1. Sedlak, Carol A.
  2. Kujath, Amber S.
  3. Luther, Brenda


The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report was released in May 2021 by the National Academies of Sciences, Engineering, and Medicine. The goal is attainment of health equity in the United States using nursing capacity and expertise by designing a pathway for the nursing profession to generate a culture of health, reduce health disparities, and improve the nation's health and well-being. The focus of this article is to develop an awareness and understanding of the nine Future of Nursing recommendations for attaining health equity over the next decade with an application to orthopaedic nursing.


Article Content

In 2020, during the year of the Nurse and the Midwife (World Health Organization, 2019), nurses experienced unthinkable events during the coronavirus disease-2019 (COVID-19) pandemic and witnessed the inequitable impact of the virus. In this special topic issue of Orthopaedic Nursing, major intertwining concepts are presented that address a national crisis of inequity. In May 2021, an evidence-based report was released by the National Academies of Sciences, Engineering, and Medicine (NASEM) titled, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (NASEM, 2021a). The report designs a pathway for the nursing profession to take a leading role over the next 10 years to reduce health disparities, generate a culture of health, and thereby improve the nation's health and well-being through a strengthened nursing capacity and expertise.


The Future of Nursing 2020-2030 addresses healthcare influence on patients and healthcare staff, particularly nurses. A robust, more diversified nursing workforce is essential for the future to provide care, promote health and well-being of all (nurses, individuals, and communities), and address systemic inequities that have triggered health disparities (NASEM, 2021a). To achieve improved health for our nation, nursing needs to commit to "upstream" interventions (interventions at both the community and individual level that would eliminate the health problem), focus nursing assessment directed to the root cause of what makes people sick, commit to addressing the underlying conditions in our client's environment, and work to mediate our client's social needs to affect health, wellness, and illness care (Castrucci & Auerbach, 2019).


The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (NASEM, 2021a), a 469-page document is the result of the Robert Wood Johnson Foundation request to the National Academy of Medicine to design a pathway for the nursing profession for generating a culture of health, reducing health disparities, and improving the nation's health and well-being. The goal is attainment of health equity in the United States created on strengthened nursing capacity and expertise. The report is free and can be found in the link in Table 1.

Table 1 - Click to enlarge in new windowTable 1. Resources for


Health equity is defined as the opportunity for all to attain full health potential and individuals should not be deprived of this opportunity because of social status or socially defined situations (NASEM, 2017). Health inequities are systematic differences in opportunities for ideal health reflected in differences in length of life, quality of life, rates of disease, disability and death, severity of disease, and access to treatment (Centers for Disease Control and Prevention, 2020). These inferior health outcomes or disparities disproportionately impact population groups such as people of color, with low income, with disabilities, living in rural areas, and the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community (NASEM, 2021a). One way to envision improving health equity is to eliminate health disparities by coordinating public health, healthcare, social services, and public policy (NASEM, 2021a).


Disparities in Clinical Care

Research examining access to primary care and disparities has been more widely addressed than disparities in specialty areas. Disparities in orthopaedics is being examined, specifically orthopaedic access to care, quality of care obtained, and outcomes of postoperative surgical intervention such as total joint arthroplasty and spine surgery (Pandya et al., 2018). Insurance status, race/ethnicity, and gender are factors related to disparities even in telemedicine for orthopaedic surgery (Xiong et al., 2021). Orthopaedic clinicians need to be aware of the disparities and develop strategies to close the disparity gap in the specialty of orthopaedics.


There are clinical practice guidelines and algorithms that have disparity regarding race (Obermeyer et al., 2019; Vyas et al., 2020). Although clinician understanding of the effects of race and genetics has advanced, diagnostic algorithms and guidelines used by clinicians often adjust or correct for race and assess minority races as having lower risks (Vyas et al., 2020). For example, the estimated glomerular filtration rate (eGFR), a commonly used screening tool and risk calculator, uses race as a factor and has been identified as promoting bias and limiting access to interventions. The eGFR has been implicated in Black patients for delaying referral to specialty care or transplant due to race adjustment indicating higher kidney function (Eneanya et al., 2019).


