Introduction

Welcome to Taking Action: Top 10 Priorities to Promote Health Equity and Well-Being in Nursing. This book serves as the third edition of The Power of Ten (2011). So much has changed since the second edition (2017), including a major global pandemic, racial unrest with subsequent calls to address health equity and structural racism, and unanticipated nursing shortages that have affected the entire well-being of our profession. We based the top 10 issues highlighted in this book on the most relevant issues facing the nursing profession, as well as the people that nurses care for. Importantly, the second future of nursing report, The Future of Nursing, 2020–2030: Charting a Path to Achieve Health Equity, was released from the National Academies of Sciences, Engineering, and Medicine in May of 2021, thus providing an additional framework for the topics. Those issues or themes include:

1. Health equity

2. Education reform

3. Diversity and mentorship

4. Care delivery: quality, safety, access

5. Multi-sector collaboration

6. Preparing for disasters and public health emergencies

7. Innovation and entrepreneurship

8. Nurse well-being: compassion for self and others

9. Global stewardship

10. Nursing’s voice in leading change

Similar to the second edition, we chose senior leaders well-versed in their chosen topics to contribute their expertise. With attention to diversity at all levels, including race, geography, gender, age, and sexual orientation, we asked the senior leaders to work with a mentee when possible to gain the perspective of up-and-coming leaders. Some of the essays were authored solely by up-and-coming diverse leaders, some of whom have never before published. To provide perspectives for all of nursing, we wanted all of nursing to be represented, or as much as we could for this small book. To gain such a diverse array of perspectives (66 essays in all), we limited each author to around 1,000 words. We have also supplemented the essays with notable quotes from experienced and novice leaders, in addition to the poetry and illustrations of Lucinda Canty and the song lyrics of Tad Worku.

We asked all authors to provide their essays based on evidence but also, importantly, their own lived experience. Due to the conversational tone of the essays, different writing styles will be encountered. Additionally, although we have not given any preference to particular nursing associations, some writers do come from associations, thus representing the work therein. Here is an overview of our top 10 issues and their contributors.

1 Health Equity

Nurses have a key role to play in addressing health equity on the front lines and beyond. Paying attention to these concepts and their application can improve health outcomes for all. Ernest Grant, President of the American Nurses Association, explains what is needed to dismantle structural racism, while frontline nurse practitioner Whitney Fear, a member of the Ogalala Sioux Tribe, states why it matters to build social capital in nursing with more intention than is currently given. Jewel Scott, a nurse scientist, provides suggestions for advancing health equity in Black mothers and pregnant women, and Rachel Walker and her colleague Favorite Iradukunda at the University of Massachusetts Amherst make the case that achieving health equity is a function of how it is defined and by whom. HRSA nurse administrator Carolyn Nganga-Good provides a rich example of how the COVID-19 pandemic has highlighted disparities, and the University of Pennsylvania School of Nursing Dean, Antonia Villarruel, and her student Melina Lopez plead that as nurses we must no longer remain silent to the injustices that lie before us and move to action. Indeed, it is our duty to take action, even if the solutions do not come overnight.

2 Education Reform

Kupiri Ackerman-Barger, an Associate Dean for Health Equity, Diversity, and Inclusion, maintains that the next generation of equity-minded nurses will need a unique knowledge base, skills, sense of self, and a bias toward collective efficacy. David Benton, CEO of the National Council of State Boards of Nursing, states that regulation, education, and services will all need to collaborate to design a fully articulate pathway to equip practitioners with the competencies needed to address health equity. Donna Meyer, CEO of the Organization for Associate Degree Nursing, believes that it is imperative that academic progression with community college graduates be strengthened to have the most highly educated and diverse nursing workforce. University of Wisconsin-Madison Dean, Linda Scott, supports the notion that approaching the student experience as a holistic process aimed at developing the breadth of nurses, while maintaining their own wellness needs, will produce a workforce better positioned to achieve health equity. Assistant Professor Regina Eddie, a member of the (Diné) Navajo Nation of Arizona and a voice for American Indian students, states that what is needed is a learning environment that embraces and improves a better understanding of American Indian students, their cultural background, and the influence of culture on life and learning experiences, attitudes, and beliefs.

