The AANP board of directors passed a resolution supporting the efforts of employers to create a safe environment and to stop the spread of COVID-19 in offices, healthcare settings, and other places where people gather.
“AANP supports employers moving to mandated vaccinations to protect employees, patients, families, friends, and all Americans across our great nation and to stop the spread of this virus," April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of AANP, said in a press release. "As nurse practitioners (NPs), we are deeply respectful of the trust patients put in us to provide the very best advice and care—and NPs will continue to deliver that care each and every day.”
"Thank you to the many AANP members who have thoughtfully considered all perspectives of this important discussion," Kapu said. "It’s critical we all get vaccinated as soon as possible. In the millions already vaccinated, vaccines have shown their ability to fight this deadly virus. They are the tool that will help us emerge from this devastating pandemic."
AANP began urging everyone to get vaccinated as soon as the first vaccine came out last year. Those currently unvaccinated continue to be at very high risk of acquiring COVID-19, and it’s these patients who are overwhelmingly the most of new hospitalizations and deaths.
Use of personal protective equipment (PPE) and social distancing continue to play an important role in alleviating transmission of COVID-19, and AANP supports the use of PPE when around this and other highly contagious viruses.
Vaccination, however, remains the most powerful and effective tool in fighting COVID-19.
Response times improved by up to 59% faster, Ohio State study says.
A new alarm system that helps nurses distinguish between emergency and all other alarms can save lives by getting nurses to the bedside of patients in cardiac arrest faster, a new study says.
"The reductions ranged from 15% to 59% faster response time during the study and they continued to improve after the study ended," Emily Patterson, principal investigator and professor in the School of Health and Rehabilitation Sciences, said in a press release.
The research team focused on the secondary alarm notification system (SANS), which sends alarms by mobile phone so nurses can receive notifications regardless of where they are on the hospital unit. It’s a common strategy that hospitals use to reduce alarm response time, and it’s used in addition to alerts at the bedside and nursing station.
SANS alerts, which can be triggered by hospital staff, patients, or machines, usually sound the same and may be accompanied by a message on the phone screen.
Ohio State researchers wanted to help nurses using SANS distinguish between emergency and all other alarms while suppressing redundant alarms or those with high false alarm rates.
For emergency alarms that require immediate action, such as code blue, researchers incorporated a distinct beacon tone and digitized speech identifying the alarm. These emergency alarms are triggered by a medical professional who identified a patient at risk of dying and are less likely to be false alarms.
For machine-triggered alarms, such as abnormal heart rhythms, only one sound served as both beacon and triggering event. The initial onset and escalation was delayed by 20 seconds on the SANS so that the nurse could respond if already in the patient’s room before it went off.
For patient-initiated alarms to request medication, water, or assistance, a sound resembling a futuristic telephone was used.
"We documented nurse alarm and response time at three hospitals for 14 months prior to implementing the alarm changes, and then we followed the same nursing units for another 25 months after the changes," Patterson said. "There was a statistically significant reduction in duration time for the code blue alarm at all three hospitals and the alarm burden fell by 20–38%. We believe by reducing the overall number of alarms, we allowed nurses to better identify code blue alarms."
Future grant-funded research led by study co-investigator Mike Rayo, an assistant professor in the College of Engineering, will focus on how auditory alarms can be integrated into visual displays to better inform nurses of patient emergencies.
Continuous care, attention, and making changes when needed are keys to a successful nurse professional governance system, a Vermont CNO says.
Shared governance is pivotal to strengthening professional nursing practice, but it requires more than simply a structure, says Peg Gagne, MSN, RN, chief nursing officer for University of Vermont Medical Center (UVMMC), a 500-bed academic medical center in Burlington, Vermont, with a staff of about 1,800 nurses.
"It needs continuous care, attention, advocacy, and that 'care-and-feeding' piece to make it successful," she says.
Gagne was part of the team that successfully redesigned UVMMC's Nursing Professional Governance (NPG) system.
