role of a registered nurse essay

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Becoming a Registered Nurse

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Published: Mar 16, 2024

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Educational requirements, importance of registered nurses, challenges and rewards.

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Nursing Roles: The Registered Nurse, Essay Example

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Critically analyse the nurses' roles and responsibilities within care provision

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Nurses have a range of roles and responsibilities in order to provide society with the highest quality of care (Peate, 2016). The Royal College of Nursing (RCN, 2014:3) define nursing as the ability to ‘improve, maintain, or recover health, to cope with health problems, and to achieve the best quality of life’ for patients until their death. This essay will critically analyse the nurses’ role and responsibilities within care provision, discussing their role as a primary caregiver, a leader, advocate, educator, collaborator, practitioner, in addition to their responsibilities in line with professional codes of practice (Nursing and Midwifery Council, 2015).

The nurse has a role as a primary caregiver, adhering to succinct evidence-based practice in order to meet the holistic needs of every patient and their families through the use of clinical judgement and expertise (RCN, 2017). They show compassion and knowledge in order to provide direct care to patients within each setting or different environments (Masters, 2015). Illness prevention and the promotion of public health initiatives are also vital roles in nursing care (Joel, 2017). However, political and societal issues place strain on the nursing workforce, hindering their ability to adhere to their roles which can negatively impact on the provision of high quality care (Ryan, 2018). For instance, with the introduction of an English test by the Nursing and Midwifery Council following Brexit, the number of EU nurses has reduced by 89% (Tapper, 2017). Furthermore, the government has removed the nursing bursary, which in turn has led to a reduction in the number of nursing students, thus leading to nurse shortages (Adams, 2017). Many nurses have stressed that they find it difficult to carry out their roles and responsibilities as a healthcare professional (Tapper, 2017).

Nurses must act as leaders, coordinating care as members of multidisciplinary care teams, contributing to a collaboration of care (Crowell, 2015). This involves physical and psychosocial assessment, provision of education, support and diagnostic testing to navigate patients through appropriate care pathways (Crowell, 2015). The nurse coordinator is a key resource for patients and families who are an integral point of contact during their care (Weberg et al, 2018). Nurse leaders need to continually contribute to the development of other healthcare professionals, ensuring that they are educated and equipped with evidence-based knowledge in order to provide high quality care (Weberg et al, 2018). Different leadership styles can be utilised to carry out this role, primarily the use of a transformational style. A transformational style encourages and motivates other staff members to improve the provision of care, without dictating information (Marshall, 2016). However, a more transactional leadership style is necessary in time-sensitive, critical situations (Stanley, 2016). These aspects are considered within the role of nurse leaders.

Nurses also act as advocates and educators, ensuring appropriate information is relayed to patients, enabling informed decisions which are fundamental to maintain patients’ autonomy (Scott, 2017). This includes developing therapeutic relationships to support and empower patients (Stein-Parbury, 2017). The nurse must provide holistic care in order to meet unmet needs through professional intervention (Weberg et al, 2018). This is especially important if a patient lacks the capacity to make informed decisions and so the nurse is responsible for adhering to health legislation (McEwen and Wills, 2017). The Mental Capacity Act 2005 provides the framework in order to protect a patient who cannot make an informed decision. Nurses should carry out an assessment in order to evaluate levels of capacity, in an appropriate manner in which the patient can understand. If the patient is found to lack capacity, the least restrictive option should be chosen in order to provide care in their best interests (McEwen and Wills, 2017). Nurses must also be aware that capacity can change at any moment and so succinct clinical judgement is key in order to provide high quality and ethical care (Stanley, 2016).

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Another important role of the nurse is as an educator, to patients, families, society, other healthcare professionals and students (Bastable, 2017). Within a hospital environment, they provide knowledge about illness and teach patients how to self-manage their conditions (Bastable, 2017). Emphasis and facilitation of self-care are vital components of nursing, especially as approximately 15 million individuals within England have one or more long-term condition (RCN, 2018). Furthermore, with the increasing concern of antimicrobial resistance, education and self-care are important, to ensure that antibiotics are taken correctly to uphold the health of society (RCN, 2018). Health education is a necessity and a key responsibility of nurses throughout the world (Bastable, 2017).

Nurses must ensure they collaborate with other professionals within multidisciplinary teams, remaining accountable with sound clinical judgement and excellent communication skills (Joel, 2017). They must appreciate the expertise of other professionals and learn from their experience in order to care holistically for patients (Bogaert and Clarke, 2018). This must include adherence to patient and family- centred care, with enthusiasm to work towards the best patient outcome (Finkelman, 2017). This role is grounded within professional and personal values, expertise, theories and practice that encompass innovative and evidence-based care, whilst complementing other healthcare providers (Joel, 2017). Patient-centred care is beneficial in that is ensures patients are treated with compassion and respect (Finkelman, 2017). Improvements are also witnessed in regards to staff performance and morale when patient-centred care is provided (Stein-Parbury, 2017).

Nurses have the responsibility to remain up-to-date with relevant evidence-based research in addition to adhering to professional standards of practice (Ellis, 2016). These standards are in place to create boundaries and a level of accountability (NMC, 2015). This will incorporate various aspects such as ethics, competence, knowledge, confidentiality, accountability and how evidence can be applied in a practical environment (Avery, 2016). Nurses are held accountable for every aspect of care, with continual documentation under the direction of management (Standing, 2017). Ethical principles are also adhered to, such as a patient’s right to autonomy, non-beneficence, maleficence and justice (Beauchamp and Childress, 2013). However, the individual self-perception of one’s role can differ, influenced by individual background, societal attitude, government policies and trends (Joel, 2017). Within contemporary nursing, role theory can be used to theoretically explain the role of the profession, with Brookes et al. (2007) noting three main perspectives that emerge from evidence-based research. They include; social structuralism, symbolic interactionism and a dramaturgical perspective. Social structuralism argues that a nurses’ role will differ in regards to different structures within society throughout time, whereas symbolic interactionism is in relation to a nurses’ environment. Dramaturgical theory notes a connection between time, place and audience (Brookes et al, 2007). However, quality assurance is expected of all nurses, within standards, legislation and society (Sherwood and Barnsteiner, 2017). These standards ensure that all professionals are providing care with utmost competence and the ability to apply evidence-based research within practice. The nurse has a responsibility to remain up-to-date and educated, as quality assurance standards across many different environments, countries and time are in a continual state of evolution (Brown, 2017).

