Health care decisions are among the most important and personal decisions anyone can face. Whether it is the patient herself grappling with a pivotal choice, or family members struggling to make the right decision for their loved one, the outcome of such choices can have significant and wide-ranging effects for the patient and the people who love her.
As a nurse, you are often eyewitness to these choices. More challenging, still, you are likely to find yourself in the position of offering guidance and support as patients and families navigate this unfamiliar terrain.
And that is a role that is at once a great privilege and a tremendous burden. As a care provider, your role, above all, is to support not only the patient’s best medical interests but also their autonomy. Unfortunately, those two imperatives are not always in agreement. Sometimes, a patient’s exercise of their independence and free will runs directly opposite to their medical needs.
So how do you balance your weighty responsibilities to your patients? How do you honor your oath to do no harm while also protecting your patients’ autonomy? Above all, how do you prevent your own personal perspectives from unduly influencing your patients, even unconsciously?
The relationship between a nurse, the patient, and the patient’s loved ones is, to say the least, a unique one. On the one hand, there is an intimacy in nursing that often doesn’t exist between patients and doctors. It is truly among the most caring of the caregiving professions. At the same time, nurses carry a store of medical knowledge that is inaccessible to most patients and their families.
As important as it is for patients and families to trust their nurse, both the nurse’s care and their knowledge, this can pose difficulties if patients come to rely too heavily on their nurse, or any other health care provider, in making vital healthcare decisions. This can easily reinforce the old paternalistic model, in which the patient’s fate was given over to the charge of the medical expert. Their “superior” medical knowledge, supposedly, gave them the right to ultimate control over decisions concerning the patient’s care.
Unfortunately, this paternalistic model might be rooted in medical best practices, in empirical, evidence-based care, cutting patients and their families out of the decision-making process can have profoundly harmful effects. Studies show that when patients and families share in the decision-making process, they are more engaged in and compliant with treatment and more confident in the treatment strategy and their healthcare team.
The Nurse as Teacher
Thankfully, in most cases, the paternalistic model is no longer the standard today, and the caregiver’s role in supporting patient autonomy is, rightfully, at the center of modern medical practice. But, unfortunately, it’s not always easy to transform theory into reality.
However, you can play an important role in helping patients to overcome the knowledge gap that makes medical decision making so difficult for patients and families. One of your most important duties as a nurse is patient education, equipping patients with the information they need to overcome the knowledge gap and make their own informed decisions about their health.
And it’s not only the major life and death decisions that your patients need to learn about. If you’ve been nursing for a while, the odds are pretty great that you have the inside scoop on matters of health and healing that just can’t be found in any medical textbook or internet search.
Similarly, educating your patients will also often involve addressing aspects of their lifestyles beyond the specifics of diseases and their treatment plans. For example, you will likely find yourself educating patients on proper diet as well as the signs, symptoms, and risks of various nutritional deficiencies, such as lack of bone density or increase in fatigue.
Such information can be essential to patient empowerment and autonomy. For example, once patients understand the role of nutrition in overall health and fitness, they may determine that they prefer to try a simple change in diet to address troubling symptoms before turning to more aggressive medical treatments.
As a nurse, you’re required to play many roles in the lives of your patients and the people who love them. You’re an empathetic caregiver, offering aid, comfort, and calm in what is often the most difficult time of your patients’ lives. You’re also the expert, one who speaks a rarefied scientific language and who possesses both the education and the experience in an arena that is a baffling, and often frightening, mystery to patients and their families. The good news is that you can build on this unique trust and intimacy to help empower your patients and provide them with the knowledge they need to make their own informed decisions.
Despite it being 2021, we just can’t seem to fully rid the world of racism and discrimination. There are very few people who can confidently say their skin color, ethnic background, social status, sexual orientation, or other defining factor hasn’t impeded their professional or personal progression in some way. It’s unfortunate discrimination finds a home in industries we should all feel equally safe in such as health care.
Discrimination based on social status, occupation, ethnicity, race, gender, and so forth make victims out of so many people each year in the health care industry. We’ve all been asked to sign the form acknowledging that we understand we have a right to adequate care and treatment no what in any health care facility. Even with this understanding among patients and workers alike, many of these facilities still have discrimination stories for days if walls could talk and more victims felt confident in speaking out against unfair treatment.
