Description
What is health policy and politics. What factors do you believe would contribute the participation in health policy work?Why should nurses be involved in the policy making process? Do you agree that nurses have an ethical obligation to be involved in health policy?Which areas in your own political competence do you believe require growth? Which AACN Essentials and/or NONPF and ALONE Competencies best capture these areas of political competence?Based on Phillips’ (2022) discussion of opportunities and avenues for policy advocacy work by advanced practice nurses to promote health equity, describe an issue within your workplace, professional organization, or the state legislature that you believe would benefit from policy advocacy work.Which of Phillip’s recommendations (“key considerations for building a policy agenda”) would this policy advocacy work address and what would be the desired outcome for it to be successful? Provide two references from the literature that provide “evidence” to support this policy work.Anser the questions using the attached material, need apa refeences and citations
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CHAPTER 6
Future of Nursing Report 2030
Susan B. Hassmiller
INTRODUCTION
In May 2021, the National Academy of Medicine, a private, non-partisan institution that advises
the nation on medical and health issues, released a long-anticipated report, The Future of Nursing
2020–2030: Charting a Path to Achieve Health Equity. The report’s audacious goal is to tap the
full potential of all nurses in every setting to give everyone a fair and just opportunity for health
(National Academies of Sciences, Engineering, and Medicine, 2021). The report arrived at an
inflection point for the nursing profession. Many nurses in mid-2021 were morally distressed from
caring for COVID-19 patients during the worst pandemic in a century. In addition, the pandemic
laid bare the stark inequities that have persisted in the United States across generations. The next
decade will require a stronger, more diversified nursing workforce that is prepared to provide care
across multiple settings; promote health and well-being among nurses, people, and communities;
and lessen systemic inequities that have resulted in wide and enduring health disparities. The report
aimed to unleash the power of nurses to achieve health equity.
The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, sponsored by
the Robert Wood Johnson Foundation (RWJF), is the second major report on the future of nursing
released by the National Academy of Medicine (NAM). The first report, The Future of Nursing:
Leading Change, Advancing Health, was released in 2011 and re-conceptualized the role of nurses
in transforming the U.S. healthcare system (Institute of Medicine, 2011). RWJF, the nation’s largest
health philanthropy, and AARP, the nation’s largest consumer membership organization and one of
the most influential on healthcare policy, formed The Future of Nursing: Campaign for Action in
2011 to advance the recommendations in the initial report. The nursing field mobilized to strengthen
nursing education, remove practice barriers, promote nursing leadership, and increase workforce
diversity, which in turn, expanded nursing’s ability to provide high-quality care to more Americans
(see Chapter 32).
As the nursing workforce continued to build its capacity, RWJF asked the NAM to convene an
expert committee to conduct a second report on the future of nursing, with the goal of charting a
path for the United States to build a culture of health, reduce health inequities, and improve the
health and well-being of the U.S. population in the 21st century. Nurses are perfectly positioned to
advance health equity, defined as everyone having a fair and just opportunity to be as healthy as
possible. Advancing health equity requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay,
quality education and housing, safe environments, and healthcare (Braveman et al., 2017). Because
nurses represent the largest segment of the health workforce and work in a range of settings spanning the home to the hospital and community, they are often the first and most frequent healthcare
contact with individuals, families, and communities. Nurses have a long history of tackling the many
social and economic drivers that affect health, from improving sanitation in cities during the late
1800s to improving the living conditions in immigrant tenements in the early 20th century (Pittman,
2019). They are repeatedly ranked by Gallup as the most trusted profession (Reinhart, 2020).