Upholding confidentiality is an additional responsibility of a nurse, that is mandatory in order to provide high quality patient care (Tingle and Cribb, 2013). Privacy is a key aspect of legislation within the UK and throughout the world, as nurses are expected to maintain confidentiality, in terms of medical records and verbal conversations (Drury, 2017). It is discussed in detail within the Nursing and Midwifery Council Code of Conduct, to uphold dignity and to provide high quality care (NMC, 2015). However, from a critical perspective there are times in which this idealism may be breached, to uphold the health of the patient or society (Blightman and Griffiths, 2013). The legitimate exceptions to confidentiality rights are in relation to disclosures with consent, disclosures required by legislation and those made in society’s best interests (Blightman and Griffiths, 2013). The NHS has historically struggled to uphold patient confidentiality, which led to the Caldicott Report, outlining a succinct process in order to protect and maintain privacy (Peate, 2012). This includes the need to justify disclosure, utilise the minimum amount of information necessary, maintain anonymity when possible, access on a ‘need-to-know’ basis and strict adherence with the law (Herring, 2015). This extends to social media platforms in which patient information should never be disclosed (Blightman and Griffiths, 2013). Confidentiality and disclosure is also influenced by capacity and so nurses have a legal and professional duty of care to consider capacity when consent is expressed (Joel, 2017). This can be challenging if a patient is in severe pain which can impact upon conscious levels and so clinical judgement is a necessity (Griffith and Tengnah, 2017).

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Nurses should also appraise their abilities, in relation to strengths, weaknesses and their preferences during the provision of care (Stanley, 2016). This should involve the process of self-analysis, to recognise one’s abilities in line with the care standard necessary, with realistic expectations to maintain high quality, safe care (Stanley, 2016). Nurses need to be able to recognise early signs and symptoms of illness, to take quick and appropriate action in addition to noting potential problems that could arise (Gulanick and Myers, 2016). This involves a succinct understanding and initiation of assessment, analysis, diagnosis, planning, an intervention and evaluation of the provision of care (Gulanick and Myers, 2016). Furthermore, these stages should be documented in a clear and concise manner, without the use of jargon or abbreviated terms in order to enhance patient-centred care and understanding (Monsen, 2017). During the provision of patient care, nurses are also required to remain self-aware, in order to evaluate personal strengths and an awareness of when to ask for help in line with personal limitations (Monsen, 2017). This upholds patient safety and the provision of high quality care (Stein-Parbury, 2017). Lastly, a nurse must be organised, with the ability to prioritise workloads in order to uphold their role (Monsen, 2017).

To conclude, the roles and responsibilities of a nurse have advanced within different spheres of practice, which will continue to adapt as healthcare within the UK evolves. As discussed, a nurse’s role is influenced by social structuralism, symbolic interactionism and a dramaturgical perspective (Brookes et al, 2007). The role and responsibility of the profession will change in regards to self-perception, influence of society, environment, time place and audience. Legislation also affects the role of a nurse, with ever changing political and legislative focus. However, there are aspects of the role which continue to prevail. For instance, the need to uphold confidentiality, dignity, competency and adhere to professional standards. Ultimately, the main role of a nurse is to provide high quality, safe care to all patients within society, with compassion, humanity, effective leadership and collaboration within multi-disciplinary teams to uphold good standards. This is in line with the Nursing and Midwifery Code of Conduct, which outlines the professional practice necessary to provide high quality care. Self-awareness is also paramount, to note personal strengths and limitations in order to uphold a sense of accountability, safe practice and protection against litigation. If nurses do not uphold the perceived roles and responsibilities of a nurse, they may be subjected to the legal implications which may impact on their ability to practice as a nurse.