Nurses have a major role in addressing disparities in orthopaedics. The focus of this article is to develop an awareness and understanding of the nine recommendations for health equity presented in the Future of Nursing 2020-2030 report and provide ideas for how to apply the recommendations to orthopaedic nursing through highlighting some of the interventions.



The vision of the Committee on the Future of Nursing 2020-2030 led to development of nine evidence-based recommendations and 54 associated action items to help society reach health equity (NASEM, 2021a,2021c). The recommendations listed in Table 2 are (1) creating a shared agenda, (2) supporting nurses to advance health equity, (3) promoting nurses' health and well-being, (4) capitalizing on nurses' potential, (5) paying for nursing care, (6) using technology to integrate data on social determinants of health into nursing practice, (7) strengthening nursing education, (8) preparing nurses to respond to disasters and public health emergencies, and (9) building the evidence base.

Table 2 - Click to enlarge in new windowTable 2. Recommendations from

The recommendations, supported by a research agenda, call for change by individuals and systems, and include nurses in all settings and practice levels, to act in moving the United States toward health equity for everyone. As calls to action, the recommendations can facilitate change for policy makers, educators, healthcare system leaders, and payers.


For approximately 4 million nurses, including almost 4,000 members of the National Association of Orthopaedic Nurses (NAON) (M. Van Fleteren, personal communication, June 11, 2021), to make an impact on health equity, a robust education, supportive work environments, and autonomy are needed (NASEM, 2021b). Orthopaedic nurses are ideally positioned to rise to this challenge through promoting musculoskeletal health in individuals throughout various settings.


The nine Future of Nursing 2020-2030 recommendations are addressed with a description and examples of some of the suggested interventions by NASEM (2021a), applications specifically to orthopaedic nursing, and research suggestions by NASEM (2021a). A complete list of all the interventions can be found in the full Future of Nursing report.


1. Creating a Shared Agenda

Unleashing the power, expertise, and resources of national nursing organizations will be necessary to achieve health equity. It is imperative that organizations work in concert to prioritize education, practice, and policy around addressing the social determinants of health (SDOH) and advancing health equity. Creating a shared agenda will provide the best effort for nurses, regardless of where they are educated or where they practice, to work toward health equity. An example of organization collaboration is The Tri-Council for Nursing ( composed of five organizations: the American Association of Colleges of Nursing, the American Nurses Association, the American Organization for Nursing Leadership, the National Council of State Boards of Nursing, and the National League for Nursing focusing on leadership for education, practice, and research. Using pertinent expertise, the Tri-Council will work with member organizations to collaboratively create an agenda within organizations to assess racism and discrimination, and across organizations for building processes to influence public health nursing expertise as a resource in the nursing community, health systems, and as developers of public policy. Nurses are the largest workforce in healthcare and with a united effort have a great opportunity to define the future.


Proposed Interventions


1. Assess diversity, equity, and inclusion and eliminate policies, regulations, and systems that perpetuate structural racism, cultural racism, and discrimination with respect to identity, place, and circumstances.


2. Leverage expertise of relevant nursing organizations in care coordination and care management principles, approaches, and evidence to create new models for meeting social needs and addressing SDOH.


3. Develop approaches to prioritize shared continued education and skill-training resources focused on a healthy nursing workforce.


4. Increase the number of nurses serving on boards and expert panels that are within and outside of healthcare (community and school) and engaging in policy activism (Nurses on Boards Coalition, 2021; Patton et al., 2018).


Application to Orthopaedic Nursing

As an organization, NAON is committed to the recommendation of creating shared agendas with national nursing organizations and has already initiated action items that support a shared agenda and will continue to find ways to support initiatives and recommendations of the Tri-Council of Nursing, as well as other nursing specialty organizations, which align with eliminating systemic inequities.


1. Establish a task force to create a strategy to assess diversity, inclusion, and equity in the organization. NAON has established a task force and prioritized a review of NAON's policies through an equity lens over the next 3 years (2021-2024).


2. Commit to the American Nurses Association's "Healthy Nurse Healthy Nation" ( initiative. NAON has committed to incorporate the shared agenda of supporting healthy initiatives and challenges into NAON activities. For example, including wellness breaks for activities such as workouts, and conducting short meditation sessions during the NAON congress. NAON has a history of implementing continuing education that includes networking events at the annual congress and webinars with wellness topics such as thriving in times of change and improving communication at work and in one's personal life.


