Nurses play essential role in efforts to advance health equity

December 1, 2021

Ministry nurses take on vaccine hesitancy, maternal health disparities, care access gaps

By JULIE MINDA

Since its beginnings, the Catholic health ministry has prioritized care of the poor and vulnerable. CHA and its members reaffirmed that commitment a year ago through the "We Are Called" initiative and the related pledge, "Confronting Racism by Achieving Health Equity."

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Family nurse practitioner and clinic supervisor Bridget Waldrup-Simpson examines Onita Sonnier at St. Bernadette Clinic in Lafayette, Louisiana. Waldrup-Simpson pursued an advanced practice credential in part to be better equipped to work to eliminate health care disparities.

As the largest bloc of health care providers in the U.S. and with a nearly ubiquitous presence across the care continuum, nurses have an essential and growing role in advancing health equity work, according to a recent analysis by the National Academies of Sciences, Engineering, and Medicine (see sidebar).

A sampling of nurse leaders from around the ministry say they felt compelled to take direct action to reduce health inequities.

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Waldrup-Simpson

"We are the eyes and ears of health care, and we know what's needed in the hospital and in the community, and we need to be at the table and in those conversations" about getting at intractable inequities that lead to poorer health outcomes, says Bridget Waldrup-Simpson. She supervises St. Bernadette Clinic, a free walk-in clinic run by Our Lady of Lourdes in Lafayette, Louisiana. That hospital is part of Franciscan Missionaries of Our Lady Health System.

Nurse advocates
About eight years ago, Waldrup-Simpson sought additional education and training beyond her R.N. credential. She joined St. Bernadette while studying to be a family nurse practitioner. Two and a half years after achieving that credential, she became the clinic's supervisor.

The clinic was established in north Lafayette to treat acute conditions in patients without insurance, most of whom are homeless. Many clinic patients have serious chronic conditions including diabetes and hypertension. The clinic provides chronic care management for the months it can take staff to find the patient a permanent primary care provider.

Many residents of north Lafayette are Black. The area lacks health care providers, particularly Black clinicians who would have an inherent level of trust among patients of the same race.

Waldrup-Simpson says that her clinic also meets a vital need for medical, dental and mental health services in an area with a high level of socioeconomic need. Staff refer patients to community partners for help with housing, food, drug rehab and other social services.

Because her patients lack timely access to specialists, Waldrup-Simpson advocates for health care equity locally and statewide. She meets with state legislators, hospital administrators, community partners and insurance companies to lobby for improved care access. She supports the Louisiana Association of Nurse Practitioners' advocacy on the state level for nurse practitioners to be able to practice to the full scope of their licenses.

"As nurses we have big, giant voices and we are such advocates for our patients," she says. Nurses should take that advocacy role beyond the bedside, she says.

'Walk where they walk'
Sr. Mary Trinita Eddington, OP, began her career and ministry in Jackson, Mississippi, more than 60 years ago as a registered nurse at FMOLHS' St. Dominic Hospital. For 35 years she held progressively more responsible administrative nursing roles at the hospital and its parent, St. Dominic Health Services. Longing to return to direct patient care, she earned her family nurse practitioner credentials in the late 1990s then opened the free clinic she's run for 24 years. She now is preparing to turn her administrator duties over to a successor.

The community in Jackson that the clinic serves is impoverished and has barriers to health care access. Sr. Eddington says evidence of systemic racism is pervasive there.

Before she opened the clinic, she immersed herself in the community and built relationships to overcome people's lack of trust in white medical providers. More than 80 percent of Jackson's population is Black or African American, according to the U.S. Census Bureau. "I knew I needed to walk where they walk and had to build trust, I had to listen to them," a mindset that she's maintained to this day.

'Window for change'
Patsy Welch is a nurse manager for labor and delivery, and a lactation consultant at the 57-bed Our Lady of the Angels, an FMOLHS hospital in Bogalusa, Louisiana. About 30% of the population of that community is impoverished, according to the Census Bureau.

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Providence St. Joseph Health community nurse Kristy Capps vaccinates William Salgado against COVID-19 outside a mobile clinic in the Walla Walla, Washington, area. Salgado's father was the first person in Walla Walla County to die of complications of COVID.
Sheila Hager, reporter, Walla Walla Union Bulletin

Welch's concern about the high percentage of expectant and new mothers with drug dependency, hypertension or other risky health conditions motivated her to spearhead multiple initiatives that she says are uncommon in small community hospitals like hers. She started screenings and referrals in prenatal offices for substance dependency and for socioeconomic needs; social workers aid moms needing assistance.

Welch also implemented an "Eat, Sleep, Console" program which makes the mother an integral part of her newborn's care. The maternal nurturing can prevent the need for pharmacological treatment for withdrawal symptoms associated with neonatal abstinence syndrome.

She's put in place breastfeeding support and a hypertension management program in inpatient and outpatient care settings.

She says she is driven to help women with substance dependence achieve sobriety by the fact that, during several years of her youth, her mother was incarcerated, although her crime was not related to substance dependency. "My passion for implementing the program is to help moms to rehab so they can be with their child. It was painful growing up without a mom. It was a huge hole in my life.

"The majority of moms I see do not want to lose their children. The biggest reward to me is seeing these moms rehabilitate and take their babies home with them," Welch says.

Boots on the ground
Across the country, in Walla Walla, Washington, registered nurse Becky Betts has built from scratch the population health department at Providence St. Joseph Health's Southeast Washington region.

