5 Ways to Stay Well While Working From Home

5 Ways to Stay Well While Working From Home

While you’re confined to working or studying full-time at home during the COVID-19 pandemic, it is vital to take measures to maintain your health and well-being. Here are five tips from Dr. Bernadette Melnyk, co-editor of Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare, to help you stay well in this era of isolation and social distancing:

1 – Guard your sleep by keeping a regular schedule

Set a regular schedule for getting up and going to sleep. It’s ideal to continue to get up and go to bed at the same time as you would if you were still going in to the office. Also keep in mind that stress takes a toll on your body; you may need more sleep than usual, and that’s okay.

2 – Eat Healthy

You now have more access to your food supply than you would in your office, so be conscious about how and what you are eating. Remember the 80/20 rule – 80% healthy foods and 20% “want” foods. It can be easy to fall into the pattern of grabbing a little food every time you are in the kitchen, but those little nibbles can pile on a lot of extra calories. Instead, set yourself regular snack times and have a healthy snack, such as piece of fruit, a lowfat yogurt or a cup of popcorn. Drink at least eight eight-ounce glasses of water per day, as even slight dehydration can make you feel tired.

3 – Beware of the Chair!

It’s important not to sit for long periods of time as it is not only good for your heart health, but it drains your energy. Try getting up and moving around once an hour to sustain your energy throughout the day. Put on some music and dance for 10 minutes, lift weights or household objects, walk up and down the stairs or take a quick wellness walk outside. If you’re home with your children, ask them to join you. You can construct a standing desk at home by piling up books or putting your laptop on a low stool on top of a table.

4 – Shed Stress Regularly

Instead of waiting until work time is over, try to release stress regularly throughout the day so that it doesn’t build up and wear you out. Try a five-minute meditation, take five slow deep breaths at regular intervals throughout the day or write in a journal about what is on your mind. Start each day by counting a few people or things you are grateful for and read five minutes in a positive thinking book. This “me” time will help you be more present for others. If you are stressed or anxious to the point that it is starting to interfere with your functioning, reach out to your healthcare provider or employee assistance program.

5 – Monitor your social wellness

Feeling isolated? Miss talking to people? Pick up the phone and call a coworker instead of sending an email. Have a virtual lunch with a friend. Don’t wait until feelings of loneliness become overwhelming—try to get a little “social time” by video conference or phone every day after work so that you can keep your spirits up.

Finally, remain vigilant in working to help prevent the spread of infection. Follow CDC guidelines for washing your hands thoroughly with soap and water, maintain physical distance from others and do your part to keep the coronavirus from spreading.

Workplace Violence Against Nurses

Workplace Violence Against Nurses

The statistics are shocking but not surprising. At least 60% of health care workers will experience workplace violence with nurses and doctors receiving the brunt. While 25% will experience physical violence, 45% non-physical violence: verbal abuse, threats, and sexual harassment. The effects may be minor. But experiencing workplace violence can lead to missed work, lost income, physical and mental injury, disability, and death.

The figures above are likely low due to underreporting. Workers are hesitant to report violence for several reasons:

  • Conditioned to believe it’s “part of the job”
  • Reporting processes are time-consuming, cumbersome, and re-traumatizing
  • Employer focus on profit and patient experience 
  • Historic non-action
  • Fear of retaliation from perpetrator or employer

Vulnerable Nurses 

Nurses’ dedication and compassion make them especially vulnerable to violence by patients or visitors. They are often in close contact with patients who have mental health or substance abuse challenges. They care for their patients despite warning signs and known violent history. Patients, in turn, are often stressed, scared, and can easily become agitated. Nurses have a reputation for sticking it out in the worst of times, Finally, they are compelled to “do no harm” and prioritize patient safety above their own. 