3. Address how SDOH effect orthopaedic outcomes and quality of life in the continuum of care for individuals with musculoskeletal conditions. NAON will continue to partner with other specialty organizations, as well as across professions to change policies that create barriers to treatment for common conditions such as low back pain or osteoarthritis.



Research Suggestions


1. Develop and assess organizational structures, interventions, and outcomes to reflect an orientation of diversity, equity, and inclusion within and across the nursing organization.


2. Examine how SDOH impact outcomes in specific populations and establish a priority for interventions to eliminate health disparities.


2. Supporting Nurses to Advance Health Equity

Everyone in our nation should have a sustained commitment to promote health and well-being for all, and nurses must lead the movement while feeling fully prepared and supported. Nursing schools, public health organizations, and healthcare institutions can do more to empower nurses to use their influence and expertise to improve health, specifically by fully addressing the SDOH and health equity across practice settings.


Proposed Interventions


1. Quickly increase the number of nurse experts in health equity and in specialties with significant shortages such as public health, behavioral health, primary care, long-term care, geriatrics, school health, and maternal health through workforce funding and major investments.


2. Direct the funding from U.S. Health Resources and Services Administration (HRSA) state governments, foundations, employers, and others to nurses and nursing schools to increase and sustain the gender, geographic, and racial diversity in nursing.


3. Provide significant investments from HRSA and the Indian Health Services in the form of nurse loan and scholarships programs to specifically address nurse retention.


4. Support nursing education through organizations at the state and federal level for socioeconomically disadvantaged students through partnerships between baccalaureate and higher-degree nursing programs and community colleges; tribal colleges; historically Black colleges and universities; Hispanic-serving colleges and universities; and nursing programs that serve a substantial number of Asian, native Hawaiian, and Pacific Islander students.


5. Help nurses play a leading role in achieving health equity through employer support (financial, technical, educational, and staffing resources).


Application to Orthopaedic Nursing


1. Disseminate orthopaedic knowledge to specialties such as primary care, geriatrics, school health, and behavioral health. Programs such as osteoporosis prevention, bone and joint health, injury prevention, and safe narcotic practices are a few examples of where orthopaedics intersects with specialties that are experiencing nursing shortages.


2. Offer expertise to organizations, such as the Movement Is Life Caucus (, which have visions to eliminate musculoskeletal disparities.


3. Disseminate knowledge of how SDOH impact orthopaedic patients.


4. Lead change in practice settings to encourage screening of all patients for SDOH such as food insecurities and housing.


Research Suggestions


1. Study and monitor entry into and exit from the workforce and determine effects on the future supply of nurses.


2. Examine how to effectively recruit nurses into underenrolled specialties, including long-term care and geriatrics, primary care, school nursing, public health, and rural nursing. This research would include identification of barriers and successful approaches to scaling these strategies.


3. Develop, implement, and evaluate interventions to eliminate implicit bias and structural racism in nursing education for students, faculty, staff, and administrators.


3. Promoting Nurses' Health and Well-being

Nursing is a demanding profession, as nurses encounter challenges that encompass physical, mental, emotional, and ethical dimensions that may lead to fatigue and burnout (NASEM, 2019, 2021a). The stress of the COVID-19 pandemic has taken a toll on nurses' health and well-being. This is due to the massive surge and exposure to crisis conditions, human suffering, moral dilemmas, bereavement, death, and obstacles such as unreasonable workloads and inadequate resources (NASEM, 2021a; Rosa, 2021). To promote health equity and address SDOH, nurses need to be healthy and supported by one another, and by stakeholders including policy makers, employers, nurse leaders, nursing programs, and professional associations.


Proposed Interventions


1. Incorporate content in nursing education programs addressing skills for nurses to learn how to facilitate their health and well-being.


2. Make available resources and support (human and material) for nurses to implement quality and safe care.


3. Create workplace policies and cultures that facilitate safety, ethical practice, and promotion of mental health without racism, bullying, microaggressions, and incivility.