Bibliography

• Adams, R. (2017) ‘Nursing Degree Applications Slump after NHS Bursaries Abolished,’ The Guardian, 2nd Feb 2017. Available at: https://www.theguardian.com/education/2017/feb/02/nursing-degree-applications-slump-after-nhs-bursaries-abolished Accessed: 24.02.18
• Avery, G. (2016) Law and Ethics in Nursing and Healthcare: An Introduction, London: Sage.
• Bastable, S. (2017) Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, London: Jones and Bartlett Learning.
• Beauchamp, T, Childress, J. (2013) Principles of Biomedical Ethics, Oxford: Oxford University Press.
• Blightman, K, Griffiths, S. (2013) ‘Patient Confidentiality: When can a Breach be Justified?’ BJA, 2 (1) pp.52-56.
• Bogaert, P. Clarke, S. (2018) The Organisational Context of Nursing Practice: Concepts, Evidence and Interventions for Improvement, London: Springer.
• Brookes, K, Davidson, P, Daly, J, Halcomb, E. (2007) ‘Role Theory: A Framework to Investigate the Community Nurse Role in Contemporary Health Care Systems,’ Contemp Nursing, 25 (1-2) pp.146-155.
• Brown, J. (2017) Evidence-Based Practice for Nurses, Burlington: Jones and Bartlett Learning.
• Crowell, D. (2015) Complexity Leadership: Nursing’s Role in Health-Care Delivery, Philadelphia: Davis Company.
• Drury, P. (2017) Core EU Legislation 2017-2018, London: Palgrave MacMillan.
• Ellis, P. (2016) Evidence-based Practice in Nursing, London: Sage.
• Finkelman, A. (2017) Professional Nursing Concepts: Competencies for Quality Leadership, London: Jones and Bartlett Learning.
• Griffith, R, Tengnah, C. (2017) Law and Professional Issues in Nursing, London: Sage.
• Gulanick, M, Myers, J. (2016) Nursing Care Plans: Diagnoses, Interventions and Outcomes, London: Elsevier.
• Herring, J. (2015) Medical Law, London: Routledge.
• Joel, L. (2017) Advanced Practice Nursing: Essentials for Role Development, Philadelphia: Davis Company.
• Marshall, E. (2016) Transformational Leadership in Nursing, London: Springer.
• Masters, K. (2015) Role Development in Professional Nursing Practice, Burlington: Jones and Bartlett Publishing.
• McEwen, M, Wills, E. (2017) Theoretical Basis for Nursing, London: Lippincott Williams and Wilkins.
• Monsen, K. (2017) Intervention Effectiveness Research: Quality Improvement and Program Evaluation, London: Springer.
• NMC. (2015) The Code, London: NMC.
• Peate, I. (2016) The Essential Guide to Becoming a Staff Nurse, London: Wiley Blackwell.
• Peate, I. (2012) The Student’s Guide to Becoming a Nurse, London: Wiley Blackwell.
• RCN. (2018) Self Care, London: RCN.
• RCN. (2017) Principles of Nursing Practice, London: RCN.
• Royal College of Nursing. (2014) Defining Nursing, London: RCN.
• Ryan, F. (2018) ‘Waiting for an Ambulance, Unable to Breathe, Brings Austerity Home,’ The Guardian, 8th February 2018. Available at: https://www.theguardian.com/commentisfree/2018/feb/08/ambulance-austerity-cuts Accessed: 24.02.18
• Scott, A. (2017) Key Concepts and Issues in Nursing Ethics, London: Springer.
• Sherwood, G, Barsteiner, J. (2017) Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, London: Wiley Blackwell.
• Standing, M. (2017) Clinical Judgement and Decision Making in Nursing, London: Sage.
• Stanley, D. (2016) Clinical Leadership in Nursing and Healthcare: Values into Action, London: Wiley Blackwell.
• Stein-Parbury, J. (2017) Patient and Person: Interpersonal Skills in Nursing, London: Elsevier.
• Tapper, J. (2017) ‘Difficulty of NHS Language Test ‘Worsens Nurse Crisis’, Says Recruiters,’ The Guardian, 24th June 2017. Available at: https://www.theguardian.com/society/2017/jun/24/english-speaking-ovserseas-nurses-fail-nhs-too-tough-language-test Accessed: 24.02.18
• Tingle, J, Cribb, A. (2013) Nursing Law and Ethics, London: Wiley Blackwell.
• Weberg, D, Porter-O’Grady, T, Mangold, K. (2018) Leadership in Nursing Practice, London: Jones and Bartlett Publishing.

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Our Press Coverage

What Is a Registered Nurse?

NurseJournal.org is committed to delivering content that is objective and actionable. To that end, we have built a network of industry professionals across higher education to review our content and ensure we are providing the most helpful information to our readers.

Drawing on their firsthand industry expertise, our Integrity Network members serve as an additional step in our editing process, helping us confirm our content is accurate and up to date. These contributors:

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• What Does an RN Do?
• Where Do RNs Work?
• Why Become an RN
• How to Become an RN
• RN Certifications and Specializations
• How Much Do RNs Make?
• FAQ About Registered Nurses

Are you ready to earn your online nursing degree?

Are you looking for a challenging and rewarding career that allows you to make a difference in the lives of others? Registered nurses (RNs) benefit from a strong employment outlook, abundant job opportunities, and a solid salary range.

This guide explores the steps to becoming a nurse, common RN work settings , and the RN salary outlook . Is this versatile healthcare career right for you? Here are all the details to help you decide.

How Long to Become 2-4 years

Job Outlook, 2022-2032 +6% annually

Average Annual Salary $94,480

Popular Online RN-to-BSN Programs

Learn about start dates, transferring credits, availability of financial aid, and more by contacting the universities below.

What Does a Registered Nurse Do?

RNs work in almost every healthcare environment imaginable, and their duties can vary tremendously from job to job and day to day.

RNs are an integral part of the care team and work closely with every team member to deliver and coordinate patient care and accommodate or advocate for patients when necessary.

RNs provide care to patients by assessing and monitoring their condition, coordinating with physicians during certain medical procedures, including surgery, and administering prescribed treatments. They also perform diagnostic tests, operate medical equipment, and educate patients on follow-up care.

A nurse’s key traits and responsibilities include the following.

Key Responsibilities

• Performing physical examinations and gathering patient health histories before making critical decisions
• Administering medications and performing personalized medical interventions
• Educating and supporting patients by providing health promotion, counseling, and emotional support
• Collaborating with other healthcare professionals on the care team to coordinate patient care
• Advocating for each patient’s health and well-being

Career Traits

• Communication Skills
• Empathy and Compassion
• Critical Thinking and Problem-Solving
• Attention to Detail
• Integrity and Advocacy
• Willingness to Learn

According to the American Nursing Association , nurses must also be even-tempered, flexible, and hard-working. A healthy sense of humor doesn’t hurt, either.

Where Do Registered Nurses Work?

RNs work in virtually every traditional healthcare setting, including hospitals, private physician practices, residential facilities such as nursing homes, and health clinics including urgent care centers. They also work in less traditional settings like schools , government agencies , airplanes , and even cruise ships . If there’s a need for healthcare expertise, there’s a good chance an RN might be nearby.

The most common work settings for RNs include:

In hospitals, RNs often monitor patient health, perform tests, deliver care like dressing wounds or administering treatments, supervise other professionals such as certified nursing assistants (CNAs) , and collaborate with physicians and other healthcare providers. Hospitals are the most common practice setting for RNs. According to the Bureau of Labor Statistics (BLS), about 60% of all RNs in the U.S. worked in a hospital as of 2022.

Outpatient Offices

In outpatient or ambulatory care settings, such as a doctor’s office or clinic, RNs may administer medications and vaccines, communicate with patients in person and over the phone, take medical histories, and educate patients.

Nursing and Residential Care Facilities

In facilities like nursing homes and residential facilities, long-term care RNs take care of patients each day, many of whom have complex or serious health problems. These RNs perform medical tests and monitoring and act as liaisons to families and other care team members.