UVMMC previously had a limited shared governance structure with nonstandardized departmental councils and a global nurse practice council that inconsistently involved clinical nurses in proposals and implementation, according to Gagne.
"The functionality of it had drifted a little bit," she says.
So, in 2017, a redesigned governance structure rolled out, featuring an inclusive approach, rather than the previous leadership-driven, top-down model, and requiring active engagement of clinical nursing staff in shared decision-making, Gagne says.
UVMMC's new structure was designed to offer nurses more autonomy than ever before.
The structure
A flow chart of the service-line structure places point-of-care—the unit practice councils—at the top of the chart, and, in descending order, the seven service line councils, six global councils, and organizational and governance leadership at the base.
Unit practice councils
The unit practice councils, organized by service line, assemble nurses who care for similar patient populations.
The medicine and oncology service line, for example, includes such departments as renal services, radiation oncology O.P., breast care center O.P, infection prevention, and the infusion O.P. clinic in its practice councils.
Service line councils
Seven service line councils were created for the new structure. Over the years they've been slightly tweaked and adjusted, and currently consist of:
Ortho & surgery
CV & neuroscience
Emergency care, access & mental health
Maternal-child health
Periop
Ambulatory care
Medicine & oncology
Global councils
Four global councils initially were established representing a specific quality focus: safety and quality, patient and family experience, professional development and scholarship, and nursing practice.
But in the "care and feeding" of the structure, global councils were changed, redesigned, and added, and the NPG currently has six global councils: communications, patient family experience; professional development & scholarship, nursing practice, experience & wellness, and LNA (licensed nursing assistant).
Coordinating council
The foundation of the structure is the coordinating council, whose members include the clinical nurse chairs of the global councils, UVMMC's chief nursing officer, and other nurses.
The coordinating council ensures alignment of work across councils so the councils' work matches the organization's strategic priorities, according to Gagne.
Making continual adjustments
The new structure eliminated the unit-based practiced councils, instead opting for a task force model.
"If you as a unit had a problem that you wanted to address and work on, you pulled a group together [to be] very problem-focused, but there wasn't an ongoing unit-based practice council as part of the structure," Gagne says.
As part of the "care and feeding" of the new shared governance structure, the hospital conducts yearly evaluations pinpointing its strengths and weaknesses, so adjustments can be made, and one of the first evaluations resulted in the return of unit-based practice councils.
"We really heard from our staff that they missed that unit-based practice structure," Gagne says. "They really wanted that forum to brainstorm ideas, evaluate the unit-based data, and be a generating group for looking at the care model on the unit and deciding what issues they needed to address."
"So, we built back the unit-based practice councils into the model about two years ago," she says, "but with COVID, it has taken a little while to get them back up and running."
During this same period, they were shifting to a collaborative leadership model on each of the units, where the nurse manager is supported by a medical director, a physician partner, and a quality partner, Gagne says.
"With bringing back the unit-based practice councils, which are more nursing focused, along with this collaborative leadership team on the unit, it really has started to strengthen that frontline staff voice in advancing practice issues," she says.
Programs from the front lines
One of the first projects that came out of the new structure was from the medicine & oncology service line council, which had implemented "The Pause," where, after a patient death, onsite caregivers who served that patient gather, along with the patient's family if they choose, and take a moment to recognize the patient and acknowledge the caregivers, Gagne says.
"The Pause has gone from initially a unit-based practice to throughout the organization," she says.
During a Joint Commission visit, a surveyor happened to visit the intensive care unit (ICU) when a patient had died, and caregivers were conducting a Pause.
"The Joint Commission surveyor said, 'I'm taking this as a best practice on the road with me,'" Gagne says.
Other shared governance initiatives include:
Creation and implementation of a Nursing Professional Practice Model—multimodal implementation including presentations, flash cards, standing displays, incorporation into document templates, and tips for incorporating into staff/other meetings.
Creation/piloting a patient-belongings box to reduce lost patient items.
Bringing and maintaining the Daisy and Bee Award at UVMMC to recognize outstanding nurses and clinical staff.
Improving hand-offs throughout the perioperative area.