As the NAM committee was in the midst of writing the report, the COVID-19 pandemic and
renewed calls for racial justice occurred. NAM delayed the report’s release to incorporate the lessons
of the pandemic, the devastating toll it had taken on nurses, and high-profile incidents of police
violence and increased calls for racial justice. Released in May 2021, the report arrived during a
critical time in the nation’s history and in nursing—when it was clear that the United States must
dismantle structural racism to eliminate injustice and inequities. Nursing needs to be at the forefront
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UNIT I: INTRODUCTION TO HEALTH POLICY
of creating a fairer and more just world, and reforms in the area of payment, laws, policies, and
regulations are needed to unleash nursing’s potential. The systems that educate, pay, employ, and
enable nurses need to permanently remove practice barriers, value their contributions, prepare them
to tackle the social factors that affect health, and fully support nurses. The need to dismantle structural racism and diversify the nursing workforce is woven throughout the report recommendations.
The report aims to achieve health equity in the United States built on strengthened nursing capacity
and expertise (Exhibit 6.1).
EXHIBIT 6.1 NURSES ARE PERFECTLY POSITIONED TO ADVANCE HEALTH EQUITY. THE
REPORT AIMS TO TAP THE FULL POTENTIAL OF ALL NURSES IN EVERY SETTING TO
GIVE EVERYONE A FAIR AND JUST OPPORTUNITY FOR HEALTH
Source: National Academy of Medicine. (2021, May 11). Report release webinar: The future of nursing 2020–2030. https://
nam.edu/event/report-release-webinar-future-of-nursing-2020-2030/.
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6: Future of Nursing Report 2030
THE NEED TO ADVANCE HEALTH EQUITY
The COVID-19 pandemic unleashed two major threats to health equity in the United States: a
pandemic that killed nearly 600,000 individuals as of late May 2021 and an economic downturn
that caused tens of millions of people to lose their jobs—the highest numbers since the Great
Depression. The pandemic underscored that everyone’s health is inextricably linked to one another’s.
It revealed that the current healthcare, public health, and economic systems do not adequately or
equitably protect people’s well-being. While every community was impacted, certain groups suffered
disproportionately, including people of color, workers with low incomes, and people living in places
that were already struggling financially before the economic downturn.
The pandemic shone a spotlight on unacceptable health inequities that have existed for hundreds
of years. Indigenous, Black, and Pacific Islander Americans experienced the highest death tolls from
COVID-19 in the United States (Figure 6.1). When age is taken into account, the Indigenous population had the highest age-adjusted mortality rate, followed by Pacific Islander, Latino, and Black
people (Figure 6.2). In other words, these groups died disproportionately from COVID at younger
ages than white and Asian Americans (APM Research Lab, 2021).
Health is significantly influenced by the social and economic drivers that affect communities, including access to jobs that pay a living wage, safe housing, reliable transportation, walkable neighborhoods,
fresh food, adequate green spaces, and more. Where people live and work, their income, their education
level, and other factors have as much, or more, influence on their physical, mental, emotional, and
spiritual health as their access to healthcare (Braveman & Gottlieb, 2014). Structural racism—defined
Cumulative actual (crude) COVID–19 mortality rates per 100,000, by race and ethnicity, Dec. 8, 2020 – March 2, 2021
250
Indigenous
200
Black
Pac. Islander
White
Latino
Asian
150
100
50
0
Dec. 8
Dec. 22
Jan. 5
Jan. 19
Feb. 2
Feb. 16
March. 2
FIGURE 6.1 Indigenous, Black & Pacific Islander Americans have experienced the highest
death tolls from COVID-19.
Note: Population estimates from the U.S. Census Bureau, latest American Community Survey. Five-year e stimates
have been used for Indigenous and Pacific Islander rates, to improve data reliability.
Source: Data from APM Research Lab. (2021, March). Color of the coronavirus. https://www.apmresearchlab.
org/covid/deaths-by-race.
Reflects cumulative mortality rates calculated through March 2, 2021.
Indigenous
3.3
2.6
Pacific Islander
2.4
Latino
2
Black
White
1
Asian
1
FIGURE 6.2 Adjusted for age, other racial groups are this many times more likely to have
died of COVID-19 than White Americans.
