Nursing leaders participating in a workshop learned how to strengthen school mentorship programs to improve graduation and National Council Licensure Exam passage rates among underrepresented students enrolled in nursing programs at Historically Black Colleges and Universities (HBCUs), Hispanic-serving institutions (HSIs), and American Indian and Alaska Native (AIAN)-serving institutions.

AARP and the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation, sponsored the Mentoring for Success with Schools of Nursing workshop Sept. 10-11, 2024, at Morgan State University in Baltimore.

While the Campaign’s mentor-training workshops have reached nursing programs at more than 100 schools, this gathering was the first time that leaders from HBCUs, HSIs, and AIAN’s met together in person. Attendees also included leaders from the Campaign’s state-based coalition, the National Council of State Boards of Nursing, and several national nursing organizations.

The Campaign and the U.S. Department of Health and Human Services’ Office of Minority Health and Health Resources and Services Administration have collaborated since 2018 to improve mentorship programs among  underrepresented students.

Many students from backgrounds underrepresented in nursing face social and academic barriers that make it difficult to stay in school. The six-year graduation rates for first-time, full-time undergraduate students who began their pursuit of a bachelor’s degree-granting institution lag for Hispanic (54%), Black (40%), and American Indian/Alaska Native students (39%) compared with Asian (74%) and white students (64%).

Mentoring programs are a proven strategy to improve retention and promote academic success, thereby increasing representation in the nursing workforce and advancing health equity in rural and underserved communities.

In addition, mentoring programs can result in more students graduating and transitioning into academic and practice settings, thereby combatting persistent nursing workforce shortages undermining care.  

The First Day

The first day of the workshop covered key topics relevant to nursing schools, including NCLEX outcomes and strategies, navigating public and institutional policies, and positioning students as future faculty. Participants learned strategies for submitting effective grant proposals, explored review criteria, and discussed common application mistakes. Participants learned fundraising and grant writing skills. They developed preliminary grant applications using tips and suggestions from facilitators.

To help the schools improve their NCLEX passage rates, a representative from the National Council of State Boards of Nursing discussed the results of the Next Generation NCLEX in a panel with nursing leaders, who shared their approaches to increasing student success in preparing for and passing the exam.

Deans and faculty explored early mentoring and recruitment opportunities to develop future faculty members and prepare students for faculty careers. A nursing faculty shortage exacerbates the nursing shortage: nursing schools turned away 65,766 qualified applicants in 2023 due to a shortage of faculty available to teach them.

According to the American Association of Colleges of Nursing, there are nearly 2,000 full-time faculty vacancies. Estimates project one-third of the nursing faculty workforce in baccalaureate and graduate programs would retire by 2025. As a result, participants learned strategies to tap into their current students as future faculty.

Day two of the workshop focused on providing mentoring refreshers tailored to the needs of AIAN, HBCU and HSI faculty. Each of the three breakout sessions were conducted as facilitated discussions to engage faculty in dialogues designed to meet the needs of students in their unique programs.

AIAN Breakout

The AIAN breakout session provided an overview, analysis, and assessment of the AIAN mentoring curriculum. The session highlighted successful mentoring programs and, using case studies, offered participants a framework for effective curriculum implementation. Additionally, participants explored practice partnerships that support academic success, highlighting how schools can collaborate with Indian Health Services, health systems and other partners

HBCU BREAKOUT

Thirty-nine participants represented HBCUs. Each nursing school described their student mentoring programs and shared their success stories and challenges. Following this dialogue, participants engaged in a role-play of pre-planned scenarios related to common issues students may experience. These included fostering mentoring relationships, establishing mentoring agreements, mentor-mentee matching, and dealing with students’ academic challenges. These scenarios enabled faculty to apply their understanding of successful mentoring practices to familiar situations. The session concluded with two pre-recorded videos featuring students who described how participating in mentoring programs benefited them.

HSI Breakout

The HSI breakout session consisted of four presentations about strategies for nursing students’ success: enrollment and recruitment, collaborations and partnerships, the CliftonStrengths assessment tool to help mentees discover their strengths to maximize their potential, and the circle of mentorship. The last session discussed using mentorship programs to recruit and retain faculty. Participants also discussed other strategies to recruit and retain faculty, such as ensuring schools offer competitive compensation packages, provide education and research opportunities and promote nurse well-being and work-life balance. New faculty also can apply to participate in the American Association of Colleges of Nursing’s Diversity Leadership Institute.  

Evaluation

One hundred forty-four participants attended the meeting. Seventy-two percent completed the workshop program evaluation; 82% rated the workshop as excellent and said the objectives were achieved.

Participants rated the conference objective most highly (90% excellent): “Compare and contrast cultural frameworks that enhance the mentoring of students from underrepresented backgrounds, ensuring everyone feels included.” This rating was evidence of the success of the workshop’s focus on mentoring for the success of underrepresented students.

Respondents identified the following recommendations they would like to incorporate to improve the mentoring programs at their universities:

• More structured support: Mentees or mentors suggested that their program could benefit from clearer guidelines or more structured sessions.
• Additional resources: More resources, such as workshops, mentor training, or opportunities for mentees to connect with other participants, are needed.
• Better mentor-mentee matching: Some responses recommended refining the process for pairing mentors with mentees to ensure they are well suited in terms of personality or goals.

Finally, a recurring theme was how the mentoring relationship contributed to personal and professional development. Mentees shared how they felt more prepared for challenges they faced in life or work, and thanks to their mentor’s guidance, they achieved their professional or personal milestones.

