The Future Of Nursing 2020-2030

The Future of Nursing 2020-2030 Report created by the National Academies of Sciences, Engineering, and Medicine produced a consensus report via an ad hoc committee that maps a path for the nursing profession to help our nation create a culture of health, reduce health disparities and improve the health and well being of the U.S. population.

Review the chapter that is ATTACHED (BRIFLY READ IS LONG) In relation to health policy development, identify an advanced practice nurse initiative, policy, law, regulation that is being promoted by a state or federal nursing organization. Research the area of concern and discuss two of the following.

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THE POLICY I PICKED IS: Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (DOCUMENT IS ATTACHED)

ANSWER THE FOLLOWING ALSO DO SOME BRIEF RESEARCH.

  • The goals of the goals of the recommended action.
  • Target possible stakeholders who would benefit from the recommendations and those organizations which may become allies.
  • Describe tactics that advanced practice nurses could implement to improve political engagement of their coworkers.

MUST BE APA 7TH EDITION. AT LEAST 1 REFERENCE ARTICLE (NOT COUNTING ATTACHMENTS AND ARTICLES MUST BE 5 YEARS OR NEWER) use credible sources such as pubmed, CINALH

NO PLAGIARISM

EXAMPLE ATTACHED (FOLLOW THE EXAMPLE ATTACHED)

AT LEAST (1 PAGE AND HALF)

There are no federal mandates regulating the number of patients a registered nurse can care for at one time in U.S. hospitals. As a result, registered nurses (RNs) are consistently required to care for more patients than is safe, compromising patient care and negatively impacting patient outcomes. This legislation would protect patients and improve health care by setting mandated, minimum, registered nurse-to-patient staffing ratios.

Low nurse staffing levels are extremely dangerous for patients » Studies show that when RNs are forced to care for too many patients at one time, patients are

at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure sores, increased length of stay, and readmissions.1 In addition, RNs experience higher burnout rates and job dissatisfaction.2

» For each additional surgical patient in an RN’s workload above the baseline nurse-to-patient ratio of 1:4, the likelihood of patient death within 30 days increases by 7 percent.3

» A 2006 study showed that if all hospitals increased RN staffing to match the best-staffed hospitals in the country, 5,000 in-hospital patient deaths and 60,000 adverse patient outcomes could be avoided.4

Studies on California’s RN-to-patient ratios statute — the only law of its kind in the country — confirm the significant impact minimum staffing ratios have on improved patient safety and outcomes » Compared to California, New Jersey hospitals would have 13.9 percent fewer patient deaths

and Pennsylvania 10.6 percent fewer deaths if they matched California’s ratios in medical- surgical units.5

» Compared to states without ratios, California RNs report having more time to spend with patients and that hospitals are more likely to have enough RNs on staff to provide quality patient care.6

Safe RN-to-patient ratios are cost-effective for hospitals » Ratios will reduce spending on temporary RNs and overtime costs,7 lower RN turnover,8

improve patient outcomes,9 and shorten patient lengths of stay.10 » A 2009 study estimated that adding 133,000 RNs (the

number of RNs needed to increase nursing staff to the 75th percentile) to the U.S. hospital workforce would result in medical savings of $6.1 billion on health care spending, not including the value of increased productivity when RNs help patients recover more quickly.11

» Combining medical savings with increased productivity, the addition of 133,000 RNs would result in an economic value of $57,700 for each additional RN.12

Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act S. 1567 Senator Sherrod Brown H.R. 3165 Representative Jan Schakowsky

OUR PATIENTS. OUR UNION. OUR VOICE.

www.NationalNursesUnited.org » NationalNurses » @NationalNurses

 

 

Sources » 1 Sochalski, J. “Is More Better? The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospitals.”

Medical Care. 2004; 42(2): 67-73. (Workload and understaffing contributes to medical errors, patient falls, unfinished nursing tasks.)

Hugonnet, S. “Staffing Level: a Determinant of Late-Onset Ventilator-Associated Pneumonia.” Critical Care. 2007; 11(4): R80. (Understaffing in intensive care units increases risk of medical complications.)

Needleman, J., et al. “Nurse Staffing Levels and Quality of Care in Hospitals.” New England Journal of Medicine. 2002; 346(22): 1715-22. (Increased RN staffing is associated with shorter patient stays, lower rates of urinary tract infections, lower rates of gastrointestinal bleeding, lower rates of failure to rescue.)

McHugh, M.D. and Ma, C. “Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia.” Medical Care. 2013; 52(1): 52-9 (Improved staffing may effectively reduce 30-day readmissions for certain patients.)

2 Aiken, L., et al. “Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.” Journal of the American Medical Association. 2002; 288(16): 1987-93, 1990. (43 percent of RNs surveyed had high burnout scores, and a similar proportion were dissatisfied with their current job. Both burnout and job dissatisfaction are indicators of turnover.)

3 Ibid. 4 Needleman, J., et al. “Nurse Staffing In Hospitals: Is There A Business Case For Quality?” Health Affairs. 2006; 25(1):

204-211, 208. 5 Aiken, L., et al. “Implications of the California nurse staffing mandate for other states.” Health Services Research. 2010;

45(4): 904-21, 917. 6 Ibid., 912. 7 Schmit, J. “Nursing shortage drums up demand for happy nomads.” USA Today. June 9, 2005. (Quoting Tenet Health

System Chief Nursing Officer. Travel nurses cost hospitals at least 20 percent more than a nurse employee even when benefits are factored in. Full-time employees are paid at least 1.5 times there regular salary for overtime hours worked.)

8 Bland-Jones, Cheryl. “Revisiting Nurse Turnover Costs, Adjusting For Inflation.” Journal of Nursing Administration. 2008; 38(1): 11-18, 12. (Finding that the total RN turnover costs for fiscal year 2017 were between $7,875,000 and $8,449,000, and estimating an RN annual turnover rate at 18.5 percent.)

Aiken. 2010. supra, note 5 at 913. (Finding that California RNs, after the implementation of the mandated nurse-to- patient ratios, experienced burnout at significantly less rates than those in New Jersey and Pennsylvania. 20 percent California RNs reported being dissatisfied with their job, compared to 26 percent in New Jersey, and 29 percent in Pennsylvania. Both burnout and job dissatisfaction are precursors of voluntary turnover.)

9 Encinose, W. and Hellinger, F. “The Impact of Medical Errors on Ninety-Day Costs and Outcomes: An Examination of Surgical Patients.” Health Services Research. 2008; 43(6): 2067-85, 2078, 2080. (Finding that, compared with patients who did not experience medical errors, insurers paid an additional 52 percent more for surgery patients who experienced acute respiratory failure and an additional 48 percent more for post-operative infections.)

10 Needleman, J. et al. “Nurse Staffing and Patient Outcomes in Hospitals.” Harvard School of Public Health. Final Report for Health Services and Research Administration, Contract 230-99-0021) 2001: xxvi. (Finding that there is at least a 3 to 6 percent shorter length of stay for patients in hospitals with a high RN staffing levels, reducing costs.)

11 Dall, T. et al. “The Economic Value of Professional Nursing.” Medical Care. 2009; 47:97-104, 101. 12 Ibid.

For more information, contact: Amirah Sequeira, [email protected]

The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act » Requires hospitals to annually develop safe staffing plans that meet the bill’s mandated

minimum RN staffing ratios and provide for additional staffing based on individual patient care needs.

» Requires hospitals to post notices on minimum ratios and maintain records on RN and other staffing.

» Provides whistleblower protections, including administrative complaint process and cause of action, for nurses who speak out against assignments that are unsafe for the patient or nurse.

» Authorizes the Secretary of the Department of Health and Human Services to enforce the minimum RN staffing ratios through administrative complaints and civil penalties.

OUR PATIENTS. OUR UNION. OUR VOICE.

042222www.NationalNursesUnited.org » NationalNurses » @NationalNurses

 

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This PDF is available at http://nap.naptionalacademies.org/25982

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021)

466 pages | 6 x 9 | PAPERBACK

ISBN 978-0-309-68506-1 | DOI 10.17226/25982

Mary K. Wakefield, David R. Williams, Suzanne Le Menestrel, and Jennifer Lalitha Flaubert, Editors; Committee on the Future of Nursing 2020 2030; National Academy of Medicine; National Academies of Sciences, Engineering, and Medicine

National Academies of Sciences, Engineering, and Medicine 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982.

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

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I believe that everything affecting our society affects nurses and that eventually will hemorrhage over

to the nursing profession.

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Nurses’ health and well-being are affected by the demands of their work- place, and in turn, their well-being affects their work and the people they care for. As it has in so many other areas, COVID-19 has imposed new challenges for the well-being of nurses. But it also has offered opportunities to give nurses’ well-being the attention it deserves and to address the systems, structures, and policies that create workplace hazards and stresses that lead to burnout, fatigue, and poor physical and mental health. This issue will take on even greater urgency over the coming years as nurses are asked to assume a more prominent role in advancing health equity. For nurses to address the many social GHWHUPLQDQWV�WKDW�LQÁXHQFH�KHDOWK³IURP�KRXVLQJ��WR�YLROHQFH��WR�SRRU� DLU�TXDOLW\³WKH\�PXVW�ÀUVW�IHHO�KHDOWK\��ZHOO��DQG�VXSSRUWHG�WKHPVHOYHV�� Policy makers, employers of nurses, nursing schools, nurse leaders, pro- fessional associations, and nurses themselves all have a role in ensuring the well-being of the nursing workforce.

301

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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302 THE FUTURE OF NURSING 2020–2030

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 303

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

304 THE FUTURE OF NURSING 2020–2030

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 305

THE STATE OF NURSES’ HEALTH AND WELL-BEING

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BOX 10-1 7HFKQRORJLFDO�)DFWRUV�,PSDFWLQJ�1XUVHV·�:HOO�%HLQJ

� 7KHUH�LV�LQFUHDVLQJ�HYLGHQFH�WKDW�WKH�JURZLQJ�XVH�RI�HOHFWURQLF�KHDOWK�UHFRUGV� (EHRs) and other technologies in the workplace is burdening health care workers DQG�DGGLQJ�WR�WKHLU�VWUHVVIXO�DQG�GHPDQGLQJ�ZRUN�HQYLURQPHQW��5HVHDUFK�KDV� indicated that nurses spend a great deal of time charting in and reviewing EHRs, and that this can deplete their time, negatively impact their morale (Berwick et DO����������DQG�WDNH�WLPH�DZD\�IURP�WKHLU�HWKLFDO�DQG�SURIHVVLRQDO�FRPPLWPHQWV� WR�VSHQG�PRUH�WLPH�ZLWK�SDWLHQWV�DQG�IDPLOLHV��$1$���������0DQ\�UHSRUWV�KDYH� considered the burden imposed by clinical documentation and other clerical tasks �$UQGW�HW�DO���������%DXPDQQ�HW�DO���������6KDQDIHOW�HW�DO���������6LQVN\�HW�DO��� ������7DL�6HDOH�HW�DO����������$FFRUGLQJO\��WKHUH�KDYH�EHHQ�PDQ\�GHPDQGV�IRU�D� VLJQLÀFDQW�UHGHVLJQ�RI�FOLQLFDO�GRFXPHQWDWLRQ��+DDV�HW�DO���������2PPD\D�HW�DO��� ������6LQVN\�DQG�/LQ]HU�������� Another technological source of workplace stress is clinical alarms, which no- WLI\�QXUVHV�WKDW�D�SDWLHQW�LV�LQ�GLVWUHVV��2QH�VWXG\�FRQGXFWHG�RYHU�D�SHULRG�RI���� days found an average of 350 clinical alarms per patient per day in an intensive FDUH�XQLW��<XH�HW�DO����������,Q�D�UHYLHZ�RI�WKH�UHVHDUFK��<XH�DQG�FROOHDJXHV�������� found that alarm-related adverse events, including patient deaths due to failures WR�PRQLWRU�DODUP�GHYLFHV��DUH�FRPPRQ�LQ�FOLQLFDO�SUDFWLFH��)DFWRUV�DVVRFLDWHG�ZLWK� alarm-related adverse events include alarm fatigue, missed alarms, and inappro- SULDWH�SDUDPHWHU�VHWWLQJV�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

306 THE FUTURE OF NURSING 2020–2030

�������SULVRQV��:DOVK�DQG�)UHVKZDWHU���������DQG�VFKRROV��-DPHVRQ�DQG�%RZHQ�� �������WKH�YDVW�PDMRULW\�RI�UHVHDUFK�RQ�QXUVHV·�ZHOO�EHLQJ�IRFXVHV�RQ�WKHLU�ZRUN� LQ�FOLQLFDO�FDUH��SRLQWLQJ�WR�D�QHHG�IRU�PRUH�UHVHDUFK�RQ�QXUVH�ZHOO�EHLQJ�LQ�DOO� VHWWLQJV��LQFOXGLQJ�SXEOLF�DQG�FRPPXQLW\�KHDOWK��

Physical Health

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Occupational Safety and Health

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 307

BOX 10-2 A Snapshot of the Physical Health of American Nurses Obesity/Overweighta,b � �� �7KH� DYHUDJH� ERG\� PDVV� LQGH[� IRU� QXUVHV� LV� ������� ZKLFK� IDOOV� LQWR� WKH�

RYHUZHLJKW�FDWHJRU\�� • Roughly half (52 percent) of nurses say that they have adequate access to

KHDOWK\�IRRG�FKRLFHV�ZKLOH�DW�ZRUN� • Only 11 percent of nurses report a daily intake of at least two servings of

IUXLWV�DQG�WZR�DQG�D�KDOI�VHUYLQJV�RI�YHJHWDEOHV� • Fewer than half (47 percent) of nurses report not engaging in regular

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� �� �-XVW�RYHU�RQH�WKLUG�����SHUFHQW��RI�QXUVHV�VD\�WKH\�KDYH�DGHTXDWH�DFFHVV� WR�HPSOR\HU�EDVHG�H[HUFLVH�IDFLOLWLHV�DQG�SURJUDPV�

• Only 44 percent of nurses rate their health as good, 25 percent as very JRRG��DQG���SHUFHQW�DV�H[FHOOHQW�

Sleepa � �� �-XVW����SHUFHQW�RI�QXUVHV�UHSRUW�JHWWLQJ���RU�PRUH�KRXUV�RI�VOHHS��7KH�1D-

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&RQVHTXHQFHV�RI�6KLIW�:RUN�DQG�/RQJ�+RXUVc,d • Long-term insomnia is reported by 32 percent of night workers and 26

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� �� �7KH�PDMRULW\�����SHUFHQW��RI�QHZO\�OLFHQVHG�QXUVHV�ZRUN����KRXU�VKLIWV�� a near majority work the night shift (44 percent), and more than half (61 SHUFHQW��ZRUN�RYHUWLPH��PDQGDWRU\�RU�YROXQWDU\��ZHHNO\��

• Nurses working weekly overtime are associated with a 32 percent increase in the risk of a needle stick, while those working night shift are associated ZLWK�D����SHUFHQW�LQFUHDVH�LQ�WKH�ULVN�RI�D�VSUDLQ�RU�VWUDLQ�LQMXU\�

Smokinge,f • Around 7 percent of registered nurses (RNs) smoke tobacco, while almost

���SHUFHQW�RI�OLFHQVHG�SUDFWLFDO�QXUVHV�GR�VR�� • From 2003 to 2010–2011, the prevalence of smoking among RNs declined

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

308 THE FUTURE OF NURSING 2020–2030

input, and nurses are a critical component of this process. As mentioned in Chap- WHU����OHDGHUV�DQG�RUJDQL]DWLRQV�ZLOO�KDYH�WR�VXSSRUW�DQ�DFWXDO�FXOWXUH�RI�HTXLW\� WKURXJKRXW��DQG�ZLOO�UHTXLUH�LQWHQWLRQDO�FKDQJH�

Mental and Behavioral Health

0HQWDO�KHDOWK�LV�GHÀQHG as ´D�VWDWH�RI�ZHOO�EHLQJ�LQ�ZKLFK�HYHU\�LQGLYLGXDO� UHDOL]HV�KLV�RU�KHU�RZQ�SRWHQWLDO��FDQ�FRSH�ZLWK�WKH�QRUPDO�VWUHVVHV�RI�OLIH��FDQ� work productively and fruitfully, and is able to make a contribution to his or her FRPPXQLW\µ��:+2���������0HQWDO�KHDOWK�LVVXHV��LQFOXGLQJ�VWUHVV��EXUQRXW��DQG� GHSUHVVLRQ��DUH�FRPPRQ�DPRQJ�QXUVHV��$GULDHQVVHQV�HW�DO���������’D�6LOYD�HW�DO��� ������*óPH]�8UTXL]D�HW�DO���������������0DUN�DQG�6PLWK��������0F9LFDU��������� :KHUHDV�WKH�H[DFW�SUHYDOHQFH�RI�SRVWWUDXPDWLF�VWUHVV�GLVRUGHU��376’���DPRQJ� QXUVHV�LV�XQFOHDU��VHH�6FKXVWHU�DQG�’Z\HU���������LQWHQVLYH�FDUH�XQLW�QXUVHV�DUH� SDUWLFXODUO\�H[SRVHG�WR�UHSHDWHG�WUDXPD�DQG�VWUHVV�DQG�RIWHQ�H[SHULHQFH�376’�� DQ[LHW\��GHSUHVVLRQ��DQG�EXUQRXW��0HDOHU�HW�DO����������

These mental health issues have effects on multiple levels. They adversely LPSDFW�LQGLYLGXDO�QXUVHV·�TXDOLW\�RI�OLIH�DQG�HQMR\PHQW�RI�ZRUN��7DUFDQ�HW�DO��� �������WKH\�LQFUHDVH�DEVHQWHHLVP�DQG�VWDII�WXUQRYHU��%XUOLVRQ�HW�DO���������’DYH\� HW�DO���������/DYRLH�7UHPEOD\�HW�DO���������2\DPD�HW�DO����������DQG�WKH\�LPSDFW� QXUVHV·�DELOLW\�WR�SURYLGH�TXDOLW\�DQG�VDIH�FDUH��UHVXOWLQJ�LQ�VXFK�FRQVHTXHQFHV� DV�JHQHUDO�DQG�PHGLFDWLRQ�DGPLQLVWUDWLRQ�HUURUV��SRRU�UHODWLRQVKLSV�ZLWK�SDWLHQWV� and coworkers, and lower patient satisfaction (GlUWQHU�HW�DO����������,Q�DGGLWLRQ�� QXUVHV�ZLWK�PHQWDO�KHDOWK�FRQFHUQV�PD\�EH�VWLJPDWL]HG�DQG�GLVFULPLQDWHG�DJDLQVW� E\�51�OLFHQVLQJ�ERDUGV��$�UHFHQW�VWXG\�E\�+DOWHU�DQG�FROOHDJXHV��������IRXQG� WKDW�RI����ERDUGV�WKDW�DVNHG�TXHVWLRQV�DERXW�PHQWDO�LOOQHVV�����DVNHG�TXHVWLRQV� not compliant with the Americans with Disabilities Act (ADA).