Workplace Violence Prevention

Health care organizations are beginning to understand the scope of the problem and respond. But we have a long way to go before health care workers can feel safe and sound at work. Occupational Safety and Health Administration (OSHA) does not currently require employers to implement workplace violence prevention programs but encourages it. Its guidelines include 5 core elements: 

  • Management commitment and employee participation
  • Worksite analysis and hazard identification
  • Hazard prevention and control
  • Safety and health training
  • Record keeping and program evaluation

Legislation

Under the proposed bill H.R. 1309, the Department of Labor would require health care employers to develop and implement a comprehensive plan for protecting their workers from workplace violence. On November 21, 2019, H.R. 1309 was passed in the US House of Representatives and received by the US Senate for review. 

Nurses should not be afraid at work. If everyone works together, we can turn this tide. Nurses contact their state senator and urge them to pass H.R. 1309. They should encourage their employers to proactively develop workplace violence protection. Most all, nurses must support one another and encourage reporting to help end this crisis. 

Resources: 

ANA: Workplace Violence

OSHA Worker Safety in Hospitals Guidelines

Silent No More Foundation

Keeping Calm in the Uncertain Times

Keeping Calm in the Uncertain Times

Nurses are on the front lines quite a lot. And they’re known for being strong, forging ahead, and getting the job done.

But everyone facing this pandemic is dealing with something we’ve never experienced before—not on this level. Nurses often put everyone else in their lives first and themselves last.

It’s important, now more than ever, to keep calm and use self-care. If you’re not at your best, you won’t be able to take care of others.

Natalie Dinkins, Psychotherapist, MHC-LP, Bethany Medical Clinic, gives great tips on keeping calm and caring for yourself as we navigate the future.

How can nurses keep calm during this uncertain and tough time?

We all have our unique ways of handling stressful situations and it is important to take a daily personal inventory on how you are processing and coping with stress. During this time, it is natural to feel a wide range of emotions from fear, anxiety, sadness, irritability, or even feeling detached and numb. It’s important to note that we all deal with stressful life events differently, but the one thing we do know is that as humans we all thrive on feeling validated and supported. Here at Bethany Medical Clinic we would like to take a moment to let you know that you are not alone. As a result, we would like to share some helpful tips you can consider while you are at home or work.

  • Actively participate in self-care activities. This could mean taking a pause to do something mindful — boil a hot cup of tea and sip it slowly engaging your five senses, write in a journal, meditate/yoga, exercise, or engage in a nice cleansing breath.
  • Acknowledging your stress and coping with it as you continue to provide care will help you and your family stay well.

What can nurses do to keep calm if there are scared and are being called into work?

  •  Always check in with coworkers on their emotions and have them check on you. Find ways to support the community.
  • Form a buddy system. You are not alone during this. Work as a community to maintain a healthy balance.
  • Try to separate emotions from facts. When discussing COVID-19 it is important to discuss feelings and validate others’ concerns.
  • Allow yourself and your family time to recover from responding to COVID-19. This also means allowing yourself time after shifts to process, decompress, or just sit before heading home.

What should they not be doing?

Providing care to individuals during crisis can be just as stressful as rewarding. It is important to remind yourself to:

  • Don’t over work. Try to keep reasonable working hours to lessen overall exhaustion. It is never selfish to engage in small breaks to ensure time to rest, eat, and relax. There is power in time we take for ourselves, even if it’s 5 minutes.
  • Don’t push your limits. With the myriad of platforms for social media and instant fact gathering, it is important to limit saturation of media exposure i.e. print news, TV, radio, pod casts, online discussion forums that promote fear/panic, and overly utilizing search engines to research.
  • Don’t engage in unhealthy coping skills. Try to limit or avoid the amount of alcohol, caffeine, or nicotine intake.

There are many job-related stressors that nurses may face while providing care during COVID-19. These include intense work hours, overwhelming responsibilities, lack of a clear direction, poor communication, and work environments that are not secure. Providing patient care during stressful situations can take an emotional toll on you. This can lead to burnout or secondary traumatic stress. Being able to recognize the signs of these conditions in yourself and others is important to ensure breaks and additional resources one may need. These signs may be physical (fatigue, poor hygiene, racing heart, nightmares) and mental (fear, withdrawal, guilt). Most importantly, if you find yourself experiencing a shift in your mood that does not feel like your typical self, and you find yourself struggling to cope, please reach out and seek out treatment for further support.