Note: Indirect age-adjustment has been used. On April 15, 2021, the age-adjusted mortality rate for the nation’s
Indigenous population was corrected from what had previously been published. This includes correcting the
ratio presented in this graph.
Source: Data from APM Research Lab. (2021, March). Color of the coronavirus. https://www.apmresearchlab
.org/covid/deaths-by-race
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UNIT I: INTRODUCTION TO HEALTH POLICY
as a system in which public policies, institutional practices, cultural representations, and other norms
work in various, often reinforcing ways to perpetuate racial group inequity—is directly linked to how
long and well people live today (Aspen Institute, 2016). Compared to white people, Black individuals
are more likely to live in neighborhoods with more pollution and that lack healthy food options, green
spaces, and places to exercise safely. Many of these neighborhoods suffer from the legacy of redlining,
in which mortgage lenders denied loans or restricted services based on race (Ray, 2020).
The effects of the pandemic on health were especially severe for low-income individuals and people of color. Pandemic-related household financial challenges also disproportionately impacted those
who were already struggling. Low-income individuals and people of color were more likely to live in
crowded housing, rely on public transportation, and be essential workers. They were also more likely
to lack health insurance and less likely to be able to access care (Centers for Disease Control and Prevention, 2020). Access to primary care and specialty care physicians were less available in communities
of color due to the segregation of healthcare. COVID-19 testing centers were more likely to be located
in wealthier suburbs where predominately white residents live, rather than in predominately Black,
lower-income neighborhoods (Williams & Cooper, 2020). All of these factors made it difficult and
often nearly impossible to follow recommended social distancing guidelines during the pandemic and
put people who live in these neighborhoods at higher risk of getting sick or dying from COVID-19.
Furthermore, Black people and other marginalized groups encounter bias and discrimination in
healthcare settings and often receive subpar care compared with white people. A landmark 2003
NAM (formerly Institute of Medicine) report, Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care, concluded that across nearly every type of medical intervention, Black
people and other minorities receive fewer procedures and poorer quality medical care than white
people, even when socioeconomic status is taken into account (Smedley et al., 2003). The report
attributed the cause to implicit bias—unconscious racial stereotypes that grow from our personal
and cultural experiences—among health providers (Chapman et al., 2013).
The culmination of stress from experiencing persistent racism in healthcare, education, housing,
public housing, and criminal justice contributes to Black people living shorter and sicker lives. The life
expectancy in 2014 at birth was 75.6 years for Black people and 79.0 years for their white counterparts (National Center for Health Statistics, 2016). The differences are exacerbated at the neighborhood level: Life expectancy can differ by as much as 20 years in neighborhoods only about five miles
apart from one another—largely the result of residential segregation, as demonstrated in the map at
the following link: https://societyhealth.vcu.edu/work/the-projects/mapsphiladelphia.html (Virginia
Commonwealth University Center on Society and Health, 2016). Black and Indigenous babies experience higher rates of infant mortality; Black children experience higher rates of asthma and obesity;
pregnant Black women experience higher rates of complications and infant/maternal death; and Black
people experience earlier inception of multiple chronic conditions like obesity, hypertension, heart
disease, diabetes, and cancers (Cooper, 2020). These underlying health conditions—often the result of
structural racism—also placed Black people at higher risk for more severe COVID-19 cases.
As marginalized groups suffered disproportionately from COVID-19, the brutal police killing of
George Floyd in the summer of 2020 sparked renewed calls for racial justice. While Floyd’s murder
received the most attention, he was one of too many Black and Brown murder victims. Breonna Taylor’s killing by police officers and Ahmad Arbery’s murder by armed white men while he was out for
a jog—and the unconscionably long list of black and Latino victims who preceded them and came
after them—as well as the more than 6,603 reports of hate incidents against Asian Americans and
Pacific Islanders in 2020–2021 (Jeung, 2021), underscore the need to adequately acknowledge, confront, and dismantle systems of structural racism—including within nursing. The nursing profession
must prioritize advancing health equity in the next decade.
