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Journal of Nursing Education, 2022;61(1):3–4
Published Online:https://doi.org/10.3928/01484834-20211204-01

Introduction

Over the course of many years, our nation has witnessed visceral, alarming acts of hate and racial injustices. Images of life and death, which are vivid and daunting ever-present reminders of the social inequities and racial injustices, contribute to the often-silent fears and generational stressors plaguing our nation's marginalized populations. These stress-ors perpetuate health inequities, contributing to the poor health outcomes pervasively illustrated by the disproportionately high infection and death rates of racial and ethnic minorities in the United States during the coronavirus disease 2019 pandemic (Centers for Disease Control and Prevention, 2020). Evidence supports that a diverse health care workforce, reflective of the population, improves trust, retention, engagement, and reduces health disparities. Investing in our nursing workforce and the structures that support our vitality is critical to addressing health reform and requires that we work together across health professions to successfully address discrimination and bias. The Josiah Macy Jr. Foundation (2020) commissioned report, Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments, is a blueprint for change and timely response to the consensus vision statement calling for “Our nation's health professions learning environments—from classrooms to clinical sites to virtual spaces—should be diverse, equitable, and inclusive of everyone in them, no matter who they are. Every person who works, learns, or receives care in these places should feel that they belong there.” So how do we move toward a health care system that is diverse, equitable, and inclusive?

The movement begins with recommendations that support successful and sustainable pathways into the workforce that eliminate discrimination and address bias including (1) build an institutional culture of fairness, respect, and antiracism by making diversity, equity, and inclusion top priorities; (2) develop, assess, and improve systems to mitigate harmful biases and eliminate racism and all other forms of discrimination; (3) integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination, racism, and all other forms of oppression; and (4) increase the numbers of health professions students, trainees, faculty, and institutional administrators and leaders from marginalized and excluded populations. But how? A macro-level discussion focuses on strategies centered on “culture change” and highlights case studies of bias and discrimination. Examples include how to address bias and discrimination against patients by their providers and the health care system, discrimination directed at providers from patients, and discrimination (structural and interpersonal) against health professions students. All are important tenets when addressing bias and discrimination, but what was not discussed is the bias and discrimination experienced across health professions. The ongoing leveling, hierarchies, and submission result in an environment of miscommunication, burnout, turnover, mistrust, indecision, and inability to practice to the full extent of licensure. The latter impedes pathways into nursing practice and academia. The health professions hierarchy and subsequent scaffold of physician privilege is slowing the progress of addressing bias and discrimination in our educational institutions and health care settings and contributing to health disparities and lack of access to care.

When envisioning a hospital Board of Trustees, often they are not representative of the patient population. Many are physicians and none are nurses (so not representative of the health care team). In academia, colleges of medicine are usually more highly resourced than other health professions colleges and, often but not always, the Dean of Nursing reports to an Academic Health Center Director, who is often a physician. In practice, most standing committees include physicians, again typically older, White, and male, with few if any other health professionals, who develop and enforce policy about quality, finance, governance and planning, compliance, strategic planning, and physician relations. Interesting that although nurses are the vast majority of professionals employed by hospitals, physician relations, instead of human relations, is the nomenclature reflecting the long-standing cultural bias toward physicians as the “captain of the ship.” The hierarchy continues with physician dominance over the scope of practice of the nurse and the advanced-practice nurse. The bedside nurse's information is often ignored or under-valued because of a physician-focused framework. Barriers to scope of practice expansion for advanced-practice nurses translate into decreased access of care despite excellent outcomes. The entire team must be valued, engaged, and heard. All need a seat at that table where decisions are made.

Health care will be better when nurses are respected (and feel this value) in the workplace. Students will follow pathways into nursing when they see nurses valued in educational and hospital systems. The nurse faculty shortage will be addressed when colleges of nursing receive fair compensation and equitable resources. We must cultivate a culture of value, one that is characterized by fairness, respect, antiracism, and inclusion as stated in the Josiah Macy Jr. Foundation (2020) report. And, it is not missing for the authors that racial and ethnic minority representation is missing from authorship, and that the onus is on us. Cultivating a culture of value will require resonant leaders to stop compromising human capital for a bottom line that does not serve our population equitably. We need trusting, engaged, respected relationships between nurses and physicians, in addition to other health professionals, to support inclusive health professions' learning and practice environments so that health equity can be achieved.

Angela Clark, PhD, RN, CNE, FAAN

Denise K. Gormley, PhD, RN, FNAP

Christine Colella DNP, APRN-CNP,

FAANP

Greer Glazer RN, CNP, PhD, FAAN

University of Cincinnati College of

Nursing

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