Home Care Nursing

In addition to working in a healthcare facility, RNs can provide care in patients’ homes as home care nurses , palliative care nurses , wound care nurses , and more. Depending on the patient, these nurses perform assessments, provide day-to-day assistance as well as more complex care, manage medication, educate patients, and much more.

Why Become a Registered Nurse?

According to the results of a 2024 Gallup poll, nursing is the most trusted profession in the United States.

There are other benefits, too. The average RN salary of about $94,000 is well above the BLS national average of $65,470 for all occupations. Salary and professional opportunities can further increase with more advanced education credentials.

For example, nurses whose highest degree is the two-year associate degree in nursing (ADN) earn an average annual salary of $80,707 , according to ZipRecrtuier. Graduates of the four-year bachelor of science in nursing (BSN) degree program earn an average of $90,046 per year. Meanwhile, nurses who complete a graduate-level master of science in nursing (MSN) program earn an average of $172,199 per year.

The demand for RNs continues to grow as the nation’s nursing shortage continues.

However, the nursing profession comes with its challenges. While it’s a rewarding career for millions of people, it is not for everyone. Here is a list of common advantages and disadvantages to being an RN. This list is general and not intended to apply to every workplace.

Advantages of Becoming a Nurse

Disadvantages of becoming a nurse, how to become a registered nurse.

To become an RN, you must complete four broad steps.

• Graduate from an accredited program
• Pass the NCLEX-RN exam
• Receive your nursing license from your state board of nursing
• Get hired as an RN, gain experience, maintain licensure

The minimum educational requirement for RNs is an RN diploma or associate degree in nursing (ADN) . However, more states and employers now require or prefer BSN degrees . Research has shown that BSN-trained nurses help reduce patient mortality, shorten the length of stay in a hospital or similar facility, and lower the rates of readmission back into the hospital.

After graduating from an accredited nursing program , candidates must pass the NCLEX-RN to get a state nursing license.

To qualify for the NCLEX-RN, a candidate must have graduated from an accredited program and meet the requirements for licensure in their state (check with your state board of nursing for more information). Specific application processes and fees usually apply.

Registered Nurse Specializations

RNs can focus their careers in dozens of different ways, specializing in specific patient populations, such as children, or a specific type of patient care, such as heart surgery. After acquiring the necessary experience, RNs may obtain a certification to prove their expertise in a given specialty.

Certifications validate an RN’s knowledge in a given specialty and illustrate their commitment to professional development. Certifications can also increase earning potential.

Here are six common nurse specialties including average annual salary data from Payscale , but please note that there are many more nursing specialties and salary ranges available.

Pediatric Nurse

Pediatric RNs specialize in caring for children at family care physician practices, hospitals, or schools. They also educate families on child health in general and how to address a specific health need.

Average Salary: $69,040

Neonatal Nurse

Neonatal RNs can care for newborn infants in various settings. They may work in hospital maternity units, neonatal intensive care units (NICU), or in the community, helping parents care for their newborns.

Average Salary: $78,182

Critical Care Nurse

Critical care RNs provide care to patients with the most serious conditions or injuries, usually in intensive care units or emergency departments. This specialty requires steadiness under pressure, specialized knowledge, and quick decision-making.

Average Salary: $81,935

Gerontology Nurse

Gerontology RNs work with older patients, often in long-term residential care (nursing homes) or rehabilitation settings. They may care for patients for a long time, which can be both emotionally challenging and rewarding.

Average Salary: $76,053

Oncology Nurse

Oncology RNs specialize in helping cancer patients, generally in hospitals and specialized care facilities. Like gerontology, oncology nursing can be emotionally stressful and rewarding.

Average Salary: $81,987

Emergency Nurse

Emergency nurses care for patients from birth to death and treat every patient demographic and medical condition in the emergency department. This specialty requires steadiness under pressure, broad medical knowledge, hustle, and excellent critical thinking skills.

Average Salary: $77,834

Nursing Certification

A nursing certification is a credential that demonstrates expertise in a specific area of nursing. Nurses earn it through a combination of experience and passing an exam. While it’s not necessary to obtain a certification, it can increase your opportunities and earning potential.

Requirements to take a certification exam typically include an active, unencumbered license in Canada or the U.S., 24 months and at least 2,000 hours of experience in the specialty, and employment in the specialty within the last 24-36 months.

How Much Money Do RNs Make?

According to the BLS, the average annual salary for RNs is $94,480. However, the amount an RN makes is influenced by several factors, including experience level, geographic location , work setting, certifications, and more.

The BLS estimates that RNs in the lowest 10% of the pay range earn an average annual salary of $61,250. Those in the highest 10% of the workforce earn $129,400.

The biggest employers include general medical and surgical hospitals, where nurses earn an annual mean salary of $96,830. Physician’s offices have the lowest pay for RNs, with an annual mean salary of $83,110. Even the lower salary averages, however, still significantly outpace the national average of $65,470.

Location can make a major impact on your salary. Keep in mind, of course, that the cost of living also varies and can greatly affect spending power and earnings. Below is a list of the top-paying states for RNs and the total number of RNs employed there.

Frequently Asked Questions About Registered Nurses

What is the role of the registered nurse.

Registered nurses work just about anywhere healthcare is delivered. They are essential to the healthcare team, whether in the operating room or the family doctor’s office. Nursing specialties vary tremendously, and RNs deliver many types of care to many different patient groups. RNs also use their expertise to become leaders and advocates away from the bedside.

What does it mean to be registered as a nurse?

Becoming an RN is a significant responsibility and privilege. Nurses are the nation’s most trusted profession and are tasked with caring for patients, many of whom are at their most vulnerable. RNs provide expertise, education, advocacy, emotional support, and much more.

How long does it take to become a registered nurse?

It takes about 2-4 years to become an RN, but the length of time varies based on your schedule, education level, and the nursing program you wish to pursue. Associate degrees in nursing programs typically take two years, while bachelor’s programs take about four years. There are, however, a variety of other programs with differing lengths, and different steps you can take to make nursing school shorter or longer .

What is the difference between a nurse and a registered nurse?

