Public health cannot achieve health equity without nurses

The United States is amid a persistent and critical nursing shortage.

In a U.S. Bureau of Labor Statistics report, 275,000 additional nurses will be needed by 2030. According to a report from the National Academy of Medicine, nursing in the next 10 years will demand a larger, more diversified workforce to address the root causes of poor health outcomes and respond to national public health emergencies. Public health must support and protect all nurses’ physical, emotional, and mental well-being before it can progress towards achieving health equity.

Representing the largest segment of the United States workforce, the 2020 State of the World’s Nursing report shows that nurses make up nearly 60% of the professional health workforce. Nurses additionally deliver approximately 90% of primary care services globally. Today nurses take to social media about unsafe working conditions and participate in labor strikes to ensure the well-being of their patients and communities, causes linked to nurses leaving the bedside. However, their role in advocacy and addressing health inequities does not currently cross into public health.

The term “health equity” is central to public health today. It is one of the priorities of Healthy People 2030, along with eliminating health disparities and improving the health and well-being of all. Nurses are already facing expectations to address health and social justice issues. These include increasing demands of caring for an aging population, responding to behavioral and mental health crises, conducting research, and taking a role in shaping healthcare policy. However, of the 358 core objectives listed, none of them involve protecting the nurse workforce.

While health equity cannot be achieved without all health professions working within and across disciplines, a new report from the National Academy of Medicine recognizes nurses as the link between clinical care, public health, and social services. With a combination of professional knowledge and skills, reasonable care, and humanitarian values, nurses have a unique perspective on disparities across the health care system and within their workforce. While the provision of clinical care is a downstream determinant of health, opportunities exist for nurses to address social needs. Nurses are trusted professionals who spend significant time with patients and families.

With many factors contributing to the long-standing shortage in nursing, a survey by the staffing firm Incredible Health reports that 44% of nurses cited a high-stress environment and burnout had a significant role in leaving their positions. Policymakers and health system leaders insist there are protections to mitigate violence against healthcare workers but argue the threat persists due to security costs. However, stagnant measures and lack of incentive have created an environment where not all nurses report assaults, often due to fear of retaliation. In protecting the well-being of nurses, challenges associated with the staffing crisis have offered the opposite of support; nurses instead face forced overtime and denials of requests for vacation time.

As policymakers and healthcare leadership turn to the public to raise awareness of these critical issues and show their dedication to their nursing staff, the actual experience of nurses does not reflect these commitments. Despite petitions, press conferences, and informational picket lines year after year, the cries of nurses fail to be heard as they battle an environment built on misconceptions that nurses will continue to show up despite poor working conditions. Until these systemic issues are appropriately addressed, progress cannot be made towards eliminating health disparities and improving the health and well-being of all.

Tarissa J. Host

Nurses are strong leaders, skilled critical thinkers, compassionate patient advocates, empathetic communicators, and interdisciplinary practitioners. To make substantial progress in achieving health equity, it will need to make expanded investments in building nurse capacity and support nurses’ in new and expanding roles. Public health must concern itself with creating a more vital, more diversified nursing profession to address the structural and systemic inequities which fuel widespread health disparities. Organizations must foster healthy working environments that support nurses across all settings. This includes reasonable working hours, social protections, occupational safety, and fair working conditions for nurses.

Therefore, public health needs to ensure nurses have the resources and support to address social determinants of health more comprehensively, starting with protecting all nurses’ physical, emotional, and mental well-being. Healthcare leadership has had plenty of opportunities throughout the past two decades to not only promote the interests of nurses but implement actual change in improving workplace conditions and the well-being of their nursing staff. The nursing shortage is a public health crisis and requires public health response before the needle can be moved toward achieving health equity. Nobody is invincible to illness and disease, and without sustainable change, across the nursing workforce, there may be no nurses at the bedside when it truly matters.

Tarissa J. Host is a research professional within the University of Minnesota Medical School in the Department of Medicine’s Division of Geriatrics, Palliative, and Primary Care. She is also a graduate student at the University of Minnesota School of Public Health.