Developing a quick nurse reference guide called Know Your Resources to address most common resource needs: procedure guide, drug lists, interpreter services, etc.
Achieving satisfactory staffing
A collaborative stance with frontline nurses has helped UVMMC achieve staffing levels acceptable to their nurses—a challenge facing nearly every health system or hospital.
"It's another way that we have been trying to empower and support that frontline staff voice in impacting professional nursing practice by having their direct review and involvement in what staffing model and staffing levels should look like across the organization," Gagne says of the two-year project.
"A unit-based group of staff and leaders reviewed national benchmarks in terms of staffing levels for every unit and department across the organization, including our ambulatory sites as well as our in-patient sites," she says. "They talked about the care delivery model in each area, looked at the benchmarks, compared the work they were doing to where the benchmarks were coming from and then came back with recommendations of what the staffing model and levels should look like in each area."
Those recommendations were evaluated in partnership with their nursing union's bargaining unit, she says.
"The president of the nurses union and I spent countless hours meeting with each of these groups over the fall and spring, getting their recommendations and evaluating the recommendations," she says. "We ended up adding a substantial number of FTEs to our next year's budget to support the recommendations of the unit staffing collaborative."
"It was a big piece of work," she says, "but it was really needed and had a good outcome."
Ritual ceremony emphasizes the human connection in healthcare.
Fifty schools of nursing nationwide have been selected to receive funding to host White Coat/Oath Ceremonies—a ritual designed to highlight the importance of compassionate care to nursing students early in their professional formation.
"The compassionate connection that nurses forge with their patients is the foundation of humanistic healthcare—care that all people deserve," said Dr. Richard I. Levin, president and CEO of the Arnold P. Gold Foundation, in making the announcement via a press release.
"We are delighted to join with American Association of Colleges of Nursing (AACN) to support 50 schools of nursing in establishing this humanistic ritual and emphasizing the importance of the human connection in their future care," Levin said.
When nurses and other healthcare providers build caring, trusting, and collaborative relationships with patients, studies reveal a connection to better care decisions, improved patient adherence to treatment plans, and less costly healthcare outcomes.
"Quality healthcare is not possible without compassion," said Dr. Deborah Trautman, AACN president and CEO. "Academic nursing is grateful to the Gold Foundation for their groundbreaking work to help all members of the healthcare team understand the importance of delivering patient-centered care."
Though White Coat/Oath Ceremonies are not new in the health professions, they are relatively new to nursing. Since 2013, AACN and the Gold Foundation have worked together to implement this rite of passage in nursing, which has resulted in 410 schools of nursing in 50 states including the District of Columbia, receiving support as part of this initiative.
While these seeding grants are limited each year, all nursing schools are eligible to receive Gold lapel pins for their nursing students participating in White Coat/Oath Ceremonies. The pins include a signature Gold loop, which represents the essential bond between clinicians and patients, and serve as a reminder of their ceremony.
View a list of nursing schools selected to receive funding from the Gold Foundation to offer White Coat/Oath Ceremonies in the Fall 2021 and Spring 2022 semesters.
Catholic healthcare systems must treat employees 'respectfully and justly,' which includes a right to organize, labor network president writes.
The Catholic Labor Network, a national group focused on social justice and supporting workers, has reminded Trinity Health of New England of the ethical and religious directives of the Catholic Church after alleged retaliation by Trinity of two Mercy Medical Center nurses engaging in union activity.
Clayton Sinyai, president of the Catholic Labor Network, wrote a letter to Dr. Reginald Eadie, CEO of Trinity Health, a Catholic health system, saying the network is "deeply concerned" about action taken against the nurses, according to a press release from the Massachusetts Nurses Association (MNA).
The letter referenced ethical and religious directives of the Catholic church that say Catholic healthcare institutions such as Trinity must treat "employees respectfully and justly," which includes "the rights of employees to organize and bargain collectively without prejudice to the common good."