Application to Orthopaedic Nursing


1. Continue to place high regard for orthopaedic nurses' promotion of physical health via the prevention of musculoskeletal injuries through promotion of safe patient handling and mobility (Satusky, 2021).


2. Provide resources for nurses (education, webinars, and blogs such as [NAON News]) addressing burnout, mental health issues, and a healthful practice environment (NASEM, 2019; Satusky, 2020).


Research Suggestions


1. Collect data from employer, state, and national levels to recognize nurses' health and well-being for developing evidence-based interventions to relieve burnout and health problems.


2. Decrease incivility and bullying among nurses and healthcare staff in the workplace as well as violence from patients, visitors, and family members.


4. Capitalizing on Nurses' Potential

Nursing is the largest U.S. healthcare workforce and ideally positioned to affect healthcare outcomes, as nurses protect, promote, and optimize health and clients' ability to optimally care for themselves within their environment (home, work, and communities) (American Nurses Association, 2020; Salmond & Echevarria, 2017; Thornton & Persaud, 2018). Transforming healthcare requires rethinking the role of nursing and capitalizing on nurses' potential to improve access to care, healthcare quality, and value of care provided to clients (Lal, 2020; NASEM, 2021a). Nurses traditionally have practiced in acute care environments applying evidence-based care processes required for intense care moments such as postoperative recovery or stabilization of life-threatening conditions. Nursing's potential now lies in nonacute care settings within clients' homes and communities where the focus of prevention and protection of health exists (McCauley & Coburn, 2021).


Employing the skills of licensed registered nurses (RNs) to work in ambulatory settings where they work to the top of their education, licensure, and expertise is a step forward in meeting the challenges of healthcare transformation (Flinter et al., 2017). Capitalizing on nurses' effect on health now requires nurses to be located in nonacute care environments where prevention of illness and optimization of health exist. This needs to be done in a way that recognizes, and pays for, the unique contribution of nursing and is supported by regulatory changes and payment structures (NASEM, 2021a).


Foundational nursing knowledge includes biophysical, psychosocial, economic, and cultural care thus positioning nurses to provide assessment and care planning for clients, as they experience a range of responses to health and illness within their physical and social environments. Some examples of an RN working to "the top of their licensure" are seen in chronic care management, transitional care, annual wellness visits, and advanced care planning (Blankson, 2021). All of these examples are billable services, which can be provided by an RN (May et al., 2021).


Nurses' skills and knowledge promote wellness and management of chronic illness, and foster team-based care outcomes such as decreasing provider burden and increasing workplace satisfaction (Flinter et al., 2017). Optimizing the role of the RN to focus on "upstream" preventive services in these settings expands care that can be offered to clients, increases access to care for them, decreases healthcare costs, as well as brings in revenue to these settings (Fraher et al., 2015).


Proposed Interventions


1. Mandate practice changes to include RNs working to the top of their licensure in all interprofessional team-based care (Salmond & Echevarria, 2017).


2. Strengthen nursing's capacity to promote value-driven initiatives in all care settings including focused skills of population health, care coordination across settings, chronic illness prevention and/or management, and health promotion/prevention of illness (Pittman et al., 2021).


3. Develop roles and responsibilities of nursing within interprofessional teams including identification and measurement of nurse-sensitive outcomes of care processes such as chronic care management, annual wellness visits, advanced care planning, and transitional care management (Fraher et al., 2015).


Application to Orthopaedic Nursing


1. Promote the education, expertise, and licensure of the orthopaedic nurse in the provision of value-driven, evidence-based nursing care for musculoskeletal health and injuries in nonacute care settings focused on wellness and prevention for population groups (Lal, 2020; Satusky, 2020).


2. Increase the capacity of the nursing workforce by providing ongoing education for promoting health equity and improving health for individuals and population groups (NASEM, 2021a).


3. Identify the role of nursing in nonacute, orthopaedic settings with a focus on prevention, optimal self-care management, and care coordination across all care settings (McCauley & Coburn, 2021).


Research Suggestions


1. Employ evidence-based orthopaedic nursing care practice in acute and nonacute care settings.


2. Identify orthopaedic nurse-sensitive outcomes of care.


3. Examine effects of orthopaedic nurse-sensitive outcomes of care on patient-related outcomes of care and costs of care.


