospital was ready. While St. Elizabeth did not flood, many nurses were stranded in their homes, surrounded by water.

As part of the hospital’s disaster response plan, nearly 100 replacement nurses and other licensed professionals were flown in from CHRISTUS facilities elsewhere in Texas and Louisiana over five days. Once onsite, these volunteer nurses were paired with staff members to ease the adjuncts’ transition to a new hospital and electronic health record system.

By planning ahead, the hospital was able to remain fully operational and continue caring for patients.

Meeting the Mental Health Challenge

St. Elizabeth’s knew how to handle another aspect of the disaster, too: its effect on staff nurses. One in five CHRISTUS Southeast Texas nurses lost their homes in the storm. Dealing with Federal Emergency Management Agency and insurance settlements, displacement, and loss of clothing are some of the ongoing stresses that impact their lives.

As a faith-based institution, St. Elizabeth’s response included prayer circles and other types of spiritual support. And CHRISTUS Health alleviated financial stress by paying the wages of every nurse who could not get to work during the hurricane. Guidroz plans to propose a buddy system in which each nurse who lost his or her home is adopted by another nurse, for emotional support.

“Recovery,” he says, “is long.”

Preparation Is Key

Disasters, of course, can strike anywhere, and take many forms including terrorist attacks, climate-related events, and new infectious diseases. Veenema, the disaster preparedness expert, has practical suggestions nurses can follow so they are ready to serve in the next crisis.

When new nurses join St. Elizabeth, they are oriented to their roles in the hospital’s disaster management plan, and after each disaster has passed, they are informed of changes to the plan. The hospital also engages in regular community-wide and tabletop disaster drills—practices that other hospitals, health systems, and nurses would be wise to consider adopting.

The post Hurricane-Battered Hospital Offers Lessons in Disaster Preparedness appeared first on Campaign for Action.

Approach: Business, academic, nonprofit, and nursing leaders developed a one-day training curriculum in communication, professionalism, and community engagement.  Select Texas public health nurses employed by Texas Department of State Health Services received the training. Training contents were consolidated into a toolkit for web publication.

Products/Outcome: Pre- and post-session surveys were conducted, showing slight improvement in both identifying and active seeking of new collaborations post training, but not in confidence engaging as leaders in community partnerships. A toolkit, including the curriculum agenda, training slides, course objectives, and additional resources, will be published online at the Texas Nurses Association website.

Implications: Nurses possess a unique potential for influence, and when trained for influential engagement, see their potential more broadly and want to engage more fully.  More training is needed to enhance nurses’ confidence engaging as leaders.  This and other types of shared leadership curricula may encourage practicing nurses to engage and influence.

The post Community Health Advocacy Training for Nurses – Texas, 2016 appeared first on Campaign for Action.

Problem Statement: Creating a culture of health in the Rio Grande Valley is a priority, especially in Brownsville. This area bordering Mexico has some of the highest rates of chronic disease, poverty, and illiteracy.  Public health departments experienced significant budget reductions, leaving the area especially vulnerable.  After receiving RWJF’s Culture of Health Prize, we identified a need to create sustainable leadership. One way is to educate present and future leaders by introducing them to successful public health leaders working in similar circumstances.

Approach: We held a one-day leadership track within the South Texas Environmental Health Association’s annual conference. Faculty included experienced national public health leaders and a university nursing professor, who shared leadership experiences and principles.

Products/Outcome: The leadership track attendees were surveyed on their willingness and readiness to continue learning about professional and personal leadership development. The attendees responded to follow up surveys at the end of the conference and at 30, 60 and 90 days. Of 16 initial participants, 15 completed all surveys.  Surveys taken at 30 days post conference were not used due to technical difficulties with the survey software.

The respondents identified themselves as Gen X (40%), Baby Boomers (40%) and Gen Y (20%) (Millennials). They increasingly ranked their employers as loyal to them, at the close of the conference (62%), post 60 days (66%) and post 90 days (80%). Most survey respondents rated their current training as adequate at the close of the conference (93%), post 60 days (80%) and post 90 days (93%). A majority of respondents rated themselves as preferring supervising others (60%) at 60 and 90 days, followed by leading others with no supervisory title. Respondents could also choose not seeking a leadership or supervisory role, but instead seeking self-understanding and self-reflection. Preference for this option decreased over the time span of the surveys. Overall, a majority of survey respondents at 60 days (66%) and 90 days (72%) plan to develop their leadership skills, most likely in 6-12 months and beyond.

Implications: Emerging local public health leaders are available and willing to take on developing a culture of health in their communities, given the opportunity to develop their leadership skills.

The post Propelling Public Health Leadership across South Texas: appeared first on Campaign for Action.

“Texas is overwhelmingly rural,” writes the director of AARP Texas; it ranks 41st in the nation for the number of physicians per 100,000 people. So why aren’t nurses allowed to provide all the care they’ve been trained to provide?

In the online paid piece on TribTalk, part of The Texas Tribune, AARP’s Bob Jackson points out the good news, which is that many Texans get high-quality care from advanced practice registered nurses.  But he also points to the bad: “Some patients don’t have access to APRNs because of restrictions placed on them under Texas law.”

Poor access to primary care means many of the state’s 28 million residents to wait till they have to go to an emergency room for their health. Jackson’s message to the legislature to update regulations echoes last month’s encouragement from then-CEO of the Texas Association, who noted too that the regulations added to the cost of care and were sending nurses out of state.

Someone must be listening: Two state legislators just introduced bills in each house to ease the restrictions that keep nurses from providing more care.

The post “Give Texas Nurses Full Authority to Heal” appeared first on Campaign for Action.

State

California: Bay Area Council Economic Institute Analysis Finds Granting Full Practice Authority for Nurse Practitioners Increases Access and Controls Costs

Florida: Expanding Scope of Practice for Advanced Registered Nurses, Physician Assistants, Optometrists, and Dental Hygienists

Kentucky: Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

Massachusetts: Controlling Health Spending in Massachusetts

Minnesota: Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

New Jersey: Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

North Carolina: Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina.

Ohio: The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practice Registered Nurses in Ohio

Pennsylvania: The Value of Full Practice Authority for Pennsylvania’s Nurse Practitioners

Texas: The Economic Benefits of More Fully Utilizing Advanced Practice Registered Nurses in the Provision of Health Care in Texas: An Analysis of Local and Statewide Effects on Business Activity

National

 Medicare and Medicaid: Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients

Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians

Anesthesia: Cost Effectiveness Analysis of Anesthesia Providers

Maternity care: Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center

Neonatal: Collaboration, Not Competition

Long term care: Onsite Nurse Practitioners at Skilled Nursing Facilities Prevent Avoidable Hospitalizations

Retail clinics: Scope-of-Practice Laws for nurse Practitioners Limit Cost Savings That Can Be Achieved in Retail Clinics

The post Studies That Show the Economic Benefits of Removing Barriers to Practice and Care appeared first on Campaign for Action.

• Distribution of population by race/ethnicity
• Percentage of population living in rural versus urban areas
• Distribution of population by federal poverty level
• Areas in which there is a shortage of primary health professionals

These statistics can guide your Action Coalition’s work in shaping a nursing workforce to better meet local needs and overcoming health disparities in your state. As you integrate other Culture of Health aspects into your work, consider how demographics play a role in health equity and fostering cross-sector collaboration.

The post Demographic and Workforce Facts appeared first on Campaign for Action.