3 Diversity and Mentorship

Wallena Gould, Founder and CEO of the Diversity in Nurse Anesthesia Mentorship program, presents a list of specific actions to help remove barriers to increase the number of diverse nurse anesthetists. Dean of Florida State University Jing Wang describes her strategies to increase diversity including a partnership with the Boys and Girls Club, which provides academic support and programming for first generation and underserved populations. Derrick McCoy, a Black male nurse at Grady Memorial, pays tribute to the mentors who helped him with his nursing career. Chief Diversity, Equity and Inclusion Officer at the American Association of Colleges of Nursing, Vernell P. DeWitty, asserts that although the percentage of graduates from nursing schools has increased by 10% from 2012–2022, it is still not representative of the general population. Executive Vice-President and Chief Nursing Officer of CommonSpirit, Kathleen Sanford, states that academia and practice must partner in implementing concrete strategies to increase the diversity of nurses and describes her attempts to do so. Duke Assistant Dean of the PhD program, Rosa Gonzalez-Guarda, claims that anti-racist frameworks are needed in nursing education that call for policies and actions that directly call out and address overt or covert manifestations of racism. Gaurdia Banister, Executive Director of the Institute for Patient Care at Massachusetts General Hospital, describes her beginnings as the only Black nursing student at her school and how she has started programs at her institutions to help bring more supportive strategies for nurses of color.

4 Care Delivery: Quality, Safety, Access

Cyrus Batheja and Treyce Gladney, leaders at UnitedHealthcare, describe how their company is now intentionally screening their members for social barriers, including the programs and resources in place to address those barriers. Chief Operating Officer at the Institute for Healthcare Improvement, Cynthia Barginere, portrays her personal journey correcting poor maternal morbidity and mortality rates for women of color and how she is now proudly serving at an institution dedicated to improving quality for maternal health. Johns Hopkins School of Nursing Dean, Sarah Szanton, describes a program she co-developed called CAPABLE: a participant-directed, home-based program that increases mobility and function of older adults in their home environment and decreases emergency department visits. Julius Jonson, an academician at the School of Nursing at Long Island University Brooklyn, and Carter Todd, an Assistant Nurse Manager at Kaiser Permanente, depict unique but familiar and comfortable locations to provide Black men’s healthcare, including barber shops, the Black church, and nightclubs. Billy Caceres, Assistant Professor at Columbia University School of Nursing, provides his recommendations for nursing practice, research, education, and policy in an effort to improve care delivery for marginalized populations.

5 Multi-Sector Collaboration

Dean Linda McCauley of the Emory University Nell Hodgson Woodruff School of Nursing depicts how cross-disciplinary and cross-sector collaboration are essential in solving the complex issues of health inequity. Vice President of State Government Affairs for the American Association of Nurse Practitioners, Tay Kopanos, provides a vivid case study of how a failed effort with a piece of legislation was later rectified when a strong unified collaboration was formed. Adriana Perez, Associate Professor at the University of Pennsylvania School of Nursing, outlines challenges and strategies for multi-sector collaboration. Keys to collaboration include developing a shared agenda, clearly defining roles, finding funding and managing resources, and sharing data, says Donna Mazyck, Executive Director of the National Association of School Nurses. Garrett Chan, President and CEO of HealthImpact, explains how his company created VaxForce, a workforce management system to vet healthcare professionals and students and match them with existing vaccination events in partnership with community-based organizations. Lauran Hardin, Vice President and Senior Advisor for National Healthcare & Housing Advisors, highlights the need for creating community structures that allow for competitors to collaborate in a meaningful way.

6 Preparing for Disasters and Public Health Emergencies

The Chief Nurse of the American Red Cross, Linda McIntyre, describes how nurses can and should volunteer for her organization and the training needed to do so, while Aisha Mix, Chief Nurse of the Public Health Service, provides a comprehensive overview of how disasters affect health inequities. Kathryn Booth, Manager of Emergency Medical Services at Illinois Masonic Medical Center, illustrates how nurses serving in disasters and public health emergencies are victims themselves of stress and chaos and offers a methodology called HeartMath® as a resilience-building strategy. Zenobia Harris, nurse and Past President of the Association of Public Health Nurses, provides a historical overview of the pandemics that have plagued us and the need for a strengthened public health nursing sector. Hope Williamson-Younce, Deputy Corps Chief of the United States Army Nurse Corps, describes how the military provided support during the COVID-19 pandemic, within the context of achieving health equity.

