As nurses we are the core level of a patient’s trajectory of care. We pride ourselves on being astute eyes and ears calling attention to matters unnoticed by others. We can pinpoint areas that require continued monitoring and ones needing immediate plan of action. Healthcare disparities are like the urine bag that’s overflowing and now backing up into your patients foley.
These matters need prompt but careful attention.
Let’s backup a bit and explain what a healthcare disparity is. The Centers for Disease Control and Prevention (CDC) defines healthcare disparities as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
These differences include access to care, quality of care, ability to seek care (insurance), reliable transportation, safe housing, and quality education. The bottom line is that Black people are not on an equal playing field when it comes to healthcare, hence the disparity.
If we as nurses can recognize, push for change, and offer appropriate alternatives, we can help identify and diminish healthcare disparities from our vantage point. How can we do this?
Awareness
Many studies show medical professionals hold implicit biases: “they have views about racial minorities of which they are not consciously aware—views that lead them to make unintentional, and ultimately harmful, judgments about people of color,” says Khiara M. Bridges, professor of law and anthropology at Boston University.
Underlying thought processes can affect treatment, from not prescribing the correct medications to suggesting older, outdated surgery options. As a nurse (sometimes the only Black nurse), just as we ask questions for clarity about an order or surgical technique, we can ask for further explanation regarding a treatment plan or medical decision that can have negative long term effects for a patient.
You can also challenge yourself and others by asking, “Would there be a different outcome if this were a different patient, or is this the standard of care we normally provide?” Asking questions to the medical team can trigger people to contemplate things from a different perspective as well as begin to uproot patterns of ingrained thinking.
Recourse
Whether learning comes in the form of an experience or a textbook, change never happens without education. As medical professionals, we love a good evidence-based practice reference, so the more we inform ourselves the more we can enlighten others. There are countless resources you can find discussing cultural competency and systemic racism as it relates to healthcare as well as the overall racial division of healthcare services.
Another area we can actively participate in as nurses is the health equity teaching of our patients. Patient-centered care must involve the patient, but “patients with limited health literacy and chronic illness have less knowledge of disease management than those with higher literacy levels,” says Bill Frist, a physician and senator from Tennessee. In other words, every nurse should be a “nurse educator” of sorts.
Assessing a patient's level of understanding can aid in educational absorption and adherence, which can lead to better outcomes. Taking the time to put yourself in someone else’s shoes and reflect on the gained knowledge can help you return empathy and compassion toward the patient and their situation.
This can effect change in individual healthcare equality and also wider communities.
Solution
Getting another set of eyes or raising a red flag about something is how lives are saved. Healthcare disparities are life changing, so remember small things such as transportation have a larger effect on compliance, follow-up, and disease management.
Advocating for our patients is one of our most important job descriptions. Utilizing the relationships built between you and the patient can elicit information sharing between the medical team to suggest community resources and programs, involve other consulting teams, and help communication of potential blocks or issues to provide quality care.
Pushing ancillary staff to think of alternatives that can increase adherence, such as more readily available/cost effective wound care supplies, can help a person not have to choose between buying bandages and buying food. As nurses, one of our main goals is to problem solve; once we acknowledge healthcare disparities as a problem, we can direct our efforts towards useful resolutions.
Eliminating healthcare disparities over time will not only help the Black community, but every minority community, and ultimately, every individual out there. Better outcomes mean less stress on the system as a whole, from lower financial burden, minimal readmissions, decreased stress on resources, and quality vs. quantity of time utilized.
Financial analyses showed “disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year as well as economic losses due to premature deaths.” The call bell has been ringing in regard to healthcare disparities in the Black community, but we have been ignoring it—and sometimes even cancelling it—without response.
Dismantling these issues is a team effort, with nurses being a vital part of the team. It’s time for us to answer this call bell.