We need to prioritize obtaining insight on discrimination in health care and forge a path forward that creates a just health care system that prides itself on honoring our cultural differences, personal perspectives, and individual needs. Here are 4 ways we can remedy discrimination in health care.
1. Representation Across All Positions
We should all feel like we have at least one ally in our health care facilities. Those allies are often chosen based on the similarities you have with various patients. There should be adequate representation across all positions in your health care facility.
The health care industry not only faces discrimination issues based on race, gender, age, sexual orientation, and social status, discrimination based on shape, size, and weight is also a prominent issue. This is why it’s increasingly important to have every race, social status, gender identity, ethnicity, body type, and so forth represented across all positions in every health care facility to ensure every patient feels supported, comforted, and cared for.
The Derm Review furthers this point by stating: “Opening the door to usher in a diverse team offers more than just innovation for successful product creation, but also brings an element of authenticity, which is critical as trust waivers among consumers who question historical body and beauty standards that they cannot relate to — and no longer wish to aspire to.”
2. Adequate Diversity Training
In the wake of the widespread social unrest of 2020, bias within the health care system was further highlighted by the Covid-19 pandemic. Adequate diversity training may be necessary to ensure you aren’t participating in any behaviors or activities that could be deemed discriminatory.
This global pandemic revealed just how disproportionately affected Black and Brown people are when it comes to health care treatment itself. A telling example of this would be how African Americans account for 32% of the population in Louisiana but 70% of COVID-19 deaths. We have to consider that the reason for this racial gap in fatalities is due to a disconnect in the quality of care African Americans receive.
It’s important to prioritize attending every diversity training if at all possible. Diverse backgrounds mean diverse needs, fears, experiences, and expectations. Be fully present and interactive in these meetings. Take an interest in the differences you, your coworkers, and your patients possess and leverage them to better the health care experience in your facility.
3. Lead with Empathy and Understanding
You should display a special level of empathy and understanding when working in the health care industry. In interacting with a diverse group of patients, you must be privy to the cultural, emotional, and physical factors that could affect a patient’s health care experience.
Empathy and understanding build trust. And trust is especially important in the health care industry. If patients don’t trust you, they’re less likely to allow you to do your job at the highest level. They’ll be resistant to routine activities, potentially question your every move, and make the interaction rockier than it needs to be.
As you lead with empathy and understanding in every action, your patient will be encouraged to do the same. Eliminating discrimination in health care is dependent on the changed behavior of professionals AND patients.
4. Take Advantage of Health and Well-Being Resources
Surprisingly, most health care facilities lack in supporting their employees adequately with accessible health and well-being resources. It’s so important that you’re fresh, confident, and constantly bettering your being. If your facility offers health and well-being resources, take advantage of them or offer to put some together should time and scheduling permit.
You must take care of yourself just as well as you take care of your patients. If you’re not prioritizing your mental health, physical wellness, and emotional strength, it will be hard to offer a solid health care experience to your patients. Absenteeism and/or presenteeism will compromise your productivity.
Invest in self-care. Utilize mental health resources like counseling and support groups. Ensure you aren’t overwhelmed emotionally or physically. If you don’t feel good, you won’t be able to perform adequately at work, so take care of yourself.
The fact that discrimination occurs anywhere, especially within health care, is disheartening and disappointing despite increased efforts to remedy its existence. You can help fight discrimination in health care by prioritizing self-care, leading with empathy and understanding in every action, being fully present in diversity training, and advocating for representation across all positions.
No one enters the health care profession because they want to discriminate against their patients. You don’t sacrifice years of time and energy, tears and sweat, just to indulge your biases and serve your stereotypes.
But the simple truth is that health care providers aren’t just healers, they’re human. And that makes them every bit as vulnerable to unconscious bias in their practice. This shapes not only caregivers’ relationships with their patients, but it also threatens to severely undermine equity and quality of care.
This article examines gender bias in health care and discusses strategies for preventing it.
What Is It and Why Does It Matter?
