key: cord-274388-hk2103ir
authors: Russell, Naila
title: America Needs Nurse Practitioners to Advocate for Social Justice
date: 2020-07-25
journal: J Nurse Pract
DOI: 10.1016/j.nurpra.2020.06.024
sha: 
doc_id: 274388
cord_uid: hk2103ir

The era of COVID-19 has highlighted disparities within the health care system. The pandemic, in combination with the death of George Floyd, has resulted in professional organizations condemning racism as a public health issue. But what is the role of individual nurse practitioners in addressing systemic racism within the healthcare system? The Code of Ethics for Nurses requires that all nurses actively work to reduce disparities. The code states that universal access to nursing is a human right and that health must be considered in the frame of social determinants. America needs nurse practitioners to reimagine the healthcare system and to develop policy and legislation that results in change. Nurse practitioners are among the most trusted professionals in America, and we can help the country heal from centuries-old injustices.

America Needs Nurse Practitioners to Advocate for Social Justice Naila Russell As the nation reels from COVID-19, the pandemic has laid bare racial disparities within the health care system. In a world where nothing is the samedand everyone is at risk of a novel virusdemotions are heightened. People of color have reached a breaking point and the death of George Floyd reinvigorated calls for reform. Perhaps this was the perfect storm that America needed to say "Yes, black lives matter." I have heard colleagues ask whether nurses are doing enough. Some who have spent a lifetime fighting against racial injustice are cautiously optimistic. This time seems differentda historically diverse group of Americans is demanding change. Health care professionals are kneeling in solidarity and professional organizations are issuing statements on implicit bias and health.

As our country reckons with centuries of systemic racism, I find myself giving consideration to how our profession should best respond. Yes, our professional organizations have issued statements, 1 boldly labeling racism a public health issue. But is issuing statements enough? What is our obligation as individuals to combat the systemic racism that has infiltrated the healthcare system and created generational inequities?

The issue of social justice is detailed in the Code of Ethics for Nurses. 2 This ethical code provides a framework for social justice that all nurse practitioners should be following. According to the Code of Ethics for Nurses, we have an obligation to advance health and human rights and to reduce disparities. Despite our ethical mandate, many nurses are not prepared for or willing to have conversations related to social justice.

In an attempt to start the conversation, I asked a group of DNP students these same questionsdmainly what is the obligation of nurse practitioners to address systemic racism in healthcare? The issue of racism in American has become so politically charged, their instinct was to shy away. They indicated a belief that patients do not want providers to be politically active, and therefore it is best to remain silent as an individual.

Most were supportive of professional organizations making statements condemning racism and calling for an end to disparities. Beyond this, they were unsure how nurse practitioners should react. They surmised that the position of nurse practitioners in the United States is precarious. Ultimately, they voiced a fear that we cannot risk our standing by becoming involved in controversial issues. Others lamented the power differential between nurses and physicians, believing that this imbalance in power would make it difficult for nurse practitioners to lead on issues of racial injustice.

Nurse practitioners may feel powerless, but if marginalized citizens can find the strength to demand change, so can we. We can draw inspiration to imagine change from the words of the marginalized. Those who despite unequal opportunity persisted in advocating for change. People like civil rights leader Angela Davis who stated that she "learned … to live in an imagined new world and to recognise that things would not always be as they were." 3 Nurse practitioners can envision a new worldda new health care systemdwhere race does not dictate access to care, morbidity, or mortality.

But we must do more than imagine change. We must collaborate to address barriers and engage in open discussion. To advance change, we must go beyond issuing statements. We must propose solutions and implement the changes that we wish to see in society.

Nurse practitioners already have guidance on how to effect change. Provision 8 of the Code of Ethics 2 calls for nurses to lead on issues of public health and to collaborate to change unjust structures. In addressing the context of health, the code tells us to consider social determinantsdbecause where people live, work, play, and worship has a lasting impact on health.

Nurse practitioners should be serving on local, state, and federal commissions that draft policy and legislation. We can help connect the dots between seemingly disconnected issues such as public education or housing and urban development and health. The World Health Organization reminds us that we must interject health in all policies. 4 Our code of ethics deems access to nursing a human right; thus, we must advocate for universal health care. We cannot rely on a system that is mainly employer-based when the structure of employment in the United States disproportionately favors some over others.

I believe that nurse practitioners should be leading the charge on dismantling policies that reinforce disparities. This is no time to remain silent; even if we feel less powerful than other professions, silence is akin to complicity. We are among the nation's largest number of healthcare professionalsdAmerica's most trusted profession. Our practice model is based on caring, and America needs providers that can empathize now more than ever.

The nation is in need of healing. Who better to provide that healing than nurses and nurse practitioners?

The Journal for Nurse Practitioners j o u r n a l h o m e p a g e : w w w . n p j o u r n a l . o r g

Racism is a public health issues in need of decisive action

American Nurses Association. Code of ethics for nurses with interpretive statements

we knew that the role of the police was to protect white supremacy

World Health Organization. Health in all policies: framework for country action

She is a fellow of the Harvard Media and Medicine Program

/ The Journal for Nurse Practitioners xxx (xxxx) xxx