Sinyai sent the letter after the network learned the National Labor Relations Board (NLRB) issued a formal complaint against Trinity Health, finding that the hospital violated federal law protecting employees when they engage in union activity by reporting the two nurses to the Massachusetts Board of Registration in Nursing.
The NLRB issued the formal complaint in May detailing that Trinity management submitted written allegations to the registration board last summer about two nurses because, according to the NLRB, the nurses "assisted the union and engaged in protected concerted activities and/or to discourage employees from engaging in such activities," therefore violating the National Labor Relations Act provision that says it is "unlawful for an employer to interfere with, restrain, or coerce employees in the exercise of their rights."
"Trinity's complaints against the nurses were completely unfounded and fabricated only to intimidate and threaten them for engaging in union activities," the MNA said in the release.
The NLRB is an independent federal agency that protects the rights of private-sector employees to join together to improve their wages and working conditions.
"Instead of listening to nurses and improving patient care and working conditions, Trinity Health decided to retaliate against my protected union activity by filing a complaint that jeopardized my nursing license and also forced me to hire a lawyer to fight for my license," Alex Wright, RN, and co-chair of the MNA Bargaining Committee at Mercy Medical Center, one of the nurses involved, said in the release.
"This sort of behavior shows how intent Trinity is on undermining nurses' collective voices rather than giving us an equal seat at the table to make positive changes for nurses, patients and our community," Wright said.
Mercy nurses have engaged in public action throughout the COVID-19 pandemic, calling for improved safety standards for patients, nurses, and other healthcare workers.
Tower Health's Reading Hospital also netted lower turnover rates and higher job satisfaction.
After wrestling with staffing issues that placed too many nurses on a unit one hour and too few the next, Tower Health took a deep dive into staffing and workforce optimization using predictive algorithms and surfaced with major cost savings, a more efficient staffing plan, and greater nurse job satisfaction.
"We wanted to use predictive analytics to help us staff-to-demand and reduce variations in staffing in situations we could predict and in unpredictable variation as well," says Mary Agnew, DNP, RN, NEA-BC, senior vice president and chief nursing officer of Tower Health, based in West Reading, Pennsylvania.
"It was quite an involved process," Agnew says of the project that began in 2017. A new staffing model based on predictive analytics was rolled out at Reading Hospital, the health system's flagship hospital, in 2018, and in four more Tower Health hospitals in 2019.
But first, exhaustive and painstaking data-gathering had to be done, and Tower needed help, Agnew says. They worked with management consulting company Kaufman Hall to do the initial exhaustive and painstaking data gathering.
"You need to have the right partners, and the right plan, and the right expertise," Agnew says. "This is a heavy lift."
Gathering the data
Tower Health began its work with Reading Hospital, gathering data from payroll, staffing grids, the historical census—including the hourly census—for the previous three years for each individual unit, bed capacity, nonproductive time, turnover rate, vacancy rate, hours used for FMLA (Family and Medical Leave Act), nurse-to-patient ratio, and all other essential information to put into a workforce optimization engine, she says.
"It was time intensive and very comprehensive. You really have to gather everything," Agnew says. "Your staffing is impacted by dozens of other variables other than hours per patient day."
With the goal to level over- and under-staffing, Tower collected hourly censuses at different hours of the day seven days a week, she says.
"The average hourly [census] in the ER is very different on a Sunday morning than on a Friday evening," she says. "You can't rely on the 'flaw' of averages; it doesn't give you the data you need."
After putting three years of historical data for each unit into the optimization model, the tool created a model for each unit, and identified what core staffing the hospital system would need to fulfill scheduling demands, Agnew says.
The next part of the equation was deciding what portion of their workforce would be flexible.
"You have your core workforce, which is lean, and then your flexible workforce, which is there for unpredicted variations," she says. "If a bus [full of patients] pulls up or [there's] some other spike in census not anticipated, you have the ability to deploy a flexible workforce. That model gets rid of the variation that causes over- and under-staffing."
Previously, subsets of time were not delineated by shifts, but rather in terms of two- and four-hour increments, Agnew says, offering a heat map illustration to explain how staffing patterns were off balance.