Gender bias in health care is, of course, nothing new. For centuries, women’s health care was far different — and often far inferior — than that given to men. This was often driven by sometimes breathtaking misconceptions (and stereotypes) about women and women’s bodies, such as the infamous diagnosis of the “wandering womb” and of various forms of “hysteria” and nervous exhaustion that for so long were blamed for nearly every symptom a woman might experience.
To be sure, we’ve come a long way since those days, but we’ve still not come far enough. There’s increasing evidence that gender bias continues to impact most every domain of health care, from patient diagnosis and treatment to the training, hiring, and promotion of female health care providers.
For example, a recent study from the National Institutes of Health (NIH) found that male patients receive appropriate care 85% of the time, compared with 82% for women. This may seem like a relatively small difference, but it is one that can — and has — claimed untold numbers of lives.
This is especially true when it comes to issues such as the early detection and effective treatment of heart disease. Although cardiovascular disease is the number one killer of women, just as it is for men, the research shows that care providers are still notoriously slow to recognize the signs of heart disease in women.
For women of color, the problem is especially significant. For instance, a recent COVID-19 survivor, Karla Montessero, describes how unconscious biases nearly cost her her life. Despite the fact that Montessero had recently traveled, despite the prevalence of the virus that was already sweeping across the US, and despite the symptoms that should have set off a symphony of alarm bells, Montessero was repeatedly dismissed by the emergency care team at Alameda Hospital in California. Her concerns were downplayed and discounted — the result of panic and fear, of a Black woman’s overwrought emotions, rather than being recognized as a respected patient’s accurate reporting of her symptoms.
A Lack of Knowledge
It’s not only unconscious gender bias, however, that leads to the inaccurate or delayed diagnosis of women. Historically, women have been grossly underrepresented in medical research. Clinical trials on disease and disease treatment have traditionally excluded or limited the number of women included in them. This was particularly true for women of childbearing age, as researchers feared potential risks to fetuses in the case of unexpected pregnancy.
What this means, ultimately, is that this lack of data is hurting women and claiming women’s lives simply because clinicians do not understand how disease may manifest or progress differently in women than in men. Women, for example, typically do not experience the tell-tale signs of heart attack that men do. Rather, their signs are often far more subtle and systemic, making it far easier for clinicians to miss, or dismiss, them unless they know precisely what to look for.
What Is to Be Done
As persistent and pervasive as bias in the health care system may be, the situation is not hopeless. There are proactive measures that can be taken to reverse this trend.
One of the most important, perhaps, is to promote equity in hiring and promotion practices. Despite the heavy presence of women in nursing, the fact remains that men disproportionately occupy leadership positions in the health care industry. Increasing the number of women at the highest levels of the health system will offer an essential depth of experience and understanding of women’s unique health care needs.
It is also essential that reforms and regulations be introduced to eliminate the marked cost inequities that female patients suffer. Studies show that women’s health care costs are significantly higher than those of men, even for the same or equivalent services. This isn’t just unfair, it’s also dangerous, a potential disincentive for women to seek care for concerning symptoms or to pursue routine and preventative health services.
It is also essential to revamp training and clinical practices to support more informed, gender-appropriate care. For example, studies suggest that gender biases have filtered even into the nursing education system, with scorers tending to grade female nursing students more generously than their male counterparts. And that bias can all too easily lead to a compromising of the quality of female students’ education.
In addition to ensuring gender equity in education, it is also imperative that students and clinicians alike be trained in practical strategies to recognize and eliminate gender bias in patient care. This would include strategies such as checklists, the use of open-ended questions in patient interviews, and the inclusion of more female practitioners.
Health care providers are society’s true heroes, but they’re not perfect. Unconscious gender bias does exist, but that does not mean clinicians, or their patients, are hopeless. There are strategies that can be taken to optimize the quality of care for female patients. These include promoting gender diversity in health leadership, increasing the representation of women in medical research, and training practitioners to recognize and eliminate their own biases.
As the largest contingent within the health care workforce, nurses are vital to shaping the future of not just their profession but medicine as a whole. Even during the COVID-19 pandemic, seasoned nurses and those currently studying to join their ranks must come together to tackle the issues that are critical to the future of nursing.
The first step is gathering information and seeking to understand complex issues such as antibiotic resistance, environmental sustainability, and remote accessibility. Nurses who work in clinical environments must collaborate with nurses in non-clinical roles to formulate evidence-based action plans that include educating the general public.