THE REPORT’S FOUR KEY MESSAGES
The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity was released as
this book went to press. NAM used four key messages when the report was released (National
Academy of Medicine [NAM], 2021). The four messages are (a) permanently remove nurse practice
barriers; (b) value nurses’ contributions; (c) prepare nurses to tackle health equity; and (d) fully
6: Future of Nursing Report 2030
support nurses. Each key message contains a series of recommendations that, if implemented, will
better enable nurses to advance health equity. Organizations with an interest in advancing nursing
were, as this book went to press, assessing what these messages meant for them. Each message is
discussed below.
KEY MESSAGE 1: PERMANENTLY REMOVE NURSE
PRACTICE BARRIERS
The report clearly conveys that people’s ability to access high-quality care is hindered by artificial
and regulatory barriers that prevent nurses from practicing to the top of their education and training.
Many people in the United States cannot see a healthcare provider when they need one because they
don’t have health insurance, the ability to pay, or clinics and physicians where they live, particularly
in rural and urban areas. Nurses can help more people get healthcare services through their work
at federally qualified health centers, retail clinics, home health and home visiting, telehealth, school
nursing and school-based health centers, and nurse-managed health centers. All RNs, for example,
can improve the quality of healthcare by managing and coordinating care and providing support
during care transitions, such as when people are discharged from the hospital and return home.
In addition, about 70% to 80% of advanced-practice RNs work in primary care—in pediatrics,
adult health, gerontology, and nurse midwifery. The nurse practitioner field has grown considerably
in recent years, while the number of physicians going into primary care has remained stagnant or
declined (Barnes et al., 2018; Xue et al., 2016). Studies have repeatedly demonstrated that nurse
practitioners provide care that is equivalent to the care provided by physicians (Perloff et al., 2019;
Yang et al., 2020). Nurse practitioners are 10% to 30% less expensive to employ than physicians,
and are more likely to care for non-white, non-English-speaking Medicare and Medicaid beneficiaries, including those in rural areas, at a lower cost of care (Perloff et al., 2016).
However, the ability of all nurses—APRNs, RNs, and licensed-practical nurses (LPNs)—to practice fully in these and other settings is limited by state and federal laws, institutional barriers, and
restrictive health systems policies prohibiting them from working to the full extent of their education and training. While progress has been made in removing some of these state-level barriers,
27 states still do not permit full practice authority for nurse practitioners (American Association of
Nurse Practitioners, 2020) (Figure 6.3). During the pandemic, multiple governors issued executive
orders expanding the scope of practice for nurse practitioners to care for critically ill patients, and
the report calls on these orders to be made permanent.
The report also recommends that all organizations, including state and federal entities and employing organizations, enable all nurses to practice to the full extent of their education and training by
removing regulatory and public and private payment limitations and restrictive policies and practices.
Until this happens, significant and preventable gaps in access to care will continue. Millions of people
who need healthcare will be unable to receive it as easily as others who happen to live in states where
nurse practitioners’ scope of practice is unrestricted. For many people, delays in care lead to worsening of symptoms and disease progression, and to greater costs when they ultimately do get care.
KEY MESSAGE 2: VALUE NURSES’ CONTRIBUTIONS
Nurses can address the social and economic drivers of health and advance health equity through their
roles in care management and team-based care; preventative care; community nursing, including
serving as school nurses; and providing telehealth services. School nurses, for example, can bridge
health and social needs and fill gaps in access to primary care. They are a lifeline for 56 million
students, particularly children from low-income families. They can build relationships with students,
connect them with needed resources, and address the root causes of poor health. Yet funding for
school nurses is insufficient, particularly in low-income and underserved communities: Roughly
25% of U.S. schools do not employ a school nurse, and 35% employ one part-time (Willgerodt
et al., 2018). Public health nurses similarly play vital roles in improving community health, yet their
work is often underfunded and undervalued.
