A Vision for the Future of Nursing: Ten Key Points in History Worth Reminiscing

A Brief Background on Social Justice in the 21st Century

To this day in the 21st century, social justice remains ambiguous, if not abstract. Examining its very core in the context of healthcare, especially in terms of theories, we find its deep significance embedded in the very relationship between the nurse and the patient.

Social justice should be a core priority for nurses globally. Why? For one, health inequities to this point in the 21st century remain ubiquitous despite dramatic efforts of leaders in equal rights advocacies, and seeming improvements in opportunities in the United States (and around the world).

In the US, tremendous investments are being placed in healthcare, and enormous strides have been made by healthcare advocates who rally support for social justice, yet statistics continue to show that a black baby still has threefold the risk of death in the first year real of life vs. a white baby.  Life expectancy among people with color is also significantly lower.

Returning to the Roots: Social Justice and Nursing

Nursing needs to be redesigned to allow nurses to go back to this noble profession’s very roots – to an age where social justice was at the core of the profession.  Once we have realized the essence of social justice concepts and its practical application in modern day nursing practice, then we will be ready to incorporate its elements in effective tools or programs that will powerfully transform nursing principles in this light.

One of my specific objectives in my advocacy for social justice is to educate the nursing workforce so that we can all look back meaningfully to the core principles that matter and address issues of social injustices and structural inequalities, also known as healthcare inequities here in the US.


The Roles Nurses Play

Today, the call to provide culturally competent nursing care that’s patient-directed, and based on the best available evidence is the goal and role we nurses hope to play. Just how should we play this role so that we are able to achieve remarkable results in terms not just of statistics, but breakthrough methods that will expand across nursing, and healthcare in general?

At Transform Nursing, I will share with you firsthand tips on how to journey in this profession with tools that will give you the leading edge to make a difference in the work that we do.

Let me begin by sharing with you some important elements in this process:

  1. Healthcare should be a team sport. Nurses should be vigilant in looking for “red flags”, and at the same time collaborate with other members of the healthcare team to ensure that individualized needs of our patients are being met.
  2. Talking meaningfully with significant others. We should know how to obtain pertinent information, and partner with family members to be able to provide holistic care for patients, and their significant others as well.
  3. Culturally tailored interventions. Nurses need to utilize transformative and socially sensitive strategies that will enable us to implement individually-tailored nursing care at the bedside, in school, or other communities where we provide care.
  4. New methods for structural change. To address the issues in social justice, it is imperative that new methods (and paradigms) be redesigned to reflect the critical importance of addressing social determinants of nursing and healthcare in general, utilizing upstream

At Transform Nursing, it is my steady goal to assist nurses in being familiar with thinking upstream. I will re-introduce to you, and guide you closely to influential leadership tools that will broaden your concept in social justice, through an approach that is easy to grasp and applicable to your own facility or cultural environment.

I believe that the interweaving concepts of social justice, diversity, inclusion, and influential leadership should come as a package, to empower you in your practice as a therapeutic nurse. It is this call that I continue to find evidence-based, practical solutions to in my own journey as a professional nurse.


Responding to the Call

In the US alone, structural injustices continue to plague our healthcare systems. These inequities are so pervasive and reflected in patterns of marginalization, exclusion, and discrimination of class, race, gender, sexuality, etc.

Being the largest segment of the healthcare workforce, we should collectively respond with a systematic and sustained effort to alleviate these injustices. Social justice has been a recurrent theme for several decades. Although not everyone rallies to support the cause, this has been a topic of studies and discussions in healthcare, and among nurses. Many nurses have felt the socio-political obligation to participate in movements towards this end.

Here are some points to ponder:

  1. What are your thoughts on social justice?
  2. Do you work to rally for support towards this concern, or do you choose to remain passive?
  3. Do you consider your efforts or silent stand on this concern beneficial for your practice as a nurse?
  4. How do you personally feel about sounding the alarm when social injustices in nursing or healthcare arise?

The Minimal Involvement of Nurses in the Call for Social Justice

Evidence suggests that today there is lack of knowledge and awareness among nurses with regards to the political context of healthcare, including social structures, and inconsistencies that define social justice in our society. There seems to be the existence of an overriding bias towards individualized patient care that has conspired and resulted in nurses being minimally involved in socio-political reforms and advocacy.

This truth is in sheer contrast to the views of nurse reformers including Florence Nightingale, who believes that concern for social justice and reforms were essential to the profession.

Returning to the Roots: Social Justice in Nursing

Today, in the midst of healthcare inequities, spiraling costs, and growing disparities in nearly all segments of society, it is time for nurses to reclaim our rightful stand as reformers that dedicate time and effort to alleviate the myriad social injustices in society that ultimately lead to poor health outcomes.

My unique approach in Transform Nursing would like to help you toward this end. Because it is only with a concrete conviction to return to the very roots of this profession, and with a plan of action, that nurses can be adequately equipped to engage in political activities and advocate policy changes that will better achieve socially healthy outcomes in the nursing practice, and for those we serve.


Socio-political Action in Nursing: The Significant Story Behind

Believe it or not, the binding roots of nursing and social justice go as far back as the profession itself.