"Let's say the heat map is green and you're good [with staffing] and yellow is on the edge, and red is not enough staff," she says. "We would see green, orange, red, and yellow all in the same day. On a Monday morning, it might be green all morning and orange at noon, which means we're overstaffed in the morning and understaffed in the afternoon."
Predictive analytics provided a completely different way of scheduling, Agnew says.
"It took a lot of work away from nurse manager or director who previously constructed that schedule," she says.
"It was great and also problematic. Nurse directors wanted to have that control and put extra people where they thought they needed them or to make deals where some nurses would work just certain days," she says. "Special deals are not part of this. That went away."
When managers and directors saw on the heat map how the new patterns improved staffing, they became believers, she says.
"When [they] saw the heat map, it was a real eye-opener," she says.
An economical staffing model
The new staffing model decreased the number of core staff, but grew the flexible staff "a great deal," Agnew says.
To be most economical and efficient with their new staffing model, they needed to increase the number of "point 6," or part-time, positions.
That required some creativity, Agnew says.
"When we tried to entice people to take those point 6 positions, a lot said, 'We would love to work point 6 … but from a financial standpoint, we can't afford to,' or the biggest issue was they would have higher premiums for health benefits, which was a deal breaker," Agnew says.
"So, we created a flexible schedule for work-life balance. We paid an additional incentive, an hourly incentive, that defrayed the cost of … higher premiums for part-time benefits," she says. "Many people took advantage of it and appreciated it."
Filling those point 6 positions resulted in $1 million a year in savings at Reading Hospital, Agnew says.
The new staffing model has resulted in increased job satisfaction, both for nurses who wanted a more flexible work schedule and for core staff, called the Tower Select team, who wanted more variety in their work.
"When we created the Tower Select team … some of them wanted to work on other units to have something new and different," she says. "They received incentive to do that because they are going to different units and receiving different education and training."
Turnover rates improved and Tower has received positive employee feedback, Agnew says.
That positive feedback can partly be attributed to the fact that Tower employees were part of the staffing project from the beginning, she says.
"We didn't want this to be top down," she says, so the project included a group of peers making decisions with health system leaders about work rules, processes, and scheduling.
"It was a great exercise in building collaboration and teamwork and that was the reason for the success of the project: engaging people early on," she says.
Continually tweaking the plan
The new staffing model has been worth the data-gathering and hard work required to implement it, Agnew says.
"It was just a much more objective, data-driven process; more efficient and not based on emotion," she says. "It gave people predictability so they knew the number of hours they were getting."
"As we improved and tweaked the models the last few years and gotten data down, we've gotten more precise in our staffing," she says. "Capacity may change, so you have to consistently remodel every year and continue to keep it current."
"If you have a bus that pulls up with 30 people, the flex staff is not going to be able to cover it," she says. "But on daily predictions, we have the right number and a system of deploying them."
About 135 million healthcare professionals around the world remain unvaccinated, according to the World Health Organization (WHO). Many are nurses on the frontlines of this relentless pandemic, providing care to communities in low- and middle-income countries that lack a steady and sustainable supply of COVID-19 vaccines.
"It is deeply concerning that at this point in the pandemic, many nurses abroad do not have access to the recommended dose regimen of COVID-19 vaccines," ANA president Ernest J. Grant, PhD, RN, FAAN, said in a press release. "ANA fully backs the CDC's recommendation to prioritize the vaccination of nurses and other frontline health care workers."
"Immediate action to broaden public health strategies that will increase the global supply and distribution of COVID-19 vaccines is critical," Grant continued. "This is key to protect the health of nurses, healthcare teams, patients, and communities."
ANA supports President Joe Biden and his administration’s strategy to allocate resources to help increase the global production and sharing of COVID-19 vaccines.
All nurses should get vaccinated against COVID-19, unless a provider advises otherwise, according to the current recommendations of WHO for immunization.
Ongoing clinical trials, research, and evidence demonstrate that authorized COVID-19 vaccines are stable and effective in preventing the spread of the virus and mitigating the impact of variants that account for new COVID-19 infections and hospitalizations daily.
