Dainty was rejected by a nursing school in a southern state in 1960. Her story captures the glaring discrimination faced by African-Americans wanting to become registered nurses at that time. Finally, she was accepted in a ‘‘more liberal college,’’ and had a successful career in nursing. She is now a professor and admits that the journey has not been that easy.
Forty years later, Marie, felt a subtler form of discrimination. She tells of having high grades in a previous degree and was shocked when she found out that she was the only black face in her nursing class. She recalled how it felt like– “I felt like I was their success story”.
Shane narrates her story, “This physician asked if I could find the nurse in charge?’’ I stood in front of him in my RN uniform and watched as he became more agitated with what he saw as my noncompliance with his request. ‘‘Please look at my name tag,’’ I said quietly. He responded with embarrassment and confusion but never made that mistake again. Another time, Shane was in her full RN uniform, and working with another African-American nurse in the unit, when the doctor told the supervisor that he didn’t think it was right that two nurse aids should be working there.
Experiencing unfairness based on account of nurses like Dainty and Marie, and Shane, they believe, are linked in part to a negative perception that they were “different”. Many colored nurses like them have experienced the unfairness of the nursing and healthcare system, in more ways than one.
Playing Multiple Roles in the 21st Century: A Call to Social Justice in Nursing
It is because of injustices that many nurses (including Dainty, Marie, and Shane) have faced in the past and even today, that we nurses are inspired to play important roles to stand up for social justice in the 21st century.
Apart from the multiple roles that we play, we are called to promote health equity and social justice in everyday practice. This noble calling goes as far back as the profession itself. In playing this role, it is essential that we be able to identify opportunities for multi-level interventions that can promote social justice in our own organizations.
At Transform Nursing, I would like to share with you vital information on topics like inclusion which involves just social relations and social structures that will enable opportunities for better nursing practice right where you do the wonderful work that you do for your patients, and society in general.
Looking at social justice and inclusion from various perspectives is an essential first step in the journey that I invite all nurses to take to be able to integrate an effective framework that will guide the nursing practice, and make a lasting impact on those we serve, as well as the people we care for. We shall also look deeper into the different domains of social justice, namely the relational and structural dimensions.
What is the relationship between Nursing and Social Justice? What is your personal view on this?
Looking through the Eyes of Social Justice in Nursing
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According to nursing research evidence, interventions rooted in social justice hold significant potential to employ actions that should help ameliorate inequities and health disparities for vulnerable groups in society.
Looking through the (ethical) lens of social justice, we should be able to realize and implement interventions that we as nurses can engage in to remedy disparities that contribute to poor leadership, management, and adverse health outcomes.
Today, it is a reality that nursing may be at a juncture where nurses in different institutions find it important to expand their roles to include social activism for oppressed populations.
The Importance of Social Justice-based Actions in Nursing
Interventions or actions based on social justice has a profound impact on the general health status of people we serve and their significant others, as well as our own sense of well-being as caregivers. It is worth knowing that ethnic and racial disparities are a key influence on overall health outcomes in the US.
For instance, in the US, non-white women with low socioeconomic status have approximately three to four times greater infant mortality rates than white women in the same socio-economic level. Hence, non-white women who experience health disparities (1/3 of the US population of women), have significantly higher mortality rates for infants.
Nowadays, for gaps with risks in health for the most vulnerable in society, we as nurses are called to address a broad range of social, economic, cultural, environmental, and legal factors that influence health disparities.
Just how do we view health disparities?
According to the Institute of Medicine (IOM), health disparities are differences in prevalence, incidence, mortality, the burden of disease or other complicated health conditions that exist among a specific group of people.
Many advocates of health suggest that social factors are the very roots of health inequities and disparities. These influence access to resources that can minimize risk and consequences of an illness or development of an illness.
Factors Nurse Leaders Should Understand
Nurses are in an ideal position to lead the nation using innovative strategies to promote health equity. Why? Because nurses are role models in society, serving as patient care experts, patient advocates, community-focused educators, among others.
To be even more efficient as leaders in society, nurses should understand the spectrum of social determinants of health that have a profound impact on the prevalence of health disparities and health status. In the US for instance, significant improvements in national health indices are not possible without addressing first social determinants of health.
Saying YES and embracing a nursing leadership role in the 21st century takes competency, courage and some important tips on the use of tools including interdisciplinary collaboration, political involvement, advocacy, and community partnerships. Here at Transform Nursing, we will go through the essentials of these aspects of influential leadership one-by-one through courses that will enlighten, enrich and empower.
Nursing Leadership Towards Equitable Health Outcomes
What we do as nurses on a daily basis is of integral importance in the larger scheme of things in healthcare. Whether we practice in public health, primary care or other facilities, our primary aim is to ensure optimal health outcomes through efficient processes.
The leadership style to address marginalized and vulnerable groups and focus on health equity has scarce related literature from various scholarly sources. This is ironic since social justice is a considered a core value of nursing as a profession.