Workshop Takeaways

The workshop offered participants opportunities to network, share strategies, and explore solutions. For example, nursing educators from two different schools discussed the possibility of sending qualified nursing applicants that were turned away from one school due to space constraints to the other school, which had openings. A nursing leader expressed support for a statewide initiative to create a centralized database or use the NursingCAS system to match qualified nurse applicants with available spots at schools, ensuring capacity limits do not prevent qualified candidates from enrolling in nursing school.

In addition, AARP will host a 2025 grant-writing workshop. This workshop will further AARP’s efforts to improve student outcomes, address the nursing faculty shortage and expand nursing program capacity.

The post Strengthening Nursing School Mentorship Programs appeared first on Campaign for Action.

The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation, is pleased to announce it is accepting applications for a new award program, co-sponsored by nursing organizations, that will recognize nurses who are helping lead the way to health equity through practice, education, research or leadership. We hope you will consider applying, nominating someone, or sharing word of the program with others who may be interested.

Five winners in separate categories will receive $1,000 each, plus paid travel to and attendance at the Campaign’s health equity summit in Washington, D.C., where awardees will be recognized at a reception. The AARP Health Equity and Nursing Summit: Turning Commitments into Action is scheduled for Oct. 31-Nov. 1 at AARP’s National Office. The conference will bring together leaders from health care delivery, nursing, unions, business, social services, social justice and consumer organizations to identify evidence-based solutions to the problems of disparities in health care delivery and access.

The Campaign launched an equity-minded nurse initiative in 2022 as part of its work to implement recommendations from the National Academy of Medicine report, the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. The Campaign defines equity-mindedness for nurses as so deeply understanding and embracing health equity, social justice, anti-racism, and cultural humility that these concepts emerge as normalized, automatic and default thought processes no matter the setting or the group of people they work with. In addition, AARP has launched the AARP Center for Health Equity through Nursing^SM, known as A-CHEN.

Individuals can apply or nominate others for an award beginning July 17 through Aug. 18. The Campaign will convene reviewers for each award category to evaluate applications and select winners, who will be notified in September.  

The award categories are: 

• The Equity-Minded Rising Star for student or early career nurses whose contributions show promise for ongoing impact in reducing health disparities and advancing health equity. This award is co-sponsored by the National League for Nursing.

• The Equity-Minded Practice Award for a nurse whose work with patients, families and/or communities exemplifies efforts to reduce health disparities and advance health equity.

• The Equity-Minded Research Award for a nurse researcher whose scholarship advances science knowledge that advances health equity.

• The Equity-Minded Educator Award for a nurse educator whose efforts demonstrate excellence in diversifying the nursing student body, inclusive teaching/learning practices, and whose teaching and/or curriculum design includes topics that lead to the graduation of equity-minded nurses. This award is co-sponsored by the American Association of Colleges of Nursing. (Updated: July 27, 2023).

• The Equity-Minded Leader Award for a nurse who is a catalyst for change at the systems or organization level to address and dismantle policies and structures that contribute to disparities and inequities. This award is co-sponsored by the American Organization for Nursing Leadership.

For more information about the award program, please see the frequently asked questions on the Campaign’s website.  

We thank you for your interest and hope you will consider applying or nominating someone.

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What actions can nurses take to advance health equity?

Answers to this question were the focus of Building Equity in Nursing and Health Care Leadership, a December 1 summit sponsored by AARP and the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation. Sponsors included AHIP, The Leapfrog Group, UnitedHealth Group, and The Joint Commission.

Summit participants included frontline nurses; nurse managers, educators, and employers; leaders in government, business, and professional organizations; and members of the Campaign’s state Action Coalitions, who are at the forefront of advancing health equity. Their calls to action were personal, programmatic, or focused on policy. Here are a few highlights of what they said.

Nurses need a stronger voice, said Mix, who believes all nurses have a role to play in advancing health equity. In her keynote address, she said the COVID-19 pandemic had produced a shift in nurses’ sense of self-worth. “Nurses have seen how valuable we actually are,” she said. “We have to do a better job of helping people understand what it means to be a nurse and the value that [we] add.”

Another powerful call to action came from Tasheeba Mongeon, who works at a federally qualified health center in Rochester, NY. Mongeon described what she learned caring for underinsured patients, many of them Black patients.  “It’s really not fair for us to judge anyone else…because we don’t know what happened to that person. No one wakes up and says, I want to be homeless today. No one wakes up and says, I may harm myself today,” Mongeon told attendees. How does she view her job as a Black nurse concerned about health equity? “To advocate for [my patients], to provide support, to jump in there before something happens.”

Beard recalled conversations with her grandfather, a Black man who refused to seek health care despite his cancer-related pain because “they don’t treat me the way that I should be treated,” he told her. Beard called racism “the elephant in the room,” and said the time had come for institutions to decide who within their ranks will take responsibility for addressing the problem.

Diversifying the health care workforce to address disparities in care is a strategy the Campaign has long embraced, but its implementation is still a work in progress. Another summit panelist, J. Margot Brooks Carthon, PhD, RN, FAAN, Tyson Endowed Termed Chair for Gerontological Research and Associate Professor of Nursing, University of Pennsylvania, proposed a related call to action. She urged nurse researchers to examine what specific skills and strategies nurses of color employ with their patients and for these effective practices to be standardized. “Are they building trustful relationships? Is it something about their communication patterns? Are they using deep, different teaching or motivational interview tactics? It’s not that they just show up in their melanated skin and they’re magic.”

How can a health system advance health equity? Luminis Health offers vivid examples.