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UNIT I: INTRODUCTION TO HEALTH POLICY
VT
(2011)
WA
ND
(2011)
MT
OR
SD
(2017)
ID
WY
NV
(2013)
CA
(2020)
UT
(2016)
MN
(2014)
WI
PA
IL
(2017)
KS
NH
MI
IA
NE
(2015)
CO
NY
(2014)
ME
OH
IN
WV
(2016)
VA
KY
(2014)
MO
NC
NJ
MA (2020)
RI (2013)
CT (2014)
DE (2015)
MD (2015)
DC
TN
AZ
OK
NM
SC
AR
MS
TX
AK
AL
GA
LA
FL
(2020)
HI
Full access achieved before campaign began
Full access achieved since campaign began
Substantial improvement made since campaign began
Incremental improvement made since campaign began
No progress has been made since the campaign began
FIGURE 6.3 State progress in improving access to care by nurse practitioners.
Notes: Updated January 4, 2021. Years denote when laws were passed.
Source: Data from Robert Wood Johnson Foundation and AARP Foundation.
While nursing offers many successful, evidence-based strategies to improve care, their widespread
adoption will remain limited if they are not adopted seamlessly and if nurses do not receive adequate
compensation for them (Chin & Bisognano, 2021). Health systems should make it straightforward
for nurses to advance health equity, rather than adding to their workload. For example, nurses at
Rush Medical Center in Chicago ask an admitted patient a standardized set of screening questions
about housing insecurity and access to food, primary care, and transportation that appear on the
electronic medical record system that the hospital uses. If the patient demonstrates a need, the nurse
can click twice in the computer system to refer the patient to programs that can assist with unmet
social needs. The programs reach out to patients after they return to their home to connect them to
services in their community. Patients with demonstrated food insecurity also receive a grocery bag
packed by volunteers to take home once they are discharged (NAM, 2021).
The current U.S. payment system rewards quantity over quality of care, treatment of existing
illnesses over preventing them in the first place, and prioritizes hospital and specialty care over primary and preventative care. Public and private payment systems need to be designed to intentionally
incentivize healthcare and public health organizations to allow nurses to perform prevention, health
promotion, primary care, and community and public health as part of their regular jobs.
In addition, payment systems often fail to explicitly value nurses’ contributions. Payment systems
are geared toward directly reimbursing physician services, and they seldom recognize the contributions of nurses and advanced-practice registered nurses. Medicare considers nurses to be part of
“hospital services,” which underestimates nurses’ work and does not account for nurses’ contributions to improving the quality of care, increasing revenues, and decreasing costs. In practice, nurses
can lower costs by providing transitional care, care coordination, and care management for patients
with chronic illnesses that eliminate hospital re-admissions and repeat visits to the emergency room
(National Conference of State Legislators, 2016).
6: Future of Nursing Report 2030
The report recommends that federal, tribal, state, local and private payers, and public health
agencies champion payment reforms allowing nurses to fully address social needs, improve community health, and advance health equity. These recommendations include reforming and embracing
new payment models, such as accountable care organizations, accountable health communities, and
value-based payment, which can give healthcare organizations the flexibility to pursue these goals.
The report also advances the idea of a National Nurse Identifier to facilitate recognition and
measurement of the value of services that nurses provide, and nurses should be able to bill for telehealth services so they can reach people anywhere. Performance measures should be centered on
health equity to incentivize nursing roles and functions that address the social and economic drivers
of health. In addition, school and public health nurses should be adequately funded so that they can
expand their reach and help improve health for all, including reimbursing school nurses for the care
that they provide.