6WXGLHV�KDYH�IRXQG�WKDW�FDULQJ�IRU�SDWLHQWV�RQ�WKH�IURQW�OLQHV�RI�WKH�&29,’���� SDQGHPLF�FDQ�LQFUHDVH�VWUHVV��GHSUHVVLRQ��DQ[LHW\��DQG�376’�IRU�QXUVHV��.DQJ�HW�DO��� ������/DL�HW�DO����������(DUO\�UHVHDUFK�UHVXOWV�VXJJHVW�WKDW�WKH�SDQGHPLF�KDV�SODFHG� QXUVHV�DW�KLJK�ULVN�RI�PHQWDO�KHDOWK�VHTXHODH��SDUWLFXODUO\�DQ[LHW\��GHSUHVVLRQ��DQG� SHULWUDXPDWLF�GLVVRFLDWLRQ��$]RXOD\�HW�DO����������%R[������GHVFULEHV�KRZ�DGGUHVV- LQJ�WKH�&29,’����FULVLV�KDV�LPSDFWHG�QXUVHV·�KHDOWK�DQG�ZHOO�EHLQJ�

Burnout

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��7KH�$PHULFDQ�3V\FKLDWULF�$VVRFLDWLRQ�GHÀQHV�376’�DV�´D�SV\FKLDWULF�GLVRUGHU�WKDW�PD\�RFFXU�LQ� SHRSOH�ZKR�KDYH�H[SHULHQFHG�RU�ZLWQHVVHG�D�WUDXPDWLF�HYHQW�VXFK�DV�D�QDWXUDO�GLVDVWHU��D�VHULRXV�DFFLGHQW�� D�WHUURULVW�DFW��ZDU�FRPEDW��RU�UDSH�RU�ZKR�KDYH�EHHQ�WKUHDWHQHG�ZLWK�GHDWK��VH[XDO�YLROHQFH�RU�VHULRXV� LQMXU\µ��VHH�KWWSV���ZZZ�SV\FKLDWU\�RUJ�SDWLHQWV�IDPLOLHV�SWVG�ZKDW�LV�SWVG�>DFFHVVHG�$SULO���������@��

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 309

DQG� QXUVHV� WKHPVHOYHV�� %XUQRXW� V\QGURPH� LV� FKDUDFWHUL]HG� E\� WKUHH� FRPSR- QHQWV��HPRWLRQDO�H[KDXVWLRQ��GHSHUVRQDOL]DWLRQ��H�J���F\QLFLVP��DSDWK\���DQG�D� ORZ�VHQVH�RI�SHUVRQDO�DFFRPSOLVKPHQW�DW�ZRUN��0DVODFK�DQG�-DFNVRQ��������� (VWLPDWHG�UDWHV�RI�EXUQRXW�DPRQJ�8�6��QXUVHV�KDYH�UDQJHG�EHWZHHQ����DQG���� SHUFHQW� �$LNHQ�HW�DO���������0RVV�HW�DO����������DOWKRXJK�PDQ\�VWXGLHV�IRFXV� RQO\�RQ�WKH�HPRWLRQDO�H[KDXVWLRQ�FRPSRQHQW�RI�EXUQRXW��SDLQWLQJ�DQ�LQFRPSOHWH� SLFWXUH��1$6(0������D���7KH�FRQVHTXHQFHV�RI�EXUQRXW�FDQ�LQFOXGH�SRRU�SDWLHQW� RXWFRPHV��KLJK�WXUQRYHU�UDWHV��LQFUHDVHG�FRVWV��DQG�FOLQLFLDQ�LOOQHVV�DQG�VXLFLGH� �1$6(0������D���)DFWRUV�LQFOXGLQJ�KLJK�ZRUNORDGV��VWDII�VKRUWDJHV��H[WHQGHG� VKLIWV��6WLPSIHO�HW�DO����������DQG�WKH�EXUGHQ�RI�GRFXPHQWDWLRQ��VHH�%R[������� can all contribute to nurse burnout. Another known contributor to burnout is a

BOX 10-3 &29,’����DQG�1XUVHV·�+HDOWK�DQG�:HOO�%HLQJ

Nurses can struggle with determining how to uphold their professional ethical YDOXHV�LQ�WKH�FRQWH[W�RI�FRPSHWLQJ�REOLJDWLRQV�WR�SDWLHQWV��WKHLU�RZQ�IDPLOLHV��DQG� WKHLU�KHDOWK��0DQ\�FOLQLFLDQV�DOUHDG\�IDFHG�DQ[LHW\��EXUQRXW��GHSUHVVLRQ��VWUHVV�� and risk of suicide prior to the pandemic, but the COVID-19 crisis has presented DQ�HYHQ�JUHDWHU�KDUGVKLS�WKDW�FDQ�H[DFHUEDWH�H[LVWLQJ�OHYHOV�RI�EXUQRXW�DQG�PHQ- WDO�KHDOWK�VWUHVVRUV��6TXLUHV�HW�DO���������8OULFK�HW�DO����������6RXUFHV�RI�VWUHVV� LGHQWLÀHG� LQ�D�UHFHQW�TXDOLWDWLYH�VWXG\�RI�QXUVHV�FDULQJ� IRU�&29,’����SDWLHQWV� EHWZHHQ�0D\�DQG�-XO\������LQFOXGHG�SHUVRQDO�H[SHULHQFHV�RI�VRFLDO� LVRODWLRQ�� witnessing large numbers of deaths, increased patient acuity, caring for families, WKH�XQFHUWDLQW\�RI�KRZ�WR�FDUH�IRU�SDWLHQWV��DQG�VHYHUH�VWDIÀQJ�VKRUWDJHV�DQG� RUJDQL]DWLRQDO�LVVXHV��6TXLUHV�HW�DO����������1XUVHV�PD\�H[SHULHQFH�YDU\LQJ�GH- grees of moral suffering that result in moral residue and fatigue as they respond WR� FRPSOH[� DQG� RIWHQ� XQVROYDEOH� HWKLFDO� WUDGH�RIIV� LQ� FDULQJ� IRU� SDWLHQWV� ZLWK� &29,’�����5RVD�HW�DO����������$GGLQJ�WR�WKHVH�VWUHVVRUV��QXUVHV�DUH�DFWLQJ�DV� GH�IDFWR�VRFLDO� LQWHUPHGLDULHV�IRU�SDWLHQWV�ZKR�DUH�LVRODWHG�IURP�WKHLU�IDPLOLHV�� )RU�H[DPSOH��QXUVHV�DUH�XVLQJ�WHFKQRORJ\�WR�KHOS�SDWLHQWV�VWD\�FRQQHFWHG�ZLWK� WKHLU�IDPLOLHV�ZKHQ�YLVLWRUV�DUH�QRW�SHUPLWWHG��6KDSLUR���������&29,’����LV�DOVR� highlighting the challenges that nurses and nurse leaders have in reporting staff VDIHW\�LVVXHV�DQG�HTXLW\�LVVXHV��5DQJFKDUL�DQG�:RRGV�������� � 7KH�GLVSURSRUWLRQDWH�LPSDFW�RI�&29,’����RQ�SHRSOH�RI�FRORU��VHH�&KDSWHU���� has highlighted the need for nurses to focus on caring for the underserved and DGGUHVVLQJ�VRFLDO�DQG�VWUXFWXUDO�EDUULHUV�WR�KHDOWK��1XUVHV�DW�WKH�IURQW�OLQHV�VHH� ÀUVWKDQG�WKH�FRQVHTXHQFHV�RI�VRFLDO�DQG�HFRQRPLF� LQMXVWLFH�ZKHQ�WKH�SHRSOH� most negatively affected by the disease are people of color, immigrants, and other vulnerable groups who are providing essential services often without needed pro- tections, who lack basic access to health services, and who live in overcrowded FRPPXQLWLHV��$EVHQW�LQWHUYHQWLRQV��DV�&29,’����UDWHV�HEE�DQG�SHDN�DURXQG�WKH� 8QLWHG�6WDWHV��WKH�LPSDFW�RQ�QXUVHV�LV�OLNHO\�WR�EH�ORQJ�ODVWLQJ��1HOVRQ�DQG�/HH� :LQQ��������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

310 THE FUTURE OF NURSING 2020–2030

mismatch between the skills and preparation of workers and the jobs that they DUH�H[SHFWHG�WR�SHUIRUP��0DVODFK���������

1XUVHV�LQ�DOO�UROHV�DQG�VHWWLQJV�FDQ�H[SHULHQFH�EXUQRXW��1XUVLQJ�VWXGHQWV�PD\� H[SHULHQFH�DFDGHPLF�DQG�HPRWLRQDO�EXUQRXW�EHIRUH�WKH\�HYHQ�HQWHU�WKH�ZRUNIRUFH� �5tRV�5LVTXH]�HW�DO����������$�VKLIW�WRZDUG�SUHYHQWLYH�FDUH�DQG�FDUH�PDQDJHPHQW� EDVHG�LQ�SULPDU\�FDUH�RU�SDWLHQW�FHQWHUHG�PHGLFDO�KRPHV�PHDQV�WKHUH�LV�D�JURZ- LQJ�GHPDQG�RQ�QXUVHV�WR�WDNH�RQ�PRUH�FRPSOH[�SDWLHQWV�DQG�DVVRFLDWHG�WDVNV�� LQFUHDVLQJ�EXUQRXW�DPRQJ�QXUVHV�LQ�SULPDU\�FDUH��’XKRX[�HW�DO����������1XUVHV� LQ�RWKHU�VHWWLQJV�WKDW�HQWDLO�SURORQJHG�FRQWDFW�ZLWK�SDWLHQWV�VXFK�DV�FULWLFDO�FDUH�� RQFRORJ\��DQG�SV\FKLDWULF�QXUVLQJ�H[SHULHQFH�EXUQRXW�DV�ZHOO��&DxDGDV�’H�OD� )XHQWH�HW�DO���������-DFNVRQ�HW�DO����������:KLOH�GDWD�DUH� ODFNLQJ�RQ�EXUQRXW� DPRQJ�QXUVH�SUDFWLWLRQHUV��VRPH�HYLGHQFH�VKRZV�WKH\�FDQ�H[SHULHQFH�EXUQRXW� FRPSDUDEOH� WR� WKDW�H[SHULHQFHG�E\�QXUVHV�DQG�SK\VLFLDQV��+RII�HW�DO���������� 1XUVHV�ZKR�ZRUN�LQ�ORQJ�WHUP�FDUH�VHWWLQJV�IDFH�SDUWLFXODU�RFFXSDWLRQDO�VWUHVVRUV�� VXFK�DV�SK\VLFDO�RU�YHUEDO�DEXVH�IURP�UHVLGHQWV�ZLWK�GHPHQWLD��IUHTXHQW�SK\VLFDO� WUDQVIHUV�RI�UHVLGHQWV��H[SRVXUH�WR�GHDWK�DQG�GHFOLQLQJ�KHDOWK�DPRQJ�UHVLGHQWV�� DQG�FDULQJ�IRU�LQGLYLGXDOV�ZLWK�YHU\�GLIIHUHQW�FDUH�QHHGV��:RRGZDUG�HW�DO����������

Compassion Fatigue

&RPSDVVLRQ�IDWLJXH��FRQVLGHUHG�GLVWLQFW�IURP�EXUQRXW��LV�GHÀQHG�DV�´D�KHDOWK� FDUH� SUDFWLWLRQHU·V� GLPLQLVKHG� FDSDFLW\� WR� FDUH� DV� D� FRQVHTXHQFH� RI� UHSHDWHG� H[SRVXUH�WR�WKH�VXIIHULQJ�RI�SDWLHQWV��DQG�IURP�WKH�NQRZOHGJH�RI�WKHLU�SDWLHQWV·� WUDXPDWLF� H[SHULHQFHVµ� �&DYDQDJK� HW� DO��� ������ S�� ������ &RPSDVVLRQ� IDWLJXH� RFFXUV�ZKHQ�D�QXUVH·V�DELOLW\�WR�HPSDWKL]H�ZLWK�SHRSOH�LV�UHGXFHG�DV�D�UHVXOW�RI� UHSHDWHG�H[SRVXUH�WR�RWKHUV·�VXIIHULQJ��3HWHUV���������5HVHDUFK�VXJJHVWV�D�QXPEHU� RI�IDFWRUV�WKDW�FDQ�OHDG�WR�FRPSDVVLRQ�IDWLJXH��VRPH�RI�ZKLFK�DUH�RUJDQL]DWLRQDO� DQG�VRPH�RI�ZKLFK�DUH�LQGLYLGXDO��2UJDQL]DWLRQDO�IDFWRUV�LQFOXGH�FKURQLF�DQG� LQWHQVH�SDWLHQW�FRQWDFW��SURORQJHG�VWUHVV��D�ODFN�RI�VXSSRUW��KLJK�ZRUNORDG��KRXUV� SHU�VKLIW��DQG�WLPH�FRQVWUDLQWV�WKDW�KLQGHU�TXDOLW\�FDUH��3HWHUV���������,QGLYLGXDO� factors include a personal history of trauma, a lack of awareness about compas- VLRQ�IDWLJXH��DQ�LQDELOLW\�WR�PDLQWDLQ�SURIHVVLRQDO�ERXQGDULHV��H�J���WDNLQJ�RQ�H[WUD� VKLIWV���DQG�D�ODFN�RI�VHOI�FDUH��3HWHUV���������

Suicide

1XUVHV��OLNH�SK\VLFLDQV��DUH�DW�KLJKHU�ULVN�WKDQ�WKH�JHQHUDO�SRSXODWLRQ�IRU� VXLFLGH��’DYLGVRQ�HW�DO�������D��1$6(0������D���/RQJLWXGLQDO�GDWD�IURP������ WKURXJK������VKRZHG�WKDW�QXUVHV�FRPPLWWHG�VXLFLGH�DW�D�KLJKHU�UDWH�UHODWLYH�WR�WKH� JHQHUDO�SRSXODWLRQ��%RWK�IHPDOH�DQG�PDOH�QXUVHV�ZHUH�DW�JUHDWHU�ULVN�RI�VXLFLGH� �IHPDOH�LQFLGHQW�UDWH�UDWLR�>,[email protected]� ������������FRQÀGHQFH�LQWHUYDO�>&,@������² �������S��������PDOH�,55� ������������&,���������������S���������’DYLGVRQ�HW�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 311

DO�������D���’HVSLWH�WKLV�LQFUHDVHG�ULVN��UHODWLYHO\�OLWWOH�DWWHQWLRQ�KDV�EHHQ�SDLG�WR� XQGHUVWDQGLQJ�DQG�SUHYHQWLQJ�QXUVH�VXLFLGH��’DYLGVRQ�HW�DO�������D���

Behavioral Health

(VWLPDWHV�LQGLFDWH�WKDW�QXUVHV�KDYH�WKH�VDPH�UDWH�RI�VXEVWDQFH�XVH�GLVRUGHUV� �68’V��DV�WKH�JHQHUDO�SRSXODWLRQ��6WUREEH�DQG�&URZOH\��������:RUOH\��������� ZLWK�DSSUR[LPDWHO\����SHUFHQW�RI�WKH�QXUVLQJ�SRSXODWLRQ�KDYLQJ�DQ�68’��:RUOH\�� �������,Q�DGGLWLRQ�WR�WKH�JHQHUDO�ULVN�IDFWRUV�WKDW�DUH�DVVRFLDWHG�ZLWK�68’��LQFOXG- LQJ�JHQHWLF�SUHGLVSRVLWLRQ��KLVWRU\�RI�WUDXPD�RU�DEXVH��HDUO\�DJH�DW�ÀUVW�XVH�RI�D� VXEVWDQFH��DQG�FRPRUELG�PHQWDO�KHDOWK�GLVRUGHUV��QXUVHV�PD\�DOVR�KDYH�XQLTXH� risk factors that include access to controlled substances, workplace stress, and ODFN�RI�HGXFDWLRQ�DERXW�68’V��:RUOH\���������1XUVLQJ�VWXGHQWV�DUH�DOVR�DW�ULVN� RI�68’V��$1$��������6WUREEH�DQG�&URZOH\��������

Moral Well-Being

1XUVHV�LQ�DOO�UROHV�DQG�VHWWLQJV�DUH�FRQIURQWHG�ZLWK�HWKLFDO�FKDOOHQJHV�WKDW� KDYH�WKH�SRWHQWLDO�WR�FDXVH�PRUDO�VXIIHULQJ��$1$���������LQFOXGLQJ�PRUDO�GLVWUHVV� RU�PRUDO�LQMXU\��5XVKWRQ���������:KHQ�QXUVHV�DUH�XQDEOH�WR�FRQYHUW�WKHLU�PRUDO� FKRLFHV� LQWR� DFWLRQ� EHFDXVH� RI� LQWHUQDO� RU� H[WHUQDO� FRQVWUDLQWV�� PRUDO� GLVWUHVV� HQVXHV� DQG� WKUHDWHQV� WKHLU� LQWHJULW\� �8OULFK� DQG� *UDG\�� ������� 0RUDO� GLVWUHVV� DOVR�DULVHV�WR�YDU\LQJ�GHJUHHV�LQ�UHVSRQVH�WR�PRUDO�XQFHUWDLQW\��PRUDO�FRQÁLFWV� RU� GLOHPPDV� LQYROYLQJ� FRPSHWLQJ� HWKLFDO� YDOXHV� RU� FRPPLWPHQWV�� RU� WHQVLRQV� UHVXOWLQJ�IURP�QRW�EHLQJ�DEOH�WR�VKDUH�PRUDO�FRQFHUQV�ZLWK�RWKHUV��0RUOH\�HW�DO��� �������0RUDO�GLVWUHVV��WKH�PRVW�ZHOO�UHVHDUFKHG�IRUP�RI�PRUDO�VXIIHULQJ��RFFXUV�LQ� response to moral adversity that threatens or violates an individual’s professional YDOXHV�DQG�LQWHJULW\��DQG�LV�DVVRFLDWHG�ZLWK�P\ULDG�QHJDWLYH�FRQVHTXHQFHV��%XU- VWRQ�DQG�7XFNHWW��������(SVWHLQ�DQG�’HOJDGR��������0RUOH\�HW�DO���������5XVKWRQ� HW�DO����������1XUVHV�FDQ�H[SHULHQFH�PRUDO�GLVWUHVV�ZKHQ�WKH\�IHHO�LQDGHTXDWHO\� supported, when health care resources are inappropriately used, and when there LV�GLVDJUHHPHQW�EHWZHHQ�WKH�SDWLHQW·V�FDUH�SODQ�DQG�WKH�SDWLHQW·V�IDPLO\·V�ZLVKHV� �%XUVWRQ�DQG�7XFNHWW��������(SVWHLQ�HW�DO����������)RU�H[DPSOH��QXUVHV�PD\�H[SH- rience moral distress when asked to provide life support care that is not in the best LQWHUHVW�RI�WKH�SDWLHQW��.DVPDQ���������0RUDO�LQMXU\��D�PRUH�H[WUHPH�IRUP�RI�PRUDO� VXIIHULQJ��RFFXUV�ZKHQ�WKHUH�LV�´D�EHWUD\DO�RI�ZKDW·V�ULJKW��E\�VRPHRQH�ZKR�KROGV� OHJLWLPDWH�DXWKRULW\�«�LQ�D�KLJK�VWDNHV�VLWXDWLRQµ��6KD\��������S��������,W�LQYROYHV� D�YLRODWLRQ�RI�RQH·V�PRUDO�FRGH�E\�ZLWQHVVLQJ��SDUWLFLSDWLQJ�LQ��RU�SUHFLSLWDWLQJ�D� YDULHW\�RI�PRUDO�KDUPV��:KLOH�WKH�URRWV�RI�WKH�FRQFHSW�EHJDQ�LQ�WKH�PLOLWDU\��QXUVHV� DQG�RWKHU�FOLQLFLDQV�LQFUHDVLQJO\�DUH�H[SORULQJ�LWV�DSSOLFDWLRQ�LQ�KHDOWK�FDUH��

Nurses can suffer from moral distress when they lack the resources or capac- LW\�WR�KHOS�WKHLU�SDWLHQWV��.HOO\�DQG�3RUU��������RU�DUH�XQDEOH�WR�WDNH�WKH�HWKLFDOO\�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

312 THE FUTURE OF NURSING 2020–2030

appropriate action because of constraints or moral adversities (Ulrich et al., �������1XUVHV�ZRUNLQJ�LQ�FRPPXQLWLHV�RU�ZLWK�SHRSOH�ZLWK�FRPSOH[�KHDOWK�QHHGV� DQG�VRFLDO�ULVNV��VXFK�DV�68’V�DQG�SV\FKRORJLFDO�DQG�EHKDYLRUDO�GLVRUGHUV��DQG� WKRVH�ZRUNLQJ�LQ�KLJK�LQWHQVLW\�VHWWLQJV�RU�SDOOLDWLYH�FDUH�FDQ�H[SHULHQFH�PRUDO� GLVWUHVV�GXH�WR�WKH�FRPSOH[�PRUDO�DQG�HWKLFDO�LVVXHV�WKH\�FRQIURQW��(QJODQGHU�HW� DO���������6$0+6$��������:HONHU�+RRG��������:ROI�HW�DO����������1XUVHV�ZKR� work in clinical care often lose contact with patients when they leave the clinical VHWWLQJ��:ROI�HW�DO����������ZKLFK�PDNHV�LW�GLIÀFXOW�WR�KHOS�WKHVH�SDWLHQWV�ZLWK� WKHLU�QRQFOLQLFDO�QHHGV��VXFK�DV�IRRG��VDIH�KRXVLQJ��DQG�D�VXSSRUW�QHWZRUN��7KLV� FDQ�OHDYH�QXUVHV�IHHOLQJ�WKDW�WKHLU�HIIRUWV�DUH�IXWLOH�ZLWKRXW�VRFLHWDO�FRPPLWPHQW� to systemic reforms.

$GGUHVVLQJ�LVVXHV�RI�KHDOWK�HTXLW\�FDQ�LQYROYH�FRQIURQWLQJ�VH[LVP��UDFLVP�� DEOHLVP��[HQRSKRELD��DQG�WUDXPD��ZKLFK�FDQ�EH�XQFRPIRUWDEOH�DQG�FKDOOHQJLQJ� IRU� DOO� LQYROYHG� �0XQQDQJL� HW� DO��� ������� ,Q� DGGLWLRQ�� WKH� KLVWRULFDO� URRWV� RI� WUDXPD�DUH�RIWHQ�´LQYLVLEOHµ��&RPDV�’tD]�HW�DO���������+HOPV�HW�DO����������ZLWK� LQGLYLGXDOV�RI�FRORU�VXIIHULQJ�IURP�UDFH�EDVHG�VWUHVV��&RPDV�’tD]�HW�DO���������� 0RUHRYHU��QXUVHV�PD\�QRW�IHHO�HPSRZHUHG�WR�UDLVH�WKHLU�FRQFHUQV�DERXW�WKHVH� LQHTXLWLHV�EHFDXVH�RI�IHDU�RI�UHWDOLDWLRQ�RU�FRPSURPLVHG�UHODWLRQVKLSV��8OULFK� HW� DO��� ������� :KHQ� WKH� FODLPV� RU� YRLFHV� RI� QXUVHV� DQG� RWKHU� FOLQLFLDQV� DUH� GLVFRXQWHG��WKHLU�VWUHVV�LV�KHLJKWHQHG��+XUVW���������

,Q�WKH�FRQWH[W�RI�&29,’�����VHH�%R[��������HYLGHQFH�LV�HPHUJLQJ�WKDW� QXUVHV�KDYH�H[SHULHQFHG�PRUDO�GLVWUHVV�DV�WKH\�KDYH�DGGUHVVHG�WKH�VWDUN�HWKLFDO� WHQVLRQV��0RUOH\�HW�DO���������8OULFK�HW�DO���������FUHDWHG�E\�WKH�SDQGHPLF�� IDFLQJ�D�JDS�EHWZHHQ�´ZKDW�WKH\�FDQ�GR�DQG�ZKDW�WKH\�EHOLHYH�WKH\�VKRXOG� GRµ��3HDUFH��������5RVD�HW�DO����������7KLV�VLWXDWLRQ�OHG�WKH�$PHULFDQ�1XUVHV� $VVRFLDWLRQ��$1$��WR�GHYHORS�JXLGDQFH�WR�KHOS�QXUVHV�XQGHUVWDQG�WKHLU�HWKLFDO� REOLJDWLRQV� GXULQJ� D� SDQGHPLF�� SDUWLFXODUO\� ZLWK� UHVSHFW� WR� SUHVHUYLQJ� WKHLU� LQWHJULW\�DQG�ZHOO�EHLQJ��$1$������D�E���8SKROGLQJ�WKH�HWKLFDO�PDQGDWH�RI� QXUVHV�WR�SURYLGH�UHVSHFWIXO��HTXLWDEOH�FDUH�IRU�DOO�SHUVRQV�DQG�WKH�UHVSRQVLELOLW\� WR�DGGUHVV�LVVXHV�RI�VRFLDO�MXVWLFH�FDQ�EH�HVSHFLDOO\�FKDOOHQJLQJ�GXULQJ�D�SDQ- GHPLF��$1$��������$1$�DQG�$$1���������0RUDO�LQMXU\�KDV�EHFRPH�D�IRFXV� RI�LQTXLU\�ERWK�SULRU�WR�DQG�GXULQJ�WKH�SDQGHPLF��’HDQ�HW�DO���������.RSDF]�HW� DO���������0DJXHQ�DQG�3ULFH��������5XVKWRQ�HW�DO����������DQG�HDUO\�GDWD�VXJJHVW� WKDW�LW� LV�HPHUJLQJ�DV�D�IDFWRU�DVVRFLDWHG�ZLWK�WKH�GLIÀFXOW�HWKLFDO�WUDGH�RIIV� H[SHULHQFHG�E\�FOLQLFLDQV�LQ�WKH�FRQWH[W�RI�WKH�SDQGHPLF��+LQHV�HW�DO��������� :LOOLDPV�HW�DO���������DQG�LQ�UHVSRQVH�WR�WKH�GHDWKV�RI�%ODFN�LQGLYLGXDOV�DW�WKH� KDQGV�RI�SROLFH��%DUERW���������7KH�SUDFWLFH�VHWWLQJ�DQG�HWKLFDO�FOLPDWH�RI�WKH� KHDOWK�FDUH�RUJDQL]DWLRQ�DUH�SRVWXODWHG�DV�IDFWRUV�WKDW�LQÁXHQFH�WKH�SUHYDOHQFH� RI�PRUDO�GLVWUHVV��5DWKHUW�HW�DO���������6DXHUODQG�HW�DO����������0RUH�UHVHDUFK� LV�QHHGHG�WR�XQGHUVWDQG�WKH�UHOHYDQFH�RI�PRUDO�LQMXU\�DPRQJ�KHDOWK�FDUH�SUR- IHVVLRQDOV�DQG�WR�VWXG\�LWV�UHODWLRQVKLS�WR�YDULRXV�PHDVXUHV�RI�ZHOO�EHLQJ�DQG� PRUDO�UHVLOLHQFH��5XVKWRQ��������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 313

Social Health and Well-Being

7KH�QDWXUH�RI�QXUVLQJ�ZRUN�PHDQV�WKDW�QXUVHV�DUH�FRQVWDQWO\�LQWHUDFWLQJ�ZLWK� RWKHU�SHRSOH��LQFOXGLQJ�LQGLYLGXDOV��IDPLOLHV��FRPPXQLWLHV��SK\VLFLDQV�DQG�RWKHU� providers, administrators, staff, and other nurses. While these social interactions DUH�HVVHQWLDO�WR�WKH�ZRUN�RI�FDULQJ�IRU�LQGLYLGXDOV�DQG�FRPPXQLWLHV��WKH\�FDQ�DOVR� EH�D�VRXUFH�RI�VWUHVV�DQG�DGYHUVHO\�LPSDFW�QXUVH�ZHOO�EHLQJ��7KLV�VHFWLRQ�H[SORUHV� WKUHH� W\SHV� RI� QHJDWLYH� VRFLDO� LQWHUDFWLRQV�� EXOO\LQJ� DQG� LQFLYLOLW\�� ZRUNSODFH� violence, and racism and discrimination.

Bullying and Incivility

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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314 THE FUTURE OF NURSING 2020–2030

Workplace Violence

,Q� WKH�8QLWHG�6WDWHV��KHDOWK�FDUH�ZRUNHUV�H[SHULHQFH� WKH�KLJKHVW� OHYHO�RI� DVVDXOW�RI�DOO�RFFXSDWLRQV��DQG�DPRQJ�KHDOWK�FDUH�ZRUNHUV��QXUVHV�DQG�SDWLHQW� FDUH�DVVLVWDQWV�H[SHULHQFH�WKH�KLJKHVW�UDWHV�RI�YLROHQFH��*URHQHZROG�HW�DO��������� 26+$���������$JJUHVVLRQ�DQG�DVVDXOW�FDQ�UHVXOW�LQ�ORQJ�WHUP�HIIHFWV�RQ�QXUVHV� that include posttraumatic stress and lower levels of productivity (Gates et al., ������� 1XUVHV� HQGXUH� ERWK� HPRWLRQDO� DQG� SK\VLFDO� DEXVH� IURP� SDWLHQWV� �*D- EURYHF��������*DWHV�HW�DO����������$Q�$1$�KHDOWK�ULVN�DVVHVVPHQW�RI�QXUVHV�GXULQJ� ����²�����LQGLFDWHG�WKDW����SHUFHQW�RI�QXUVHV�KDG�H[SHULHQFHG�YLROHQFH�DW�WKH� KDQGV�RI�SDWLHQWV�RU�WKHLU�IDPLO\�PHPEHUV��$1$���������+RZHYHU��LQFLGHQWV�RI� assault are substantially underreported by as much as 50 percent because of a lack RI�ZRUNSODFH�UHSRUWLQJ�SROLFLHV��D�ODFN�RI�FRQÀGHQFH�LQ�WKH�UHSRUWLQJ�V\VWHP��DQG� IHDU�RI�UHWDOLDWLRQ��26+$���������

$������VXUYH\�RI�PRUH�WKDQ�������FULWLFDO�FDUH�QXUVHV�IRXQG�WKDW����SHUFHQW� RI�UHVSRQGHQWV�KDG�H[SHULHQFHG�YHUEDO�DEXVH�DW�OHDVW�RQFH�GXULQJ�WKH�SDVW�\HDU�� QHDUO\�KDOI�SK\VLFDO�DEXVH�DQG�GLVFULPLQDWLRQ��DQG����SHUFHQW�UHSRUWHG�VH[XDO� KDUDVVPHQW��8OULFK�HW�DO����������3DWLHQWV�DQG�IDPLO\�PHPEHUV�ZHUH�UHSRUWHG�DV� WKH�PRVW�IUHTXHQW�VRXUFH�RI�DEXVH�����SHUFHQW�DQG����SHUFHQW��UHVSHFWLYHO\���IRO- ORZHG�E\�SK\VLFLDQV�����SHUFHQW��DQG�RWKHU�QXUVHV�����SHUFHQW���)HZHU�WKDQ�KDOI� RI�QXUVHV�UHSRUWHG�WKDW�WKHLU�RUJDQL]DWLRQ�KDG�]HUR�WROHUDQFH�SROLFLHV�IRU�YHUEDO� DEXVH��ZKLOH����SHUFHQW�UHSRUWHG�VXFK�SROLFLHV�IRU�SK\VLFDO�DEXVH��7KHVH�GDWD� SDLQW�D�SLFWXUH�RI�ZRUN�HQYLURQPHQWV�WKDW�DUH�KRVWLOH�WR�WKH�SV\FKRORJLFDO�VDIHW\� DQG�ZHOO�EHLQJ�RI�QXUVHV��8OULFK�HW�DO���������

While much of the research on workplace violence focuses on hospital set- WLQJV��QXUVHV�ZRUNLQJ�LQ�RWKHU�VHWWLQJV�DUH�DOVR�DW�ULVN�RI�YLROHQFH�DQG�DJJUHVVLRQ�� +RPH�YLVLWLQJ�QXUVHV��ZKR�RIWHQ�ZRUN�DORQH�LQ�G\QDPLF�HQYLURQPHQWV�FKDUDFWHU- L]HG�E\�SRWHQWLDOO\�KLJK�ULVN�VLWXDWLRQV��DUH�DW�ULVN�RI�YHUEDO�DQG�SK\VLFDO�DVVDXOW� ZKLOH�LQ�WKH�FRPPXQLW\�RU�SHRSOH·V�KRPHV��0DWKLHZV�DQG�6DOPRQG���������7KH� LQFLGHQFH�RI�ZRUNSODFH�YLROHQFH�LQ�KRPH�QXUVLQJ�LV�OLNHO\�XQGHUUHSRUWHG�EHFDXVH� RI�IDFWRUV�LQFOXGLQJ�WKH�SHUFHSWLRQ�WKDW�YLROHQFH�LV�SDUW�RI�WKH�MRE�DQG�WKH�PRUDO� FRQÁLFW�QXUVHV�IDFH�EHWZHHQ�GXW\�WR�WKHLU�SDWLHQWV�DQG�GXW\�WR�UHSRUW�DQ�LQFLGHQW�RI� YLROHQFH��0DWKLHZV�DQG�6DOPRQG���������:KLOH�PDQ\�RUJDQL]DWLRQV�DUH�DWWHPSW- LQJ�WR�UHVSRQG�WR�WKHVH�FKDOOHQJHV��HGXFDWLRQ�DQG�WUDLQLQJ�DORQH�DUH�OLNHO\�LQVXI- ÀFLHQW�WR�DGGUHVV�WKH�URRW�IDFWRUV�WKDW�FRQWULEXWH�WR�WKHP��*HRIIULRQ�HW�DO���������

Racism and Discrimination

$V�GLVFXVVHG�LQ�&KDSWHU����UDFLVP�FDQ�VLJQLÀFDQWO\�LPSDFW�WKH�SK\VLFDO�DQG� mental health of individuals. Health can be affected by structural racism (poli- cies and systems), cultural racism (stereotypes, beliefs, and implicit biases), and GLVFULPLQDWLRQ��EHLQJ�WUHDWHG�GLIIHUHQWO\�EDVHG�RQ�UDFH���:LOOLDPV�HW�DO���������� 0LFURDJJUHVVLRQV��ZKLFK�DUH�EULHI�DQG�FRPPRQSODFH�GDLO\�LQGLJQLWLHV��DUH�DOVR�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 315

correlated with poor health (&UX]�HW�DO���������1DGDO�HW�DO���������2QJ�DQG�%XU- URZ��������6XH�HW�DO����������1XUVHV�PD\�HQFRXQWHU�UDFLVP��GLVFULPLQDWLRQ��DQG� PLFURDJJUHVVLRQV� IURP� D� QXPEHU� RI� VRXUFHV�� LQFOXGLQJ� HPSOR\HUV�� HGXFDWRUV�� PDQDJHUV�� FROOHDJXHV�� DQG� SDWLHQWV�� 1XUVHV� DQG� RWKHU� FOLQLFLDQV� RI� FRORU� FDQ� H[SHULHQFH�KDUGVKLS��EXUQRXW��DQG�WKH�LQFUHDVHG�HPRWLRQDO�ODERU�DQG�EXUGHQ�RI� DQ�DOUHDG\�HPRWLRQDOO\�GHPDQGLQJ�MRE�ZKLOH�GHDOLQJ�ZLWK�WKH�SHUVRQDO�QHJDWLYH� FRQVHTXHQFHV�RI�UDFLVP�IURP�SDWLHQWV��&RWWLQJKDP�HW�DO���������3DXO�(PLOH�HW� DO����������$FFRPPRGDWLQJ�SDWLHQWV·�SUHIHUHQFHV�UHJDUGLQJ�WKH�UDFH��JHQGHU��RU� UHOLJLRQ�RI�WKHLU�SURYLGHUV�KDV�EHHQ�FRPPRQ�SUDFWLFH�LQ�WKH�8QLWHG�6WDWHV��RIWHQ� LQ�D�FRQWH[W�RI�OLWWOH�JXLGDQFH�RQ�KRZ�WR�DSSURDFK�WKHVH�VLWXDWLRQV��3DXO�(PLOH�� �������7KLV�SUDFWLFH�FDQ�KDYH�DGYHUVH�HIIHFWV�RQ�FOLQLFLDQV��HVSHFLDOO\�ZKHQ�WKH\� are rejected by patients or subject to abuse because of their race. However, nurses’ H[SHULHQFHV�RI�UDFLVP�DUH�QRW�OLPLWHG�WR�WKHVH�W\SHV�RI�GLVFUHWH�HYHQWV�EXW�DUH�SDUW� RI�WKH�ODUJHU�V\VWHP�RI�VWUXFWXUDO�UDFLVP�LQ�WKH�8QLWHG�6WDWHV��:DLWH�DQG�1DUGL�� ��������

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

316 THE FUTURE OF NURSING 2020–2030

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APPROACHES TO IMPROVING WELL-BEING

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 317

7KHUH�LV�HPHUJLQJ�HYLGHQFH�WKDW�GHVSLWH�WKH�FRQVWUDLQWV�LPSRVHG�E\�WKH�V\VWHP�� VRPH�QXUVHV�DUH�DEOH�WR�UHPDLQ�KHDOWK\�DQG�ZKROH�DQG�JURZ�LQ�UHVSRQVH�WR�DGYHU- VLW\��&XL�HW�DO���������,W]KDNL�HW�DO���������2NROL�HW�DO���������7UDXGW�HW�DO���������� 1XUVHV�QHHG�WKH�VNLOOV�DQG�WRROV�WKDW�HQDEOH�WKHP�WR�H[HUFLVH�WKHLU�DXWRQRP\�� DJHQF\��DQG�FRPSHWHQFH�ZLWKLQ�WKHVH�V\VWHPV��)XUWKHU�LQYHVWLJDWLRQ�LV�QHHGHG� to understand the individual and system characteristics that create the conditions IRU�QXUVHV�WR�WKULYH�LQ�WKH�PLGVW�RI�FRPSOH[LW\��XQFHUWDLQW\��DQG�XQSUHGLFWDELOLW\��

7KLV�VHFWLRQ�ÀUVW�H[DPLQHV�LQGLYLGXDO�OHYHO�DSSURDFKHV�WR�ZHOO�EHLQJ�DQG� then turns to a review of approaches at the systems level. The committee notes WKDW�DOWKRXJK�WKHUH�H[LVWV�QR�PHQX�RI�UHDG\�WR�LPSOHPHQW��HYLGHQFH�EDVHG�LQWHU- YHQWLRQV�IRU�LPSURYLQJ�QXUVH�ZHOO�EHLQJ��1$6(0������D���D�JUHDW�QXPEHU�RI� HIIRUWV�FXUUHQWO\�EHLQJ�SXUVXHG�FDQ�RIIHU�LQVSLUDWLRQ�DQG�RSSRUWXQLWLHV�IRU�HYDOX- DWLRQ��UHSOLFDWLRQ��DQG�VFDODELOLW\��+RZHYHU��DV�QRWHG�E\�0HOQ\N�DQG�FROOHDJXHV� �������LQ�D�UHFHQW�V\VWHPDWLF�UHYLHZ�RI�LQWHUYHQWLRQV�IRFXVHG�RQ�LPSURYLQJ�SK\- VLFLDQV·�DQG�QXUVHV·�SK\VLFDO�DQG�PHQWDO�ZHOO�EHLQJ��PRUH�UDQGRPL]HG�FRQWUROOHG� WULDOV��5&7V��DUH�QHHGHG�WR�H[DPLQH�WKH�HIÀFDF\�RI�VXFK�LQWHUYHQWLRQV�DV�PDQ\�RI� WKH�DYDLODEOH�VWXGLHV�KDYH�ZHDNQHVVHV�LQ�WKHLU�PHWKRGRORJLHV��

Individual-Level Interventions

:KLOH�KHDOWK�FDUH�RUJDQL]DWLRQV�PXVW�FUHDWH�WKH�ZRUNSODFH�FRQGLWLRQV�IRU� ZHOO�EHLQJ�DQG�LQWHJULW\�WR�WKULYH��QXUVHV�DUH�DOVR�UHVSRQVLEOH�IRU�LGHQWLI\LQJ�WKHLU� RZQ�QHHGV�DQG�LQYHVWLQJ�LQ�WKHLU�ZHOO�EHLQJ��5RVV�HW�DO����������7KLV�UHVSRQ- VLELOLW\�DULVHV�IURP�WKHLU�LQKHUHQW�KXPDQ�GLJQLW\�DQG�WKHLU�SURIHVVLRQDO�HWKLFDO� PDQGDWH�WR�LQYHVW�LQ�WKHLU�RZQ�LQWHJULW\�DQG�ZHOO�EHLQJ�VR�WKH\�FDQ�H[HFXWH�WKH� UHVSRQVLELOLWLHV�RI�WKHLU�QXUVLQJ�UROH��$1$���������3URYLVLRQ���RI�WKH�$1$�&RGH� RI�(WKLFV�VWDWHV�WKDW�QXUVHV�VKRXOG�´HDW�D�KHDOWK\�GLHW��H[HUFLVH��JHW�VXIÀFLHQW�UHVW�� PDLQWDLQ�IDPLO\�DQG�SHUVRQDO�UHODWLRQVKLSV��HQJDJH�LQ�DGHTXDWH�OHLVXUH�DQG�UHFUH- DWLRQDO�DFWLYLWLHV��DQG�DWWHQG�WR�VSLULWXDO�RU�UHOLJLRXV�QHHGVµ��$1$��������S�������

$OWKRXJK� QXUVHV� DUH� RIWHQ� NQRZOHGJHDEOH� DERXW� WKH� LPSRUWDQFH� RI� WKHVH� LVVXHV��WKDW�NQRZOHGJH�GRHV�QRW�DOZD\V�WUDQVODWH�LQWR�DFWLRQ��5RVV�HW�DO���������� 5RVV�DQG�FROOHDJXHV��������LGHQWLI\�D�QXPEHU�RI�LQWULQVLF�DQG�H[WULQVLF�IDFWRUV� WKDW� DIIHFW� QXUVHV·� SDUWLFLSDWLRQ� LQ� KHDOWK�SURPRWLQJ� EHKDYLRUV�� ,QWULQVLF� IDF- WRUV�LQFOXGH�SHUVRQDO�FKDUDFWHULVWLFV�DQG�EHOLHIV��SHUFHLYHG�EHQHÀWV�DQG�EDUULHUV�� VHOI�HIÀFDF\��JHQGHU�DQG�DJH��IDWLJXH��GHSUHVVLRQ��DQG�DQ[LHW\��([WULQVLF�IDFWRUV� LQFOXGH� QRUPV�� VRFLDO� VXSSRUW�� UROH� PRGHOLQJ�� ÀQDQFLDO� DQG� WLPH� FRQVWUDLQWV�� DQG�LQVWLWXWLRQDO�VXSSRUW��6KLIW�ZRUN�DQG�ZRUN�VFKHGXOHV��DV�ZHOO�DV�FRPSHWLQJ� GHPDQGV�RXWVLGH�RI�ZRUN��VXFK�DV�FDULQJ�IRU�DGXOW�RU�FKLOG�GHSHQGHQWV��DUH�DGGL- WLRQDO�EDUULHUV�WR�SDUWLFLSDWLRQ��5RVV�HW�DO���������

%HORZ��WKH�FRPPLWWHH�H[DPLQHV�LQWHUYHQWLRQV�DQG�LQLWLDWLYHV�GLUHFWHG�DW�LP- SURYLQJ�LQGLYLGXDO�QXUVHV·�KHDOWK�DQG�ZHOO�EHLQJ�LQ�D�QXPEHU�RI�DUHDV��0DQ\�VXFK� LQLWLDWLYHV�DGGUHVV�PXOWLSOH�DUHDV�RI�ZHOO�EHLQJ�DQG�XVH�PXOWLSOH�DSSURDFKHV��)RU� H[DPSOH��WKH�+HDOWK\�1XUVH��+HDOWK\�1DWLRQ��+1+1��*UDQG�&KDOOHQJH��DQ�HIIRUW�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

318 THE FUTURE OF NURSING 2020–2030

RI�$1$�DQG�LWV�SDUWQHUV��VHHNV�WR�WUDQVIRUP�WKH�KHDOWK�RI���PLOOLRQ�51V�WKURXJK�D� IRFXV�RQ�SK\VLFDO�DFWLYLW\��QXWULWLRQ��UHVW��TXDOLW\�RI�OLIH��DQG�VDIHW\��$1$�(QWHU- SULVH���������2UJDQL]DWLRQV�WKDW�SDUWLFLSDWH�LQ�+1+1�KDYH�GHYHORSHG�D�QXPEHU� RI� LQGLYLGXDO�IRFXVHG� LQLWLDWLYHV�� VXFK� DV� RIIHULQJ� RQVLWH� ÀWQHVV� RSSRUWXQLWLHV�� ZDONLQJ�SURJUDPV��LQFUHDVHG�DFFHVV�WR�KHDOWK\�IRRG��PLQGIXOQHVV�UHVRXUFHV��DQG� GHGLFDWHG�URRPV�IRU�QXUVHV�WR�UHVHW�DQG�UHOD[��$1$�(QWHUSULVH��������������-DUUtn HW�DO����������2WKHU�ZHOO�EHLQJ�LQLWLDWLYHV�DUH�IRFXVHG�RQ�D�VSHFLÀF�EHKDYLRU�RU� KHDOWK�FKDUDFWHULVWLF��EXW�RQH�WKDW�PD\�KDYH�FRQVHTXHQFHV�IRU�PXOWLSOH�DUHDV�RI� ZHOO�EHLQJ��)RU�H[DPSOH��SRRU�VOHHS�SDWWHUQV�DUH�DVVRFLDWHG�ZLWK�SRRU�SK\VLFDO� and mental health, an increased risk of obesity, and an increased risk of accidents ERWK�LQ�DQG�RXWVLGH�RI�WKH�ZRUNSODFH��,20���������

7KH�LQLWLDWLYHV�DQG�LGHDV�GHVFULEHG�EHORZ�DUH�GHVLJQHG�WR�LPSURYH�WKH�KHDOWK� RI�QXUVHV�E\�DGGUHVVLQJ�D�ZLGH�YDULHW\�RI�WDUJHWV��

�� SK\VLFDO�DFWLYLW\��GLHW��DQG�VOHHS�� �� VXEVWDQFH�XVH� �� UHVLOLHQFH� �� PHQWDO�KHDOWK� �� HWKLFDO�FRPSHWHQFH� �� LQFLYLOLW\��EXOO\LQJ��DQG�ZRUNSODFH�YLROHQFH��DQG • racism, prejudice, and discrimination.

Physical Activity, Diet, and Sleep

A recent systematic review of workplace interventions to address obesity in nurses found limited evidence of successful interventions. The authors rec- RPPHQG�WKDW�LQWHUYHQWLRQV�EH�WDLORUHG�WR�WKH�XQLTXH�DVSHFWV�RI�QXUVHV·�ZRUNLQJ� OLYHV��.HOO\�DQG�:LOOV��������DQG�WKDW�LQWHUYHQWLRQV�QRW�EH�XQLYHUVDO�EXW�WDUJHWHG� WRZDUG�WKRVH�ZKR�DUH�REHVH��,Q�WKHLU�V\VWHPDWLF�UHYLHZ��0HOQ\N�DQG�FROOHDJXHV� �������IRXQG�WKDW�YLVXDO�WULJJHUV��SHGRPHWHUV��DQG�KHDOWK�FRDFKLQJ�FDQ�LQFUHDVH� SDUWLFLSDWLRQ�LQ�SK\VLFDO�DFWLYLW\��7KH�1XUVHV�/LYLQJ�)LW�SURJUDP�ZDV�HIIHFWLYH� LQ�UHGXFLQJ�QXUVHV·�ERG\�PDVV�LQGH[��%0,��RYHU�D����ZHHN�LQWHUYHQWLRQ�SHULRG�� KRZHYHU��WKH�HIIHFWV�RI�WKH�SURJUDP�RQ�%0,�ZHUH�QRW�VXVWDLQHG��6SHURQL�HW�DO��� �������

$�UHFHQW�VFRSLQJ�UHYLHZ�RI�VWXGLHV�ORRNHG�DW�LQWHUYHQWLRQV�WDUJHWHG�DW�QXUVHV� ZKR� ZRUN� VKLIWV� DQG� DLPHG� DW� LPSURYLQJ� VOHHS� SDWWHUQV� RU� PDQDJLQJ� IDWLJXH� �4XHUVWUHW�HW�DO����������,Q�WKHVH�VWXGLHV��PRVW�RI�ZKLFK�ZHUH�FRQGXFWHG�LQ�,WDO\�� 7DLZDQ��DQG�WKH�8QLWHG�6WDWHV�LQWHUYHQWLRQV�IHOO�LQWR�WKUHH�SULPDU\�FDWHJRULHV�� QDSSLQJ��ZRUNLQJ�GLIIHUHQW�VKLIW�SDWWHUQV��DQG�H[SRVXUH�WR�OLJKW�RU�OLJKW�DWWHQ- XDWLRQ��:LWK�UHJDUG�WR�QDSSLQJ�LQWHUYHQWLRQV��WKH�DXWKRUV�IRXQG�PL[HG�UHVXOWV�� For studies that measured performance at work as an outcome, there was im- SURYHPHQW�RQ�VRPH�PHDVXUHV��H�J��� LQIRUPDWLRQ�SURFHVVLQJ�LPSURYLQJ�DIWHU�D� ���PLQXWH�QDS���6WXGLHV�WKDW�H[DPLQHG�VKLIW�SDWWHUQV��H�J���URWDWLQJ�VKLIW�SDWWHUQV��

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 319

À[HG�QLJKW�YHUVXV�GD\�VKLIWV����KRXU�YHUVXV����KRXU�URWDWLQJ�VKLIWV��IRXQG�WKDW� VKLIW�SDWWHUQV�LQFOXGLQJ�QLJKW�VKLIWV�ZHUH�DVVRFLDWHG�ZLWK�SRRUHU�VOHHS�TXDOLW\�DQG� LQFUHDVHG�IDWLJXH��5HVXOWV�RI�OLJKW�H[SRVXUH�VWXGLHV�ZHUH�VLPLODUO\�PL[HG��)RXU� VWXGLHV�IRXQG�WKDW�VHOI�UHSRUWHG�HQHUJ\�OHYHOV�LQFUHDVHG�ZLWK�H[SRVXUH�WR�EULJKW� OLJKW��$QRWKHU�VWXG\��KRZHYHU��IRXQG�QR�HIIHFW�RI�DQ�LQWHUYHQWLRQ�LQYROYLQJ�OLJKW� YLVRUV�RQ�IDWLJXH�RU�VOHHS��7KH�VFRSLQJ�UHYLHZ�IRXQG�QR�VWXGLHV�FRQGXFWHG�RQ� VDPSOHV� LQYROYLQJ�QXUVH�PLGZLYHV��4XHUVWUHW�DQG�FROOHDJXHV��������FRQFOXGH� WKDW�WKH�OLWHUDWXUH�LV�LQFRQVLVWHQW�UHJDUGLQJ�KRZ�WR�LQWHUYHQH�WR�LPSURYH�VOHHS� DQG�UHGXFH�IDWLJXH�IRU�QXUVHV�ZKR�ZRUN�VKLIWV��DQG�WKDW�WKH�LQWHUYHQWLRQV�DQG� measures used in these studies were disparate in nature.

