Nurses Key to Achieving Health Equity Over Next Decade

'This is a transformational time for the field of nursing,' says co-author of a new report. 

Nursing over the next decade will demand a larger, more diversified workforce prepared to respond to future public health emergencies and address systemic inequities that have fueled health disparities, says a report released yesterday from the National Academy of Medicine.

By 2022, all state and federal policy changes in response to the COVID-19 pandemic that expanded scope of practice should be made permanent, along with telehealth eligibility, insurance coverage, and equal payment for services provided by nurses, says The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity.

Nurses in the next 10 years will face such demands as caring for an aging population, responding to increased behavioral and mental health conditions, conducting research, and helping shape healthcare policy. Building an able workforce requires a significant increase in the number, types, and distribution of nurses across geographic areas, specialties, and care settings, the report says.

Particularly needed are nurses in specialties with significant shortages, such as public and community health, behavioral health, primary care, long-term care, geriatrics, school health, and maternal health, along with those who hold bachelor’s and PhD degrees, the report says.

"This is a transformational time for the field of nursing," Mary Wakefield, PhD, RN, FAAN, co-chair of the committee that wrote the report and visiting professor at The University of Texas at Austin, said in a press release. "While the pandemic has changed nearly every aspect of healthcare, the impacts on nursing may be the most profound, as demand for their skills is at an all-time high."

Full practice authority

In the 23 states and Washington, D.C., that permit full practice authority, access to primary care has improved, especially considering the ongoing pandemic and physician shortages, according to the report.

Despite considerable progress in waiving scope of practice regulations, 27 states still do not allow full practice authority for nurse practitioners, so federal authority should be used to supersede restrictive scope of practice state laws, the report says.

'A duty and responsibility'

Nurses already play a significant role in addressing social needs and the social determinants of health (SDOH) such as access to healthcare, physical environment, and housing stability.

"The committee believes that all nurses, at all levels, and no matter the setting in which they work, have a duty and responsibility to work with other health professionals and sectors to address SDOH and help achieve health equity," says the report.

As such, government agencies, healthcare and public health organizations, and payers should ensure nurses have the resources and support to address SDOH in a more comprehensive way, and that payment models recognize the value of those services and offer adequate reimbursement, the report says.

"Nurses are often the first to check if patients have enough to eat, if they can afford their medications, whether they need housing assistance, and if they have reliable internet access for telehealth visits," said David Williams, co-chair of the committee, professor of public health and chair of the department of social and behavioral sciences at Harvard’s T.H. Chan School of Public Health, and professor, department of African and African American studies at Harvard University. "When we invest in nurses, more people and communities will have the opportunity to live their healthiest lives."

The report identified several priorities to meet the needs of the U.S. population and the nursing profession for the next decade:

Strengthening nursing education: In addition to hospital-based care, schools of nursing should also emphasize primary care in community settings, rural health clinics, schools, workplaces, and home health. They should also prepare students for new technologies, particularly telehealth and big data.

Promoting diversity, inclusivity, and equity in nursing education and the workforce: Nursing students and faculty not only need to reflect the diversity of the U.S. population but also need to help dismantle structural racism prevalent in education and the workforce.

Investing in school and public health nurses: A school nurse may be the only health professional some students see regularly. However, about 25% of schools do not employ a school nurse, and school nursing remains underfunded, especially in schools serving children in low-income homes.

Protecting nurses’ health and well-being: As more nurses are expected to address both health and social justice issues, they will have to take on more emotionally taxing work, and employers need to provide adequate space and support.

Preparing nurses for disaster and public health emergency response: The Centers for Disease Control and Prevention should fund a National Center for Disaster Nursing and Public Health Emergency Response, along with regional centers, to provide relevant education, training, and career development.

Increasing the number of PhD-prepared nurses: PhD-prepared nurses can conduct research, serve as faculty and focus on the connection among SDOH, health disparities, and health equity to help build a knowledge base for other nurses to translate to practice.

"Nurses are powerful in number and in voice, and the world needs their dedication and persistence more than ever," said Victor Dzau, president of the National Academy of Medicine. "I am confident that the nursing community and other important stakeholders will use the report recommendations to unleash the power of nurses and usher in a new era of health equity and well-being."