How 12-hour Nursing Shifts Impact Burnout and Job Satisfaction

How 12-hour Nursing Shifts Impact Burnout and Job Satisfaction

A large European study linked hospital nurses who work 12-hour shifts to adverse outcomes like burnout and job dissatisfaction. The survey published in BMJ Open involved more than 31,000 nurses in 488 hospitals across 12 countries.

One of the major results was that nurses working 12 hours or more in a shift experienced high burnout. Most notably, nursing shifts of at least 12 hours increased the odds of high emotional exhaustion by 26%, compared with nurses working shifts of eight hours or less. Nurses who worked longer shifts were also more likely to experience high depersonalization (a dreamlike or detached state of mind) and low personal accomplishment.

Another important finding was the connection with job dissatisfaction. Nurses who worked shifts of 12 hours or more were 40% more likely to report being dissatisfied with their job — and 31% were more likely to plan to leave their job — compared with nurses working shifts of eight hours or less.

The researchers noted a paradox. Nurses prefer longer shifts because of the perception that they improve job satisfaction, but longer shifts may have the opposite effect. “Nurses may be choosing to sacrifice work satisfaction for benefits in other spheres of life,” they said. “However, this type of choice is likely to compromise nurses’ recovery sleep, physical and psychological well-being: the stress of those long workdays and the recovery time needed may counterbalance any perceived benefit.”

Similar findings were seen in an American study of more than 22,000 nurses in four states. According to researchers in Health Affairs, longer nursing shifts “were associated with significant increases in the odds of burnout, job dissatisfaction, and intention to leave the job.” In particular, the odds of burnout and job dissatisfaction were up to two and a half times higher than nurses working eight- to nine-hour shifts.

Perhaps most striking was the study’s conclusion that the longer the shift for hospital nurses, the higher the levels of patient dissatisfaction. In fact, both studies warned how nurse burnout and job dissatisfaction could adversely affect patient safety.

Evaluating Job Performance for Nurses Working Longer Shifts

If longer nursing shifts contribute to burnout and job dissatisfaction, the consequences fall across two general spheres. One is the impact that issues like turnover and absenteeism can have on an organization’s culture and finances. The other area encompasses issues, according to BMJ Open, like higher risks of medical error, lower quality of care, and reduced well-being (for nurses and patients).

While there’s no consensus that 12-hour shifts are a health risk, it’s not hard to find sources that support the affirmative. That’s the case for the two major studies mentioned so far, and researchers in Health Affairs were much bolder with their results. “Our findings contribute to a growing body of research associating nurses’ shift length with patient safety issues,” they said while noting four additional studies. “The results also highlight an area of health care ripe for policy development at both national and institutional levels.”

The other side of the debate is well-represented. A separate study in BMJ Open was the first to bring in an objective measure of missed care, in the form of missed or delayed vital signs observations, to gauge any impact on the quality of care. Healthcare assistants who worked long shifts at the large hospital in England had a significant increase in delayed vital signs observations, but the same wasn’t true for RNs. According to those nurses, time constraints result in less interpersonal care (such as comforting patients and planning their care) instead of clinical care.

Another study published in the Journal of the Intensive Care Society compared eight- and 12-hour shifts during a two-year period at a large intensive care unit in Wales. The first year everyone worked the traditional shift, and the second year, the longer shift was introduced for those who opted in. The results showed no significant differences between the two groups across multiple outcomes, including clinical incidents, sickness rates, personal injuries, and staff training. An improvement was found in emotional exhaustion and depersonalization for those working 12-hour shifts.

Perspective on the Debate Over Nursing Shift Length

It’s important to remember the complexity surrounding research on extended nursing shifts.