The public places great trust in nurses, and while the media may choose to feature doctors in its coverage, regular people generally reach out to nurses for honest information and level-headed advice. Simply put, when nurses talk, people listen. The public trust they’ve cultivated puts them in a unique and powerful position to bring about change in nursing and propel the health care industry into the future. It is a challenging yet exciting time to be in the nursing profession.
Ask any nurse what their primary responsibility is, and they will likely answer that they have to protect their patients from otherwise preventable harm. The rise in antibiotic-resistant bacteria, also known as “superbugs,” is making this task more difficult. One of the most vital issues to the future of nursing is understanding how to protect patients from superbugs and educate the public about antibiotic resistance.
Antibiotic resistance occurs when, over time, bacteria adapt to drugs that are formulated to kill them. When the bacteria changes as a means of ensuring survival, this renders widely-used treatments for infections significantly less effective, and in some cases, completely ineffective. Medical professionals have linked drug-resistant bacteria to pneumonia, urinary tract infections, and skin infections. In some extreme cases, the patient has even died.
Unfortunately, because it is a naturally occurring phenomenon, antibiotic resistance cannot be stopped. However, it can be slowed. For this to happen, the public must be educated on the proper use of antibiotics. As one of society’s most trusted voices, nurses must lead the educational charge and raise awareness. Furthermore, since they make up the majority of the health care workforce, nurses’ commitment to proper cleaning, disinfecting, and sanitizing would go a long way in combating antibiotic resistance.
Like antibiotic resistance, another issue vital to the future of nursing is environmental sustainability. All industries have an ecological footprint, and the health care industry is no exception. In fact, the health care industry is one of the primary culprits. Currently, industry practices account for a large percentage of the country’s energy consumption and pollution emissions including 10% of the nation’s greenhouse gases.
When nurses treat patients with environmental-related illnesses, there’s a chance that it was the health care industry’s ecological impact that made them sick in the first place. Over the years, nurses and other health care providers have made efforts with sustainability, but there’s still more that needs to be done.
Nurses, perhaps better than any other medical professional, understand the limited resources their industry must contend with. This puts them in an influential spot to enact eco-friendly strategies such as using plastic more intentionally and promoting renewable energy.
One strategy nurses can use to embrace environmental sustainability and provide better care to more patients is prioritizing remote accessibility. Telemedicine, which relies on telecommunications, allows health care professionals to evaluate, diagnose, and treat patients without needing to be face to face.
Even before the era of social distancing, remote accessibility was in high demand. Cost and location force people to choose between their health and spending time and money to attend regular checkups. People living in rural communities disproportionately have inadequate access to health care. Nurse educators teach other nurses that preventative care is essential to the health and well-being of the communities they serve.
Improving accessibility could also help improve the overall efficiency of a health care organization. Nurses wouldn’t need to spread themselves as thin since people with symptoms that can be managed from home could be treated via telemedicine. With more people attending their regular checkups and showing up (albeit virtually) for follow-ups, there are more opportunities for preventive care that could also lighten nurses’ workload in the long run.
Remote accessibility, environmental sustainability, and antibiotic resistance are three of the most important issues demanding the attention of the health care industry. Change needs to happen, and nurses are the ones to lead it. Because of their trusted position, nurses can positively influence their medical colleagues as well as the general public. The future of nursing runs parallel to that of the health care industry, and if nurses step up and make a strong case for a particular course of action, they can determine the direction of both.
With the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, or more commonly, COVID-19), healthcare workers were thrown headlong into the fray of managing healthcare protections. In many cases, this occurred without adequate preparation and supplies.
In a survey conducted by National Nurses United, only 30% of healthcare workers reported that their employer had enough PPE on hand to sufficiently protect staff in the event of a COVID-19 outbreak. Another 38% did not know. At the time of the survey, only 19% reported knowing that their employer had a plan to address when an employee contracted the virus.
Such a lack of preparation — when a pandemic of one form or another was inevitable — is unacceptable. Negligence in care facilities and at a federal level put healthcare workers at more undue risk, and the future demands better solutions.
With the right culture shifts and policies in place, we can ensure that the next public health crisis is met with a prepared and protected workforce.