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Betts

She came to the population health field having worked as a nurse in almost every department of Providence St. Mary Medical Center. She says she's seen patients whose noncompliance with medical orders led to frequent preventable readmissions and increased pain and suffering. She's seen how poverty contributed to poor control of chronic disease. She felt limited in her ability to address such issues as a staff nurse and so she shifted her focus to population health.

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Family nurse practitioner Sr. Mary Trinita Eddington, OP, treats Sie Lee Donalds at the free clinic she founded and heads in Jackson, Mississippi.

The department relies on community health needs assessments and data ana–lytics to pinpoint health inequities. The analysis has shown great gaps between the health outcomes of Latino patients as compared to white patients. Betts has been hiring community health workers from the Latino community and partnering with community health workers from other organizations to do outreach to medically underserved Latinos.

Many immigrants without legal immigration status work in agriculture and meat processing in the Walla Walla area. Betts and the health workers have taught members of this vulnerable population how to access health care and protect themselves and their families from COVID-19.

Betts says the work is having an impact on health status. For instance, there has been a reduction in avoidable emergency department visits, increased medication adherence and reduced hospital readmission rates.

Betts says nurses have the skill set to lead health equity work. "We are trained in whole-person care, and we're about taking care of family units."

Clinical lens
Ursula Wright is a nurse practitioner and vice president of clinical care and redesign at Chesterfield, Missouri-based Mercy.

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Wright

In addition to providing hands-on care, Wright has been helping with systemwide efforts to recruit and promote colleagues with diverse racial and ethnic backgrounds. She co-chairs a committee that is working to provide mentoring, training and career ladders for minority clinicians and finding ways to meet the unique needs of diverse patient populations.

Wright says nurses at Mercy have "become a critical component" in making changes at the system in a way that keeps patient needs at the heart of decisions, where they should be. "We've come up with new and innovative ways to approach patient care. And it's part of our DNA as nurses to have that love of our patients and to have that concern to improve their health outcomes," she says.

'Future of Nursing' report says nurses are poised to lead on health equity

Nurses have a critical role to play in promoting health equity, but in order to fully achieve their potential as leaders and influencers, they need robust education, a supportive work environment and autonomy. That is according to "The Future of Nursing 2020 – 2030: Charting a Path to Achieve Health Equity," a report released in May by the National Academies of Sciences, Engineering, and Medicine.

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According to the authors, the nearly 4 million registered nurses across the U.S. are in a strong position to have an impact on health equity. They are present throughout acute care, community and public health settings and so can influence medical and social factors "that drive health outcomes, health equity and health care equity," the report says.

Nurses should serve as "bridge builders and collaborators, who engage and connect with people, communities and organizations to promote health and well-being," the authors say. According to the report, in the interest of advancing health equity nurses should have a clear role in disaster response and public health emergency management. Health equity is relevant to disaster planning because pandemics and other health and environmental emergencies may have a disproportionately negative impact on communities of color.

There are many barriers to nurses taking on wider responsibilities to advance health equity. They include a shortage of nurses and a growing number of unfilled positions, restrictions that prevent nurses from practicing to the top of their licenses and outdated payment systems that do not reward preventive health care.

The report calls for states to lift restrictions on scope of practice regulations in order to allow nurses to apply the full extent of their training and education. The authors support value-based payments and other reimbursement structures that can give health systems more financial flexibility to engage in work that addresses social determinants of health and advances health equity. And the report calls for nurse education that prepares students to take on health care from a population health perspective and nurses to develop leadership and advocacy skills to advance health equity.

Acknowledging the stress shouldered by nurses, the authors write that it is important to protect nurses' health and well-being, particularly as they are taking on increased responsibility.

The Future of Nursing is the second in a series of reports of the same name. It is the result of a study conducted by a committee under the National Academies. The committee undertook the study at the request of the Robert Wood Johnson Foundation and examined how to strengthen the nursing profession to meet the challenges of the coming decade. The AARP and the Robert Wood Johnson Foundation have launched the Future of Nursing: Campaign for Action to address recommendations covered in the study.

 

Nursing schools help prepare students to advance health equity

Nursing schools, including Catholic institutions, are equipping nursing students to play a central role in addressing health disparities.

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Sr. Donley

Sr. Rosemary Donley, SC, is a Duquesne University School of Nursing professor and the school's Jacques Laval Chair for Justice for Vulnerable Populations. For a dozen years she has organized an annual national symposium on health care justice. Among the attendees are nurses, nursing students and other health care providers.

Sr. Donley says the curriculums of Catholic nursing schools in the U.S. including Duquesne incorporate coursework that exposes students to the human cost of health disparities in economically marginalized and vulnerable communities.

She says nurses are taught to take the time to understand how well patients can care for their own health when outside the hospital walls, given their circumstances. For instance, nurses will want to know whether patients can realistically adhere to discharge instructions, whether they have access to the foods clinicians advise they eat, whether they have the facilities for the exercises clinicians advise them to do, whether they can afford the drugs they're prescribed. This nursing mindset — looking at the practicalities of care adherence — naturally leads to a focus on social determinants of health and other health equity factors, Sr. Donley says.

She says topics related to the social determinants of health and health equity are core to the Duquesne nursing school curriculum. She notes that the Pittsburgh school recently has been adding technology coursework to prepare nursing students to provide telehealth, which is proving essential for addressing health care access inequities affecting rural populations. The nursing school also has courses on ethics.

Sr. Donley says she encourages beginning nursing students to pursue bachelor-level education and advanced certifications, including nurse practitioner credentials. Many nurse practitioners want to work in medically underserved communities, she says, and that commitment could improve care access.

 

Copyright © 2021 by the Catholic Health Association of the United States
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