“It is difficult to control extraneous variables, including shift sequence, overtime and break patterns,” according to authors in the Journal of the Intensive Care Society, when discussing their perception about the research varying in quality. “Age, grade, and experience of the nurse may also influence study findings.”

Another thing to keep in mind is whether shift length is the most critical issue in the broader discussion. “This is a topic in nursing that has been debated for many years,” said Leeann Denning, assistant professor and chair of the nursing department at Shawnee State University. “I know nurses who prefer and do well with 8-hour shifts and those who prefer and perform well with 12-hour shifts. Research is clear on the effects of fatigue, but I think the conversation needs to move from the hours worked to what level of care is required of that nurse during the shift.”

From shift length to the level of care, research on those types of topics can help raise more awareness and ultimately improve the quality of care. Engage in these conversations while you earn your online RN to BSN — a designation that research has linked to improved patient care. You’ll gain the knowledge and skills to prepare for leadership or specialized roles to make a positive impact in your career.

Achieve your goals with the fully online RN to BSN from Shawnee State University.

COVID-19: Report from California

COVID-19: Report from California

Coping With COVID-19

On Tuesday, Dr. Jeanne Noble devoted time between patient visits to hanging clear 2-gallon plastic bags at each of her colleagues’ workstations. Noble is a professor of emergency medicine and director of the UC-San Francisco medical center response to the novel coronavirus that has permeated California and reached into every U.S. state.

The bags were there to hold personal protective equipment — the masks, face shields, gowns and other items that health care providers rely on every day to protect themselves from the viruses shed by patients, largely through coughs and sneezes. In normal times, safety protocols would require these items be disposed of after one use. But just weeks into the COVID-19 pandemic, supplies of protective gear at UCSF are already so low that doctors and nurses are wiping down and reusing almost everything except gloves.

“It is not a foolproof strategy at all; we all realize the risk we are taking,” Noble said. But as supplies dwindle, she increasingly finds herself asking the folks in charge of infection control at the hospital if they can make changes to protocols. “As days go by, one regulation after the other goes out,” she said.

Noble is among the Bay Area physicians applauding the decision this week by seven Bay Area counties and multiple others across California to order residents to shelter in place for the foreseeable future, directives that are upending life for millions of people and shuttering schools and businesses across the state. Without swift and dramatic changes to curb transmission of the virus, hospital officials say, it is just a matter of time before their health systems are overwhelmed.

Interviews with California physicians on the front lines of COVID-19 offer a sobering portrait of a health care system preparing for the worst of a pandemic that could be months from peaking. In the Bay Area, the battle is being waged hospital by hospital, with wide variations in resources.

Waging the Battle, Hospital By Hospital

The tent where Noble tended to patients this week was set up to deal with a recent rise in people showing up with respiratory illness. Even without the coronavirus threat, UCSF’s emergency room is a busy one, and doctors frequently see patients in hallways and other spaces. But the current outbreak makes that close contact unsafe. So instead, everyone who comes to the hospital is being triaged. Most people with fever, cough or shortness of breath are diverted to the tent, which is heated and has negative air pressure to prevent the spread of infection. For now, the pace is manageable, but Noble fears what’s ahead.

Farther south, in Palo Alto, Stanford Medical Center was testing patients with respiratory problems in its parking garage. The private university hospital has more protective gear than the public one in San Francisco; a global scavenger hunt several weeks ago bolstered supplies, though Stanford, too, has adapted protocols to be more sparing with some items.

“We don’t have an unlimited supply,” said Dr. Andra Blomkalns, professor and chair of the Stanford School of Medicine’s Department of Emergency Medicine. “But at least we’re not looking at our last box.”

The entire country is short on protective gear, a result of both the surging demand for such equipment as the virus spreads and the implosion of supply chains from China, where much of the equipment is manufactured.

Noble believes some equipment will need to be made locally. “If the [federal] government doesn’t step in and force manufacturing of these products here now, we are going to run out,” she said.