Substance Use

$�UHFHQW�SRVLWLRQ�VWDWHPHQW�IURP�WKH�(PHUJHQF\�1XUVHV�$VVRFLDWLRQ�DQG� the International Nurses Society on Addictions called for four primary actions to DGGUHVV�QXUVHV�ZLWK�68’V��6WUREEH�DQG�&URZOH\���������SURYLGLQJ�HGXFDWLRQ�WR� QXUVHV�DQG�RWKHU�HPSOR\HHV��DGRSWLQJ�DOWHUQDWLYH�WR�GLVFLSOLQH��$7’��DSSURDFKHV�� FRQVLGHULQJ�GUXJ�GLYHUVLRQ�LQ�WKH�FRQWH[W�RI�SHUVRQDO�XVH�DV�D�V\PSWRP�DQG�QRW�D� FULPLQDO�RIIHQVH��DQG�HQVXULQJ�WKDW�QXUVHV�DQG�QXUVLQJ�VWXGHQWV�DUH�DZDUH�RI�WKH� risks associated with SUDs and have a way to report concerns safely. The two pri- PDU\�DSSURDFKHV�WR�WUHDWLQJ�QXUVHV�ZLWK�68’V�KDYH�EHHQ�HLWKHU�D�GLVFLSOLQDU\�DS- SURDFK�RU�DQ�$7’�SURJUDP��0RQURH�HW�DO���������1&6%1��������5XVVHOO��������� 0RQURH�DQG�FROOHDJXHV��������FRQFOXGH�WKDW�$7’�SURJUDPV�KDYH�D�JUHDWHU�LPSDFW� WKDQ�GLVFLSOLQDU\�SURJUDPV�RQ�SURWHFWLQJ�WKH�KHDOWK�DQG�VDIHW\�RI�WKH�SXEOLF��DV� they identify and enroll more nurses and in turn remove more nurses with SUDs IURP�GLUHFW�SDWLHQW�FDUH��7KHVH�SURJUDPV�KDYH�EHHQ�DGRSWHG�E\�PDQ\�VWDWH�ERDUGV� RI�QXUVLQJ��5XVVHOO���������,Q�DQ�DQDO\VLV�RI����VWDWH�ERDUG�RI�QXUVLQJ�SURJUDPV�� 5XVVHOO��������IRXQG�D�ODFN�RI�FRQVLVWHQF\�DPRQJ�WKHP�DQG�VXJJHVWV�WKDW�PRUH� UHVHDUFK�LV�QHHGHG�WR�LGHQWLI\�WKH�HVVHQWLDO�FRPSRQHQWV�RI�VXFK�SURJUDPV��&RP- PRQ�FRPSRQHQWV�LGHQWLÀHG�LQ�DW�OHDVW�KDOI�RI�WKH�SURJUDPV�LQFOXGHG�DQ�DOFRKRO� GUXJ�DEVWLQHQFH�UHTXLUHPHQW��XVH�RI�PRRG�DOWHULQJ�PHGLFDWLRQV�IRU�SV\FKLDWULF� PHGLFDO�FRQGLWLRQV��DQ�$OFRKROLFV�$QRQ\PRXV�RU�1DUFRWLFV�$QRQ\PRXV�SURJUDP�� DQG�UHVWULFWHG�KRXUV�RU�VKLIWV��5XVVHOO���������

,Q�D�UHWURVSHFWLYH�VWXG\�RI�������QXUVHV�SDUWLFLSDWLQJ�LQ�68’�SURJUDPV�EH- WZHHQ������DQG�������6PLOH\�DQG�5HQHDX��������IRXQG�WKDW�ELPRQWKO\�UDQGRP� GUXJ�WHVWV��D�PLQLPXP�RI���\HDUV�LQ�D�SURJUDP��DQG�GDLO\�FKHFN�LQV�ZHUH�DVVRFL- DWHG�ZLWK�VXFFHVVIXO�SURJUDP�FRPSOHWLRQ��7KH\�DOVR�IRXQG�WKDW�VWUXFWXUHG�JURXS� PHHWLQJV�ZHUH�KHOSIXO��7KH�EHVW�UHVXOWV�ZHUH�IRU�WKRVH�QXUVHV�ZKR�VWD\HG�LQ�D� SURJUDP�DW�OHDVW���\HDUV�DQG�ZHUH�WHVWHG�WZLFH�SHU�PRQWK��7KH�DXWKRUV�UHFRP- PHQG�WKDW�DQ�H[SHUW�SDQHO�UHYLHZ�WKHVH�UHVXOWV�DQG�GHYHORS�IRUPDO�JXLGHOLQHV�IRU� VXFK�SURJUDPV��DQG�WKDW�ERDUGV�RI�QXUVLQJ�WHVW�WKHVH�JXLGHOLQHV�LQ�WKHLU�$7’�SUR- JUDPV��,Q�DGGLWLRQ��KHDOWK�FDUH�RUJDQL]DWLRQV�DQG�HPSOR\HUV�KDYH�D�UHVSRQVLELOLW\�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

320 THE FUTURE OF NURSING 2020–2030

WR�GHWHFW�HDUO\�SDWWHUQV�RI�GUXJ�GLYHUVLRQ7 proactively before they become severe. 7R�WKLV�HQG��RUJDQL]DWLRQV�DUH�XVLQJ�VXFK�WHFKQRORJLHV�DV�DXWRPDWHG�GLVSHQVLQJ� FDELQHWV��DGYDQFHG�DQDO\WLFV��DQG�PDFKLQH�OHDUQLQJ�8

Resilience

7UDLQLQJ�IRFXVHG�RQ�EXLOGLQJ�LQGLYLGXDO�UHVLOLHQFH�LV�RIWHQ�RIIHUHG�WR�SUHSDUH� QXUVHV�IRU�WKH�IDWLJXH��VWUHVV��ZRUNORDG��DQG�EXUQRXW�WKH\�PD\�IDFH��7D\ORU��������� 5HVLOLHQFH�UHIHUV�WR�´WKH�FDSDFLW\�RI�G\QDPLF�V\VWHPV�WR�ZLWKVWDQG�RU�UHFRYHU� IURP�VLJQLÀFDQW�GLVWXUEDQFHVµ��0DVWHQ��������S��������+XPDQV�DUH�WKRXJKW�WR� KDYH�DQ�LQQDWH�UHVLOLHQFH�SRWHQWLDO�WKDW�HYROYHV�RYHU�WLPH�DQG�ÁXFWXDWHV�GHSHQG- LQJ�RQ�WKH�FRQWH[W��WKH�LQWHUSOD\�RI�LQGLYLGXDO�IDFWRUV��VRFLDO��FRPPXQLW\��HQYL- URQPHQWDO��DQG�VRFLHWDO�FRQGLWLRQV��DQG�PRUDO�HWKLFDO�YDOXHV�DQG�FRPPLWPHQWV� �5XVKWRQ��������6]DQWRQ�HW�DO����������5HVLOLHQFH�LQFOXGHV�´WKH�DELOLW\�WR�IDFH� DGYHUVH�VLWXDWLRQV��UHPDLQ�IRFXVHG��DQG�FRQWLQXH�WR�EH�RSWLPLVWLF�IRU�WKH�IXWXUH�µ� DQG�LW�LV�GHVFULEHG�DV�D�´YLWDO�FKDUDFWHULVWLFµ�IRU�QXUVHV�LQ�WKH�FRPSOH[�KHDOWK�FDUH� system. Resilience is associated with reduced symptoms of burnout, improved PHQWDO�KHDOWK��DQG�UHGXFHG�WXUQRYHU��5XVKWRQ�HW�DO����������

7D\ORU��������VXJJHVWV�RIIHULQJ�UHVLOLHQFH�LQWHUYHQWLRQV�DW�WKH�SULPDU\��VHF- ondary, and tertiary levels. At the primary level, such interventions would focus RQ� EXLOGLQJ� VHOI�DZDUHQHVV�� FRSLQJ� VNLOOV�� DQG� FRPPXQLFDWLRQV� VNLOOV��$W� WKH� VHFRQGDU\� OHYHO�� WKH\� PLJKW� LQFOXGH� VFUHHQLQJ� IRU� EXUQRXW� DQG� SURYLGLQJ� WKH� associated resources and supports nurses will need. Finally, at the tertiary level, LQWHUYHQWLRQV�ZRXOG�WDUJHW�QXUVHV�ZKRVH�UHVLOLHQFH�WKUHVKROG�KDG�EHHQ�EUHDFKHG� DQG� VXSSRUW� WKHLU� KHDOLQJ� DQG� UHWXUQ� WR� ZRUN�� 8QGHUVWDQGLQJ� DQG� DGGUHVVLQJ� UHVLOLHQFH�DPRQJ�QXUVHV�KROGV�SURPLVH�IRU�DWWHQXDWLQJ�WKH�HIIHFWV�RI�ZRUNSODFH� GHPDQGV�WKDW�H[FHHG�SHUVRQDO�UHVRXUFHV��<X�HW�DO����������$�QXUVH�VXLFLGH�WDVN� force led by ANA9�KDV�EHHQ�UHIRFXVHG�RQ�UHVLOLHQFH�DQG�LV�PDNLQJ�UHVRXUFHV� DYDLODEOH�WKDW�FDQ�DGGUHVV�PHQWDO�KHDOWK��SDUWLFXODUO\�GXULQJ�WKH�UHVSRQVH�WR�WKH� &29,’����SDQGHPLF��’DYLGVRQ�HW�DO�������D���

+RZHYHU�� IRFXVLQJ� RQO\� RQ� LQGLYLGXDO� UHVLOLHQFH� LV� LQVXIÀFLHQW� WR� FUHDWH� ZRUNSODFHV�GHVLJQHG�WR�SUHVHUYH�LQWHJULW\�DQG�ZHOO�EHLQJ��7D\ORU���������(YHU\� V\VWHP��LQFOXGLQJ�WKH�KXPDQ�V\VWHP��KDV�OLPLWV�EH\RQG�ZKLFK�LW�FDQQRW�UHFRYHU� DQG�FDQ�EHFRPH�SHUPDQHQWO\�GHJUDGHG��7KH�FKDOOHQJH�LV�WR�EHWWHU�XQGHUVWDQG� KRZ�WR�UHFRJQL]H�WKH�V\PSWRPV�RI�WKRVH�WKUHVKROGV�DQG�WR�GHYHORS�VWUDWHJLHV�WKDW�

7 ‘UXJ� GLYHUVLRQ� LV� ´WKH� GHÁHFWLRQ� RI� SUHVFULSWLRQ� GUXJV� IURP� PHGLFDO� VRXUFHV� LQWR� WKH� LOOHJDO� PDUNHWµ� �VHH� KWWSV���ZZZ�FPV�JRY�0HGLFDUH�0HGLFDLG�&RRUGLQDWLRQ�)UDXG�3UHYHQWLRQ�0HGLFDLG� ,QWHJULW\�(GXFDWLRQ�’RZQORDGV�LQIRJUDSK�’R�<RX�.QRZ�$ERXW�’UXJ�’LYHUVLRQ���%$SULO� ������’�SGI�>DFFHVVHG�$SULO���������@���

8 6HH� KWWSV���ZZZ�ÀHUFHKHDOWKFDUH�FRP�KRVSLWDOV�LQGXVWU\�YRLFHV�DV�FRYLG����ÁDUH�XSV�FRQWLQXH� KHDOWKFDUH�RUJDQL]DWLRQV�PXVW�GRXEOH�GRZQ��DFFHVVHG�$SULO�����������

9 6HH� KWWSV���ZZZ�QXUVLQJZRUOG�RUJ�JHW�LQYROYHG�VKDUH�\RXU�H[SHUWLVH�SUR�LVVXHV�SDQHO�PRUDO� UHVLOLHQFH�SDQHO��DFFHVVHG�$SULO�����������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 321

VXSSRUW�KXPDQ�V\VWHPV��WHDPV��DQG�RUJDQL]DWLRQV�LQ�DGDSWLQJ�KHDOWKIXOO\�WR�WKH� DGYHUVLWLHV�WKH\�LQHYLWDEO\�HQFRXQWHU�E\�PRGLI\LQJ�WKRVH�FKDUDFWHULVWLFV�WKDW�DUH� DPHQDEOH�WR�LQWHUYHQWLRQ��0RVV�HW�DO����������,Q�DGGLWLRQ�WR�LPSURYLQJ�WKH�UHVLO- LHQFH�RI�LQGLYLGXDOV��RUJDQL]DWLRQV�FDQ�VHHN�WR�LGHQWLI\�DQG�DPHOLRUDWH�WKH�QHJD- WLYH�FRQGLWLRQV�WKDW�V\VWHPDWLFDOO\�XQGHUPLQH�KHDOWK�DQG�ZHOO�EHLQJ��*UHJRU\�HW� DO����������%DUUDWW��������VXJJHVWV�WKDW�HIIRUWV�WR�LPSURYH�LQGLYLGXDO�UHVLOLHQFH� IRFXV�RQ�EXLOGLQJ�WKH�UHVLOLHQFH�RI�WHDPV�DQG�RUJDQL]DWLRQV�WR�JLYH�LQGLYLGXDOV� the support and resources they need. Resilience is discussed further in the section on system-level approaches later in this chapter.

Mental Health

3URPLVLQJ�DSSURDFKHV�IRU�IRVWHULQJ�QXUVHV·�PHQWDO�KHDOWK�DQG�ZHOO�EHLQJ�LQ- FOXGH�WKH�GHYHORSPHQW�RI�VNLOOV�LQ�PLQGIXOQHVV�DQG�FRJQLWLYH�EHKDYLRUDO�WKHUDS\� VNLOOV�EXLOGLQJ�LQWHUYHQWLRQV��0LQGIXOQHVV�VNLOOV�DUH�DLPHG�DW�EXLOGLQJ�DZDUHQHVV� RI�RQH·V�UHDFWLRQV�DQG�EHLQJ�DEOH�WR�FKRRVH�KRZ�WR�UHVSRQG�LQ�WKH�PRPHQW��7KH� development of new neuropathways to calm a reactive nervous system is not DLPHG�DW� WROHUDWLQJ�LQWROHUDEOH�VLWXDWLRQV��EXW�DW�UHVWRULQJ�VWDELOLW\�VR�LQGLYLG- XDOV�FDQ�FKRRVH�WKH�UHVSRQVHV�WKDW�EHVW�UHÁHFW�WKHLU�YDOXHV�DQG�FRPPLWPHQWV�� 0LQGIXOQHVV� LQWHUYHQWLRQV�� LQFOXGLQJ� PLQGIXOQHVV�EDVHG� VWUHVV� UHGXFWLRQ� DQG� PLQGIXOQHVV�EDVHG�FRJQLWLYH�WKHUDS\��DUH�LQFUHDVLQJO\�EHLQJ�XVHG�WR�WUHDW�DQ[LHW\� DQG�GHSUHVVLRQ��+RIPDQQ�DQG�*RPH]���������DQG�PD\�EH�SDUWLFXODUO\�HIIHFWLYH� LQ�IRVWHULQJ�VHOI�FRPSDVVLRQ��:DVVRQ�HW�DO����������5HFHQW�UHYLHZV�RI�5&7V�KDYH� IRXQG�WKDW�PLQGIXOQHVV�EDVHG�LQWHUYHQWLRQV�DUH�HIIHFWLYH�LQ�WUHDWLQJ�D�UDQJH�RI� FOLQLFDO�V\PSWRPV�DQG�GLVRUGHUV�� LQFOXGLQJ�DQ[LHW\��GHSUHVVLRQ��SV\FKRORJLFDO� DQG� HPRWLRQDO� GLVWUHVV�� DQG� JHQHUDO� ´TXDOLW\� RI� OLIHµ� FRQFHUQV� �+RIPDQQ� DQG� *RPH]���������

2QH�HYLGHQFH�EDVHG�VNLOOV�EXLOGLQJ�LQWHUYHQWLRQ�EDVHG�RQ�FRJQLWLYH�EHKDYLRUDO� WKHUDS\�WKDW�LQWHJUDWHV�PLQGIXOQHVV³0,1’%2′<67521*³�DGDSWHG�IURP�WKH� &23(�FRJQLWLYH�EHKDYLRUDO�VNLOOV�EXLOGLQJ�LQWHUYHQWLRQ��LV�GHOLYHUHG�E\�D�QXUVH� WR�QHZ�QXUVH�UHVLGHQWV��0,1’%2′<67521*�FRPSULVHV�HLJKW�ZHHNO\�VHVVLRQV� IRFXVHG�RQ�FDULQJ�IRU�WKH�PLQG��FDULQJ�IRU�WKH�ERG\��DQG�EXLOGLQJ�VNLOOV��6DPSVRQ� HW�DO����������(YLGHQFH�IURP�DQ�5&7�VXSSRUWV�0,1’%2′<67521*·V�HIÀFDF\�LQ� LPSURYLQJ�PHQWDO�KHDOWK��KHDOWK\�OLIHVW\OH�EHOLHIV��KHDOWK\�OLIHVW\OH�EHKDYLRUV��DQG� MRE�VDWLVIDFWLRQ��6DPSVRQ�HW�DO����������VXVWDLQLQJ�LWV�SRVLWLYH�LPSDFWV�RYHU�WLPH� �6DPSVRQ�HW�DO����������

,Q� D� UHFHQW� V\VWHPDWLF� UHYLHZ�� 0HOQ\N� DQG� FROOHDJXHV� ������� IRXQG� WKDW� LQWHUYHQWLRQV�LQYROYLQJ�PLQGIXOQHVV�DQG�WKRVH�XVLQJ�FRJQLWLYH�EHKDYLRUDO�WKHU- DS\� ZHUH� HIIHFWLYH� LQ� DGGUHVVLQJ� VWUHVV�� DQ[LHW\�� DQG� GHSUHVVLRQ� LQ� FOLQLFLDQV� �0HOQ\N�HW�DO����������’HHS�EUHDWKLQJ�DQG�JUDWLWXGH�LQWHUYHQWLRQV�DOVR�VKRZHG� SURPLVH��7KHVH�ÀQGLQJV�DUH�FRQVLVWHQW�ZLWK�WKRVH�RI�RWKHU�UHYLHZV��H�J���/RPDV� HW�DO����������7KH�SURJUDPV�UHYLHZHG�E\�0HOQ\N�DQG�FROOHDJXHV��������W\SLFDOO\� LQFOXGHG�HLJKW�ZHHNO\����WR�����KRXU�VHVVLRQV�SOXV�DERXW���KRXUV�RI�PLQGIXOQHVV�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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322 THE FUTURE OF NURSING 2020–2030

SUDFWLFH�DW�KRPH��KRZHYHU��WKH�DXWKRUV�FRQFOXGH�WKDW�WKHVH�SURJUDPV�ZHUH�SR- tentially too time-intensive for clinicians to accommodate within their schedules. They also note that many hospitals do not have mindfulness trainers available to LPSOHPHQW�WKHVH�SURJUDPV��

*LYHQ� WKH� FKDOOHQJHV� RI� LPSOHPHQWLQJ� WLPH�LQWHQVLYH� LQWHUYHQWLRQV� KLJK- OLJKWHG� E\� 0HOQ\N� DQG� FROOHDJXHV� �������� WKHUH� LV� DOVR� SURPLVLQJ� HYLGHQFH� that brief mindfulness interventions may have positive impacts on compassion, DOWKRXJK�+RIPDQQ�DQG�*RPH]��������REVHUYH�WKDW�LW�LV�XQFOHDU�ZKHWKHU�EULHI� LQWHUYHQWLRQV�FDQ�KDYH�WKH�VDPH�NLQG�RI�LPSDFW�RQ�DQ[LHW\�DQG�GHSUHVVLRQ�DV�WKDW� RI�WKH�ORQJHU�LQWHUYHQWLRQV��%R[������GHVFULEHV�SURPLVLQJ�LQWHUYHQWLRQV�WKDW�XVH� PRELOH�WHFKQRORJLHV�WR�VXSSRUW�PLQGIXOQHVV�DQG�RWKHU�ZHOO�EHLQJ�VNLOOV��

$QRWKHU�SURPLVLQJ�DSSURDFK�WR�HDUO\�VFUHHQLQJ�DQG�WUHDWPHQW�LV�WKH�+HDOHU� (YDOXDWLRQ�$VVHVVPHQW�DQG�5HIHUUDO��+($5��SURJUDP��ÀUVW�SLORWHG�ZLWK�QXUVHV� LQ�������’DYLGVRQ�HW�DO�������E������E���7KLV�SURJUDP��D�FROODERUDWLRQ�EHWZHHQ� WKH�8QLYHUVLW\�RI�&DOLIRUQLD��6DQ�’LHJR��DQG�WKH�$PHULFDQ�)RXQGDWLRQ�IRU�6XL- cide Prevention, includes a set of educational presentations focused on burnout, GHSUHVVLRQ�� DQG� VXLFLGH�� DV� ZHOO� DV� DQ� HQFU\SWHG� DQG� FRQÀGHQWLDO� ZHE�EDVHG� DVVHVVPHQW�WRRO�GHVLJQHG�WR�LGHQWLI\�DQG�UHIHU�LQGLYLGXDOV�DW�ULVN�IRU�GHSUHVVLRQ� DQG�VXLFLGH��7KH�SLORW�DVVHVVPHQW�VKRZHG�LW�WR�EH�DQ�HIIHFWLYH�VFUHHQLQJ�WRRO��’D- YLGVRQ�HW�DO�������E���7KUHH�\HDUV�DIWHU�WKH�SLORW������QXUVHV�KDYH�EHHQ�VFUHHQHG�� ZLWK���SHUFHQW�RI�WKRVH�VFUHHQHG�H[SUHVVLQJ�WKRXJKWV�RI�WDNLQJ�WKHLU�RZQ�OLIH�� 176 nurses have received treatment, and 98 have accepted referrals for treatment.

