1. Woolforde, Launette EdD, DNP, RN, NPD-BC, NEA-BC, FAAN

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Inequity in health care is far from a new discovery. The Institute of Medicine, in their report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, provided one of the first detailed, systematic examinations of racial and ethnic disparities in health care and offered a blueprint on how to address these disparities. The report revealed that there are differences in the kinds and quality of health care received by racial and ethnic minorities and nonminorities in the United States and (a) disparities in health care exist and are associated with worse health outcomes; (b) healthcare disparities occur in the context of broader inequality; (c) there are many sources across health systems, providers, patients, and managers that contribute to disparities; and (4) bias, stereotyping, prejudice, and clinical uncertainty contribute to disparities. They concluded that a comprehensive, multilevel strategy is needed to eliminate these disparities (Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care et al., 2003).

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Nursing professional development (NPD) practitioners have a unique opportunity to advocate for equity in care delivery. NPD practitioners influence care by preparing nurses and other members of the care delivery team for practice throughout their careers. NPD practitioners are often regarded as influential, nonpunitive team members as the staff they support most often do not report to them in the organizational structure model. It is a tremendous honor to be entrusted with the responsibility of preparing those who will, in turn, touch the lives of millions of patients and families. Thus, incorporating equity awareness should be an integral part of our role and practice.


The journey through health care can be one of the most inequitable experiences one can have. In March of 1966 at a meeting of the Medical Committee for Human Rights in Chicago, in reference to the disparate medical care received by Black people, Dr. Martin Luther King, Jr., stated, "We are concerned about the constant use of federal funds to support this most notorious expression of segregation. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death." (King, 1966). Still, healthcare inequities persist for millions of people and have been exacerbated and brought to the forefront recently by the COVID-19 pandemic. Communities comprised primarily of people of color are consistently disproportionately exposed to pollution, environmental hazards, and discriminatory practices that put them at greater risk for almost all illnesses. The age-old pandemic of racism underscores inequities and its manifestations in times of crises. COVID-19 is showcasing how housing disparities, employment disparities, and other historic inequities impact communities differently and increase illness and death in communities of color.


So where does advocating for equity fit into NPD practice? Well, attention to diversity and inclusiveness exposes the need to examine ourselves and the inclusiveness, or lack thereof, of our settings and of our practice (Woolforde, 2018). Picture it. You are an NPD practitioner whose primary goal, of course, is to facilitate the growth and development of others. Your organization has a clearly stated mission-to be the best of the best. For nursing, this has been translated into hiring nurses from top tier schools only. Seems harmless, right? Not really. Recognizing that the education system houses gross inequities impacting the journey to college is an important basis for advocating mindfulness to include students who have great potential but are unable to attend top tier schools for any number of reasons. It is likely that, in doing so, you will raise awareness about and open up opportunities for the many talented students of color who simply need consideration and inclusion in order for their abilities to shine.


Or how about this, you are the NPD practitioner working with a team to help get a COVID-19 vaccination tent up and running for community immunization. All is going well as the tent operations are set to begin soon from 8 a.m. to 6 p.m. outside your beautiful suburban hospital. Seems harmless, right? Not really. Recognizing that access to care locations, especially in suburban areas, is more challenging for those who are socioeconomically disadvantaged, who tend to be people of color. Add to that the hours of operation, which may mean choosing between work or vaccination, and we have effectively excluded the people who may need it most.


Both examples present inequities that we, as NPD practitioners, can bring awareness to as we work with teams that are planning programming. We must remember that our role is not limited to the execution of a specific set of duties or tasks. NPD practitioners are busy facilitating professional role development, supporting and overseeing role transitions at all levels of practice, managing change, championing scientific inquiry, collaborating interprofessionally, and so much more (Harper & Maloney, 2016). Still, we must remember that is not the totality of our role. In order to help learners self-actualize and ultimately help patients achieve the health outcomes they deserve, we, as NPD practitioners, must include the realities of inequity in our programming and teach others to do the same.


So, what are some key steps NPD practitioners should take?


Understand your community.


Although there are constants in health care that have not changed in centuries, such as handwashing as the most effective method to prevent the spread of infection, we as NPD practitioners have to go beyond the constants to understand the composition and specific needs of the communities we serve. We must then adjust education programming to teach to the needs of the community. Point out and address the disparities and place emphasis on adjusting planning and resources according to these realities in order to achieve optimal wellness throughout communities. Inequities might be related to language, lack of cultural awareness among staff, lack of cultural awareness integration into the plan of care, and more. Having a diverse workforce that is reflective of the community helps to mitigate these divides. These changes can translate into significant improvements in health outcomes and great satisfaction among those providing care, not just those receiving care.


Do not just educate others, educate yourself.


NPD practitioners spend an inordinate amount of time educating others. Equally important, however, is educating oneself-not just on the latest in clinical care but also on one's own biases or lack of knowledge about the community one serves and how to adjust plans and care to address needs. NPD practitioners have the power to design programs that incorporate equity considerations and demonstrate for others how this is done.


Build an army of advocates.


NPD practitioners interact with a wide variety of care providers at all levels of practice. Role modeling advocacy practices is an important part of our responsibility. Take a stance on unequal treatment and build an army of people who have learned from you that they too must do the same. Trade fear for fearlessness. Advocating for equity is not a spectator sport. NPD practitioners cannot and should not stand on the sidelines while inequity grows deeper roots. Through the power of teaching, we can be champions of the equity message.


There is no healthcare issue that can truly be considered "somebody else's problem." What affects one affects us all. The effects may not be immediate or obvious, but in time inequity will cause harm to more than just the groups on the margins. There are many ways for NPD practitioners to advocate for equity, and the first step is to recognize it as a critical part of our role and responsibility.




Harper M. G., Maloney P. (Eds.) (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Association for Nursing Professional Development. [Context Link]


Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley B. D., Stith A. Y., Nelson A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press. [Context Link]


King M. L. (1966). King charges Negro medical care inferior (Associated Press). Mt. Vernon Register News, March 26, p. 5, Column 3. [Context Link]


Woolforde L. (2018). Nursing professional development: Our spheres of expansion. Journal for Nurses in Professional Development, 34(4), 237-238. [Context Link]