KEY MESSAGE 3: PREPARE NURSES TO TACKLE HEALTH EQUITY
The pandemic accentuated the importance of all nurses possessing a deep understanding of the
social and economic drivers of health. However, too often nurses receive limited information about
health equity in their education, including during their clinical experiences. Nursing educators need
to better prepare their students to understand and identify the complex social and environmental
factors that affect health, effectively care for an aging and more diverse population, engage in new
professional roles, adapt to new technology, collaborate with other professions and sectors, and
adapt to a changing policy environment. It is especially important for nurses to be able to form
multisector partnerships with organizations outside of healthcare, such as transportation, housing
and food security, to address the root causes of poor health. A strengthened nursing field will be
especially critical as Baby Boomer nurses continue to retire this decade.
Diversifying Nursing Education
Developing a more diverse nursing workforce will be key to advancing health equity. The new report
unequivocally states that the nursing field needs to address systemic racism and bias within nursing,
and prioritize diversity and cultural humility—defined by flexibility, a lifelong approach to learning
about diversity, and a recognition of the role of individual bias and systemic power in healthcare
interactions (Agner, 2020). Nurses in education need to acknowledge and confront structural racism
in nursing, so that the field can address the systemic barriers that keep the nursing profession
overwhelmingly white and female. Despite decades of emphasizing diversity, the nursing field
remains approximately 80% white, even though whites make up just 60% of the U.S. population.
The gap widens further for nurses in leadership positions, including in academia, with few Black
nurses holding leadership positions (Iheduru-Anderson, 2021).
Nursing students and faculty need to reflect the diversity of the population and break down barriers
of structural racism present in nursing education, including in the curricula, institutional polices and
structures, and the formal and informal distribution of resources and power (Iheduru-Anderson, 2021).
Nursing students—and faculty—must reflect the diversity of the population and break down barriers
of structural racism present in today’s nursing education, including in the curricula, institutional polices and structures, and the formal and informal distribution of resources and power. All nurses need
to communicate and connect with people of different backgrounds and be self-reflective about how
their own beliefs and biases may affect the care that they provide. Diversifying and strengthening the
student body—and eventually the nursing workforce—requires cultivating an inclusive environment,
recruiting and admitting a diverse group of students, and providing them with the resources needed
and to address barriers to success throughout their academic career and into practice.
Revamping Curricula
Everyone involved in nursing education needs to see health equity as a core component of nursing.
Content about the social and economic drivers of health, health inequities, and population health are
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currently not well integrated into undergraduate and graduate education. The report recommends
that schools of nursing integrate these concepts and competencies throughout the coursework.
Similarly, schools should expand community learning opportunities. Right now, clinical learning
opportunities prioritize the hospital setting. Substantive education in the community—such as
schools, workplaces, home healthcare, public health clinics, and telework settings—enable nursing
students to learn about the wide variety of care environments and to work collaboratively with
other health and non-health professionals. Students need to actively engage in experiences that will
expand and diversify their understanding of nursing practice, prepare them to care with empathy
for diverse populations, and permit them to acquire the required skills and competencies to advance
health equity.
Recommendations to Diversify Workforce
The report also includes a number of recommendations for nursing education that will ultimately
diversify the workforce. Among the recommendations are to (a) identify and eliminate policies,
procedures, curricular content, and clinical experiences that perpetuate structural racism
and discrimination among faculty, staff and students; (b) increase academic progression for
geographically and socioeconomically disadvantaged students through academic partnerships that
include community and tribal colleges located in underserved areas; and (c) recruit diverse faculty
with expertise in health equity and use evidence-based and other trainings to develop the health
equity skills of current faculty.
Disaster Preparedness
The pandemic illuminated how poor and marginalized communities are disproportionately affected
by disasters, including earthquakes, floods, and hurricanes. Disasters disproportionately affect
people of color, those with low incomes, those experiencing housing insecurity, and those with
limited access to healthcare and transportation, ultimately exacerbating health inequities (Davis
et al., 2010). From working in hospitals during a disease outbreak or shelters after a hurricane,
nurses serve on the frontlines of emergencies and help people and communities to cope and recover.