5. Paying for Nursing Care

The Affordable Care Act of 2010 shifted the focus from fee-for-service payment (paying healthcare systems for the volume of care provided) to value-based payments wherein systems are paid based on the health and wellness outcomes of their clients. Shifting to value-driven outcome payment structures is pushing healthcare organizations to put nurses on the front lines of healthcare where they are positioned to target their support on clients' health and well-being, develop interventions to prevent or manage illness, and promote health, as well as decrease unnecessary and low-value healthcare usage (Fraher et al., 2015; Pittman et al., 2021).


Nursing's role in value-driven outcome payment models is limited by lack of measurement of nurse-sensitive outcomes of care and vague regulations defining nursing scope of practice (NASEM, 2021a); as well as hindered by the educational and institutional preparation and expectations of nurses working to eliminate low-value, high-cost care (Pittman et al., 2021). Innovation created within highly functioning, value-driven practices has demonstrated the effectiveness of nursing's role in healthcare transformation, which should be measured using nurse-sensitive outcomes of care. This includes promoting, paying for, and measuring nurse-led management of chronic illness, promotion of wellness, advanced care planning, and transitional care coordination in nurse-led initiatives in a variety of conditions and settings. For example, nurses have led programs for hypertension, anticoagulation management, smoking cessation, medication management for opioid use disorder, caregiver and patient support with dementia care, and women's health screening.


Proposed Interventions


1. Develop protocol-driven nurse-led assessments and interventions including the development of coding practices to capture billing for nurse-led encounters (May et al., 2021).


2. Perform risk stratification on population groups to identify high-risk, high-cost patient groups, and develop evidence-based nursing care and intervention for these groups (McCauley & Coburn, 2021).


Application to Orthopaedic Nursing


1. Continue to refine orthopaedic nursing care assessment and intervention for clients within bundled payment structures (Salmond & Echevarria, 2017).


2. Develop new prevention and care models for orthopaedic conditions within acute care and ambulatory settings (McCauley & Coburn, 2021).


Research Suggestions


1. Develop nurse-led encounter data base tracking to measure nurse actions and patient-related and financial outcomes.


2. Monitor bundled payment structures for disparities within groups to ensure the system of payment is not contributing to health inequities.


3. Track outcomes of care and nursing actions across systems of care.


6. Using Technology to Integrate Data on SDOH into Nursing Practice

Advances in the development of new technologies are requiring nurses and healthcare staff to possess technical skills for the practice setting (NASEM, 2021a). Nurses need to be involved in designing and using new technologies to obtain and integrate data on SDOH, and to assess population needs for healthcare equity. Use of telehealth care is moving nurses forward for reaching those in need. Nurses, as major stakeholders, need to be involved in the development, implementation, and evaluation of new tools using technology for providing care.


Proposed Interventions


1. Develop nursing-specific technical competency in use of digital health tools, and data analytics.


2. Hire and/or promote the development of nurses with proficiency in informatics, telehealth, and advanced digital technologies to enhance health of individuals and populations.


3. Advocate for resources for nurses to provide telehealth by increasing the national plan for broadband/5G infrastructure to facilitate access to a wide range of services in communities.


Application to Orthopaedic Nursing


1. Apply technology in designing tools (personal and mobile) across all healthcare settings for communication, assessments, and evaluation of interventions. For example, investigation by Wittig-Wells et al. (2020) addressed the impact of technology through smartphone preset app reminders on medication adherence of twice-a-day aspirin in adults as antithrombotic therapy after a knee or hip arthroplasty.


2. Disseminate knowledge of apps or other technology to promote health and well-being of nurses and patients.


Research Suggestions


1. Explore effectiveness in nursing education of virtual teaching, virtual reality simulations, and impact on ease of access for minority and rural nursing students.


2. Develop a nationwide collaborative framework for telehealth and digital medicine equity to achieve balanced and accessible healthcare delivery (Rokosh et al., 2021).


