1. Ramirez, Elda G. PhD, RN, FNP-BC, ENP-C, FAEN, FAANP, FAAN
  2. Guest Editor

Article Content

Writing about diversity, equity, and inclusion (DEI) and not reiterating the same slogans about health care disparities, implicit bias, White privilege, or "Black Lives Matter," over and over is painfully difficult. Before I was tasked with writing this piece, I had been educating myself for years on the issues that revolved around DEI. I immersed myself in topics such as implicit bias and gender inequality. I acquired knowledge about how to foster inclusive climates and to even employ strategies to implement DEI initiatives. I was so excited and hopeful that my commitment to implementing DEI initiatives in all my endeavors would be fruitful. I could be impactful.


My self-taught educational endeavors launched me into a deep dive of American history. I recalled that in 1862, Abraham Lincoln and the Emancipation Proclamation (2021), followed by the 13th Amendment of 1865, were both efforts to end slavery. Fast forward nearly 100 years to 1964 with the Civil Rights Act to end segregation. This Act was among a myriad of other freedoms. On my educational journey, I delved into the longevity and efforts of so many brave individuals who sought to enact change. So much death and sacrifice. It seemed incomprehensible that there was divergence on the issues of slavery, segregation, voting rights, equality for women, and health care affordability. After the Civil War, slaves in the Southern States were not aware of their freedom for years. Incomprehensible-but true.


I also refreshed my memory of national health care legislation. President Harry S. Truman called for the creation of a national health insurance fund in 1945. President Lyndon B. Johnson signed Medicare into law in 1965. The Emergency Medical Treatment & Labor Act (EMTALA) of 1986 finally ensured that patients lacking insurance had access to safe health care. Most recently, the Affordable Care Act was ratified in 2010. For more than a century, these health care initiatives also simultaneously introduced efforts to halt racism, end inequities, and protect Americans.


So, what does any of these have to do with the 21st century and DEI? It has to do with COVID-19 decimating the aged, Latino, and Black communities at staggering rates; with increasing awareness, these outcomes are in a large part due to structural racism and implicit bias. Then there are the racial injustices surrounding George Floyd and Emmett Louis Till, and so many others since 2013. We have children dying in detention centers on the border to Mexico, and hundreds of whom are alive but separated from their parents. The recent insurrection at the Capitol is a tragedy of monumental proportion.


DEI in 2021 means we need to have a conviction and a belief in something bigger than ourselves. We must confront our own biases and commit to treating everyone with the same dignity and respect. Taking up a centuries-old cause not for what it will do for your career or how the actions you take will influence the next rung in your ladder to success is not what we are talking about. We need to create an architectural framework in institutions and an infrastructure for organizations that cannot be abolished with budgetary or transient leadership. DEI maintains its core constructs inclusive of abolishing racism, equal rights for all, and social justice; yet, the amplification is having the world at our fingertips with social media-when utilized ethically assuming a role of accountability. It is not just about race or ethnicity. The movement is about DEI not being a segregated "add on" to the decision table but an integrated component of each domain within an institutional or organizational strategic plan. No, DEI is not just a catchphrase-It is our present-day Emancipation Proclamation, our manifestation of the Civil Rights Act of 1964-It is OUR time!


I challenge all of us to look within and as an outcome of that introspection make a decision. Does what you believe help or hurt the community you serve? The ability to speak freely comes with great sacrifice and responsibility. I believe silence has many outcomes. Silence does not mean dissonance or indifference. Sometimes silence is the best response to events that cannot be comprehended or defended. Make a decision-Remain silent or make meaningful change.


-Elda G. Ramirez, PhD, RN, FNP-BC, ENP-C, FAEN, FAANP, FAAN


Professor Clinical Nursing


Assistant Dean of Diversity


Equity and Inclusion


Track Coordinator Emergency/


Trauma Nurse


Practitioner Program


Cizik School of Nursing


UT Health


Houston, Texas


Guest Editor




Emancipation Proclamation. (2021, January 25). Retrieved from[Context Link]