Empty supply closets affect everyone who needs care, including heart attack victims and people in need of emergency surgery, said Dr. Vivian Reyes, president of the California chapter of the American College of Emergency Physicians and a practicing emergency physician in the Bay Area.

“I know it’s really hard for us Americans because we’re never told no,” she said of the shortfall of supplies. “But we’re not in normal times right now.”

And protective equipment isn’t the only thing in short supply.

Looming Shortages

Until a few days ago, UCSF had to rely on the San Francisco Department of Public Health for coronavirus testing, and a shortage of test kits meant clinicians could test only the most critically ill. The situation improved March 9, when the university started running tests created in its own lab. First, there were 40 tests a day. By Tuesday, there were 60 to 80. But a new shortage looms: The hospital has just 500 testing swabs left.

Stanford pathologist Benjamin Pinsky built an in-house test that has been approved for use by the federal Food and Drug Administration. Since March 3, Stanford has used it to test more than 500 patients, 12% of whom had tested positive as of Tuesday. The university has been running tests for other hospitals as well, including UCSF. It’s a dramatic improvement from a few weeks ago, when Stanford relied on its county lab.

Blomkalns saw a sick patient in mid-February, before the hospital had its own test kits, who had symptoms of COVID-19 but didn’t qualify for testing under the narrow federal guidelines in place at the time. He went home, only to return to the hospital after his condition deteriorated. This time, he was tested and it came back positive.

In Santa Clara County, home to Stanford, 175 people have tested positive for COVID-19 and six have died. Late last week, the medical center’s emergency department saw the highest number of patients in one day in its history. Blomkalns doubts it’s because there are more cases in her area. “If you don’t test, you don’t have any cases,” she said.

Blomkalns worries about staffing shortages as health care workers are inevitably exposed to the virus. As of Tuesday, one doctor in the Stanford ER had tested positive. At UCSF, six health care providers had.

Not all Bay Area hospitals are seeing a flood of patients. In fact, some have fewer patients than usual, as they have canceled elective surgeries in anticipation of a COVID-19 surge.

The doctors treating COVID-19 patients say nearly all who test positive have a cough. They complain of fatigue, body aches, headaches, runny noses and sore throats. While most people are well enough to recover at home, those who get critically ill tend to do so in their second week of symptoms, and can deteriorate very quickly, several doctors noted. “We are recommending that patients get intubated a little earlier than they might otherwise,” said Reyes.

COVID-19 in CA: The Symptoms They’re Seeing

In general, officials are asking people who have mild cases of COVID-19 to treat their symptoms at home, as they would a cold or flu, and refrain from seeking care at hospitals. People experiencing shortness of breath, however, should definitely go to the emergency room, said Blomkalns.

For children, the criteria may be a bit different. Shortness of breath should trigger a visit, as should altered mental state, excessive irritability, or an inability to eat or drink, said Dr. Nicolaus Glomb, a pediatric emergency care physician at UCSF Benioff Children’s Hospital.

Gov. Gavin Newsom said Tuesday that rough projections suggest the state could need anywhere from 4,000 to 20,000 additional beds to treat patients with serious cases of COVID-19.

The testing problems worry Noble, as do the equipment shortages, but not nearly as much as the potential for a lot of sick people. “I’m mostly worried about a tsunami of very ill patients that we’re not equipped to take care of,” said Noble.

Blomkalns isn’t sure whether or when Stanford might exceed capacity, saying the caseload trajectory may hinge on how aggressively state and national authorities move to cut off routes of community transmission. “It all depends on what happens in the coming weeks and days,” she said. “We know what we need to do, and we’re doing the job.”

KHN Senior Correspondents JoNel Aleccia and Jenny Gold contributed to this report.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Reposted courtesy of Kaiser Health News, a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Health Equity: What Does it Mean for Nursing?

Health Equity: What Does it Mean for Nursing?