3. Examine outcomes of mobile health technologies on well-being of nurses.


7. Strengthening Nursing Education

Because the profession of nursing will change greatly by 2030, strengthening nursing education will help to prepare and educate nurses to promote health equity, decrease health disparities, and enhance health and well-being. Nursing programs need to help prepare future nurses to have the skills to identify SDOH, and experience community learning opportunities while working with individuals in a diverse and aging population with different cultural values (NASEM, 2021a).


Proposed Interventions


1. Integrate core concepts (social needs, SDOH, population health, ambulatory care, environmental health, trauma informed care, and health equity) and competencies seamlessly throughout the curriculum, and in clinical and experiential learning.


2. Use guidelines from national nursing education organizations such as the American Association of Colleges of Nursing (2021) and the National League for Nursing (2019) for preparing nurses to integrate SDOH and health equity.


3. Ensure that test items are incorporated by the National Council of State Boards of Nursing for meeting social needs through care coordination and addressing health equity needs.


4. Recruit, support, and mentor faculty and students with a wide range of diverse backgrounds.


5. Enhance partnerships with public and private sector organizations and associations to strengthen nursing education.


Application to Orthopaedic Nursing


1. Ensure that the Orthopaedic Nursing Certification Board (ONCB) specialty certification examinations for Orthopaedic Nurse Certified (ONC), Orthopaedic Nurse Certified Advanced (ONC-A), and Orthopaedic Nurse Practitioner Certified (ONP-C) address social needs, SDOH, population health, environmental health, trauma-informed care, and health equity as core concepts and competencies.


2. Cultivate an inclusive nursing environment acknowledging facilitators and barriers to achieving success.


Research Suggestion


1. Explore methods for educators to teach students and nurses in a variety of settings specific content addressing SDOH, health equity, and structural racism.


8. Preparing Nurses to Respond to Disasters and Public Health Emergencies

Across all practice settings, the COVID-19 pandemic has highlighted the essential role of nurses on the front lines and the need for emergency preparedness for disaster planning. From community testing sites, emergency shelters, emergency rooms, inpatient units, to intensive care units, nurses responded. However, 78% of nurses do not feel prepared for public health emergencies such as natural disasters (NASEM, 2021a,2021d). Nurses will need to be prepared for human-caused disasters including the rise in gun violence and mass shootings, and climate change natural disasters such as wildfires, flooding, and intense heat waves.


Proposed Interventions


1. Formulate a National Center for Disaster Nursing and Public Health Emergency Response through federal agencies such as the Centers for Disease Control and Prevention addressing the lack of nurse preparedness and disparities in public health emergencies.


2. Transform nursing education to tackle workforce expansion in disaster nursing and public health preparedness and ensure the National Council of State Boards of Nursing include test items encompassing nurse responsibilities.


3. Incorporate nursing expertise in the development and implementation of emergency response plans for natural disasters and public health emergencies.


4. Provide family support and behavioral health promotion to protect nurses' health and well-being during natural disasters and public health emergencies.


Application to Orthopaedic Nursing


1. Maintain skills to quickly pivot from the specialty of orthopaedics to disaster or public health emergency needs, as elective service lines are quickly closed during a disaster or public health emergency.


2. Advocate for cross-training of orthopaedic nurses to feel comfortable in nonorthopaedic settings during emergencies.


3. Recognize signs of trauma or behavioral health concerns in nurse coworkers grappling with the stress of disasters or public health crisis and provide support and reprieve.


Research Suggestions


1. Assess areas and roles that nurses need to be educated and trained in for disaster preparedness and public health emergency response to promote population health and health equity.


2. Develop a program of research leading to intervention studies addressing research gaps in nurses' roles in disaster preparedness and public health emergency response.


9. Building the Evidence Base

Improving health and addressing the holistic experience of health needs and illness experiences for clients are the strength of nursing practice. Research created and evidence used in nursing practice is being called on to encompass the "whole picture of health" for clients, which includes SDOH, health equity factors, and translating this knowledge into nursing and healthcare system practices and policy (National Institute of Nursing Research, 2021). Nursing has always been an evidence-based practice (Dang & Dearholt, 2018; Grady, 2010).