The nurse profession includes registered nurses, but other nurses, including non-RNs, are also part of it. This includes licensed practical/vocational nurses (LPN/LVN) and advanced practice registered nurses (APRNs) , with the latter category including nurse practitioners, nurse-midwives, and nurse anesthetists .

Is a registered nurse the highest-paid nurse?

Though RNs can and do earn competitive salaries, the highest-paid nurses are typically APRNs, particularly certified registered nurse anesthetists (CRNAs) , for whom the minimum training requirement is a doctoral degree. According to the Bureau of Labor Statistics, CRNAs had an average annual salary of $214,200 as of 2023.

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How to Write a Nursing Essay Introduction

by ella | Feb 11, 2024 | Medical and Health

Writing an essay starts with making a good introduction. The introduction helps grab the reader’s attention and explains what the essay will be about. In nursing, it’s important to make your introduction clear, interesting, and related to healthcare. This article will guide you on how to write a nursing essay introduction step by step, making it easier to create a good start to your essay. Through simple tips and explanations, you’ll learn how to catch your reader’s interest and prepare them for what you will discuss in your essay. Introductory Paragraph Definition The introductory paragraph is the first part of your essay that readers see. It’s like a door to your essay. When readers go through it, they get to know what topic you’ll be talking about. This paragraph helps catch readers’ attention and gives them a reason to keep reading. It often starts with something interesting, like a surprising fact or a short story. Then, it briefly explains the topic of your essay. Finally, it states your main point or argument, a thesis statement. The introductory paragraph sets the ground for everything else in your essay, making it crucial for getting your readers interested and understanding what to expect as they read on. How Long Should an Introduction Be? When you write an essay, the introduction is the starting point where you tell your readers what the essay is about. Now, how long should this introduction be? A good rule is to make it about 8% to 9% of your essay’s total words. So, if your essay is 1000 words, the introduction would be around 80 to 90 words long. Why this length? Well, it’s long enough to give your readers a clear idea about your topic and get them interested, but not too long that it gets boring or gives away too much information. It’s just the right length to introduce your topic, grab the reader’s attention, and tell them your main argument, the thesis statement, without diving into the main points you’ll discuss in the rest of the essay. What Makes a Good Introduction A good introduction acts like a map that guides your readers into the main part of your essay. Here’s what makes an introduction good:

Catches Attention: A good introduction starts with something interesting to catch your reader’s attention, like a surprising fact, a question, or a short story.

Introduces the Topic: It tells your readers what the essay is about clearly and simply.

Has a Thesis Statement: A good introduction includes a thesis statement and a clear and strong point or argument you will make in your essay. It tells the reader what to expect as they read on.

Not Too Long or Short: It should be just the right essay length, not too long to lose interest, and not too short to miss important information.

Engaging: It should make your readers want to read more. It’s like inviting them into your essay, making them curious about what comes next.

Clear and to the Point: It should be clear, straightforward, and concise so readers can easily understand what the essay will discuss.

Previews What’s Coming: A good introduction previews what topics or points will be covered in the essay without giving away too much.

What Are the 3 Parts of an Introduction Paragraph? The introduction paragraph is important as it helps the reader understand what your essay will be about. It’s made up of three main parts: Part 1: Essay Hook The essay hook in the introduction of a nursing essay acts as a catalyst to ignite the reader’s curiosity and ensure they continue reading. In nursing, this initial hook carries a particular significance as it provides a window into a field that is as emotionally charged as it is technical.  For instance, in a nursing essay focused on patient care, the hook might take the form of a compelling narrative of a nurse’s experience on a hectic night shift. The activities in a ward, the emotions of patients and their families, and amidst it all, the steadfast presence of a nurse could be the scene set as the hook. This imagery captures the essence of nursing and resonates with the reader, drawing them into the narrative. Similarly, if the essay is geared towards exploring the evolving role of nurses in modern healthcare, the hook could present a stark statistic highlighting the growing responsibilities shouldered by nurses. Through the hook, the readers are not merely observers but become emotionally invested, making the subsequent exploration of the nursing profession deeply engaging and insightful. The 5 Types of Hooks for Writing Here are some simple ways to create a hook in your essay:

A Common Misconception: This is about sharing many people’s false beliefs or misunderstandings and correcting them. Example: “Many believe that nurses only follow doctors’ orders, but they make crucial decisions that impact patient care daily.”

Statistics: Sharing a surprising or interesting number or data related to your topic. Example: “Research shows that nurses spend up to 60% of their time on paperwork, taking them away from patient care.”

Personal Story: Telling a brief story from real life or your own experience that connects to your essay topic. Example: “My sister’s caring nature as a nurse brought comfort to fearful patients, making me realize the emotional impact nurses have.”

Scenes: Painting a picture with words about a certain scene or situation related to your topic. Example: “Imagine a busy hospital ward, nurses swiftly moving from one patient to another, showcasing their ability to multitask and provide personalized care.”

Thesis Statement: Stating the main point or argument of your essay in a clear and precise way. Example: “This essay will delve into the indispensable role of nurses in improving the patient experience and healthcare outcomes.”

Part 2: Connections “Connections” in an introduction represent the bridge between the initial hook and the main topic or thesis of the essay. This section further draws the reader into the central theme by establishing context, relevance, and the importance of the subject. It ensures the reader isn’t left hanging after the hook, making the transition smoother. In nursing essays, connections might explore why a particular misconception, statistic, or story (from the hook) is significant to the broader world of nursing or healthcare. For example, suppose the hook was a statistic about the number of hours nurses spend with patients. In that case, the connection might discuss the significance of nurse-patient interactions, how they are at the heart of patient care, or how they can significantly influence a patient’s recovery and overall hospital experience. In essence, the “connections” part links the specific instance or fact from the hook to the broader implications or themes you’re about to explore in your essay, ensuring the reader understands why what they’re about to read matters. Part 3: The Thesis Statement The thesis statement is the most important part of an introduction paragraph. It is usually the last sentence of the introduction. The thesis statement clearly states the main idea or argument of the entire essay in one concise sentence. It answers the prompt or question asked in the assignment.  The thesis sets up the entire essay by establishing the focus and purpose of the writing. A good thesis statement is clear, focused, take a stand or position, and can be supported by evidence. The rest of the essay will provide details, facts, arguments, and evidence that support the thesis statement.  The thesis gives the essay direction and focus. The thesis statement must be narrow enough to fully cover the essay but broad enough for analysis and discussion. The reader should finish the introduction paragraph understanding exactly what the essay will be about based on the thesis statement. Steps to Write an Essay Introduction Here are the steps to write an effective nursing essay introduction: Step 1. Engage Your Reader The opening sentence or “hook” of an introduction paragraph grabs the reader’s attention. A strong hook makes the reader interested and want to keep reading. Here are some tips for engaging the reader right from the start:

Ask a thought-provoking question

Use an interesting, shocking, or intriguing statistic

Open with a relevant quotation, anecdote, fact, news story, vivid description, or definition

Create a conversation, scenario, or narrative to draw the reader in

Use humor, irony, or an unusual perspective to surprise the reader

The goal is to create curiosity, emotion, and connection immediately so the reader feels invested. An engaging hook gives a reason to care about the topic and hooks the reader into wanting to read more. After an attention-grabbing beginning sentence, the introduction can provide context and background to transition smoothly into the essay’s main argument. But a strong, thoughtful hook comes first to capture interest and attention. Step 2. Give Background Information After grabbing the reader’s attention with an opening hook, the next step is to give some context and background information about the essay’s topic. The background should be brief but informative, helping the reader understand the topic and its significance.  The background information should be connected to and help frame the essay’s main argument. It allows the writer to define key terms, frame the scope, provide historical context, or share social/political background before transitioning to the essay’s thesis.  The goal is to orient the reader without overloading them with too many details at the start. A few concise but meaningful sentences of background can set the stage before delivering the essay’s central argument in the thesis statement. Step 3. Expose Your Thesis Statement The thesis statement is the most integral part of an introduction. It comes at the end of the intro paragraph and establishes the essay’s central argument or main point. The thesis directly responds to the prompt or question posed in the assignment. It lays out the essay’s key position and focus in one concise, declarative statement. All the background information should lead up to and frame this thesis. This thesis takes a clear stand while summarizing the main argument. The rest of the essay will provide evidence and analysis to support and develop this position. The thesis statement gives the reader insight into the essay’s purpose and direction. It must be argumentative, focused, and thoughtful – a signpost for the essay’s content. With an engaging hook, informative background, and clear thesis statement, an introduction orients readers and sets an essay up for success. Step 4. Draft Your Essay Structure After writing a solid thesis statement, the next step is to map out the main points supporting and developing that central argument throughout the essay. Planning the basic structure gives the writer a logical progression and flow for the essay’s body paragraphs. For example, each body paragraph could contain a major reason why the thesis is true. Drafting a basic outline ensures the essay will thoroughly explain the thesis. The structure provides organization and direction. While the outline may change as the essay develops, having a planned structure guides the writer. The introduction doesn’t need to preview the full outline, but the thesis should directly lead to the topics of the body paragraphs. This continuity reinforces the central argument and establishes the logical support and analysis to validate the essay’s claim. Step 5. Revise After drafting the introduction paragraph, including an opening hook, background information, thesis statement, and outline, the next step is to revise. Revising allows the writer to strengthen and refine the introduction. Here are tips for revising an essay introduction:

Make sure the hook immediately draws in the reader.

Check that background info is brief but informative. Cut unimportant details.

Read the thesis statement carefully. Is it clear, focused, arguable, and well-written?

Ensure the thesis directly answers the prompt or assignment question.

Review that the essay outline logically flows from the thesis.

Check for varied sentence structure and smooth transitions between sentences.

Ensure the introduction is written in the student’s original, unique voice.

Ask – does this intro give the reader essential context and clearly state the essay’s central argument?

Revising the introduction allows the writer to catch any underdeveloped, awkward, or unclear areas. Refining the intro before writing the full essay ensures the foundation is established to convince readers of the thesis logically. Catchy Introductions for Different Essay Types Here are some examples of writing catchy introductions tailored to different essay types: Narrative Introduction The lights were bright and the room was freezing. I could hear the muffled cries of the two-day-old infant in the incubator beside me as I carefully calculated the dosage. This was my first time administering medication on the job as a nursing student in the NICU. I knew neonatal nursing would be challenging, but I realized in that moment it would also reshape my perspective.

The fragility of life was tangible, yet amidst wires and monitors, there was hope. This experience taught me that something as small as an injection has the power to heal and comfort. My nursing journey began with that first nervous med pass late one night in the NICU, starting me on a path I could not yet fully envision. This introduction establishes the narrative scene while hinting at the insights explored in the essay. The hook places the reader in the story while introducing the reflective tone and theme. The background about starting nursing school and working in the intensive care unit provides context. The thesis hints at a transformative experience that led to a new understanding, setting up the reflective narrative about this memory’s significance. The introduction draws readers into the moment while establishing the personal growth narrative to come. Analytical Introduction The current nursing shortage in the United States has reached critical levels, with the deficit of registered nurses projected to exceed 500,000 by 2025. This shortage impacts healthcare facilities nationwide, diminishing the quality of care and patient outcomes. While an aging workforce and increased healthcare demands contribute to the problem, the root causes are unsatisfactory working environments, leading to high turnover rates.

Inadequate staffing ratios, lack of leadership support, workplace violence, and burnout exacerbate nurse shortages. However, developing effective retention strategies to improve modifiable workplace factors could help healthcare organizations recruit and retain qualified nurses. Targeted interventions to empower nurses and cultivate supportive, collaborative environments will be essential to overcoming the nursing shortage crisis. This introduction establishes the nursing shortage problem and notes some surface-level contributing factors. The thesis then points to underlying workplace environment issues as the root causes. This analytical stance sets the essay to examine these modifiable factors and the solutions they highlight rather than just describing the problem. The introduction primes readers for an analytical discussion on empowering nursing workplace improvements. Persuasive Introduction The COVID-19 pandemic has revealed cracks in the foundation of the United States healthcare system. Addressing the longstanding nurse staffing crisis has become urgent as nurses comprise the largest segment of the health workforce. For decades, research has shown inadequate nurse staffing increases patient and nurse risks. However, hospitals and legislators have delayed mandating minimum nurse-to-patient ratios. With recent data revealing up to 20% of nurses plan to leave their positions, safe staffing levels are imperative.