ICN estimates that more than 2,000 nurses across 59 countries have died from COVID-19. However, this number is likely much higher as tracking among health workers is inconsistent.
"When a nurse contracts COVID-19 or tragically dies from the virus, healthcare systems lose an invaluable healthcare professional to care for COVID-19 patients and all other patients battling various diseases and aliments. We also lose a colleague, friend, and loved one," Grant said. "Imagine risking your life everyday while watching the rest of the world enjoy re-openings of society and some sense of normalcy. We can and we must do better. Global mass vaccination of all healthcare professionals is a moral imperative."
ANA continues to strongly advocate for all nurses and healthcare professionals to have the highest level of protection, which includes access to COVID-19 vaccines.
An adverse safety event is "an injury that was caused by medical management (rather than the underlying disease) and that prolonged the hospitalization, produced a disability at the time of discharge, or both," as defined by investigators in the Harvard Medical Practice Study.
The Urban Institute analysis looked at quality of care using 11 patient safety indicators and found:
In six out of 11 indicators, Black adult patients experienced significantly worse patient safety outcomes compared to White patients in the same age group, of the same gender, and treated in the same hospital.
For Black adults, adverse safety events that involved surgical measures occurred more frequently than general patient safety indicators. Relative to White patients, Black adults experienced higher rates of press ulcers, catheter-related infections, perioperative hemorrhage or hematoma, postoperative respiratory failure, perioperative pulmonary embolism, and postoperative sepsis.
Even when comparing patients with similar types of insurance coverage, Black-White disparities in patient safety within the same hospital were prevalent.
Black patients experienced worse patient safety events relative to White patients in hospitals that served more Black patients.
Of the six patient safety indicators, safety disparities remained significant across five indicators in hospitals where more than 25 percent of patients were Black.
The Urban Institute's previous research examined how racial disparities in the quality of inpatient care could be attributed to differences in the quality of hospitals that Black patients are admitted to compared to White patients.
This new analysis, however, indicates that these disparities also exist among Black and White patients treated in the same hospital.
"Our previous work suggested increasing the racial diversity of patients that high-quality hospitals serve or concentrating resources to improve quality of care at low-performing hospitals would narrow racial inequities in care," said Anuj Gangopadhyaya, senior research associate at the Urban Institute. "This study’s findings show that achieving racial equity in patient safety requires transforming the way care is delivered within hospitals as well."
"Studies show the healthcare system fails Black patients regardless of their age, gender, insurance status, or where they access care," said Mona Shah, senior program officer at the Robert Wood Johnson Foundation. "The way care is delivered to diverse patients must fundamentally change and achieving equitable outcomes needs to be a healthcare priority."
As the pandemic continues, employers must address serious safety issues, nurse union says.
National Nurses United (NNU) registered nurses plan a national day of action on Wednesday, July 21, to demand that employers prioritize safety and workplace protections and address problems highlighted by the COVID-19 pandemic.
Tens of thousands of NNU RNs are in the process of bargaining contracts that govern safe patient care conditions and their own workplace safety. The RNs say it is crucial to win these protections in writing to hold employers to prioritize occupational and public health and safety, NNU said in a press release.
To date, more than 400 RNs have died of COVID-19, according to NNU.
"Nurses across the country are standing up and demanding critical change," said NNU president Deborah Burger, RN. "Let's be clear that with the number of COVID cases going back up in some areas of the country, and more contagious and deadly variants spreading, the pandemic is not over. Our employers must act today to address serious issues in our facilities."
Among their demands:
Optimal personal protective equipment (PPE), as many nurses still report being told to use the same N95 respirator for an entire shift or for multiple shifts, or not being given an N95 respirator at all.
Safe staffing levels, and other measures to ensure patient safety during COVID-19.
Employers help protect their patients against racial health disparities by expanding and preserving healthcare services, rather than shrinking, eliminating, and consolidating them "to maximize profit," NNU said.