According to the Robert Wood Johnson Foundation, “Health equity means increasing opportunities for everyone to live the healthiest life possible, no matter who we are, where we live, or how much money we make.”

Health equity is of vital concern to nurses, whose daily work as patient educators and healthcare practitioners is influenced by interrelated factors such as:

  • Health Disparities
  • Social Determinants of Health
  • Cultural Competence
  • Social Justice

With the help of Drs. Janice Phillips (PhD, RN, FAAN) and Margaret Moss (PhD, RN, JN, FAAN), editors of the upcoming book Health Equity and Nursing, DailyNurse is looking at these basic concepts and exploring the role of health equity considerations in the day-to-day work of nursing.

Health Disparities

“Health disparities” refers to the inequalities in health and health care between different population groups. There are widespread inequalities that impinge upon public and individual health and well-being. Among the patients most directly affected are members of ethnic minorities, immigrant and low-income families, and people living in areas far from accessible care. According to a 2018 study, the US spends an estimated $93 billion in excess medical costs per year due to racial disparities alone.

DailyNurse: Can nurses help to overcome health disparities that affect their patients?

Janice Phillips: “It’s been over a decade since nurse leader Dr. Gloria Smith wrote a commentary “Health Disparities: What Can Nursing Do?’ In her commentary, Dr. Smith encouraged nurses to promote nurse managed primary care and focus on changing local, state and national policies to help address health disparities.

In recent years however, we have expanded our efforts to reduce health disparities to include an emphasis on achieving health equity. Healthy People 2020 defines health disparities as a type of particular difference in health status that is closely linked with economic, social, or environmental disadvantages. Populations that experience greater social and economic hardships are more likely to experience health disparities.

In contrast, health equity is a principle that underscores a commitment to reducing and ultimately eliminating health disparities. Health equity occurs when all populations (especially vulnerable, less advantaged socioeconomic populations) experience their highest level of health. Efforts to achieve health equity are intertwined with our ability to effectively eradicate health disparities. In our daily practice, nurses can be mindful to assess for these and other conditions that may adversely impact health outcomes and make appropriate referrals to members of the health care team such as social workers and case managers who are skillful in addressing identified social needs and can make appropriate referrals for additional services.

On a higher level of intervention, nurses must become skillful in advocating for social policies that can positively impact the myriad of social and economic conditions (inadequate housing, lack of employment and education opportunities) that adversely impact the health and well-being of those we serve.”

Health Equity and Social Determinants of Health (SDOH)

Social determinants of health (SDOHs) are factors apart from medical care and genetics that account for roughly 80 percent of overall individual health outcomes, according to the National Academy of Medicine. SDOHs are factors such as socio-economic status, availability of nutritious food, air and water quality, housing, education, transportation, racial segregation, and exposure to racism and violence. SDOHs can include a patient’s neighborhood and environment, access to health care (including insurance); social, cultural, and community context; level of education; and economic stability—all of which play a role in a nurse’s assessment of a patient’s wellbeing and risks to the same.

DN: In what ways can a nurse incorporate SDOH considerations into treatment?

Janice Phillips: “As they are working on the frontlines providing direct care to patients, it is important for nurses to be mindful of the many social and economic factors that may impact the health and well-being of patients and communities at large. In recent years hospitals have started screening patients for social needs that may have some bearing on a patient’s health and health outcomes. Factors such as access to stable housing, primary care, nutritious foods and transportation have emerged as significant factors impacting health status and health outcomes. Thus nurses are pivotal to integrating these factors when conducting patient assessments and making referrals that can help address the identified social needs. Other factors such as structural racism, income, education, poverty also impact health status and outcomes.

As patient advocates, nurses are well positioned to relay important information to social workers, case managers and other members of the interprofessional health care team who have the expertise to refer patients to needed resources. Nurses are valued collaborators in this regard and are encouraged to familiarize themselves with how their respective hospitals and health care systems are assessing and addressing the identified needs of patients. According to the American Hospital Association, by 2023, 48% of health care organizations will have a standardized means for collecting data on the social determinants of health, making this an important opportunity for nursing practice. Knowing where one’s organization stands with these efforts is an important first step.

