Jun 05, 2023

How I Became “The Health Equity NP”

I recently learned about and strongly resonated with the concept of the equity-minded nurse, as described by Piri Ackerman-Barger, PhD, RN, FAAN, senior health equity fellow for the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation.  

“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 their lack of knowledge about the history of race and racism and how this history impacts current health outcomes, to take responsibility for 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.”  

My path to becoming a speaker, educator, consultant, implicit bias, racial health disparities, and health equity content expert has been a journey. I practiced for more than a decade as a registered nurse and have been an adult nurse practitioner in primary and GYN primary care in New York City, one of the world’s most racially and ethnically diverse cities, for over 20 years. I am a nurse by choice, not by default, and I chose nursing as a career because nursing philosophy is holistic. Nurses focus on more than body systems or disease entities. Instead, we assess the whole person to determine how to intervene and guide the patient to a state of wellness. The holistic approach of nursing is inherently equity focused. This ideology appealed to me decades ago, and I still believe that becoming a nurse was one of my best life decisions.

However, my passion for educating health care providers about racial health equity developed from working in a national multidisciplinary health care organization where I was the only Black provider in the East Coast region. After a few months at the job, as an outspoken person, I could no longer keep quiet. So, I started asking questions about the lack of diversity, equity, and inclusion and its impact on health outcomes. Unfortunately, the response from the organization’s leadership was dismissive. And I realized that many health care providers, educators, and leaders do not understand foundational concepts such as race, racism, and implicit bias and how they impact the patient experience and care we provide. As a result, they cannot authentically engage in higher-level discussions about these topics. I considered leaving the practice, but instead, I was able to turn disappointment into opportunity.

Patients’ stories of encountering bias while navigating health care systems and those of friends, family, and my own inspired me to apply to the Duke-Johnson & Johnson Nurse Leadership Program, now called –the Duke Advanced Practice Provider Leadership Institute (APPLI). Thankfully, in 2018, I was accepted as one of 30 nurse practitioners and midwives from across the United States in the career-changing one-year program. My program project focused on developing evidence-based continuing education content to address the lack of knowledge I experienced among my work colleagues. The signature presentations I created fill the gaps in most providers’ formative health care education curricula that most often exclude the topics of race, racism, and implicit bias. With the support of mentors and other equity-minded advanced practice nurses in my cohort, I decided to try to educate my colleagues and leaders within the organization rather than leave my job. Unfortunately, despite my efforts, the organization was not ready to take anti-racist action by supporting and implementing a comprehensive education program to improve health equity for all. So, at that point, it was time for me to leave.

Again, motivated by disappointment about the lack of diversity, equity, inclusion, and belonging in my workplace and ignited by a passion for educating health care providers about implicit bias and health disparities, and a desire to advocate for health equity for patients of color, I became  “The Health Equity NP.” Since leaving my job, I have presented over 50 times in person and virtually to high school and college students planning to pursue careers in the health professions, nursing, nurse practitioner, midwife, nutritionist, other allied health professional organizations, and multidisciplinary medical practices. And it is my mission to continue sharing this information with nurses, the largest segment of the health care workforce, and as many other health care providers as possible.

During the “racial reckoning” of 2020, sparked by the murder of George Floyd, I received a spike in requests from health care providers, educators, and conference planners for implicit bias training. Sadly, only three years later, the increased interest in learning about bias, ways to mitigate it, and provide more equitable care, has begun to wane. We must prioritize integrating content related to implicit bias and social determinants of health, the systemic factors contributing to health disparities, and health equity into nursing, allied health, and medical curriculum and make equity-focused continuing education a requirement. In addition, we must move beyond addressing racial health disparities through implicit bias “training,” which often leads to “box checking” and believing that addressing bias is finite rather than a commitment to life-long learning and anti-racist action. As a result, I don’t consider the work I do training. Instead, I strive for personal transformation by providing historical context about race and racism, interactive evidence-based implicit bias and racial health disparities content, self-reflection activities, and opportunities for Q&A. Nursing researchers, academics, and educators must continue working to identify best practices for integrating equity into every aspect of the path of becoming health care providers and continuing education.

Many health care organizations can benefit from equity-minded nurses who can address health conditions disproportionally impacting communities of color, such as Black and Indigenous maternal mortality, asthma, hepatitis C, HIV, and chronic kidney disease, among others. I encourage nurses to look around their environment to find areas of need that spark passion, inspire them to educate themselves, and become equity-minded nurse content experts and advocates in their practice areas, institutions, and communities. There is so much work to do, and nurses are ideally suited to help advance health equity for all.

Ms. Blount is an adult nurse practitioner in New York City. She has 30 years of clinical experience in health care and has been recognized with awards for customer service, leadership and clinical excellence.