Ethical Competence

2UJDQL]DWLRQV� DUH� LQYHVWLQJ� LQ� SURJUDPV� DLPHG� DW� EXLOGLQJ� PLQGIXOQHVV�� HWKLFDO�FRPSHWHQFH��DQG�UHVLOLHQFH�WKURXJK�H[SHULHQWLDO�DQG�GLVFRYHU\�OHDUQLQJ�� VLPXODWLRQ��DQG�FRPPXQLWLHV�RI�SUDFWLFH��%URZQ�DQG�5\DQ��������*URVVPDQ�HW� DO���������5XVKWRQ�HW�DO���������6KDSLUR�HW�DO���������6LQJOHWRQ�HW�DO����������7KHVH� SURJUDPV��FRXSOHG�ZLWK�SURJUDPV�DLPHG�DW�FXOWLYDWLQJ�QXUVHV·�FRPSHWHQFLHV�WR� DGGUHVV�HWKLFDO�FRQFHUQV�WKURXJK�V\VWHPDWLF�SURFHVVHV�WKDW�HQJDJH�WKH�YRLFH�RI� WKH�IURQW�OLQH�DQG�SURYLGH�QXUVHV�ZLWK�VNLOOV�IRU�FRQVWUXFWLYHO\�DQG�FRQÀGHQWO\� UDLVLQJ� WKHLU� FRQFHUQV�� DUH� LPSRUWDQW� OHYHUDJH� SRLQWV� IRU� FUHDWLQJ� ZRUNSODFHV� where moral resilience is fostered and ethical practice is routine (Grace et al., ������+DPULF�DQG�(SVWHLQ��������5RELQVRQ�HW�DO���������5XVKWRQ�HW�DO��������� 7URWRFKDXG�HW�DO���������:RFLDO�HW�DO����������7KHVH�UHVRXUFHV�DOVR�QHHG�WR�EH� DOLJQHG�ZLWK�V\VWHP�FKDQJHV�WKDW�UHPRYH�WKH�LPSHGLPHQWV�WR�QXUVHV·�ZHOO�EHLQJ� DQG�LQWHJULW\�DQG�EXLOG�PRUDO�FRPPXQLW\��+DPULF�DQG�:RFLDO��������/LDVFKHQNR� DQG�3HWHU��������7UDXGW�HW�DO����������$GRSWLQJ�V\VWHPDWLF�PHWKRGV�IRU�EXLOGLQJ� D� FXOWXUH� WKDW� IRVWHUV� HWKLFDO� SUDFWLFH� DQG� LQWHJULW\� E\� LQYHVWLQJ� LQ� VWUXFWXUDO� HOHPHQWV�DQG�SURFHVVHV�LQ�KHDOWK�FDUH�RUJDQL]DWLRQV�ZLOO�EH�HVVHQWLDO�WR�DPSOLI\� LQWHUYHQWLRQV�DLPHG�DW�EXLOGLQJ�LQGLYLGXDO�FDSDFLWLHV��1HOVRQ�HW�DO���������3DYOLVK�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 323

BOX 10-4 Mobile Technology and Mental Health Interventions

� 0RELOH� WHFKQRORJ\�DQG�P+HDOWK�KDV�EHFRPH�D�JURZLQJ�ÀHOG�RI� LQQRYDWLRQ�� VWXG\��DQG�UHVHDUFK��3DUN���������DQG�KDV�WKH�SRWHQWLDO�WR�KHOS�QXUVHV�DQG�RWKHU� FOLQLFLDQV�PDLQWDLQ�WKHLU�ZHOO�EHLQJ��P+HDOWK�LV�D�FRPELQDWLRQ�RI�H+HDOWK�RU�WHOH- health service delivery, health care tracking, mobile computing, medical sensor, DQG�FRPPXQLFDWLRQ� WHFKQRORJLHV��,VWHSDQLDQ�HW�DO����������P+HDOWK�KDV�PDQ\� advantages, it allows users to access services in most places, at any time, and bypasses traditional barriers created by infrastructure, such as roads and trans- SRUWDWLRQ��:+2��������� � 7KHUH�KDV�EHHQ�D�VWHDG\�LQFUHDVH�LQ�WKH�XVH�RI�VPDUWSKRQHV�DQG�WKH�HPHU- JHQFH�RI�VHYHUDO�PHQWDO�KHDOWK²IRFXVHG�DSSV��’RQNHU�HW�DO����������6\VWHPDWLF� reviews have shown that these apps, including those focused on mindfulness DQG�PHGLWDWLRQ��+XEHUW\�HW�DO���������DQG�RQ�EHKDYLRU�FKDQJH��+DQ�DQG�/HH�� ������/\]ZLQVNL�HW�DO����������KROG�SURPLVH�IRU�UHGXFLQJ�V\PSWRPV�RI�PHQWDO�LOO- QHVV�DQG�PDQDJLQJ�V\PSWRPV�RI�RWKHU�FKURQLF�LOOQHVV��+RZHYHU��UHVHDUFK�LQ�WKLV� area is growing, and studies have found that many apps lack clinical evidence or PHDQLQJIXO�LQSXW�IURP�XVHUV��6XEKL�HW�DO����������RU�KDYH�EHHQ�VWXGLHG�ZLWK�VPDOO� VDPSOH�VL]HV��*RRGZLQ�HW�DO���������5DWKERQH�DQG�3UHVFRWW��������:DQJ�HW�DO��� ������:RRG�HW�DO����������2WKHU�FKDOOHQJHV�LQFOXGH�OLPLWHG�DGRSWLRQ�RI�QHZ�DSS� based health interventions because of age or access to traditional health care VHUYLFHV��$OVVZH\�DQG�$O�6DPDUUDLH��������6XEKL�HW�DO����������7KH�QHDU�XELTXLW\� and adoption of information technology and data systems in health care and the steady growth of younger nurses entering the workforce means that nurses, espe- cially during periods of public health emergencies and crises, provide an optimal SRRO�RI�SRWHQWLDO�XVHUV�IRU�HYLGHQFH�EDVHG�PHQWDO�KHDOWK�DSSV� � ,Q�WKH�FRPLQJ�\HDUV�DQG�ZLWK�KLJKHU�PRELOH�XVDJH�LQ�SODFH��$OH[RSRXORV�HW� DO����������DGGLWLRQDO�UHVHDUFK�ZLOO�VXSSRUW�WKH�GHWHUPLQDWLRQ�RI�EHVW�SUDFWLFHV�IRU� helping nurses maintain their mental health or access mental health resources WKURXJK�WKH�XVH�RI�PRELOH�WHFKQRORJ\��,Q�WKH�PHDQWLPH��VHYHUDO�UHVRXUFHV�KDYH� EHHQ�ODXQFKHG�ZLWK�D�IRFXV�RQ�KHDOWK�FDUH�ZRUNHUV��$�PHQWDO�KHDOWK�SDUWQHU�LQLWLD- WLYH�EHWZHHQ�WKH�8QLYHUVLW\�RI�1RUWK�&DUROLQD�DW�&KDSHO�+LOO�DQG�&RRSHU�8QLYHUVLW\� +HDOWK�&DUH�FUHDWHG�DQ�DSS�FDOOHG�+HURHV�+HDOWK��ODXQFKHG�LQ�-XO\������WKDW�LV� DLPHG�DW�ÀUVW�UHVSRQGHUV�DQG�KHDOWK�FDUH�ZRUNHUV��7KH�DSS�DOORZV�WKHP�WR�DQVZHU� weekly questions that assess their mental health, and users are connected to UHVRXUFHV�EDVHG�RQ�WKHLU�DQVZHUV��+HURHV�+HDOWK���������$Q�DGGLWLRQDO�IHDWXUH� WR�ZKLFK�D�KHDOWK�FDUH�RUJDQL]DWLRQ�FDQ�VXEVFULEH�DOORZV�LWV�HPSOR\HHV�WR�JLYH� IHHGEDFN�WKURXJK�DQ�DJJUHJDWH�GDVKERDUG��%ULJKDP�DQG�:RPHQ·V�+RVSLWDO� LQ� %RVWRQ�UHOHDVHG�DQ�DSS�IRU�HPHUJHQF\�SURYLGHUV�FDOOHG�´5RVHµ�WKDW�FROOHFWV�GDWD� IURP�XVHUV�WKURXJK�D� MRXUQDO� IHDWXUH�DQG�TXHVWLRQQDLUHV��7KH�DSS·V�EXLOW� LQ�$,� platform then uses these data to identify trends in stress and burnout, allowing the RUJDQL]DWLRQ�WR�ÀQG�ZDUQLQJ�SDWWHUQV�RU�WULJJHUV�WKDW�PDUN�DGYHUVH�PHQWDO�KHDOWK� V\PSWRPV�LQ�VWDII��’UHHV��������/DQGL���������$UWLÀFLDO�LQWHOOLJHQFH�WHFKQRORJ\�LQ� the app is equipped to read key words and phrases and detect signs of mental KHDOWK�SUREOHPV��LQFOXGLQJ�WUDXPD��0LOLDUG��������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

324 THE FUTURE OF NURSING 2020–2030

HW�DO����������7KHVH�HIIRUWV�DUH�V\QHUJLVWLF�ZLWK�WKRVH�DLPHG�DW�EXLOGLQJ�SV\FKRORJ- LFDO�VDIHW\��1HOVRQ�HW�DO���������DQG�PRGHOV�RI�MXVW�FXOWXUH�IRU�VDIH��TXDOLW\�FDUH�

Incivility, Bullying, and Workplace Violence

,Q�LWV������SRVLWLRQ�VWDWHPHQW��$1$���������$1$�DUWLFXODWHG�WKH�UHVSRQVL- ELOLWLHV�RI�ERWK�LQGLYLGXDO�QXUVHV�DQG�HPSOR\HUV�LQ�HQGLQJ�ZRUNSODFH�EXOO\LQJ�� LQFLYLOLW\��DQG�ZRUNSODFH�YLROHQFH��:LWK�UHJDUG�WR�EXOO\LQJ��5XWKHUIRUG�DQG�FRO- OHDJXHV��������FRQGXFWHG�DQ�LQWHJUDWLYH�UHYLHZ�RI�VWXGLHV�RI�LQWHUYHQWLRQV�DG- GUHVVLQJ�WKH�EXOO\LQJ�RI�SUHOLFHQVXUH�QXUVLQJ�VWXGHQWV�DQG�QXUVLQJ�SURIHVVLRQDOV�� ÀQGLQJ�WKDW�WKRVH�LQWHUYHQWLRQV�IHOO�LQWR�WKUHH�PDLQ�FDWHJRULHV��HGXFDWLRQ��QXUVHV� DV�OHDGHUV��DQG�SROLF\�FKDQJHV��7KH�DXWKRUV�FRQFOXGH�WKDW�HGXFDWLRQDO�LQWHUYHQ- WLRQV�DUH�LPSRUWDQW�WR�UHGXFLQJ�RU�HOLPLQDWLQJ�EXOO\LQJ�EHKDYLRU�DQG�PD\�EH�RI� WKH�PRVW�EHQHÀW�WR�VWXGHQWV��7KHVH�W\SHV�RI�LQWHUYHQWLRQV�UDQJH�IURP�MRXUQDOLQJ� WR�WHDFKLQJ�QXUVHV�KRZ�WR�DGGUHVV�EHLQJ�D�WDUJHW�RI�EXOO\LQJ�RU�LQFLYLOLW\��

2QH�LQWHUYHQWLRQ��GHVFULEHG�E\�$HEHUVROG�DQG�6FKRYLOOH���������XVHG�UROH� SOD\�VLPXODWLRQV�ZLWK�GHEULHÀQJ�VHVVLRQV�DQG�DQ�HGXFDWLRQDO�FRPSRQHQW�ZLWK� VHQLRU�OHYHO� XQGHUJUDGXDWH� QXUVLQJ� VWXGHQWV�� 3UHOLPLQDU\� TXDOLWDWLYH� HYLGHQFH� IURP�WKLV�LQWHUYHQWLRQ�LQGLFDWHG�WKDW�VLPXODWLRQ�FDQ�EH�DQ�HIIHFWLYH�VWUDWHJ\�IRU� DGGUHVVLQJ�LQFLYLOLW\�DQG�EXOO\LQJ�LQ�WKH�ZRUNSODFH��DOWKRXJK�WKLV�ZDV�D�VPDOO� SLORW�VWXG\�ZLWK�D�FRQYHQLHQFH�VDPSOH�RI�QXUVLQJ�VWXGHQWV��3IHLIIHU�DQG�9HVVH\� �������FRQGXFWHG�DQ�LQWHJUDWLYH�UHYLHZ�RI�EXOO\LQJ�DQG�ODWHUDO�YLROHQFH��%/9�� DPRQJ�QXUVHV� LQ�0DJQHW® DFFUHGLWHG�KHDOWK�FDUH�RUJDQL]DWLRQV�10 The authors IRXQG�WKDW�D�YDULHW\�RI�WHUPV�ZHUH�XVHG�WR�GHVFULEH�%/9��PDNLQJ�LW�GLIÀFXOW�WR� V\QWKHVL]H�DQG�FRPSDUH�ÀQGLQJV�DFURVV�VWXGLHV��$OWKRXJK�0DJQHW�DFFUHGLWDWLRQ� VWDQGDUGV�SURPRWH�D�PRGHO�RI�FROOHJLDOLW\�DQG�WHDPZRUN��%/9�UHPDLQV�SUHYDOHQW� DQG�H[LVWV�LQ�ERWK�0DJQHW�DQG�QRQ�0DJQHW�RUJDQL]DWLRQV��3IHLIIHU�DQG�9HVVH\� �������FDOO�IRU�PRUH�VWXGLHV�H[DPLQLQJ�WKH�SUHYDOHQFH�RI�%/9�LQ�WKHVH�DFFUHGLWHG� RUJDQL]DWLRQV�DQG�DOVR�PRUH�UHVHDUFK�DLPHG�DW�EHWWHU�XQGHUVWDQGLQJ�IDFWRUV�ZLWKLQ� RUJDQL]DWLRQV� DQG� LQWHUYHQWLRQV� WKDW� FDQ� HIIHFWLYHO\� UHGXFH� WKH� RFFXUUHQFH� RI� %/9��,Q�VXP��WKH�OHYHO�RI�HYLGHQFH�IRU�WKH�HIIHFWLYHQHVV�RI�EXOO\LQJ�LQWHUYHQWLRQV� DPRQJ�QXUVHV�LV�OLPLWHG�DQG�WKHUH�LV�D�QHHG�IRU�ULJRURXV��ZHOO�GHVLJQHG�5&7V� WR� EXLOG� WKLV� HYLGHQFH� EDVH�� PXOWLSOH�� VWUDWLÀHG� LQWHUYHQWLRQV� PD\� EH� QHHGHG� �5XWKHUIRUG�HW�DO����������

As mentioned previously, workplace violence is also a concern for nurses, SDUWLFXODUO\�WKRVH�ZKR�ZRUN�LQ�HPHUJHQF\�GHSDUWPHQW�VHWWLQJV��*LOOHVSLH�HW�DO��� ����D�E���,QWHUYHQWLRQV�WKDW�KDYH�EHHQ�GHYHORSHG�WR�DGGUHVV�ZRUNSODFH�YLROHQFH� include a hybrid educational intervention with online and classroom components �*LOOHVSLH�HW�DO�������D��DQG�D�PXOWLFRPSRQHQW�LQWHUYHQWLRQ�WKDW�LQFOXGHV�HQYL- URQPHQWDO�FKDQJHV��HGXFDWLRQ��WUDLQLQJ��DQG�FKDQJHV�LQ�SROLFLHV�DQG�SURFHGXUHV�

10 7KHVH�DUH�KHDOWK�FDUH�RUJDQL]DWLRQV�WKDW�DUH�DFFUHGLWHG�WKURXJK�WKH�$PHULFDQ�1XUVHV�&UHGHQWLDO- LQJ�&HQWHU��7KLV�PRGHO�LV�FRQVLGHUHG�WR�EH�WKH�JROG�VWDQGDUG�IRU�QXUVLQJ��3IHLIIHU�DQG�9HVVH\���������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 325

�*LOOHVSLH�HW�DO�������E���DOWKRXJK�WKHVH�DUH�QRW�VWULFWO\�IRFXVHG�RQ�QXUVHV��7KH� hybrid educational intervention showed promise with a small sample of employ- HHV�IURP�D�SHGLDWULF�HPHUJHQF\�GHSDUWPHQW��ZLWK�WKH�UHVHDUFK�WHDP�FRQFOXGLQJ� WKDW�WR�DFKLHYH�VLJQLÀFDQW�OHDUQLQJ�DQG�UHWHQWLRQ��WKH�K\EULG�PRGHO�LV�SUHIHUUHG�� 7KH�PXOWLFRPSRQHQW�LQWHUYHQWLRQ�ZDV�SURPLVLQJ��EXW�RQO\�WZR�RI�VL[�VLWHV�UH- SRUWHG�VLJQLÀFDQW�GHFUHDVHV�LQ�YLROHQW�HYHQWV��7KH�DXWKRUV�DOVR�QRWH�WKDW�HPHU- JHQF\�GHSDUWPHQW�ZRUNHUV�GLG�QRW�UHSRUW�PRVW�RI�WKH�YLROHQW�HYHQWV�WKDW�RFFXUUHG� EHFDXVH�RI�VXFK�IDFWRUV�DV�WLPH�FRQVWUDLQWV�DQG�IHDU�RI�EHLQJ�EODPHG��*LOOHVSLH� HW�DO�������E���7KHUH�LV�D�QHHG�IRU�PRUH�UHVHDUFK�WR�H[DPLQH�KRZ�WR�DPHOLRUDWH� ZRUNSODFH�YLROHQFH�DPRQJ�KHDOWK�FDUH�ZRUNHUV��DQG�IRU�UHSOLFDWLRQ�DQG�ULJRURXV� 5&7V�RI�SURPLVLQJ�LQWHUYHQWLRQV��

Racism, Prejudice, and Discrimination

$V�GLVFXVVHG�LQ�&KDSWHU����WKHUH�KDV�EHHQ�D�VKLIW�LQ�SDWLHQW�FDUH�VHWWLQJV� away from cultural competency toward cultural humility, and toward a focus RQ�D�OLIHORQJ�DSSURDFK�WR�OHDUQLQJ�DERXW�GLYHUVLW\�DQG�WKH�UROH�RI� LQGLYLGXDO� ELDV� DQG� V\VWHPLF� SRZHU� LQ� KHDOWK� FDUH� LQWHUDFWLRQV�� 6SHFLÀF� DSSURDFKHV� WR� ZHDYLQJ�FXOWXUDO�KXPLOLW\�FRQFHSWV�LQWR�QXUVLQJ�DQG�LQWHUSURIHVVLRQDO�HGXFDWLRQ� are discussed in Chapter 7. In addition, as noted in Chapter 7, research on the HIÀFDF\�RI�LQWHUYHQWLRQV�GHVLJQHG�WR�UHGXFH�LPSOLFLW�ELDV�KDV�IRXQG�WKDW�PDQ\�RI� these interventions are ineffective, and some may even increase implicit biases �)LW]*HUDOG�HW�DO����������&KDSWHU���GHVFULEHV�DQ�HYLGHQFH�EDVHG�LQWHUYHQWLRQ�� WKH�SUHMXGLFH�KDELW�EUHDNLQJ�LQWHUYHQWLRQ��&R[�DQG�’HYLQH��������’HYLQH�HW�DO��� �������WKDW�KDV�EHHQ�WHVWHG�LQ�5&7V�DQG�LV�DLPHG�DW�RYHUFRPLQJ�ELDV�WKURXJK� FRQVFLRXV�VHOI�UHJXODWLRQ�RU�EUHDNLQJ�WKH�ELDV�´KDELW�µ�5HGXFLQJ�SUHMXGLFH�DQG� GLVFULPLQDWLRQ� PD\� DOVR� EH� SRVVLEOH� WKURXJK� VLPSOH� DQG� EULHI� LQWHUYHQWLRQV�� VXFK�DV����PLQXWH�QRQFRQIURQWDWLRQDO�FRQYHUVDWLRQV��DOWKRXJK�PRUH�UHVHDUFK�LV� QHHGHG�WR�WHVW�VXFK�LQWHUYHQWLRQV�ZLWK�UDFLDO�RXWJURXSV��:LOOLDPV�DQG�&RRSHU�� �������

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

326 THE FUTURE OF NURSING 2020–2030

Systems-Level Approaches

7KH�UHVSRQVLELOLW\�IRU�QXUVH�ZHOO�EHLQJ�LV�VKDUHG�EHWZHHQ�LQGLYLGXDO�QXUVHV� and those who shape the environment in which they practice. Individual nurses’ GHGLFDWLRQ�WR�WKHLU�RZQ�ZHOO�EHLQJ�LV�HQKDQFHG�E\�WKH�VXSSRUW�RI�WKH�V\VWHP�� LWV�OHDGHUV��DQG�D�FXOWXUH�LQ�ZKLFK�ZHOO�EHLQJ�LV�SULRULWL]HG��7KH������1DWLRQDO� Academies report on clinician burnout makes clear that while interventions IRFXVHG�RQ�LQGLYLGXDOV�KDYH�WKHLU�SODFH��WKHVH�VWUDWHJLHV�DORQH�DUH�LQVXIÀFLHQW� to address the systemic contributions to the factors that erode clinician well-be- LQJ��1$6(0������D���7KH�HYLGHQFH�GHPRQVWUDWHV� WKDW� LQWHJUDWHG��V\VWHPDWLF�� RUJDQL]DWLRQ�IRFXVHG�LQWHUYHQWLRQV�DUH�PRUH�HIIHFWLYH�DW�UHGXFLQJ�EXUQRXW�DQG� LPSURYLQJ�ZHOO�EHLQJ��$�V\VWHPV�DSSURDFK�IRFXVHV�RQ�WKH�VWUXFWXUH��RUJDQL]DWLRQ�� DQG�FXOWXUH�RI�ZRUNSODFHV��’]DX�HW�DO���������6KDQDIHOW�DQG�1RVHZRUWK\�������� 6KDQDIHOW�HW�DO����������DQG�FRQVLGHUV�WKH�FRPSOH[�LQWHUSOD\�RI�IDFWRUV�WKDW�LPSDFW� ZHOO�EHLQJ�DQG�RWKHU�RXWFRPHV��1$6(0������D��3OVHN�DQG�*UHHQKDOJK�������� 5RXVH��������

$Q�LQWHJUDWHG�DQG�V\VWHPDWLF�DSSURDFK�UHTXLUHV�WKH�LQYROYHPHQW�RI�D�EURDG� UDQJH�RI�VWDNHKROGHUV�� LQFOXGLQJ�QXUVH�OHDGHUV��HGXFDWLRQDO�LQVWLWXWLRQV��KHDOWK� FDUH�RUJDQL]DWLRQV�DQG�RWKHU�HPSOR\HUV�RI�QXUVHV��SROLF\�PDNHUV��DQG�SURIHVVLRQDO� DVVRFLDWLRQV��6RPH�VWDNHKROGHUV�ZLOO�KDYH�WKH�FDSDFLW\�WR�PDNH�VZHHSLQJ�FKDQJHV� WR�SROLFLHV�DQG�ZRUN�HQYLURQPHQWV��ZKLOH�RWKHUV�ZLOO�IRFXV�PRUH�RQ�IDFLOLWDWLQJ� LQGLYLGXDO�DQG�WHDP�ZHOO�EHLQJ��%HFDXVH�WKH�IDFWRUV�WKDW�FRQWULEXWH�WR�EXUQRXW� DQG�SRRU�ZHOO�EHLQJ�DUH�PXOWLSOH��YDULHG��FRPSOH[��DQG�FRQWH[W�GHSHQGHQW��HIIRUWV� on all levels and in all areas are welcome and necessary. The National Academy RI�0HGLFLQH·V��1$0·V��&OLQLFLDQ�:HOO�%HLQJ�.QRZOHGJH�+XE�KDV�GHWDLOHG��LOOXV- WUDWLYH�FDVH�VWXGLHV�IURP�WKH�9LUJLQLD�0DVRQ�.LUNODQG�0HGLFDO�&HQWHU��DQG�7KH� 2KLR�6WDWH�8QLYHUVLW\·V�&ROOHJHV�RI�0HGLFLQH�DQG�1XUVLQJ��(PHUJHQF\�0HGLFLQH� 5HVLGHQF\�3URJUDP��DQG�:H[QHU�0HGLFDO�&HQWHU�11

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 327

Nurse Leaders

1XUVH� OHDGHUV�KDYH� WKH�SRWHQWLDO� WR�GUDPDWLFDOO\� LPSDFW�QXUVH�ZHOO�EHLQJ� E\�VKDSLQJ�WKH�GD\�WR�GD\�ZRUN�OLIH�RI�QXUVHV��VHWWLQJ�WKH�FXOWXUH�DQG�WRQH�RI� WKH�ZRUNSODFH��GHYHORSLQJ�DQG�HQIRUFLQJ�SROLFLHV��DQG�VHUYLQJ�DV�H[HPSODUV�RI� ZHOO�EHLQJ��5RVV�HW�DO����������7KH�OHDGHUVKLS�VW\OH�DQG�HIIHFWLYHQHVV�RI�QXUVH� OHDGHUV�KDYH�EHHQ�DVVRFLDWHG�ZLWK�RXWFRPHV�LQFOXGLQJ�WKH�KHDOWK�RI�WKH�ZRUN� HQYLURQPHQW��SDWLHQW�RXWFRPHV�DQG�PRUWDOLW\��MRE�VDWLVIDFWLRQ��ZRUN�HQJDJHPHQW�� EXUQRXW��DQG�UHWHQWLRQ��%DPIRUG�HW�DO���������%RDPDK�HW�DO���������&XPPLQJV� HW�DO�������D�E��5XVKWRQ�DQG�3DSSDV��������6SHQFH�/DVFKLQJHU�DQG�)LGD�������� 6SHQFH�/DVFKLQJHU�HW�DO���������:HL�HW�DO����������1XUVH�OHDGHUV�KDYH�D�UHVSRQVL- bility to create a safe work environment with a culture of inclusivity and respect, DQG�WR� LPSOHPHQW�DQG�HQIRUFH�VWURQJ�SROLFLHV� WR�SURWHFW�QXUVHV��,Q�SDUWLFXODU�� QXUVH�OHDGHUV�PXVW�EH�VNLOOHG�LQ�UHFRJQL]LQJ�VLJQDOV�RI�WR[LFLW\�DQG�VWUDWHJLFDOO\� UHVSRQGLQJ�WR�WKHP��5XWKHUIRUG�HW�DO����������7KLV�UHVSRQVLELOLW\�LV�QRW�OLPLWHG� WR�DFXWH�FDUH�RU�KRVSLWDO�VHWWLQJV��QXUVHV�RQ�DOO�IURQWV�DQG�DW�HYHU\�SRLQW�LQ�WKH� workforce pipeline deserve support from their leaders.

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Nurse leaders can also use their position to serve as educators and role mod- HOV�IRU�WKHLU�VWDII��1$6(0������D��5RVV�HW�DO����������7KH\�PLJKW�GR�VR�E\��IRU� H[DPSOH��LQYHVWLQJ�LQ�SURJUDPV�DLPHG�DW�GHYHORSLQJ�UHVLOLHQFH�VNLOOV��WHDFKLQJ� VNLOOV�EDVHG�RQ�FRJQLWLYH�EHKDYLRUDO�WKHUDS\��FUHDWLQJ�QRUPV�RI�VHOI�FDUH�ZLWKLQ� WKH�ZRUN�GD\��DQG�VHWWLQJ�ÀUP�ZRUN²OLIH�ERXQGDULHV�IRU�VHOI�DQG�VWDII��7KH�HIIHFWV� RI�VWUHVV�DQG�WUDXPD�UHODWHG�WR�WKH�&29,’����SDQGHPLF�ZLOO�LPSDFW�WKH�ZRUN- IRUFH�DW�ERWK�WKH�LQGLYLGXDO�DQG�VWDIÀQJ�OHYHOV�IRU�\HDUV�WR�FRPH��DQG�OHDGHUV� ZLOO�QHHG�YLJLODQFH�DQG�D� ORQJ�WHUP�VWUDWHJ\�WR�EXLOG� WKH�KHDOWK�RI� WKH� WHDPV� SURYLGLQJ�FDUH�

)RU�H[DPSOH��0HQVFKQHU�DQG�0DXO��������UHSRUW�WKDW�VRPH�FRPPXQLW\�EDVHG� KHDOWK�FDUH�RUJDQL]DWLRQV�DQG�KHDOWK�FDUH�QHWZRUNV�DUH�IRVWHULQJ�D�KHDOWK\�OLIH² ZRUN�EDODQFH�E\�HQFRXUDJLQJ�HPSOR\HHV�WR�OHDYH�ZRUN�PRELOH�SKRQHV�LQ�WKH� RIÀFH�DIWHU�WKHLU�VKLIWV�DQG�HQVXULQJ�WKDW�WKH\�GR�QRW�ZRUN�EH\RQG�WKHLU�GHVLJQDWHG� ���KRXUV��1XUVH�OHDGHUV�FDQ�DOVR�VHUYH�DV�UROH�PRGHOV�E\�H[DPLQLQJ�WKHLU�RZQ� KHDOWK� SURPRWLRQ� EHKDYLRUV� DQG� PDLQWDLQLQJ� WKHLU� RZQ� KHDOWK� DQG� ZHOO�EHLQJ� �5RVV�HW�DO����������$QG�WKH\�FDQ�EH�DGYRFDWHV�IRU�PDNLQJ�HQYLURQPHQWDO�FKDQJHV�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

328 THE FUTURE OF NURSING 2020–2030

LQ�WKH�ZRUNSODFH��VXFK�DV�E\�KROGLQJ�VWDQGLQJ�RU�ZDONLQJ�PHHWLQJV��DGYRFDWLQJ� IRU�KHDOWK\�ZRUN�VFKHGXOHV��RU�LPSOHPHQWLQJ�SURJUDPV�WR�KHOS�QXUVHV�FRSH�ZLWK� the stresses of work.

/HDGHUVKLS� FDQ� EH� SDUWLFXODUO\� LPSRUWDQW� GXULQJ� WLPHV� RI� WUDQVLWLRQ� DQG� FKDOOHQJH��)RU�H[DPSOH��GXULQJ� WKH�HDUO\�GD\V�RI� WKH�&29,’����SDQGHPLF��� KHDOWK�FHQWHUV�ZLWK�OHYHO�KHDGHG��GLVFLSOLQHG��DQG�XQLÀHG�OHDGHUVKLS�ZHUH�DEOH�WR� TXLFNO\�LPSOHPHQW�SODQV��OLPLW�FRQIXVLRQ��DQG�SUHSDUH�VWDII�IRU�WKH�FKDQJHV�DKHDG� �&DQWRQ�DQG�&RPSDQ\���������5RVD�DQG�FROOHDJXHV��������RXWOLQH�VWHSV�IRU�QXUVH� OHDGHUV�WR�WDNH�WR�SURPRWH�KHDOWK�V\VWHP�UHVLOLHQFH�GXULQJ�WKH�&29,’����SDQ- GHPLF��7KHVH�LQFOXGH�VSHFLÀF�ORFDO�DQG�RUJDQL]DWLRQDO�UHFRPPHQGDWLRQV�DLPHG� DW�PLWLJDWLQJ�EXUQRXW�DQG�PRUDO�VXIIHULQJ�DQG�EXLOGLQJ�D�FXOWXUH�RI�ZHOO�EHLQJ�� 7KH�WUDQVLWLRQ�DVVRFLDWHG�ZLWK�LQWHJUDWLQJ�6’2+�DQG�KHDOWK�HTXLW\�IXUWKHU�LQWR� QXUVLQJ�SUDFWLFH�ZLOO�QRW�EH�DV�VZLIW�RU�DV�EOHDN�DV�WKH�WUDQVLWLRQ�WR�&29,’���� FDUH��EXW�LW�ZLOO�VLPLODUO\�UHTXLUH�VWURQJ�OHDGHUVKLS�DQG�VWHDG\�KDQGV�WR�JXLGH� WKH�ZD\�DQG�DGYRFDWH�IRU�QXUVH�ZHOO�EHLQJ�DPLG�WKH�FKDQJHV��5RVD�HW�DO���������� 1XUVH�OHDGHUV�ZLOO�EH�HVVHQWLDO�LQ�KHOSLQJ�WR�VKLIW�WKH�SULRULWLHV�DQG�ZRUNÁRZ�RI� QXUVHV�DQG�WR�VXSSRUWLQJ�QXUVHV�WKURXJK�WKLV�WUDQVLWLRQ��$+$������E����

Educational Institutions

7KH�IRXQGDWLRQ�IRU�QXUVH�ZHOO�EHLQJ�VWDUWV� ORQJ�EHIRUH�QXUVHV�HQWHU� WKH� ZRUNSODFH��:KLOH�PRUH�GDWD�DUH�DYDLODEOH�RQ�WKH�SRRU�ZHOO�EHLQJ�RI�PHGLFDO� VWXGHQWV�� UHVHDUFK� VXJJHVWV� WKDW� QXUVLQJ� VWXGHQWV� DUH� VLPLODUO\� VWUHVVHG� RXW�� H[KDXVWHG��DQG�GLVHQJDJHG��0LFKDOHF�HW�DO���������5XGPDQ�DQG�*XVWDYVVRQ�� �������:KLOH�HYLGHQFH�RQ�EXUQRXW�DQG�SRRU�ZHOO�EHLQJ�DPRQJ�QXUVLQJ�VWXGHQWV� LV�TXLWH�OLPLWHG��1$6(0������D���WKHUH�LV�DQ�HPHUJLQJ�ERG\�RI�HYLGHQFH�RQ� the important role of resilience (see also the earlier discussion of resilience in the section on individual-level interventions). Resilience of prelicensure QXUVLQJ�VWXGHQWV�KDV�D�VLJQLÀFDQW�LQYHUVH�UHODWLRQVKLS�ZLWK�DFDGHPLF�LQWHQWLRQ� WR�OHDYH��9DQ�+RHN�HW�DO���������DQG�PRUDO�GLVWUHVV��.UDXWVFKHLG�HW�DO���������� 6WUDWHJLHV�WR�VXSSRUW�UHVLOLHQFH�LQFOXGH�SRVLWLYH�UHIUDPLQJ��$PVUXG�HW�DO��������� 0DWKDG�HW�DO���������6WDFH\�HW�DO���������7KRPDV�DQG�5HYHOO���������UHÁHFWLRQ� �+H�HW�DO����������DQG�PLQGIXOQHVV��6WDFH\�HW�DO����������,QWHJUDWLRQ�SRLQWV�IRU� resilience within the clinical and didactic components of curricula are needed IRU�VXVWDLQDEOH�LPSDFW�RQ�QXUVLQJ�VWXGHQW�EHKDYLRU��&OHDU\�HW�DO����������,Q�D� UHFHQW�V\VWHPDWLF�UHYLHZ�RI�UHVLOLHQFH�DPRQJ�KHDOWK�FDUH�SURIHVVLRQV��+XH\�DQG� 3DODJDQDV��������RXWOLQH�LQGLYLGXDO��RUJDQL]DWLRQDO��DQG�HQYLURQPHQWDO�IDFWRUV� WKDW� LPSDFW� VWXGHQW� UHVLOLHQFH� DQG� SURPLVLQJ� LQWHUYHQWLRQV�� )XUWKHU� ZRUN� LV� QHHGHG�WR�XQGHUVWDQG�WKH�UHODWLRQVKLS�DPRQJ�IDFWRUV�WKDW�VXSSRUW�ZHOO�EHLQJ�

���The American Hospital Association developed a workforce checklist for use by leaders to con- VLGHU�KRZ�WKH\�FDQ�VXSSRUW�WKHLU�ZRUNIRUFH�GXULQJ�WKH�SDQGHPLF��6HH�KWWSV���ZZZ�DKD�RUJ�V\VWHP� ÀOHV�PHGLD�ÀOH���������DKD�FRYLG���SDWKZD\V�ZRUNIRUFH�SGI��DFFHVVHG�$SULO�����������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 329

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

330 THE FUTURE OF NURSING 2020–2030

HIIHFWLYH��LW�ZLOO�EH�QHFHVVDU\�IRU�QXUVLQJ�HGXFDWLRQ�RUJDQL]DWLRQV�WR�FDUHIXOO\� DVVHVV�WKH�LPSDFW�RI�UHFUXLWPHQW�QDUUDWLYHV�DQG�RUJDQL]DWLRQDO�QRUPV�WKDW�FRQÁDWH� SHUIHFWLRQLVP�ZLWK�H[FHOOHQFH��HVWDEOLVK�SDWWHUQV�RI�XQKHDOWK\�FRPSHWLWLRQ��RU� UHLQIRUFH�V\VWHPLF�UDFLVP�RU�VRFLDO�LQMXVWLFH��6XFK�DQ�DVVHVVPHQW�UHTXLUHV�VFUX- WLQL]LQJ�JUDGLQJ�DQG�SHGDJRJLFDO�SUDFWLFHV��HQFRXUDJLQJ�D�GLYHUVLW\�RI�OHDUQLQJ� VW\OHV��DQG�HOLPLQDWLQJ�QRUPV�RI�FKURQLF�RYHUZRUN�DV�WKH�VWDQGDUG�WR�EH�DFKLHYHG�� Attention is needed to how faculty norms and behaviors impact the adoption RI�WKRVH�QRUPV�E\�VWXGHQWV��)RU�H[DPSOH��VWXGHQWV�ZKR�ZLWQHVV�H[KDXVWHG�DQG� overworked faculty who do not demonstrate investment in their own health and ZHOO�EHLQJ�H[SHULHQFH�GLVVRQDQFH�ZKHQ�WKRVH�VDPH�IDFXOW\�XUJH�WKHP�WR�DGRSW� KHDOWK\�KDELWV�DQG�ZHOO�EHLQJ�SUDFWLFHV��

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BOX 10-5 ([DPSOHV�RI�1XUVLQJ�6FKRROV·�:HOO�%HLQJ�,QLWLDWLYHV

� 7KH�&RPSDVVLRQDWH�&DUH�,QLWLDWLYH��&&,���%DXHU�:X�DQG�)RQWDLQH��������LV� DQ� LQWHJUDWHG��PXOWLIDFHWHG�SURJUDP�ZLWKLQ� WKH�8QLYHUVLW\�RI�9LUJLQLD�6FKRRO�RI� 1XUVLQJ��&&,�VHUYHV�VWXGHQWV��IDFXOW\��DQG�VWDII�DQG�SURPRWHV�ZHOO�EHLQJ�WKURXJK� such initiatives as coursework, resilience activities, workshops, retreats, and PHGLWDWLRQ�DQG�\RJD�FODVVHV��&&,�LQFRUSRUDWHV�IRXU�FHQWUDO�FRQFHSWV��UHVLOLHQFH�� PLQGIXOQHVV��LQWHUSURIHVVLRQDO�FROODERUDWLRQ��DQG�D�KHDOWK\�ZRUN�HQYLURQPHQW��7KH� initiative conducts research on compassion, resilience, and self-care, and also has an Ambassador program in which student-clinicians, faculty, and community members implement changes in their workplaces and meet monthly to share VXFFHVVHV�DQG�FKDOOHQJHV�� � 7KH� 2KLR� 6WDWH� 8QLYHUVLW\� &ROOHJH� RI� 1XUVLQJ� KDV� D� ��\HDU� VWUDWHJLF� SODQ� focused on student, trainee, and faculty well-being, with outcomes monitored on DQ�DQQXDO�EDVLV��&DSSHOXFFL�HW�DO����������/,9(�:(//�LV�D�FRUH�WHQHW�RI�WKLV�SODQ� aimed at producing nurses, leaders, researchers, and health professionals who /HDG��,QQRYDWH��9LVLRQ��DQG�([HFXWH��DQG�DUH�:HOOQHVV�IRFXVHG��(YLGHQFH�EDVHG�� /LIHORQJ�/HDUQHUV��DQG�/LJKWV�IRU�WKH�:RUOG��7KH�&ROOHJH�KDV�D�/,9(�:(//�FXU- riculum that promotes healthy lifestyles for students, faculty, and staff through VHPLQDUV��HYHQWV��DQG�ZHOOQHVV�DFWLYLWLHV�

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 331

LQJ� DQG� LQWHJULW\�� 2IWHQ� ZKHQ� LQFOXGHG�� VXFK� FRQWHQW� LV� HOHFWLYH� RU� RSWLRQDO�� +RZHYHU��WKHUH�DUH�VLJQV�RI�SURJUHVV��DQLPDWHG�E\�FRQFHUQV�DERXW�WKH�GHWULPHQWDO� HIIHFWV�RI�WKH�OHDUQLQJ�HQYLURQPHQW�DQG�UHFRPPHQGDWLRQV�WR�UHGUHVV�WKHP��/DUVHQ� HW�DO����������,QWHUSURIHVVLRQDO�LQLWLDWLYHV��VXFK�DV�WKH�1$0·V�$FWLRQ�&ROODERUD- WLYH�RQ�&OLQLFLDQ�:HOO�%HLQJ�DQG�5HVLOLHQFH�16 represent a coordinated method IRU�OHDUQLQJ�ZLWK�DQG�IURP�FROOHDJXHV��,20��������

Employers

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As discussed previously, for individual approaches to be effective, they must EH�FRXSOHG�ZLWK�UHGHVLJQ�RI�RUJDQL]DWLRQDO�SURFHVVHV��VWUXFWXUHV��DQG�SROLFLHV�WR� animate sustainable culture shifts that make interventions feasible and norma- WLYH��5XVKWRQ�DQG�6KDUPD��������6WDQXOHZLF]�HW�DO����������)RU�H[DPSOH��LI�DQ� RUJDQL]DWLRQ�HQFRXUDJHV�QXUVHV�WR�XVH�PHGLWDWLRQ�WR�GHFRPSUHVV�GXULQJ�VKLIWV� EXW�RUJDQL]DWLRQDO�FXOWXUH�IURZQV�RQ�QXUVHV�WDNLQJ�EUHDNV��WKH�LQLWLDWLYH�LV�OLNHO\� WR�KDYH�OLPLWHG�LPSDFW��(QG�XVHUV�RI�WKHVH�LQLWLDWLYHV��IURQW�OLQH�QXUVHV��FDQ�EH� HQJDJHG� SURDFWLYHO\� LQ� GHVLJQLQJ� D� GLYHUVLW\� RI� UHVRXUFHV� WKDW� WKH\� SHUFHLYH� WR�EH�YDOXDEOH�LQ�IRVWHULQJ�WKHLU�ZHOO�EHLQJ�UDWKHU�WKDQ�KDYLQJ�VXFK�UHVRXUFHV�

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

332 THE FUTURE OF NURSING 2020–2030

LPSRVHG�RQ�WKHP��5LFKDUGV���������7KH�:LNLZLVGRP��)RUXP��:LVGRP�IURP� 1XUVHV��5LFKDUGV��������LV�RQH�VXFK�HIIRUW��VSRQVRUHG�E\�1HZ�9RLFH�6WUDWHJLHV�� WKH�-RKQV�+RSNLQV�8QLYHUVLW\�6FKRRO�RI�1XUVLQJ��DQG�WKH�American Journal of Nursing WR�IDFLOLWDWH�RQOLQH�FRQYHUVDWLRQV�ZLWK�IURQW�OLQH�QXUVHV�ZKR�DUH�EDWWOLQJ� WKH�&29,’����SDQGHPLF��

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BOX 10-6 Psychological Personal Protective Equipment (PPE)

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 333

of community nurses means that employers have less opportunity to observe WKHLU�ZHOO�EHLQJ�DQG�OHVV�FRQWURO�RYHU�WKH�ZRUN�HQYLURQPHQW��0RUH�UHVHDUFK�LV� QHHGHG�RQ�LPSURYLQJ�WKH�ZHOO�EHLQJ�RI�QRQFOLQLFDO�QXUVHV��LQ�WKH�LQWHULP��JLYHQ� the lack of evidence, employers need to think creatively and communicate with nurses about their needs.

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

334 THE FUTURE OF NURSING 2020–2030

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 335

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Nursing Associations and Organizations

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

336 THE FUTURE OF NURSING 2020–2030

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CONCLUSIONS

7R�FDUH�UHVSRQVLEO\�IRU�SHRSOH³HVSHFLDOO\�DV�WKH\�SUDFWLFH�LQ�PRUH�VHWWLQJV� ZLWK�PRUH�GLYHUVH�SHRSOH�ZLWK�FRPSOH[�QHHGV³QXUVHV�QHHG�WR�IHHO�KHDOWK\��ZHOO�� and supported. The systems that educate and employ nurses have a duty to fully VXSSRUW�WKHP�DV�WKH\�WDNH�RQ�QHZ�UROHV�WR�DGYDQFH�KHDOWK�HTXLW\��:KLOH�QXUVHV� KDYH�H[SHULHQFHG�URDGEORFNV�WR�ZHOO�EHLQJ�EHIRUH³IURP�EXUQRXW��WR�FRPSDVVLRQ� IDWLJXH��WR�LQMXULHV�DQG�LQIHFWLRQ³&29,’����KDV�LQWHQVLÀHG�WKHLU�VWUHVV�DQG�OHIW� WKHP�IHHOLQJ�XQSURWHFWHG�DQG�XQVXSSRUWHG��

Conclusion 10-1: All environments in which nurses work affect the health and well-being of the nursing workforce. Ultimately, the health DQG�ZHOO�EHLQJ�RI�QXUVHV�LQÁXHQFH�WKH�TXDOLW\��VDIHW\��DQG�FRVW�RI�WKH� care they provide, as well as organizations and systems of care. The COVID-19 crisis has highlighted the shortcomings of historical efforts to address nurses’ health and well-being.

1XUVH�ZHOO�EHLQJ�LV�LPSDFWHG�E\�SK\VLFDO��PHQWDO��PRUDO��DQG�VRFLDO�IDFWRUV� RULJLQDWLQJ�LQ�D�UDQJH�RI�VRXUFHV�IURP�WKH�LQGLYLGXDO�WR�WKH�V\VWHP�OHYHO��,PSURY- LQJ�WKH�ZHOO�EHLQJ�RI�QXUVHV�ZLOO�WKHUHIRUH�UHTXLUH�PXOWLOHYHO�DQG�PXOWLIDFHWHG� approaches that address their physical, mental, moral, and social health and cre- DWH�VDIH��VXSSRUWLYH��DQG�HWKLFDOO\�JURXQGHG�HQYLURQPHQWV��2FFXSDWLRQDO�KHDOWK� KD]DUGV��ZRUNSODFH�YLROHQFH��VWUHVV�DQG�PHQWDO�KHDOWK�LVVXHV��PRUDO�VXIIHULQJ�� FRPSDVVLRQ�IDWLJXH��EXUQRXW��DQG�EXOO\LQJ�DQG�LQFLYLOLW\�DOO�QHHG�WR�EH�DGGUHVVHG�

��� 6HH� KWWS���ZZZ�QDKQQHW�RUJ�1$+1�(YHQWV�:HELQDUV�1$+1�&RQWHQW�:HELQDUV�DVS[“KNH\ �F����G��D�H���HD���E�I�GD�I���EI�GF��DFFHVVHG�$SULO������������

 

 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 337

WKURXJK�UHIRUP�DLPHG�DW�FKDQJLQJ�ZRUNSODFH�SROLFLHV�DQG�FXOWXUH�WR�VXSSRUW�WKH� ZHOO�EHLQJ�RI�QXUVHV�DQG�HQVXUH�WKHLU�FDSDFLW\�DQG�DELOLW\�WR�SURYLGH�TXDOLW\�FDUH� for people, families, and communities.

&RQFOXVLRQ�������7KH�ODFN�RI�VXIÀFLHQW�GDWD�DQG�HYLGHQFH�DERXW�WKH� negative impacts of burnout, fatigue, and stressful work environments on nurses’ health and well-being hinders understanding of the severity of these issues and limits the ability to address them appropriately. Many programs and initiatives seek to improve nurses’ health and well-being; however, the translation of effective evidence-based in- terventions into practice, further research, and rigorous studies are needed to understand the impact of these programs and initiatives and their relationship to system factors.

Conclusion 10-3: Structural racism, cultural racism, and discrimi- nation exist within nursing as in other professions. Nurses of color experience discrimination and bias within the workplace and educa- tional systems, compounded by the lack of diversity among the nursing workforce and faculty. Nurses, educators, and health care leaders have a responsibility to address structural racism, cultural racism, and discrimination within the nursing profession across educational and practice settings, and to build structures and systems that promote in- clusivity and health equity.

$V�WKH�IXWXUH�RI�QXUVLQJ�GHPDQGV� WKDW�QXUVHV� LQFUHDVLQJO\�DGGUHVV�VRFLDO� QHHGV�DQG�6’2+��DWWHQWLRQ�WR�QXUVH�ZHOO�EHLQJ�ZLOO�EH�FULWLFDO��$GGUHVVLQJ�VR- FLDO�QHHGV�DQG�6’2+�UHTXLUHV�LQ�WXUQ�FRJQLWLYH��HPRWLRQDO��DQG�PRUDO�ZRUN�WKDW� LV�QRW�FXUUHQWO\�VXSSRUWHG��WKDW�LV��WLPH�DQG�SD\PHQW�IRU�WKLV�ZRUN�DUH�ODUJHO\� QRW�DYDLODEOH��,I�QXUVHV�DQG�RWKHU�FOLQLFLDQV�DUH�H[SHFWHG�WR�IXOÀOO�WKHLU�SURIHV- VLRQDO�PDQGDWHV�IRU�VRFLDO� MXVWLFH�� LQFOXGLQJ�DGGUHVVLQJ�FRPSOH[�VRFLDO�QHHGV� DQG�6’2+��DQG�WR�VSHQG�WKH�WLPH�DQG�FRJQLWLYH�HIIRUW�WR�DGGUHVV�ERWK�KHDOWK�DQG� VRFLDO�LVVXHV��V\VWHP�ZLGH�FKDQJHV�ZLOO�EH�QHHGHG�WR�SURYLGH�VSDFH�DQG�VXSSRUW� IRU�WKDW�VKLIW��0RUH�ZHOO�GHVLJQHG��PHWKRGRORJLFDOO\�VRXQG�UHVHDUFK�VWXGLHV�DUH� QHHGHG�WR�GHYHORS�DGGLWLRQDO�NQRZOHGJH�LQ�WKLV�DUHD�

Conclusion 10-4: Coordinated and collaborative action at the individ- ual and systems levels, encompassing individual nurses, educators, employers, health systems, professional organizations, and govern- ment agencies, is needed to promote nurses’ health and well-being.

(QVXULQJ�QXUVH�ZHOO�EHLQJ�QHFHVVLWDWHV�DQ�LQYHVWPHQW�LQ�LQGLYLGXDO�VWUDWHJLHV� within a systems approach that addresses the structures and policies responsible IRU�WKH�ZRUNSODFH�KD]DUGV�DQG�VWUHVVHV�WKDW�OHDG�WR�SRRU�KHDOWK��7KLV�LQYHVWPHQW�

 

The Future of Nursing 2020-2030 Report

In 2010, the Institute of Medicine, in collaboration with the Robert Wood Johnson Foundation, released the famous “The Future of Nursing: Leading Change, Advancing Health” report. This report helped shed light on the crucial role of nurses as members of healthcare in transforming healthcare. Recently, the Institute of Medicine released “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” This report highlights the role of nurses in the next decade, especially as it regards achieving health equity. A lot of social determinants of health are to blame for the various health disparities reported in the country. Nurses are responsible for reducing those health disparities and promoting health in the country (National Academies of Sciences, Engineering & Medicine, 2022).

The American Nurses Association (ANA) has been widely involved in advocacy efforts to address health disparities and improve public health and safety. Among the areas that ANA is trying to address is gun violence in the country. Gun violence is a significant public health and safety issue. Each day, 321 Americans are shot across the United States. Among those, 111 are killed (Brady Campaign to Prevent Gun Violence, 2022). Cases of the mass shooting have significantly increased over the years. Thus, ANA is among the organizations raising concern over the country’s increased gun violence cases. ANA is calling for commonsense reforms on guns. These reforms will help keep guns out of the wrong hands. People with a history of violence, convicted felons, and those with mental illness should not have access to guns. Thus, strengthening background checks will help a lot in ensuring only law-abiding citizens have access to guns. Further, ANA calls for further investment in mental health. A lot of cases, including mass shootings, homicides, and suicides by guns, are attributed to mental illness. Thus, it is vital for the government to invest more in mental health care (American Nurses Association, 2022).

Every American adult and child will benefit a lot from the legislation of stricter gun control laws. Both adults and children have suffered the impact of gun violence. Cases of school shootings, malls, and churches affect everyone. Thus, Americans will benefit first. There are a lot of nonprofit organizations working to address the problem of gun violence in our society. These organizations will make good allies. Examples of such organizations include Moms Demand Action for Gun Sense in America, Gun Free Kids, Mayors against Illegal Guns, Brady Campaign to Prevent Gun Violence, and Everytown for Gun Safety, among others (Brady Campaign to Prevent Gun Violence, 2022).

Bringing more nurses together can help in amplifying the nurses’ call for policy change. An advanced practice nurse needs to involve coworkers in political advocacy. This can be done by highlighting the impact of the advocacy issue on the local community. More healthcare workers will be engaged if they feel the issues directly impact their communities. Further, it is important to provide sensible solutions. Having a potentially effective solution can help bring everyone on board.

 

References

American Nurses Association. (2022). ANA President Responds to Executive Actions to Regulate Gun Sales.https://www.nursingworld.org/news/news-releases/2016/ana-president-responds-to-executive-actions-to-regulate-gun-sales/ (Links to an external site.)

Brady Campaign to Prevent Gun Violence. (2022). Gun violence by numbers. https://www.bradyunited.org/key-statistics (Links to an external site.)

National Academies of Sciences, Engineering & Medicine. (2022). The Future of Nursing 2020-2030. https://www.nationalacademies.org/our-work/the-future-of-nursing-2020-2030