1. It adopted a version of the National Football Association’s Rooney Rule, requiring search committees to recruit a qualified candidate with an ethnic-minority background for the finalist pool of every leadership vacancy in the health system.
2. Luminis got rid of a tardiness policy that disproportionately resulted in the termination of staffers using public transportation. Many of these employees were people of color.
3. When Luminis realized it wasn’t reaching people of color during the COVID-19 pandemic, the health system upended the prevailing policy of requiring a doctor’s appointment and referral for a COVID-19 test or vaccine. The system opened the first drive-up, walk-in test site in their community—no appointment needed. Then they went to barber shops, food distribution sites, and day-laborer gathering points “to truly meet people where they were,” Richmond said.

The health system continues to engage in rapid-cycle improvement to make its service delivery more equitable, in part through the Leaders in Equity and Diversity (LEAD) Collaborative, an initiative spearheaded by Meritus Health and Luminis Health with AARP’s support. “There is urgency,” to advancing health equity, Richmond said. “We have just gone through a pandemic, and it’s not over. And guess what? Racism is our second pandemic that we have to address as urgently as we have been addressing COVID.”

“We all have to [focus] on data, because data is what’s going to show that impact,” Jerde told summit attendees. To track where and how many United Health Group enrollees are referred to community-based services, the insurer created an ICD-10 medical code to track referrals related to social determinants of health.

Data is prioritized at RWJBarnabas Health in New Jersey as well. They track activities related to health equity using 33 performance metrics, 15 of which sit on a scorecard. “Executive compensation is tied to those metrics,” said DeAnna Minus-Vincent, MPA, Executive Vice President, Chief Social Justice and Accountability Officer, RWJBarnabas Health. “That’s why accountability is in my title.”

Elevating data collection and the self-reporting of demographic information is critical to advancing health equity, in the view of Rear Admiral Mix. “How can you say that you’ve had an impact on a particular population if you haven’t collected the data that actually tells that story?” she asked.

Richmond, President at Luminis, agreed but cautioned those in attendance not to become paralyzed by the search for perfect data. They should set priorities and act when the data is “good enough.”

As an accrediting body most closely associated with efforts to improve patient safety and the quality of care, The Joint Commission’s decision to make health equity its number one strategic priority speaks volumes. “We’ve been bold enough to say, this is [about] quality and patient safety. [Health care organizations] cannot choose to address central line infections and not address disparities in health care,” McKee asserted.

In January 2023, her organization will release a set of requirements aimed at reducing health care disparities. Every health care organization will need to put leadership in place to address the disparities and collect data to demonstrate the impact of health equity initiatives. McKee said some health care entities are already engaged in these activities, others want to be engaged but don’t know what to do, and still others don’t believe they have a problem. “That’s what makes this work really challenging and interesting,” she said.

For many nurses, speaking out can be hard. “We don’t want to say anything for fear of retaliation, because if I talk up, then I might lose my job,” said Taquana Holley, DNP, MSN, RN, Clinical Educator, Critical Care for the Center for Professional Development Innovation and Research, Monmouth Medical Center. She urged other nurses to overcome that fear. “Sometimes you have to kick down the door and let them know, Hey, I’m here, and I’m telling you, I want to do this.”

Many of the participants also called on nurses to be mentors and sponsors, develop leadership pipelines, and build their own support teams. Jean Accius, PhD, Senior Vice President, Global Thought Leadership, AARP, who was instrumental in supporting the summit, urged attendees to build relationships that bridge divides. “Identify someone in our workplaces, who doesn’t look like us, who is not from our background or walk of life, and create an opportunity for mentorship and reverse mentorship. You both will benefit,” he said.

These calls to action were music to the ears of Campaign leaders.

Several panelists urged everyone in attendance to read the Future of Nursing report and to use the Campaign’s Health Equity Toolkit. Since the National Academy of Medicine released its 2021 report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, the Campaign’s state Action Coalitions and other stakeholders have been working to spur action on the report’s recommendations. To facilitate this effort, the Campaign created a Health Equity Toolkit with resources and information to help communities address the social determinants that influence people’s health and an Action Hub with additional resources. Both can provide a foundation for health equity initiatives by individuals and groups.

The health equity summit was organized by Winifred Quinn, PhD, FAANP(H), FAAN, Director, Advocacy & Consumer Affairs, Center to Champion Nursing in America (CNNA), an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation that runs the Campaign for Action, and Mary Anderson, JD, Director, Advocacy, AARP Illinois. Reflecting on the gathering, Quinn observed, “This event was an important step in engaging a variety of stakeholders in the effort to improve care quality and outcomes and to advance health equity through a robust, diverse nursing workforce.”

Jazmine Cooper, MBA, CCNA’s Project Advisor for Advocacy & Consumer Affairs, who served as the event’s emcee, noted that mentoring was highlighted as a key strategy for building that workforce, and she expressed optimism about the future. “We will continue to create a safe space to have difficult conversations and explore solutions to address health disparities, racism, and improving health equity,” she said.  

Fauteux is founder and principal at Propensity, LLC, a communications firm serving educational institutions and nonprofits focused on health care, health policy, and the health professions.

Reinhard is senior vice president and director of AARP Public Policy Institute and chief strategist for the Center to Champion Nursing in America and Family Caregiving Initiatives.

The post Calls to Action for Advancing Health Equity appeared first on Campaign for Action.

Attendees at the American Academy of Nursing’s annual policy conference expect insightful commentary. This year, presenters delivered drama and emotion as well. The Academy kicked off the October meeting with four presentations in the popular Ted Talk format, and judging from the chatter in the hallways, the audience of roughly 1,200 people from 16 countries was both moved and impressed.

In keeping with the conference theme, From Reflection to Impact: Positioning Nursing’s Future, four nurse leaders shared their experiences of “failing forward” as they built their courageous careers. Here are some highlights from their presentations, plus video of each of their full presentations.

“I just want to illuminate the problem.”