Here are 10 key points in history worth reminiscing:

  1. The prevailing paradigm in the era of Florence Nightingale held that socio-economic factors including living arrangements, family income, and access to adequate healthcare greatly influenced healthcare opportunities (or limitations thereof).
  2. Nightingale understood that an individual’s environment was critical for the restoration of health.
  3. Florence Nightingale, during her time in the 1850s (during the Crimean war), promoted political activism aimed towards changing social conditions and laws that contributed to health outcomes. This was a core aspect of the nursing practice, as central as compassion and caring.
  4. Nightingale, therefore, became a champion of activism – which she believed was an integral component of the nursing practice.
  5. Lillian Wald, another early nurse reformer, also referred to as the founder of public health nursing, extended nursing care beyond the individual nurse-to-patient relationship. She worked tirelessly on the lower east side of New York City to improve healthcare and social conditions for immigrants living in this area.
  6. Wald founded the Henry Street Settlement and the Visiting Nurse Service of New York. These organizations provided care through home visits to residents of impoverished neighborhoods of the lower east side.
  7. These organizations extensively taught people about the importance of and skills needed to maintain cleanliness, feed infants and children, do appropriate care, and provide sterilized milk and food. They also administered immunizations and medications in communities under her leadership.
  8. Importantly, Wald did not cease providing care to people in need. She particularly was an advocate and supporter of marginalized groups as well as challenged institutionalized power during her era.
  9. Wald dedicated efforts to fight against child labor. She was pivotal in the creation of the Children’s Bureau within the US.
  10. 10. Recognizing the huge disparities in healthcare, she helped in founding the National Association for the Advancement of Colored People in the US, which remains the largest organization dedicated to civil rights today.

 Translating Knowledge to Action: Working for Structural Change

If we closely examine the similarities among these nurse pioneers, I believe it was their courage to translate knowledge gained from patients, communities, and even vulnerable populations they cared for into political activism targeted towards structural change that defined their legacy in the nursing practice.

Tenets We Should Relearn from Iconic Nurses of the Past 

Nightingale and Wald, among other nurse reformers who shaped the nursing profession significantly, knew that the health of patients would not be improved without first addressing the social inequities and injustices these people faced including unsanitary living conditions, poor educational opportunities, and lack of access to healthcare.


A Call To Transformative Action in the 21st Century: Activating our current Workforce

Currently, there are about 3 million registered nurses in the US alone. These nurses work in hospital settings (62.2%), in ambulatory care (10.5%), and in public health settings including public health departments and schools (approximately 8%).

It is rather dismal that according to studies, a huge number of nurses today lack a clear understanding of social justice, or basically, have a lack of knowledge on how to engage in social and political activities aimed towards alleviating health inequities, possibly secondary to healthcare system and education deficits.

Transform Nursing: A Platform that Heeds the Call for Social Justice

Today there is an alarming call for influential nurse leaders to support their colleagues globally in answering the call to action. At Transform Nursing it is a primary thrust to provide explicit tools and instruction on practicing nursing upstream. I will guide you to visualize your goals and see matters from a totally different perspective. Many times this will entail leading you to a place where speaking or acting in a certain situation may feel uncomfortable. But change really happens when we find the courage to go beyond our comfort zones.

As leaders or frontline staff in your own facility, knowledge on the concepts of influential leadership, inclusion, social justice, and diversity should arm you with the competency and confidence to understand the nursing workforce which you influence and work with. It is equally important to realize that political interventions are required for upstream nursing to work. This precisely is why I am here to help.

I will guide you in re-evaluating fundamental concepts, situations, or ideas which you may have previously encountered. Leveraging on best evidence strategies in training and education, together we will open your consciousness to a whole new perspective that is essential as a first step. It is important to realize that as nurses and advocates, we have the option to sound the alarm as when situations of social injustice that lead to poor health outcomes happen in our midst. It is also imperative that we employ functional tools that empower, and in turn, engage individuals in our institutions or communities to work towards alleviating health inequities. We should make the choice to advance and equip ourselves before more lives suffer or are prematurely lost to the likes of structural violence, discrimination, racism, and many more bitter realities that continue to plague healthcare.

To be able to take on a proactive stand on these issues, one should be prepared to:

  1. Be acquainted with the skills needed to advocate for just policies at the institutional or government level.
  2. Be confident in translating inherent knowledge from intimate nurse to patient relationships to actions that are politically relevant and game-changing.
  3. Enhance what you already know and reinforce your expertise to be able to fully educate your peers and subordinates in this crucial aspect of the nursing practice.

In summary, in this day and age, nurses are witnesses to continuing disparate and inadequate health systems in the US and around the world. However, because nursing care is often focused on the individual patient with little or no regard to his or her social environment, present-day nurses miss incredible opportunities to intervene in ways that go beyond the temporary relief of addressing particular symptoms of poor health for those we serve.

At Transform Nursing, I encourage you to look back to the very roots of our profession, where nursing and social activism have laid the foundation for the practice. It is worth recalling the sacrifices and lessons we have learned from Florence Nightingale in the 19th century, and Lillian Wald in the 20th century, so we can move forward progressively. A crucial milestone would be that we recognize that our patient’s health is inextricably connected with their social situations.

Transform Nursing will provide you cost-effective solutions for you and your institution to be able to influence change beyond the bedside. Social injustice is something we should stand against and not tolerate in the 21st century. Our collective effort should lead to breakthrough changes that will remedy the unequal burden of disease in society today.

Finally, as knowledge is the pre-requisite to action, allow me and my transformative program of action to fill the knowledge base that will serve as the foundation for yourself or your organization. In no time, we shall regain in you the drive and direction to identify and address problem areas, especially pertaining to social injustices, right at its core.


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