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Observed throughout the month of February, Black History Month is an annual celebration of the achievements made by African Americans and a time for recognizing their role in U.S. history. This year, Black History Month occurs amidst the third year of the COVID-19 pandemic, during which issues of health equity have been exacerbated in minority communities across the country.
To help foster greater understanding of the issues surrounding health equity in the U.S. and the critical role nurse practitioners (NPs) play in creating a more equitable future for health care, two members of the American Association of Nurse Practitioners® (AANP) Diversity, Equity and Inclusion (DEI) Committee are sharing their insights and experiences. .
Larider Ruffin: We have a problem with misinformation and racial inequality in our country. When we talk about COVID-19 vaccines and the things we can do to bring us closer to a pre-pandemic state, there is no question that we need to get the population vaccinated. However, I see a lot of mistrust in the medical profession from the African American community. This mistrust stems from a history of inequality in our country. It is something that causes a lot of unease for NPs, like myself, whose patients refuse to take the COVID-19 vaccine because of the unfair experiences they have had with the medical profession.
When this history of racial disparity comes into contact with the misinformation floating around social media, it creates a bigger challenge for all of us. Although we know that nursing has been the most trusted profession for many years, we need to start restoring that trust within minority communities. There are opportunities for nurses and NPs to take a stand and get vaccinated so that our patients may follow in our footsteps.
Sheri Rickman Patrick: We talk about social determinants of health, we talk about implicit bias, unconscious bias, but it all is based on systemic racism. As an NP, I often order renal function tests and I’ll get a GFR (Glomerular Filtration Rate) that will say non-AA and AA. This suggests there’s a difference between non-African Americans and how their kidneys function as opposed to African Americans. As far as I was taught, all kidneys function the same, so why are we distinguishing between African Americans and all others?
Our bodies internally are all the same. Our hearts, lungs, kidneys and liver all work the same, so we should not base care on one’s race. But social determinants of health — socioeconomic status, environmental issues, where you live — can affect your health. These external factors can affect your health.
Patrick: It is challenging, especially if you’re the only person of color in your workplace. The discrimination you face can often be twofold — you can get it from the patients and the staff. But I think those NPs that are starting their careers are coming in at a time when the nursing profession is ripe for change.
We must work together to ensure that the profession makes some changes and moves forward in a more productive and equitable manner so that patients of all walks of life are cared for effectively.
Ruffin: When I think about nurses, I think about a group of critical thinkers and innovative professionals. There are a lot of challenges, but I do believe that — especially for those who have made it through higher education and become NPs — there is no doubt they will be able to overcome these challenges.
Patrick: Wherever you practice, lean in and ask for a seat at the table. Maybe you’re new to the profession or new to the practice, but if you see something that isn’t working right, don’t be afraid to speak up. Systems can change. If you see an issue where the system is not working and you think of a way to change the system, presenting that to leadership is the way to go.
Things don’t change if we don’t change statutes. Our practice is based on the law, so if we want to make it better for our patients and those working in the profession, we need to be involved with policy. We have to encourage everyone to get involved to the best of their ability.
Ruffin: First off, NPs — and especially novice NPs — need to get involved with their professional nursing organizations. Personally, there are so many wonderful resources that I have access to because of my involvement with AANP and other organizations that I belong to. As health care leaders, we must get involved with our legislators both nationally and locally to help influence policies that affect our patients and our community.
Especially when you talk about Black communities, there is a need for these communities to see NPs who really look like them. Research shows that when the patient interacts with a health care provider who they can easily identify with, they are more likely to have a positive outcome. We need to be more intentional in treating our patients as individuals while respecting and applying the platinum rule – treat others the way you’d like to be treated.
Ruffin: Actually, I was invited by former AANP President, Dr. Sophia Thomas, to serve on the DEI Committee following a recommendation from one of my mentors who happened to serve on the board. I have been a member of AANP since I was studying to become an NP, but I had never been asked to serve on a committee before. It has been such a phenomenal experience to be a part of the committee. Having a DEI Committee like this within an organization like AANP is a huge first step toward creating transparency and embracing diversity in the organization.
Patrick: I decided I wanted to get involved, so I submitted myself for nomination to various leadership roles within AANP. I served as a State Representative for Northern California for three terms before I started looking for a new role and found myself in contact with the DEI Committee.
I’ve really enjoyed working with the committee to continue my work in social justice, which has since found its way into various other aspects of my life, like my role as an educator and a member of my parish. It has really reignited my passion and I plan to continue this work even after I retire.
Patrick: The committee helps look at the demographics of our membership to see where our priorities should lie. We’ve also done some great work with webinars. I recently served as a panelist in a webinar where we discussed issues of intersectionality, systemic racism and social determinants of health, based on findings in the Future of Nursing Report.
Our third and final webinar in this series will build upon the learnings from our last two webinars to help discuss the future of nursing and our own diversity, equity and inclusivity efforts. Using P.E.A.R.L. [practice, education, advocacy, research and leadership], how can we shake up, dismantle and rebuild health care to better serve our patients?
Ruffin: Right now, the committee is looking at survey results regarding AANP’s DEI past, present and future. Through this survey, we look at where we used to be, how we’ve made a difference within AANP and where we are right now in order to chart the future of the organization and health care.
At the 2021 AANP Fall Conference, we had a DEI track in which we discussed many different topics, such as health inequities and racism. Our hope is that the more we educate our NP colleagues on the issues of racism and health care disparities, the more likely they are to become advocates for change.
In 2022, we will have Martin Luther King III as our closing keynote speaker at the 2022 AANP National Conference. This is extremely timely, given the level of racism that has surfaced in the U.S. following the death of George Floyd. Having a civil rights leader present at the conference is proof of AANP’s commitment to addressing inequality in the health care system.
Patrick: People want to know if these organizations are truly practicing what they preach. In leadership roles, you don’t see a lot of people of color, and although the Black community makes up about 13% of the U.S. population, less than 7% of the nursing population is Black.
Our white colleagues are getting recruited, retained and promoted in abundance while equally qualified Black nurses, NPs and health care leaders get turned down for those same positions. While the needle has been moving in the right direction ever so marginally, this has remained largely stagnant for far too long.
Ruffin: Unfortunately, racism has been so integrated into nursing that it’s almost becoming a part of who we are. The good news is that we are recognizing that as a problem. In a recent survey, about 94% of nurses recognize there is racism in health care. The very first step in solving a problem is recognizing the problem is there, and the nursing profession is starting to do just that.
We have a calling to treat people right. That’s our code of ethics as health care professionals. We are to treat people with dignity and respect regardless of their race, culture, creed, sexual orientation, ethnicity, gender, age, experience or any aspect of their identity.
I do believe we are in a better place, but we have a lot more work to do to make sure that patients can see health care providers that look like them, who confide in them and truly see them as human beings.
Want to engage in a dialogue around the systems and structures that impact progress toward health equity? Join your fellow NP colleagues and AANP members on February 24 by attending Charting the Future of Health Equity as NPs: Dismantling and Rebuilding Systems and Structures in Health Care! In this free, live webinar, a panel of expert clinicians will explore resources and strategies that foster the dismantling and rebuilding of our current health care systems.
Through sharing their lived experiences as NPs, the panelists strive to raise awareness, energize and empower all NPs for change. AANP members are welcome to join the DEI Committee as we continue to build vision into reality to advance health equity.