Paul Leon, BSN, PHN, wanted to become a hospital executive, but his hours as a critical care nurse were not compatible with earning an MBA. He decided to become a public health nurse in Orange County, California. The job gave him regular hours and regular contact with people living on the streets.

One chilly March night, Leon was called to a public park to assist a mother with two sick children. With no resources to give them, he promised to return the next day, but when he got home that evening, Leon broke down. As someone who had moved at least eight times a year while in junior high school, he understood too well what his clients were going through.

As Leon’s wife tried to comfort him, she asked what he wanted to do. “I just want to illuminate the problem,” he replied, and the idea to start a nonprofit was born that night. Leon founded the Illumination Foundation in 2008 and set about disrupting the cycle of homelessness in Orange County and surrounding areas. The organization provides shelter, medical services, case management, and assistance in locating permanent housing, and it has become a leading provider of recuperative care to homeless individuals following a hospital stay.

The foundation’s impact on individual lives has been palpable.  Leon described one client who had been isolated from family and friends for so long when he entered the recuperative care program that it took him weeks to engage with staff. When the breakthrough came, it was profound. “’You guys put clean bandages on my wound,’ the man said. ‘You let me sleep in a warm nice bed, and you touched me. You made me feel human,’” Leon told attendees.

Today Leon is one of two Campaign for Action senior health equity fellows, and he has achieved his dream of becoming an executive. His current title is CEO of National Healthcare & Housing Advisors (NHHA), which is striving to integrate the delivery of health care and homeless care services across the nation.

Between 40,000 and 100,000 men, women, and children die on the streets in the United States each year, Leon told attendees. His courageous career has spared many that fate.

“My name is Felesia Bowen, and I want to be a dean.”

Felesia Bowen’s, PhD, ARNP, FAAN, talk began with a story from her student days.  She recalled watching a hospitalized nine-year-old brushing her teeth and coming to the realization that the girl lived in a house without running water. She knew she had to speak up or the girl would be discharged to an environment where she would almost certainly develop an infection. “Because of my lived experience, I knew that she didn’t have plumbing in her house,” she said. “That’s what a diverse nursing workforce does.”

Fast forward, Bowen became a nurse and eventually accepted a tenure-track position on the faculty of a well-known institution. She was one of three Black full-time faculty members. She obtained funding for research on health disparities, published her findings, and was invited to be a fellow in the Robert Wood Johnson Nurse Faculty Scholars Program. Then one day, a colleague called to say she wouldn’t be recommended for tenure. Bowen was crushed.  “In that moment, I felt worthless,” she said, and she felt confused, because she had done the work expected of academics.

When the phone rang a few weeks later, Bowen received a job offer from a university 11 hours away from her home.  With two children still in school, she weighed the offer carefully, consulted her husband and her mentors, and ultimately decided to take a chance on the opportunity.  Within a year, she was nominated and inducted into the Academy, and several years later, she was recruited into her current position.

“So, what’s the moral of my story?” she asked attendees. “Don’t let others define you, your work, or your worth…. Don’t be afraid to take advantage of the opportunities that come your way… Go for it.”

She closed with a message to nursing school deans who say they want a diverse nursing workforce. “You need to recruit diverse faculty, and when you get them, foster them, set them up for success,” she urged. “Make people feel like they belong so that they’ll stay. Do the same thing for your students.”

“I failed to ask for help from others around me.”

By any measure, Sheila Burke, MPA, BSN, FAAN, has had a stellar career—as health policy specialist and later chief of staff to former Senate Majority Leader Bob Dole, as a member of the Medicare Payment Advisory Commission, and as executive dean of the Harvard Kennedy School, to name just a few of the positions she has held.

Early on, she chose to pursue a career in policy, leaving hospital nursing for an opportunity to work with the National Student Nurses Association. From there, she headed to the U.S. Senate, where she was often the only woman in the room. She found mentors who helped her survive in that “boys club” and learned the hard way about the value of compromise when her views on welfare reform led to efforts to demonize her in the press.

Burke began her Academy talk by detailing a particularly painful experience from her time as chief operating officer of the Smithsonian Institution, which faced many challenges during her tenure. The institution had decided to renovate the Reynolds Building, which houses the National Portrait Gallery and the American Art Museum. Millions of dollars had been spent and construction had begun when Burke was called before the D.C. Arts Commission to explain the project.

“I did so, and I failed,” Burke told attendees. Many months later, after visiting each member of the commission with the project architect at her side, the commission approved the project. Meanwhile, the price of steel had risen by $10 million. For Burke, the recognition that she was not always the right person to deliver a particular message “was a painful and a very expensive lesson.”

Other lessons learned? Looking back on her entire career, she stressed the importance of finding a mentor (and becoming one, too), asking for help, and learning to listen—all skills that are familiar to nurses.

“It’s amazing what nursing has prepared us to do,” she concluded. “[The ability to work in] teams is one of them, the ability to set priorities, the ability to listen, …the ability and willingness to take risks, to stand up. Every nurse is prepared to stand tall.”

“My whole life, I’m different.”

“I’m a product of assimilation laws,” Margaret Moss, PhD, RN, FAAN, told attendees, and as an American Indian in the Washington, D.C., suburbs, she stood out even before grew to be six-feet tall. At an early age, Moss and two other children from the Mandan, Hidatsa, and Arikara (MHA) Nation were adopted by a German American neurosurgeon and his Scottish/English wife and sent from North Dakota to live in Bethesda, an affluent Maryland suburb.

When Moss shared the circumstances of her upbringing with people in later life, they’d often say, “Your father was a surgeon, and you grew up in Bethesda. What could be wrong?”

“Well, a lot was wrong,” Moss would inform them.