Nursing school curricula do not always teach students thoroughly about healthcare emergency
preparedness. The report calls on nursing schools and employers to expand disaster preparedness
educational and training opportunities for nurses at all levels and in all sectors.
KEY MESSAGE 4: FULLY SUPPORT NURSES
Nurses need to feel healthy, well, and supported in order to care for people and to advance health
equity. Nurses who experience poor physical and mental health are more likely to make medical
errors (Melnyk et al., 2018). The pandemic, however, took an unprecedented toll on the nursing
workforce. Before the pandemic, many frontline nurses worked in understaffed environments and
were overworked and burned out. Many worried about bullying and violence in the workplace
(Sauer & McCoy, 2017). Many also cared for children or elderly relatives outside of work (Robert
Wood Johnson Foundation, 2019). Their long-existing stresses were exacerbated by COVID-19.
Of the more than 12,000 nurses participating in a December 2020 survey conducted by the
American Nurses Foundation, “Pulse of the Nation’s Nurses,” most shared that they were experiencing a higher likelihood of depression, anxiety, and distress from when they were surveyed earlier in
the year. During the survey’s spring 2020 administration, 50% of nurses indicated they were overwhelmed. These feelings intensified as nurses indicated that 72% of them felt exhausted (American
Nurses Foundation, 2020).
For over a year, nurses risked their lives to care for others. They cared for multiple critically
ill patients at once and served as additional support when their families could not be physically
present. They used their own phones and tablets to set up calls between dying patients and family
members, and they stayed with their patients so that they did not die alone. Other nurses were
6: Future of Nursing Report 2030
transferred from medical-surgical floors to care for large numbers of COVID-19 patients, often
without adequate training. Nurses worked long shifts, sometimes without the personal protective equipment needed to stay safe, particularly in smaller hospitals and long-term care facilities
(Doherty, 2020). More than 550 nurses lost their lives to COVID—a disproportionate number of
whom have been nurses of color, who were also more likely to work in nursing homes and with
marginalized populations who were disproportionately affected by the pandemic (The Guardian
and Kaiser Health News, 2021; Renwick & Dubnow, 2020). Some nurses who spoke up at the
onset of the pandemic to demand adequate protective equipment unjustly lost their jobs. Nurses
also faced stigma from the general public. What the workforce went through is unjust and unsustainable. One of the main imperatives from an ethical, advocacy, and policy standpoint in the next
decade will be to improve nurse well-being so that nurses will be able to provide high-quality, safe
care for patients, families, and communities.
To fully support nurses, the field also needs to address and eliminate racism in its workplaces.
Nurses of color repeatedly report experiencing discrimination and bias within their work settings
(Cottingham et al., 2018; Ghazal et al., 2020). All nurses need to create a culture of equity. Nursing
workplaces should reflect the patient population that is served, and everyone should be aware of
their biases and practice cultural humility. Implicit and explicit bias training and cultural practices accepted and championed by leaders within the institutions where nurses work will be critical. Nursing
workplaces should recruit, retain, mentor, and promote nurses from underrepresented backgrounds.
The report includes a number of recommendations that aim to tackle the systems, structures, and
policies that lead to burnout, fatigue, and poor physical and mental health among the nursing workforce. The main one is that 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. Employers, for example, should provide sufficient resources to
enable nurses to provide high-quality care; establish a culture of physical and psychological safety;
prioritize and invest in programs promoting nurse well-being; and strengthen policies to reduce
stigma associated with mental health treatment.
Nurses have enormous potential to address health equity, but they will not be in a position to
do so until policymakers, employers, and nursing leaders find long-term solutions to address the
systems, structures, and policies that create workplace hazards and stresses that lead to burnout,
fatigue, and poor physical and mental health.
CONCLUSION: CALL TO ACTION
The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity imagines a far
more equitable world than the one we live in today. Advanc