Public policies that address the root causes of poor health status and longevity are central to any effort devoted to addressing the social determinants of health. Nurses are encouraged to get involved with their professional organizations, home institutions or other stakeholders who can work together to advance a policy agenda aimed at addressing the myriad of social and economic factors that impact health.”

Cultural Competence

According to Dr Jasmin Whitfield (RN, MSN, MPH, DNP), “culturally competent care is not just acquiring information on a particular group of people but rather developing a respect for and understanding that the beliefs, attitudes, behaviors, language, and rituals of that group all play a role.” The epidemiology, manifestation of disease, and effects of medications vary among different ethnic and cultural minorities, so nurses need to make themselves aware of matters such as ethnicity and culture, sexual preferences, and other points of identity as part of their patient dialogue, as all of these matters have specific health connotations.

DN: How can a nurse deal with topics such as patients’ ethnicity, language, culture, sexual orientation, and gender identity in a sensitive, yet direct manner?

Margaret Moss: “It may be of help for the practicing nurse to know of other care modalities recognizing a cultural component. There is Cultural Safety, defined by Williams (1999), “as an environment that is spiritually, socially and emotionally safe, as well as physically safe for people”. This includes being safe to tell your nurse how you identify, relay your spiritual and other needs without fear of retribution etc. Especially when there is patient-provider racial, gender or ethnic discordance, there can be a tentativeness on either side to communicate effectively and fully.

There is Cultural Humility and Cultural Respect as well. So, a big tip is just ask…very simple. With humility, state you are unaware of any special needs or care they may have and ask. Ask, how do you identify? Instead of guessing and then go from there. Whereas Cultural Competency can be seen as useful for the dominant culture caring for the ‘other’. As an Indigenous nurse, no one offered me a Cultural Competency course or workshop as I cared for dominant culture patients. However, safety, humility and respect always serve to increase a patient’s comfort and optimize results.”

Health Equity and Social Justice in Nursing

Social justice is a key aspect of health equity and is a core concept of nursing ethics. The American Nurses Association (ANA) states that nursing has a “professional responsibility to address unjust systems and structures.” Adhering to this ethic can lead to involvement in some divisive issues, but nurses have been advocates for social justice and human rights since the days of Florence Nightingale.

DN: In your view, what role do today’s nurses have in working towards social justice?

Margaret Moss: “Social Justice (from the Oxford Dictionary at Lexico) is justice in terms of the distribution of wealth, opportunities, and privileges within a society. It is well known, published, proved, that minorities in the US suffer, daily and out of proportion to non-minority peoples, at the lower end of these distributions.  Other groups such as the poor, working poor, chronically ill and disabled, and LGBTQQ2+ suffer as well. To help even out these disparities in the health realm, nurses must advocate. At times, they are the only thing standing between a patient and health or death. 

Similarly, nurses are and must be advocates beyond the individual. Nursing programs at the bachelor’s level and above incorporate Community Health, Population Health, Leadership and often Health Policy into the curriculum. I sought a law degree after my PhD in nursing, as both have at their base-advocacy. I have worked my career in advocating for more just American Indian Health. Social Justice Issues face every nurse every day and they are deep and wide. They hit ethics; policy and procedures that may be seen as detrimental but are, “always done that way”; unpotable water such as in Flint, MI; or Uranium on American Indian reservations; lack of available medicines; unfunded programing, and the massive leading edge of aging care; autism; and a host of other issues.”

DN: Finally, what actions can nurses take to further social justice and health equity in healthcare?

Margaret Moss: “Nurses at 3 million strong have the collective and individual power to help change these imbalances, by showing up (legislatures); speaking up (comment on proposed rules); and participating (in practice and advocacy associations).”

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