"From the start of the pandemic, nurses have called on the hospitals to make appropriate plans, to increase staffing and increase training, to put in place clear infection control protocols, and to observe the precautionary principle by using the highest level of protections when dealing with a novel virus," Burger said. "The hospitals did not comply, and the consequences have been deadly. Nurses are standing up on July 21 and using our collective voices to demand that our employers put patients first."
Nurses 'have a really important role in improving health equity and addressing societal factors,' AONL conference speaker says.
Nurses play a vital role in uncovering and addressing patients' social determinants of health (SDOH), Julia Resnick, the American Hospital Association's (AHA) senior program manager of strategic initiatives, told nurse leaders during AONL 2021, the annual conference of the American Organization of Nursing Leadership.
"Health is more than just healthcare and there is a growing body of evidence showing how societal factors are linked to health outcomes across an individual's life," Resnick said during the two-day virtual conference.
"They can impact your health status, quality of life, or even how long you live," Resnick said during the program, "The Growing Role of Nurses in Addressing Societal Factors."
"[Societal factors are] the things that we experience every day—the air we breathe, the homes we live in, the food we eat, the jobs we do, and where we send our kids to school," Resnick said. "And if our air is not clean, our home is not safe, or our food isn't nutritious, if our job doesn't cover our bills, or our children don't receive a quality education, our health inevitably suffers in both the short and long term."
Role of the Nurse
Hospitals and health systems increasingly recognize the societal factors that influence health, and nurses have a vital part to play.
Indeed, the report states that "all nurses, at all levels, and no matter the setting in which they work, have a duty and responsibility to work with other health professionals and sectors to address SDOH and help achieve health equity."
As such, government agencies, healthcare and public health organizations, and payers should ensure nurses have the resources and support to address SDOH in a more comprehensive way, the report says.
"[The report] outlines four areas when nurses can make an impact in those areas," Resnick said.
1. For the patient
"The first is addressing social needs in clinical settings which include screening for social needs and referrals," she said.
Nurses can ask questions and conduct screenings for a patient to help create care plans or to refer the patient to social services or other community health workers, she said.
"NAM also noted a need to train nurses on how to have these conversations and respond to those difficult situations that might arise," she said.
2. In the community
"The second area was addressing social needs and social determinants in the community, and they specifically call out that public health nurses and home visiting nurses as being uniquely well-positioned to build trust and respect in the community," Resnick said, "and also when they're in a patient's home, recognizing that patient's limitation or social needs.
NAM noted that nurses are in a unique position to engage with partners across social, health, and other sectors to engage in health promotion and disease prevention, particularly around coalition building in case management, she said.
3. Across disciplines and sectors
"The third area was working across disciplines and sectors," Resnick said. "Community-based nurses can address health-related needs from diabetes management to transportation."
The report noted that the Community Health Needs Assessment Process is a great opportunity to involve nurses from clinical and community settings in all phases from the assessment phase through implementation, she said.
4. At the policy level
"And last but not least, there's advocating for policy change, something that nurses can contribute to," Resnick said. "They can bring a health lens to public policy and decision making since they understand these upstream determinants of health."
Nurses can engage in change efforts at the local, state, or federal level by serving in public and private sector leadership positions, she said.
"So, there's certainly an incredible role that nurses can play," Resnick said, "in advancing this work in their hospitals and communities."
A health and economic issue
Adverse societal factors can affect anyone, despite age, gender, or race, but people of color tend to experience them at a higher rate, she said.
Additionally, data indicates that addressing health equity is more than a health issue; it's also an economic issue, with immense costs, she said.
Resnick cited a 2011 study by Thomas LaVeist and colleagues on how racial health disparity results in substantial annual economic losses nationally, including $35 billion in excess healthcare expenditures, $10 billion in illness-related lost productivity, and $200 billion in premature deaths.
"There's also much to be gained," she said, citing a study that found that if the U.S. eliminated racial disparities in the areas of health education, incarceration, and employment, the economy could be $8 trillion larger by 2050. "So as a country and as a society, we can't afford not to address it."