Implementing minimum staffing ratios in every unit, improving work environments, and increasing wages can retain experienced nurses, attract new nurses, and ensure safe patient care. Now is the time to persuade lawmakers and healthcare administrators to enact evidence-based nurse staffing ratio legislation. Doing so will strengthen nursing, prevent future gaps in care, and ultimately save lives. This introduction uses the COVID-19 pandemic context to establish the urgent need for minimum staffing ratios. It references past research and alarming turnover data to highlight the significance of the problem. This leads to the thesis advocating minimum ratio legislation to improve staffing conditions and nurse retention. The intro generates urgency while summarizing the persuasive argument to come – that evidence shows implementing specific nurse staffing reforms will strengthen healthcare. Personal Introduction I remember the sterile smell of the hospital hallway as I walked into my patient’s room for the first time. As a nursing student, I had prepared extensively for this initial clinical rotation. I had memorized lab values, medications, and procedures. Yet textbook knowledge could not prepare me for the wave of nerves I felt seeing my patient lying in the stark, white hospital bed. She looked weary and frail. This was no rubber dummy I had practiced on. This was a living, breathing human who needed my care.

My textbook training came second to forging a true human connection at that moment. Sitting beside her, I listened as she shared her story, goals, and worries. The beeping monitors faded, and I saw her as so much more than a diagnosis. My first clinical rotation taught me that treating patients extends beyond treating their illnesses. In nursing, empathy and compassion for humanity manifest as acts of care. This personal nursing essay introduction draws readers into a poignant clinical scene. It sets up the student’s transition from textbook knowledge to human understanding. The vivid details and reflections establish the introspective tone and theme focused on compassion in nursing care. Tips for Writing a Winning Introduction Paragraph Here are some tips for writing an effective introduction paragraph that grabs attention and sets the stage for the essay:

Start with a strong, thought-provoking hook. Open with an interesting fact, statistic, question, an essay quote, anecdote, vivid description, etc.

Provide brief but valuable context and background on the topic. Define key terms and give relevant historical or social framing.

Build a smooth transition from the background to the specific focus of the essay. Use transitional phrases like “In light of this…”

State the thesis clearly and directly. Present the central argument or position in a concise, one-sentence statement.

Ensure the thesis responds to the prompt and launches the essay’s body.

Structure the introduction logically, moving from a broad to an increasingly narrow focus.

Engage the reader’s interest while also communicating the essay’s purpose.

Revise thoroughly to refine language, improve flow, and bolster impact.

An effective introduction grabs attention, provides a framework, presents a compelling thesis, and primes readers for future discussion. Crafting a thoughtful, polished introduction can get any essay off to a winning start. Final Thoughts The introduction of your nursing essay is your chance to grab the reader’s attention, provide insight into your chosen topic, and set the stage for the following discussion. It’s crucial to nail this part to make a compelling first impression. However, it’s a common struggle for many nursing students to pen down an engaging introduction amidst demanding academic and practical schedules. Struggling to Start Your Nursing Essay? Kickstart your nursing essay with an introduction that resonates. Click Here to Secure a Strong Start with Our Expert Assistance! Let us pave the way for your academic achievements.

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Roles of a Nurse

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Introduction Patient care Patient advocacy Planning of care Patient education and support Nursing in the COVID-19 pandemic Future outlook for nursing References  Further reading 

Introduction

Nurses serve their communities in many ways and have essential roles in healthcare. Nurses promote healthy lifestyles, advocate for patients, provide health education, and directly care for many patients. The exact functions of nurses have changed somewhat over the years; however, their importance in healthcare remains evident.

Since the advent of modern medicine, nurses' role has shifted from being comforters to modern healthcare professionals who provide evidence-based treatment and wellness education. Nurses have a multifaceted role as holistic caregivers, patient advocates, specialists, and researchers.

Patient care

The primary role of a nurse is to be a caregiver for patients by managing physical needs, preventing illness, and treating health conditions. To do this, nurses must observe and monitor the patient and record any relevant information to aid in treatment decision-making processes.

Nurses care for injuries, administer medications, conduct frequent medical examinations, record detailed medical histories, monitor heart rate and blood pressure, perform diagnostic tests, operate medical equipment, draw blood, and admit/discharge patients according to physician orders. Nurses also ensure patients' comfort, change bandages, report any changes in a patient's condition to other nurses or doctors, document patient activities, and assume other relevant tasks.

Nurses must often pay close attention to every detail of the patient's treatment and how they respond. If a problem is identified, nurses will often be the first to notice; thus, they must be able to quickly report a problem, particularly in the event of an emergency, to a physician.

Throughout the treatment process, the nurse follows the progress of the patient and acts accordingly with the patient's best interests in mind. The care provided by a nurse extends beyond the administration of medications and other therapies. Nurses are often responsible for the holistic care of patients, which may encompass the individual's psychosocial, cultural, and spiritual needs.

Patient advocacy

In addition to their role as a clinician, nurses often provide emotional support for their patients and families. This can include ensuring that the patient understands and is prepared for their treatment, listening to patients and assessing their physical, emotional, cultural, mental, and spiritual needs.

Nurses often help patients and their loved ones process their feelings and frustrations towards their illnesses. Through counseling and patient education, nurses may also be of assistance in explaining treatment options to patients and their family members, as well as advocating for the health and well-being of their patients.

A nurse often serves as a patient advocate in protecting a patient's medical, legal, and human rights. Since many sick patients may be unable to comprehend medical situations and act accordingly, it is often the nurse's role to support the patient.

This may involve representing the patient's best interests, especially when treatment decisions are being made. Furthermore, nurses will often inform and support patients when they have questions or are apprehensive about treatments, procedures, or any other aspect of their care. Nurses may also make suggestions for patients' treatment plans in collaboration with the patient, their families, and other health professionals.