A self-described “woman of a certain age,” Moss grew up at a time when American Indians were considered “colored” under Maryland law. She couldn’t drink out of certain fountains or go to the local water park and had to sit in the balcony if she went to the movies. At her Catholic school, she was told her people were savages.

Moss survived the experience, but her older siblings did not. “When we were growing up, no one ever asked us, ‘Are you okay?’ My siblings would have said, ‘No, we don’t feel safe,’ and they weren’t,” Moss recalled.

Moss currently lives and teaches in Canada, which has started down the path of acknowledging the wrongs done to its indigenous people. Canada established a Truth and Reconciliation Commission in 2015, which led to requiring mandatory health professions courses in indigenous thought, engagement, understanding, and knowledge. Moss teaches one of those courses and invites elders to share their experiences of boarding schools and Indian hospitals. She concludes the course with an indigenous “talking circle,” where every participant is invited to speak. She said half of her students leave the experience in tears.

“They’re like, ‘We had no idea. How come nobody ever told us?’” Moss explained. “I said, ‘Don’t worry. It’s by design you didn’t know, but now that you do know, it’s incumbent upon you to bring it forward.”

She urged attendees who want to create a sense of belonging for students, faculty, and other co-workers at their institutions to look for ways to better understand and acknowledge indigenous peoples’ experiences.

The Courageous Careers event was hosted by the Academy’s Institute for Nursing Leadership in partnership with the Robert Wood Johnson Foundation’s Future of Nursing Scholarship program and AARP. 

Susan Reinhard PhD, RN, FAAN, senior vice president and director, AARP Public Policy Institute and chief strategist, Center to Champion Nursing in America and Family Caregiving Initiatives, welcomed attendees. She encouraged them to apply for

Health Equity Innovations Fund grants from the new AARP Center for Health Equity through Nursing and the Future of Nursing: Campaign for Action. Applications are due Nov. 15 before 10 p.m. ET.

The Campaign for Action, which is building a healthier America through nursing, was also a conference cosponsor. The Campaign is an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation.

View all video clips from the event.

The post “Failing Forward” appeared first on Campaign for Action.

In the wake of a national inflection point after the highly publicized killings of George Floyd, Breonna Taylor, and Ahmaud Arbery in 2020, nurses have become even more activated to leverage the potential of the nursing profession to advance health equity. In May 2021, the National Academies of Sciences Engineering and Medicine released the Future of Nursing 2020-2030: Charting a Path to Health Equity. In it they stated, “A nation cannot fully thrive until everyone — no matter who they are, where they live, or how much money they make — can live the healthiest possible life. And helping people live their healthiest life is and has always been the essential role of nurses…. Nurses, then, have a critical role to play in achieving the goal of health equity” (p 3-4).

Health equity is an aspirational vision of what population health can be. To achieve health equity, we must address and solve health inequities which can be defined as the systemic, avoidable, and unjust social and economic policies and practices that create barriers to health (Braveman & Gruskin, 2003).  Health equity can only be achieved by a collective approach which embraces the wisdom of all healthcare disciplines, including nursing. At four million strong, the nursing profession has the potential to influence policy on the systems, structures, and communities in which they work. However, as Nikitas, Emmons, and Ackerman-Barger noted, “For far too long, nursing and nurses have observed the negative impact of health inequities and disparate outcomes without seeing themselves as drivers of change” (2022, p. 7). By adopting the concept of “equity-minded nurses” we can rewrite this script for ourselves and become central to constructing the health outcomes that align with our professional and personal values.

Equity-minded nurses are those with the knowledge, skills, and desire to advance health equity. Equity-minded nurses recognize themselves as informed and capable drivers of change who are uniquely poised to inform healthcare practice, policies, research, and educational standards. The term ‘equity-minded’ was coined by the Center for Urban Education and “refers to the mode of thinking exhibited by practitioners who are willing to assess their own racialized assumptions, to acknowledge their lack of knowledge in the history of race and racism, to take responsibility for the success of historically underserved and minoritized student groups, and to critically assess racialization in the their own practices as educators and/or administrators” (McNair, Bensimon, Malcolm-Piqueux, 2020, p. 20).  Translated into nursing practice we might say that equity-minded nurses are

… those who are willing to assess their own racialized assumptions and recognize how these assumptions can impact their clinical decision making, to acknowledge the history of race and racism and how this history impacts current health outcomes, to take responsibility for the optimizing the health and wellness of historically underserved and minoritized individual patients, communities, and populations, and to critically assess racialization in their own practices as nurses, policy-makers, educators, researchers and/or leaders. 

Equity-minded nurses so deeply understand and embrace health equity, social justice, anti-racism, and cultural humility that these concepts emerge as normalized, automatic and default thought processes no matter the setting or the group of people they work with.

This is an exciting time in our development as a profession. The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation,  has given us a call to action: “Achieving health equity will require serious reflection on our identities and responsibilities as nurses, nurse champions and contributing members of society. Then we will need the willpower to turn that reflection into action.”

Through blogs, webinars, and events, the Campaign will spend the next 12-months highlighting examples of how equity-minded nurses practice, innovate, collaborate, and most importantly, positively impact the health of individuals, families, and communities. We hope you will join us on this journey and exploration.

References

Braveman P., & Gruskin S. (2003). Defining equity in health. Journal of Epidemiology & Community Health. 57, 254-258.

Campaign for Action (2022). Improving Health Equity. Retrieved from /issue/improving-health-equity/

Mcnair, T.B., Bensimon, E.M, and Malcolm-Piqueux, L. (2020). From equity talk to equity walk: Expanding practitioner knowledge for racial justice in higher education. Hoboken, NJ: Jossey-Bass.

National Academies of Sciences Engineering and Medicine. (2021).  Future of Nursing 2020-2030: Charting a Path to Health Equity. Washington DC: National Academy of Medicine.