Now, the Future of Nursing 2020-2030 recommendations (NASEM, 2021a) challenge the profession to find and use evidence to: assess and address SDOH, health equity, and environments of health to create more holistic and evidence-based "upstream" nursing practice. To capitalize on the potential of nursing in these new and expanded roles, nursing also needs to measure the impact of nurse-sensitive outcomes of care, and conduct research in collaboration with communities across settings and systems. Additionally, nursing needs to use and create evidence studying best practices for nurses' well-being.


Proposed Interventions


1. Create a system-focused nursing research agenda and examine the agenda for investigating and improving health equity and community collaboration.


2. Collaborate with nursing research institutions and nursing programs at regional and local colleges.


3. Design and measure nurse-sensitive indicators of care across settings (from home to hospital and back to home and community).


Application to Orthopaedic Nursing


1. Collaborate with the evidence-based practice council within the healthcare system of employment to develop nursing practice questions related to health equity and nurses' health and well-being specific to orthopaedic settings.


2. Use established research connections within the healthcare system to design, measure, and analyze orthopaedic nurse-sensitive outcomes of care such as the impact of nursing on transitions of care, chronic care management, and prevention of illness.


Research Suggestions


1. Assess the SDOH for orthopaedic clients in healthcare systems regionally and nationally.


2. Assess health equity challenges of orthopaedic patients as a population group.


3. Collect evidence on best practices addressing SDOH and health equity for orthopaedic population groups within the healthcare system of employment.



The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (NASEM, 2021a) is the third report addressing nursing's future and health equity. The first report was The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2011) and the second was Assessing Progress on the Institute of Medicine Report: The Future of Nursing (NASEM, 2016). These reports have gathered experts in healthcare, healthcare systems, and nursing practice to provide a vision for the future needs of patients and communities. The impact of these reports has profoundly helped meet past demands on nurses and patients (NASEM, 2021a). Nursing practice and other healthcare disciplines are grounded in science and evidence-based practice frameworks to help patients and population groups prevent illness and optimally engage in self-care during acute and chronic illness episodes.


The current Future of Nursing report (NAMES, 2021a) focuses on the need to refine and conduct research on nursing care delivery by addressing new variables in the environment and life experiences of patients contributing to healthcare inequity. For many population groups, the unequal access to care, health inequity in the delivery of care, ongoing effects of bias and racism, and harmful environmental and economic factors may not be as visible to those providing healthcare and who can make an impact.


With education, training, and support, nurses can promote population health by advocating for policy changes that address factors and interventions impacting social and economic structure for decreasing health barriers, improving work and living conditions, and providing access and equity to care and services (NASEM, 2021a). As a professional responsibility, nurses can inform policy to help address problems associated with SDOH and support health equity. Policy can be influenced by acknowledging input from the nursing workplace community and from professional associations to participate in informing public policy to enhance health outcomes for individuals and populations. Nursing students can learn how to advocate for health equity early on through civic engagement and communication using various methods including social media (NASEM, 2021a).


As important as improving care delivery for patients, nurses are now more aware of the need to care for their own health and well-being. Nursing more than any other health profession has observed patients' healthcare inequity directly during the COVID-19 pandemic, as well as their own inequity as humans, with nurses, particularly nurses of color tending to die more than any other healthcare professional (NASEM, 2021a).


To serve others, nurses must provide the same quality of care for themselves. The care and health of nurses, the largest healthcare group, needs to be recognized, advocated for, and changed as a systems problem rather than just a challenge solely for individual nurses.



Application of the Future of Nursing report recommendations will help prepare the profession of orthopaedic nursing to meet the demands in the next decade while focusing on the health and well-being of patients. As a strong group of professionals, orthopaedic nurses are integral to developing and employing quality nursing care for the specialty of orthopaedics, adapting quickly in the practice setting to changes and innovations in healthcare, and achieving excellent patient outcomes for improving the lives of patients. Orthopaedic nurses are now challenged to become stronger in addressing major factors impacting equity in healthcare that includes SDOH and health disparities. As stated by Victor J. Dzau, MD, President, National Academy of Medicine, "Nurses are powerful in number and voice and the world needs their actions now more than ever on how individuals, families, and communities might be best served in a more equitable fashion" (NASEM, 2021a, p. xi).




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