7 Innovation and Entrepreneurship

Shawna Butler, a Healthtech Specialist and podcast host of See You Now, describes how COVID-19 accelerated the adoption of new technology but also revealed how easy it was to leave behind people without digital access, literacy, or devices—and the nurse’s role in helping to correct this. Liz Perpetua, Founder and Chief Clinical Officer of Empath Health Services LLC, calls nurses to action as natural innovators in the quest to achieve health equity, while Jennifferre Mancillas, Co-Founder and Chief Operating Officer of Lumify, encourages nurses to challenge the status quo within healthcare by keeping a forward-thinking mindset and by encouraging each other with nurse-led innovations. Program Director for Nursing Informatics at New York-Presbyterian Center for Professional Nursing Practice and Corporate Nursing and Filipino immigrant, Mary Joy Garcia-Dia, reports a clear lack of diversity in engaging with diverse populations during the technology development phase, which is leading to downstream health disparities and mistrust in technology. Marion Leary, Director of Innovation at the University of Pennsylvania School of Nursing, and her student, Jonathan Zhu, offer a variety of frameworks to achieve health equity through technology including human-centered design, equity-centered design, and Liberatory design, all underlined by Design Justice.

8 Nurse Well-Being: Compassion for Self and Others

Cynda Rushton, the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins Berman Institute of Bioethics and the School of Nursing, calls for the active cultivation of more compassion for the very nurses who are called to deliver such. An action framework called G.R.A.C.E. is offered as the scaffolding for application. Martha Dawson, President of the National Black Nurses Association and Associate Professor at the University of Alabama at Birmingham, calls the nursing profession to action to have brave and curious action-oriented conversations to address racism and asks her white colleagues to become active allies, open to listening and learning. The Director of Ambulatory Nursing at Stanford Health Care and CEO and Co-Founder of Fifth Window, Filipino Charlene Platon, calls for the prioritization of addressing nursing mental health needs, while understanding the stigma that exists serving as a major barrier to care-seeking behaviors. Maureen White, Executive Vice President & Chief Nursing Executive at Northwell Health, and Launette Woolforde, Chief Nursing Officer at Lenox Hill Hospital, Northwell Health, outline what employers can and should do to promote nurse self-care, while describing their own strategies.

9 Global Stewardship

Yvonne Commodore-Mensah, Associate Professor at the Johns Hopkins School of Nursing, believes that all nurses are well positioned to advance health equity and improve health locally and globally, while particularly calling out high-income countries to collaborate globally with low- and medium-income countries to help them advance their scope of practice, training opportunities, research, and clinical practice. The current President of the International Council of Nurses and Dean at the University of Virginia School of Nursing, Pam Cipriano, believes nurses around the world must learn from each other and posts four case studies to help readers identify global strategies for providing access to care for marginalized populations. Three leaders at the Pan American Health Organization, including Silvia Cassiani, Bruna Moreno Dias, and Cashimro Canha Cavaco Dias, and their colleague from the Ministry of Health and Wellness of Jamaica, Patricia Ingram-Martin, all pay testament to nurses’ leadership during the COVID-19 pandemic but claim that to be prepared for the future, a much greater investment in resources must be made within the nursing profession. Anne Marie Rafferty, Professor of Nursing Policy at King’s College London, and her PhD student, Natalie Sanford, believe that nurses must intervene at every level by building on the United Nations Commission on Employment and Economy as well as the World Health Organization Assembly resolution on nursing and midwifery, using these recommendations as nursing’s calling card to hold governments accountable and translate these into tangible strategic goals to influence policy. Professor Emerita of the Susan Wakil School of Nursing and Midwifery University of Sydney, Jill White, states there is nothing a nurse does that does not have consequences, ultimately for their patients, the community, the country, and the planet—from waste reduction to voting with knowledge and consciousness to actively collaborating on evidence to improve practice. It all matters.

10 Nursing’s Voice in Leading Change

Paule Joseph, the Lasker Clinical Research Scholar at the National Institutes of Health, strongly expresses the need for nurses to examine, unpack, and mitigate their own biases and dismantle the policies and structures that hold inequity in place. Deborah Zimmermann, CEO of the Daisy Foundation and President of the American Organization of Nurse Leaders, believes that the disruption caused by the pandemic has provided a great window of opportunity for all nurses to convene, educate, advocate, and innovate to become active strategists to lead our countries to better health. School nurse and Clinical Coordinator at Rutgers University, Robin Cogen, describes how she raised awareness and concerns that school nurses were facing through her popular blog, The Relentless School Nurse, now read by over 300,000 people. Ravenne Aponte, a PhD student at the University of Pennsylvania School of Nursing, and Joanna Seltzer, a Johnson & Johnson Innovation Fellow, shined the light on their online learning platform, “Nurses You Should Know,” which was created to diversify the nursing narrative by conveying stories of past and present-day nurses of color through bite-sized videos and blogs. And Adriana Nava, President of the National Association of Hispanic Nurses, tells of her own leadership journey with many times being the only Latina in the room to a current position of national prominence, where her mission is to lead other Hispanic nurses to policy and other leadership-oriented fields.

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