Nickitas D.M., Emmons, K.R., Ackerman-Barger, K. (2022, accepted, in press). A policy pathway: Nursing’s role in advancing diversity and health equity. Nursing Outlook.

The post The Rise of Equity-Minded Nurses appeared first on Campaign for Action.

What kind of initiative brings together a beef council, a local theater group, and a state’s largest university? A Future of Nursing: Campaign for Action-supported program where nurses take on the problem of suicide in innovative ways. The Campaign is an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation.

The Kentucky Action Coalition’s “Kentucky Partners to the BARN (Bringing Awareness Right Now)” initiative first received funding from the Campaign’s Nursing Innovations Fund in 2020. In its initial phase, the project focused on the epidemic of farmer suicide. Action Coalitions are the Campaign’s state-based coalitions.

As the program’s leaders explained in an essay, while anyone can experience mental health issues, including suicidal thoughts, certain professions are more vulnerable because of several additional factors.

“Farmers are more susceptible to suicide because of unique stressors and suicide exposures associated with agriculture production, which include social isolation, relationship problems, and unpredictable forces such as crop and livestock loss, machinery breakdown, and commodity market fluctuations,” the team wrote.

The BARN program addresses these problems through the “Farmer Dinner Theater” approach first developed by Deborah Reed, PhD, RN, FAAN. Through dramatic presentations featuring actors as well as the farmers themselves, these gatherings help farm families discuss health issues facing their communities.

In the Action Coalition’s version of the program, more than 30 students who had an interest in agricultural careers were recruited through local 4-H clubs. They were then trained in suicide prevention skills as well as theater skills in order to produce the skits for the dinner theater.

In the end, 255 people attended the dinners, far exceeding organizers’ initial estimate of 100 attendees. Participants are exposed to a variety of proven mental health interventions, from breathing techniques to basic suicide intervention resources. But all the information is grounded in re-enactments of real situations that farm families may have faced.

“It is real, it is raw, it is powerful,” said Janie Heath, PhD, APRN, FAAN, dean of the University of Kentucky’s College of Nursing and one of the program’s organizers. “I have never seen a more engaged group of people in my life.”

Reflecting on the development of the program, Heath credits advice from the Campaign that prompted her and her colleagues to better engage with the community and its needs. That idea put them on the path to partnerships with groups like 4-H, the Kentucky Beef Council, and the Actors Theater of Louisville. The University of Kentucky College of Agriculture, Food & Environment and the Kentucky Future Farmers of America Association are also partners in this effort.

“Some of the best advice we received from the Campaign was to reach out to non-nurses to help us think about our strategy and next steps,” she said.

This evolution in thinking was part of a larger turn toward health equity in nursing, said Julie Marfell, DNP, APRN, a University of Kentucky professor and another leader of the project.

Since receiving their first innovation award in 2020, the Kentucky Action Coalition has greatly expanded its impact. Another innovation award in 2021 helped the group expand the BARN program to address the issues of mental health and suicide among young people, recruiting 100 school nurses to participate.

The same training and tools will also be used to address nurses’ well-being, an urgent priority identified by National Academy of Medicine’s The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

“It’s all about getting nurses involved in this work and trained in this work, and it all goes back to that first funding from the Campaign,” Heath said.

But the increase in impact goes beyond any one program. Heath said the new strategies and connections developed over the past few years have helped Kentucky’s nurses become more influential on policy matters. For example, the state recently moved to require continuing education in suicide prevention for nurses.

“We’re working with state government. We’re working with city councils. We’ve got street cred now and everyone understands that we’re not going away,” she said.

The Kentucky Action Coalition also has big plans to share what they have learned with other states. Working with the University of Kentucky College of Agriculture, Food and Environment, the College of Nursing is developing a toolkit to reproduce their successes with funding from the U.S. Department of Agriculture. The toolkit will include a planning guide, curricula, facilitators’ guide, and “train the trainer” lessons. Organizers plan to share the toolkit throughout the southern region of the United States.

To learn more about how you can implement programs like the one in Kentucky, visit the Nursing Innovations Fund page on the project.

The post Reducing Suicide Among Kentucky Farmers appeared first on Campaign for Action.

In principle, a novel pathogen like COVID-19 should affect everyone equally. But very early in the pandemic, it became clear that this was not the case. Once the disease was established in the United States, Black and Native American communities were hit especially hard and continue to suffer disproportionate harm today.

As the Centers for Disease Control and Prevention and others have explained, these divergent outcomes are due to social determinants of health, or SDOH; understanding these factors is an essential part of responding to public health crises. That’s one reason why disaster preparedness was a significant focus of the National Academy of Medicine’s report The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. The report calls on nurses to understand how addressing social determinants can make communities more resilient in the face of disaster.

But the Wisconsin Center for Nursing had already undertaken that work a year before the report was released, with support from the Future of Nursing: Campaign for Action’s Nursing Innovations Fund. The Campaign is an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation that is building a healthier America through nursing.

“We just got there early,” said Barbara Nichols, MS, RN, FAAN, executive director of the Wisconsin Center for Nursing.

Nichols and her team developed “Nurses Respond Now,” a training course meant to prepare working nurses to understand the needs of vulnerable populations during public health disasters.

The course had its origins in a survey of the needs of Wisconsin RNs and LPNs. These nurses told the Wisconsin Center for Nursing that their employers did a good job educating them in the basics of disaster preparedness. But they felt less competent when it came to the more general topic of public health crises and how they intersect with health equity.

“What I’m pleased by is that we developed the course based on data about what nurses said they did and didn’t have,” Nichols said.

