Toward Health Equity for All: A Complex Yet Congruent Future of Nursing

With the COVID-19 pandemic quieting, at least in the United States, we are perhaps entering a time where future orientation and goal direction can begin to reenter our work and personal lives. However, there are impressions that we carry forward from 2020, individually and collectively, including perspectives of political unrest; the deaths of George Floyd, Breonna Taylor, and others by law enforcement agents; and the deaths of millions of individuals across the world from a novel coronavirus.

The COVID-19 pandemic magnified the disparate effects of institutional racism on individuals, families, and communities with preexisting health inequities. Another focus from the pandemic is the excessive risks to healthcare workers, particularly nursing personnel, not only in physical health but also in deleterious effects to mental and spiritual dimensions of well-being. Nursing deaths from work-related COVID-19 exposures differentially affected Black and Asian nurses at much higher rates than White nurses; some of the excess morbidity and mortality has been attributed to inequities in risk prevention related to insufficient supplies of personal protective equipment and shortages of hospital equipment. For nurses across practice areas, the complex situational ethics of the pandemic challenged the ability to protect self and family while also upholding the underlying values of the nursing profession—to care for patients in any circumstance. The ensuing moral distress, personal and professional, will require systematic attention and strategies to learn from and prevent such catastrophic failures in the future (Altman, 2020).

With this backdrop, the timely announcement of The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, a consensus study from the National Academies of Sciences, Engineering, and Medicine (2021), provides an orientation for nurses as instrumental agents in mitigating health inequities. In conjunction with nurses taking on broader roles in healthcare delivery and participating in institutional changes in health care, the report emphasizes the importance of nurse well-being and resilience. The report threads the underlying concepts of health equity and antiracism into nursing practice and research, and informs nurses as advocates for social justice. Specific recommendations include increasing the number of nurses available to meet the nation’s growing healthcare needs and “rightsizing” the clinical specialty distribution of nurses. Of note, the Future of Nursing 2020–2030 report emphasizes the necessity of systemic changes so that nurses can address social determinants of health across healthcare settings, including schools. Attention to these issues may preserve nurses not only as a workforce, but also as change agents who contribute to health equity in individuals, communities, and populations as a whole.

Challenging the paradigm that wellness for nurses requires individual-level focus on risk factors and interventions in stress reduction, the report emphasizes changing the institutional factors in healthcare environments that cause harm to nurses and other healthcare providers. We know that nurses in settings that entail prolonged contact with patients with critical illnesses, such as oncology, experience burnout (Cañadas-De la Fuente et al., 2017). A key recommendation from the Future of Nursing 2020–2030 report states that, in 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence-based interventions to promote nurses’ health and well-being, particularly as they take on new roles to advance health equity. However, the United States is experiencing a healthcare provider shortage and, in particular, an increasing nursing shortage. By 2022, there will be far more RN jobs available than any other profession, at more than 100,000 per year. With more than 500,000 RNs anticipated to retire by 2022, the U.S. Department of Health and Human Services (2018) projects the need for 1.1 million new RNs for expansion and replacement of retirees. Given that the achievement of health equity in the United States requires strengthened nursing capacity and expertise, careful attention should be given to quickly addressing retention of current nurses and increasing the pipeline for future nurses, with particular focus on increasing the numbers of Black and Latinx nurses for a full career span in nursing.

In concordance with the compelling issues, challenges, and opportunities for current and future oncology nurses, the Oncology Nursing Forum Editorial Board recently crafted a new mission statement:

The mission of the Oncology Nursing Forum (ONF), an official publication of ONS, is to amplify oncology nursing science and support translation of research evidence to practice and policy. The intent of ONF is to foster health equity for individuals, families, and communities affected by cancer through dissemination of research that transforms cancer care in health systems and communities.

We want our authors, researchers, nurses, and other readers to be part of the call to health equity, focusing on eliminating the effects of institutional racism and improving health for all. Our discipline must address these issues not only for the health of our population, but also for the future of our discipline.

About the Author(s)

Debra Lyon, RN, PhD, FNP-BC, FAAN, is the executive associate dean and Kirbo Endowed Chair in the College of Nursing at the University of Florida in Gainesville. Lyon can be reached at ONFEditor@ons.org.