Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action.
The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing.
The research on health disparities is stark and continues to increase. The Centers for Disease Control and Prevention’s Health Disparities and Inequalities Report–2013 found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.
But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way—lives that are often very different than our own.
I understand that it is human nature to be more comfortable with the familiar, but this is not what we are called to in nursing. More than 150 years ago, Florence Nightingale noted a strong link between a population’s health and its economic prosperity, and she called for all people to be treated equally.
My mother told me that when she first entered nurses’ training at New York City’s Bellevue Hospital School of Nursing in 1943, Director Blanche Edwards addressed the students on her conduct expectations for nurse trainees. Part of that lecture—and of the nursing culture absorbed by those being trained at Bellevue—addressed the equality of all human life and how she expected her nurses to treat everyone with equal care and attention.
My mother said that, although she was aware of differences in skin color, socioeconomic status, and country of origin, she believed that Ms. Edwards was right, and she went about caring for people as if they were equal. Everyone deserved the same care. Anything less was simply unethical.
My mother taught me the importance of treating everyone with compassion and equality, and it’s something that I’ve striven to do throughout my career as a nurse.
Workforce diversity is part of the equation. I’m proud that the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, calls for a more diverse workforce and for all health care practitioners to be culturally competent. I’m grateful that my passion and my livelihood are directing efforts to implement these recommendations. And I hope that history will view the report as a factor that spurred more nurses to advocate for a more diverse workforce and equal care for all. To act any other way would not be in keeping with the privilege of being a nurse.
Hello Susan,
I enjoyed reading your article and am encouraged to comment as this issue is imperative in nursing. Cultural competence was a topic heavily enforced during my nursing education. I learned much about this topic in the classroom and it served to prepare me for my first encounters in the nursing profession. Patient interactions continues the learning. Every encounter has a learning potential to take and add to our cultural, or in this global village, intercultural competence.
I work at a large hospital in a large, central, and coastal city. As such, I care for a majority of patients that reside in my local community. As the hospital is specialized and renowned, I also care for individuals from varied cultures and customs. I have learned much humility and acceptance and to not be quick to judge. For example, whereas someone might say that a patient waited too long before seeking treatment, I plan on figuring whether the patient has adequate access to health care and insurance and anticipate the needs that must be corrected for the patient to follow through on treatment. We all come from different walks and no one should be quick to judge, especially nurses.
Thank you for this article. For the most part, I feel that the majority of nurses I have worked with treat patients with care, regardless of their background. It is important for us as nurses to acknowledge those quick automatic judgments that show up, so we can be aware of them and set them aside (otherwise they stay hidden in the shadow). For example: I immediately formed a judgment when I heard report on a 5 cm dilated labor patient because her Arabian husband didn’t want her to get an epidural because his culture didn’t do that. Recognizing my immediate judgment allowed me to set it aside and take care of her. He came around and she had a comfortable birth.
I think access to care has improved but remains an issue to be addressed with creative approaches.
I suppose I’m wondering when has the philosophy of treating all patients equally not been a part of nursing !