The project was initially piloted with 37 nurses caring for vulnerable populations in Milwaukee, then developed into a continuing education course available to nurses throughout the state. Partners in sharing the curriculum included the Rural Wisconsin Health Cooperative, the Wisconsin Primary Health Care Association, and the Bellin School of Nursing in Green Bay.

Nichols says the team is also looking at additional approaches to getting the word out, including the development of a “masterclass” for nursing school faculty.

The course addresses two central themes: the need to identify vulnerable populations in public health crises and the specific role nurses can play in serving them.

“The nurse has a specific role in responding to public health emergencies, and if nurses are prepared, the hospitals and communities they are a part of will do a better job,” she said. “The course helps you connect those dots. It makes you a better practitioner.”

Some of the “dots” connected by the course were identified by program exit surveys. More than 90 percent of nurse participants said that after the course they could explain the specific impacts of COVID-19 on vulnerable communities, use social determinants of health as a framework to analyze their needs, and provide care in spite of their own unconscious biases.

The course also served as a platform to discuss systems-level changes that nurses desire in their communities. Many participants said that they wanted to see their organizations develop specialized teams devoted to addressing the social determinants of health, or new resources frontline nurses can access.

More generally, Nichols said she saw the course as a way for Wisconsin’s nurses to become more comfortable discussing the topic of race. More than 85 percent of the state’s population is white; more than 90 percent of the nurses are as well, she said.

“You could live in Madison and never come into contact with a Black person, even though there are 10,000 of us,” she said.

For other organizations looking to make a similar impact on health equity issues, Nichols’ advice is simple: start with data. By asking the state’s nurses what they needed, the Center was able to make more effective use of its funds.

“You don’t necessarily need a lot of money to be impactful if you are focused,” she said.

Read more about the Campaign’s Nursing Innovations Fund and Wisconsin’s program.

The post Wisconsin Nurses Lead in Disaster Preparedness appeared first on Campaign for Action.

Nurses’ efforts to achieve health equity are always stronger when they form partnerships with the community being served. That’s why matching funding and local partnerships were a requirement for every project supported by the Future of Nursing: Campaign for Action’s Nursing Innovations Fund. The connections facilitated by this design were essential for these projects’ impact.

But an Innovation awardee in North Carolina took an especially effective approach to forming partnerships: engaging a “coalition of coalitions.”

This approach was pursued by Project RARE (Reciprocal, Authentic Relationships for Equity), an initiative of the North Carolina Agricultural and Technical University (NC A&T) supported by the North Carolina Action Coalition, a state-based arm of the Campaign. Initially focused on COVID-19 vaccinations in underserved communities, the program has since expanded to focus on an array of health conditions in African-American and rural communities.

According to program leaders, the relationships at the heart of this initiative were actually formed at a meeting about the Campaign’s Health Equity Toolkit. That’s where the Campaign, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation, took care to introduce Action Coalition leaders with representatives of Historically Black Colleges and Universities (HBCUs) from their states. That’s how Valerie Howard, EdD, RN, FAAN, met Lenora Campbell, PhD, RN.

“That was where the relationship began,” said Howard, who was recently named Dean of the College of Nursing at University of North Carolina Chapel Hill. “It’s all about building and maintaining relationships with others, even if you don’t know exactly what opportunity is going to come of that.”

Howard and Campbell, who served as Dean of NC A&T’s College of Health and Human Sciences until 2021, were soon using the toolkit to design a new approach to addressing social determinants of health in North Carolina. Cone Health, their partner and the provider of the matching funds, identified six North Carolina ZIP Codes with the highest number of low-acuity emergency room visits — a classic sign that a community lacks access to health care resources.

Then the team worked with churches in each ZIP Code to identify their most important health needs. Crucial to this partnership was the Congregational Nurse Program established by Cone Health in 1998, which had already identified trusted health professionals in many faith communities.

Congregational nurses are members of churches who serve as health advisers to their co-parishioners. According to Howard, these members of the most trusted profession enjoy an even higher level of trust. “It’s not just that you brought in a nurse to speak to this congregation,” she said. “She is a part of the congregation, a trusted member of the community.”

By the time Howard and Campbell began meeting with the pastors and nurses, it was clear that the COVID-19 pandemic would be the most pressing health need for their communities. So they agreed to work with Cone Health and the Guilford County Health Department to set up church-based sites for testing and vaccinations.

Campbell said that an important strength of the churches, Cone Health, and all the partners involved in the work was that they each already represented strong local coalitions. This helped bring whole communities on board from the start.

“If you can come to the table with people who already understand the importance of forming partnerships and coalitions, and who bring some themselves, then you are going to be ahead of the game,” Campbell said.

“You can already have diversity of thought when you receive an opportunity,” Howard added. “We all bring our own ideas and opinions, and that strengthens any proposal or initiative.”

That’s not to say the program did not face challenges, however. Campbell said that in early conversations, it was unclear what role pastors would play. They were more comfortable serving as spiritual leaders than health leaders, she said.

“They were pretty quiet in those meetings when we started out,” she said. “We let them be quiet if that is what they needed to be. But then we provided expertise that helped them feel like they could engage on these issues.”

One key area where the pastors could lead was building trust. As in underserved communities all over the country, the mostly Black church communities had a higher level of distrust in the health care system due to a history of racial violence and oppression.

The team took care to explicitly address these concerns. For example, presentations by a virologist explicitly contrasted the development of today’s vaccines with traumatic episodes from the past such as the Tuskegee Syphilis Study.

“He couched what he was saying in terms of historical information for marginalized communities,” Campbell said. “For many of the pastors, this was an a-ha moment. It said ‘We have this history, but we also have this virus that knows no history.’ The virologist himself was African-American, so he understood the full weight of what they were dealing with.” The pastors, in turn, felt comfortable embracing the information shared.”

