The 2023 Magnet(R) Application Manual reinforces the importance of diversity, equity, and inclusion (DEI) for healthcare workers, patients, and communities.1 The focus on DEI was driven by societal concerns, issues experienced in healthcare delivery systems, and feedback from subject matter experts including members of the Commission on Magnet Recognition, Magnet Program Office, and nursing experts.
Equity, as an issue in healthcare, has been identified in the literature for many years as a focus of public health objectives involving the social determinants of health.2,3 Acknowledging this, delivery of culturally and socially sensitive care by nurses was included in the 2019 Magnet Application Manual as a source of evidence (SOE) under the structural empowerment (SE) component of the Magnet model.4 More recently, the Future of Nursing 2020-2030 report identified health equity as an issue in healthcare and emphasized the integral role that nursing, and specifically the diversity of the nursing workforce, plays in ensuring health equity for all patients.5
The American Nurses Association (ANA) publicly identified racism as a public health crisis and took positions against racism, discrimination, and health disparities6 in alignment with The Code of Ethics for Nurses with Interpretive Statements7 and Nursing: Scope and Standards of Practice, 4th Edition.8 The Code obligates nurses to be allies, to advocate, and to speak up against racism, discrimination, and injustice.7Nursing: Scope and Standards of Practice, 4th Edition articulates the role of nursing's social contract in addressing social determinants of health and addresses nursing's role in the "unrelenting, unwavering, and encompassing efforts for equity, diversity, inclusion, and social justice," including diversity within the nursing profession.8 In January 2022, the National Commission to Address Racism in Nursing released survey data that examine the issue of racism among nurses in the workplace. The survey findings provide evidence of racist behaviors and structures, with more than half of survey respondents stating that racism affects them negatively. Nursing's challenges with the issue of racism are reflective of the larger society and directly impact the quality of care for the patients and communities served.9
Diversity, equity, and inclusion are each defined in the 2023 Magnet Application Manual glossary. Diversity is described as human differences, including but not limited to gender, sexual orientation, race, ethnicity, nationality, religion, age, cultural background, socioeconomic status, disabilities, and language.1 Equity is described as freedom from bias.1 Inclusion is described as including and accommodating people who have historically been excluded because of race, gender, sexuality, or ability.1 These terms reflect the intention for Magnet-designated organizations to demonstrate policy and action toward a diverse, nonbiased, and inclusive organizational culture. "Diversity is about who is represented in the organization, whereas inclusion speaks more to who is respected, expected, and integrated into an institution."10
The manual's organizational overview (OO) items demonstrate the foundational support for DEI in Magnet-designated organizations. Equity and inclusion are added in the 2023 Magnet Application Manual as essential elements of an organizational culture which supports diversity initiatives for healthcare workers, patients, and families. The intention is for a culture conducive to shared decision making, innovation, evidence-based practice, and other hallmarks of nursing excellence that flourish in practice environments that embrace DEI. Expanding on the 2019 Magnet Application Manual,4 OO items OO7 and OO8 require organizations to provide the policies or evidence depicting the organizational advocacy initiatives for staff regarding DEI and policies specific to initiatives for patients and families related to DEI. These OO items align closely with Nursing: Scope and Standards of Practice,8 which acknowledges personal and professional identity as related concepts that influence the characteristics, norms, and values of the nursing discipline and calls upon nurses as patient advocates to embrace DEI to address social determinants of health.
Three SOE examples address DEI in the 2023 Magnet Application Manual. These SOE examples describe and provide evidence of the processes and/or initiatives for DEI in Magnet-designated organizations. The transformational leadership (TL) component SOE TL2 requires an example of a nurse assistant vice president (AVP)/nurse director or nurse manager participation in an initiative promoting workplace DEI, consistent with the organization's strategic plan. The example may involve the workforce, patients, and/or families. The intent for this new SOE is that Magnet-designated organizations support DEI initiatives through strategic planning and nursing leadership participation.
In the SE component SOEs, SE13a and SE13b require an example of a nurse or group of nurses delivering culturally and/or socially sensitive care. Added in the 2019 Magnet Application Manual, this SOE demonstrates the integration of DEI into patient care and requires support of diversity and removal of bias, and represents a commitment to patient care that acknowledges the patient's cultural and social needs. This source reflects the Scope and Standards: Standard of Respectful and Equitable Practice.8
Magnet-designated organizations exemplify nursing excellence and continue to innovate, involve, and inspire. The focus on DEI in the 2023 Magnet Application Manual reinforces the responsibility of nursing to meet the needs of diverse patient populations through policy and practices that reflect diverse, nonbiased, and inclusive cultures and environments for both patients and nurses.
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