Here at Transform Nursing, allow me to teach you interesting tools to effectively respond to diverse situations where you have experienced inequities or unequal treatment in the practice, or to equip you better in dealing with patients who are marginalized and vulnerable.
As nurse leaders, or practicing frontline nurses in hospitals, facilities or communities, even student nurses (or individuals who plan to enter this noble profession), it is of the essence that we are able to fully comprehend the social justice agenda, and apply this orientation to become better professionals in this practice.
Bridging the Gap
Up to the present times, evidence shows that nurses show lack of competency and leadership development skills because it was not made a core subject in nursing schools. Looking at history, we appear to have been complicit in the physician-to-nurse model. Hence, through the years, we have not played major roles in shaping policies but simply allowed people from other sectors to command policies to us even when concerns are within our domains. Regrettably, even when we should have disagreed or seen vivid conflicts of interest.
For many years, nurses have been a rather passive group. Other members of healthcare or society did not see us speaking the language of policy or address political processes and issues.
But today, we slowly make way for big transformations in nursing. Now, as a group, we choose to be included. We choose to participate actively in decision making on how to improve quality of care for our patients. Never again will we acquiesce to be a part of a faulty hierarchical system that largely contributes to inequities and inequalities.
Challenges We Face, Steps We Take
Transformed nurses today are in a position to challenge hierarchy and lead to achieve equality. Let me guide you to emerge as an empowered leader ready to forge full, new, and powerful partnerships with other professionals, policymakers and the people we serve.
Truth is, we have a big voice in health and policy decision making and should engage urgently to implement efforts that will altogether collapse the fragments of hierarchical silos that have been built.
The Key to Effective Nursing Leadership
Courageous nurse leaders hold stakeholders accountable for improving equitable care and decreasing preventable adverse events. We should make a stand once and for all that to be effective in what we do, we should rally against disparities in healthcare and healthcare systems. This cannot be something we surrender to good fortune, intuition, instinct, or happenstance guidance. We should deliberately choose to do what is right, and be responsible for the practice.
As effective nurse leaders, we should have a clear vision and take into account the essential elements of ethics, social justice, and socio-politics; and by heart incorporate the lessons we take from the bedside (or work environment that we have), from our very patients, and utilize these towards the needed dynamic movements for change and reform.
Nursing Leadership for Equitable Healthcare
Significant components that undergird social justice in nursing include professional growth and development, organization, collaboration, resource management, leadership development and cultural competence.
Empowered nurse leaders who lead to work for equitable healthcare are badly needed across all healthcare settings today, particularly in home and community settings. In communities, nurses are actually able to work more autonomously with patients and families than in acute care settings, as in hospitals. Nonetheless, whether in clinics, health units, schools or hospitals, effective nurse leaders are in demand.
According to IOM (2014), Nurses should understand that effective leadership is as important to providing quality care as the safe and effective technical skills and ability they possess at the bedside.
What do Nurse Leaders Working For Health Equity Need to Possess?
- Nurse leaders working for health equity understand the implications of equitable health care for the community and society in general. This is true since health care from an economic perspective is in part a public good. Hence, the public, in general, should benefit, and not just the individuals receiving the services. An implication is that nurses should competently provide health services for persons with communicable diseases (e.g., H1N1, pertussis, and tuberculosis) with the goal of protecting all of society.
- Nurse leaders should handle healthcare as an ethical and moral matter. Therefore, when people have lack of access to adequate health care, we should stand as advocates to our patients. If we fail to perform this role, the people we serve may expire, suffer tremendously, or never reach his or her full potential and become a fully functioning citizen.
- Nurse leaders are responsible for guiding other nurses to address and meet the health and social needs of the public, in particular, marginalized and vulnerable populations. This involves standing up for work that is valuable and important, and insisting on doing it in a compassionate and reflexive way; not simply capitulating to imperatives generated by a domineering boss, or an aggressively defiant client.
- Nurse leaders should have a population consciousness. That is, they see aspects of health care beyond the immediate situation. This view requires critical analysis of patterns and norms in health care and the larger society. The nurse leader, therefore, is compelled to shift his or her focus from the individual patient’s current health needs to a comprehensive understanding of health, healthcare, patterns, and social trends that affect populations.
- Nurse leaders should become cognizant of the realities of economic and social marginalization. They should sound the alarm when inequitable access or use of health care systems are visible; higher mortality rates are seen from an array of acute and chronic diseases; higher rates of morbidity become prevalent from preventable diseases, and when certain groups are placed at a disadvantage in healthcare processes and procedures
- Nurses must be able to lead in areas where they have been traditionally prohibited or discouraged. This way these leaders are challenged and given the opportunity to compensate for health inequities in various strategic ways. These areas include creating new integrated practice models, working with policymakers and state legislators, improving work processes, developing policy and legislation, leading curriculum changes, translating and applying research findings into practice, preparing the workforce to meet community and patient needs, developing operational models of care, and serving on institutional and policy-making boards where crucial decisions affecting patients are made (IOM, 2011).