While the counties targeted by the program had COVID-19 vaccination rates that were lower than average overall, the data show signs of hope in the communities being served by the program, with vaccination rates rising among the targeted communities The team attributes this difference to the work of Project RARE.

Now the project has turned to designing interventions for hypertension, cardiovascular disease, and other chronic diseases exacerbated by social determinants of health. But no matter what health issues are addressed, Campbell said, nurses will still be key to the program’s success.

“Nurses have always been focused on the whole patient,” she said. “That’s our history. They were focused on social determinants before anyone even coined the term.”

If you want to build programs like the one that emerged in North Carolina, learn more by visiting the Nursing Innovations Fund page or by downloading the Campaign’s Health Equity Toolkit.

The post To Achieve Health Equity, Build a “Coalition of Coalitions” appeared first on Campaign for Action.

When nurses are empowered to create health equity in their communities, they bring together a network like nobody else can.

The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation, has demonstrated this principle through its Nursing Innovations Fund that supports the Campaign’s state-based Action Coalitions in creating replicable and promising solutions for improving health equity through nursing.

The Nursing Innovations Fund was also designed to spark collaboration with partners outside of nursing. One condition of the award is that applicants must seek matching funds from other organizations. In combination with other tools to engage local stakeholders, the awards have led to an impressive array of new multi-sector relationships, helping nurses discover new allies for creating better access to care and services.

Launched in 2018, the Nursing Innovations Fund has led to new projects in 23 states. The Campaign has awarded more than $850,000 to a wide variety of initiatives, with every dollar being matched by other funders. This blog highlights the collaborations and projects from the 2019 and 2020 cohorts representing 17 states, whom created over a dozen publicly accessible tools to be used for building health equity. All of the resources are available on the Campaign website.

State coalitions secured investment from multiple organizations that understand why it is so important to invest in better access to care and services. They include organizations one might expect, such as hospitals, nursing schools, and regional philanthropies. Action Coalitions also secured funding from unexpected sources:

• In Georgia, funding from the Clayton County Fire and Emergency Services helped create more effective paths for Black men to enter nursing.  
• In Kentucky, the Kentucky Beef Council supported an initiative to prevent suicide in the farming community, and
• In Nebraska, Scoular, an agriculture supply chain company, contributed matching funds to a project aimed at improving health equity.

In addition to funders, Action Coalitions garnered critical support from community partners representing dozens of different organizations. Here are a few of their stories:

• In Pennsylvania, a podcast highlighting nurses in health equity roles featured many local partners, including Sanctuary Farm, a program that converts abandoned areas in Philadelphia to farm plots.
• In Washington, a program to bring culturally appropriate food and essentials to older Filipino community members worked with local and national groups such as the National Alliance for Filipino Concerns.
• In Indiana, nurses from the Indiana Center for Nursing collaborated with the AARP state office to enable nursing schools across the state to implement holistic admissions programs

Crucial to the impact of these projects is the idea that all of them can provide insights that help many other organizations disrupt disparities and improve access to care and services.

Actions Coalitions drew on well-established tools to address health disparities, including the Campaign’s Heath Equity Toolkit and the Centers for Disease Control and Prevention’s (CDC) Healthy People 2030. In turn, many of them developed new resources to help others:

• In Wisconsin, the Action Coalition developed a curriculum to improve nurses’ disaster response capabilities, and it is being shared throughout the state.
• In Massachusetts, nurses developed an anti-vaping resource kit for use in public schools.
• The Pennsylvania initiative centers on a podcast that helps nurses envision new careers in health equity.

Together, these partnerships, resources, and insights add up to a powerful network working to achieve health equity in the U.S. built on strengthened nursing capacity and expertise, as the National Academy of Medicine’s Future of Nursing 2020—2030 report has envisioned.

In the coming weeks, this Campaign blog will feature more detailed explorations of how this work brought together local and state coalitions to address health equity. Projects to be featured include:

• Indiana – This project brought together partners including AARP Indiana State office and Orbis Education to help nursing programs implement holistic admissions and peer-to-peer mentoring for the Nursing Education, Engagement, and Diversity Statewide Initiative, or NEEDS.
• Kentucky – The Kentucky Nurses Action Coalition enlisted school nurses to address the state’s disproportionate suicide rate, culminating in a dramatic presentation designed with the Actors Theater of Louisville. Title: School Nurses to BARN Camp for the Mental Health and Wellness of Kentucky Youth.
• Massachusetts – This project addressed vaping in youth in partnership with education and law enforcement groups from across the state, yielding new curricula to aid teachers in elementary and secondary schools. Title: Promoting Health Literacy to Influence Health and Wellness of Students in the Community: Widening the Connections.
• North Carolina – Working with the North Carolina Action Coalition, the North Carolina Agricultural and Technical University developed a new model of coalition-building to help African American and rural communities. Title: Project RARE (Reciprocal, Authentic, Relationships for Equity).
• Wisconsin. The Wisconsin Nurses Center explored gaps in the state’s emergency preparedness plans, then developed a training to help nurses address the problems. Partners included nursing schools as well as the Rural Wisconsin Health Cooperative and the Wisconsin Primary Health Care Association. Title: Preparing Wisconsin Nurses to Address the Needs of Vulnerable Populations in a Public Health Emergency.

Previous blog entries have also explored Nursing Innovations Fund programs in Pennsylvania, West Virginia, and Wyoming.

Are you interested in addressing health equity in ways like the Campaign’s Action Coalitions? Visit the Nursing Innovations Fund page for a complete list of programs as well as the Campaign resources nurses used to create them.

The post Nursing Innovations Funds Stimulate Partnerships appeared first on Campaign for Action.