Actionable Items for Healthcare Worker Protection
After the failure that has been the COVID-19 response, healthcare workers are demanding better protection now and in the future. Care facilities and government institutions alike must come together to create an actionable approach in providing the proper equipment and policies to frontline workers. This means equitable, widespread material solutions, and culture shifts that make for a safer America.
Here, we have outlined five of these actionable items to better ensure healthcare worker protections come the next public health crisis.
1. Create a More Equitable System of Care Resources and Delivery
A functioning safety net for health care does not discriminate based on locale or access to wealth. To provide proper protection to our healthcare workers, it is vital that access to resources is not placed behind a barrier of marginalization. This means taking lessons from global health exemplars to improve systems of community care and streamline emergency resource usability.
Community care workers in Malawi, for example, are funded at a national level and provide care outside of traditional clinics. Government agencies should come together with communities to create safety nets like these—especially for the most underserved and disenfranchised areas. With a comprehensive approach to healthcare solutions, governments can more equitably distribute resources. As a result, healthcare workers will be better protected against the overwhelming tides of future public health crises when they inevitably arrive.
2. Strengthen and Encourage the Growth of the Healthcare Industry
A fundamental aspect of worker protection facing the next health care crisis is the support of the industry through respect, growth, and education. CNAs, for example, are vital healthcare providers who bridge gaps in care for what is often a one-to-one-thousand ratio in terms of patients to physicians. Information about the nobility and necessity of these roles must be spread through public education systems and through incentives offered in both the public and private sectors.
With a sufficiently staffed facility, hospitals need not fear the breakdown of their ability to care for patients in the event of staff exposure. Of course, all staff should also be provided sufficient PPE to avoid exposure wherever possible.
3. Institute Price Controls on Essential Medical Equipment like PPE
One outcome of the coronavirus pandemic has been the consolidation of medical institutions as losses over $200 billion cripple the industry. When these consolidations occur, costs of medical care and equipment trend upwards. This is why a national movement to institute price thresholds and cost controls for medical equipment and pharmaceuticals will be an essential aspect of ensuring healthcare worker protection.
In the event that costs of healthcare continue to climb as they have been, care providers will be hard-pressed to purchase and maintain an inventory of PPE capable of protecting their employees. A national push to institute price controls will better prepare healthcare workers for the next crisis.
4. Shift the National Culture Towards Hygiene and Safety
Keeping not just frontline healthcare workers but all Americans safe during the next public health crisis will require a shift in culture towards the practice and celebration of better health and safety standards. We have potentially seen the beginnings of this shift in the response to COVID-19, with the embracing of masks and efficient hand washing hygiene. However, long-term protective practices will need to run deeper.
Shifting the national culture towards better hygiene must begin in early education. Children should be taught good personal hygiene habits that protect them and others. This includes staying home when they are sick.
Rather than incentivizing perfect attendance, institutions of education can incentivize the protection and care of health instead, reinforcing safe habits for life. Then, when a new pandemic emerges, the odds are better for less-overwhelmed care facilities and healthcare workers.
5. Develop Waste Reductive, Sustainable Medical Equipment Solutions
Medical waste is a problem in environmental sustainability as well as a contributor to high medical costs and limited supplies. Reportedly, care facilities spend $10 billion per year on waste management. Hazardous and regulated biochemical waste is barely a factor in this expense as well, with 85% being often-recyclable standard trash generated by hospitals.
Finding solutions to reduce hospital waste and recycle equipment can help care facilities save on costs while maintaining readiness for a greater need. In the future, healthcare workers will require a profusion of sustainable and reusable medical equipment such as N95 respirators to ensure they are well equipped in a crisis.
Preparing for the Next Public Health Crisis
COVID-19 caught the medical industry unprepared. This placed millions unnecessarily at risk when better protections could have been created through a culture of care and community support.
With more equitably distributed resources, price controls, and sustainable solutions, healthcare facilities can better be protected against health crises of any kind. These protections should be instituted at every level, through joint efforts of the public and private sector. Only then can we build a culture that celebrates health and hygiene, and in turn ensure that more lives are saved. Support frontline healthcare workers in the inevitable healthcare challenges of the future by striving for these community safety nets wherever you are.