Planning of care

A nurse is directly involved in the decision-making process of treating patients. Thus, it is essential that nurses think critically when assessing patient signs and identify potential problems to make the appropriate recommendations.

Although clinicians like physicians, physician associates, and nurse practitioners typically make final treatment decisions, nurses also have a crucial role in patient treatment plans. This is because nurses are typically most familiar with the individual patient, as they monitor their signs and symptoms on an ongoing basis. Thus, nurses should collaborate with other medical team members to promote optimal patient health outcomes.

Patient education and support

Nurses are also responsible for ensuring that patients can understand their health, illnesses, medications, and treatments to the best of their ability. This is particularly important when patients are discharged from the hospital and are responsible for continuing their treatments at home.

A nurse should take the time to explain to the patient and their family or caregiver what to do and expect when they leave the hospital or medical clinic. Nurses should also ensure that the patient feels supported and knows where to seek additional information if needed.

In every aspect of healthcare, nurses provide education, promote healthy practices, share their expertise, and help patients heal. By guiding patients and their families, nurses can also provide patients with appropriate referrals for other services, resources, and classes.

In addition to when patients leave the hospital, nurses also educate patients about their care plan daily. This is essential for the success of the treatment, as patients must be prepared for all steps of their treatment and recovery. Nurses are also responsible for training and helping other nurses.

Nursing in the COVID-19 pandemic

Throughout the coronavirus disease 2019 (COVID-19) pandemic, nurses have remained at the front line of hospital patient care. In addition to their everyday responsibilities, nurses have also acquired various additional roles to mitigate the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19.

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For example, during the numerous waves of COVID-19, wherein community transmission rose, and hospitalization rates subsequently increased, nurses were often responsible for assisting in the planning of how these outbreaks would be managed at the patient level. This often involved maintaining the supplies and appropriate usage of sanitation materials and personal protective equipment (PPE), as well as offering patients screening information, quarantine guidelines, and triage protocols based on the most recent guidance.

Since nurses often have immediate contact with potentially infectious COVID-19 patients, they have frequently been at risk of infection throughout the pandemic. Thus, nurses must abide by specific infection prevention measures to protect not only themselves against infection, but also their families, co-workers, and other patients. Some of the PPE limiting the spread of SARS-CoV-2 to nurses caring for COVID-19 patients include ventilators, masks, robes, goggles, face shields, and gloves.

Due to the spread of misinformation that has become increasingly prevalent throughout the COVID-19 pandemic, nurses have also been considered distinguished healthcare workers capable of discrediting myths and other conspiracies. Thus, nurses have also increased public awareness of effective disease prevention methods, guided others to available healthcare services, provided evidence-based patient care, and practiced important infection-reducing measures.

The increased demand for healthcare services throughout the pandemic led many clinicians to transition their services to virtual visits. Thus, nurses must now possess a wide range of technical skills that allow them to provide patient care through these different avenues. Nurses should also have the communication skills that will enable them to assess and support their patients through various media sources.

As patient advocates, nurses must also be aware of the potential risk that certain patient groups, particularly those of older age or lower income, may not be comfortable with technology-mediated healthcare services. Thus, in these situations, nurses should continue to ensure that patient-centered care is achieved by adapting the treatment approach to accommodate each patient's specific needs, abilities, and characteristics.

Future outlook for nursing

The demand for qualified nurses is growing in many regions worldwide, particularly in light of nursing shortages that increased throughout the COVID-19 pandemic. Due to the increasingly complex role of nurses following the pandemic, allocating specific roles, such as medication administration and patient education, to specific nurses may reduce burnout among current nurses while also allowing nurses to focus their efforts on specific aspects of patient care that they are most suited for.

In addition to a growing aging population, the demand for nurses will also increase due to the increasing number of patients who have contracted COVID-19 and now experience long COVID, as well as patients who will still contract COVID-19 and require hospitalization. Furthermore, it remains unclear how delayed care throughout the COVID-19 pandemic will affect inpatient hospitalizations in the future, as well as outpatient procedures.  

It should be noted that COVID-19 has taken the lives of over 6.4 million individuals throughout the world to date, with millions of individuals who have recovered from the disease, despite experiencing severe effects. Thus, it is inevitable that nurses, as well as many other healthcare professionals, have experienced a wide range of psychological and physical effects from their experience in caring for patients during this global health emergency.

As a result, it is vital that hospitals and clinics offer comprehensive support for the existing nurse workforce to retain current nurses, as well as encourage others to pursue this profession. Several different initiatives have been proposed to reduce the burden on nurses through digital, clinician, regulatory, and labor union collaborations.

• What Do Nurses Do? [Online]. Available from: https://www.gmercyu.edu/academics/learn/what-do-nurses-do#whatisnursing .
• Fawaz, M., Anshasi, H., & Samaha, A. (2020). Nurses at the Front Line of COVID-19: Roles, Responsibilities, Risks, and Rights. The American Journal of Tropical Medicine and Hygiene 103 (4); 1341-13342. doi:10.4269/ajtmh.20.0650.
• Barrett, D., & Heale, R. (2021). COVID-19: reflections on its impact on nursing. Evidence-Based Nursing. doi:10.1136/ebnurs-2021-103464.
• Assessing the lingering impact of COVID-19 on the nursing workforce. [Online]. Available from: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce .
• The Role of a Professional Nurse Today [Online]. Available from: https://degree.astate.edu/articles/nursing/role-of-professional-nurse-today.aspx .
• 5 Important Roles for License Practicla Nurses [Online]. Available from: https://penncommercial.edu/5-important-roles-licensed-practical-nurses/ .
• What is the Role of Nurses in the Community? [Online]. Available from: https://penncommercial.edu/5-important-roles-licensed-practical-nurses/ .

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Last Updated: Sep 4, 2022

Pooja Toshniwal Paharia

Pooja Toshniwal Paharia is an oral and maxillofacial physician and radiologist based in Pune, India. Her academic background is in Oral Medicine and Radiology. She has extensive experience in research and evidence-based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

Please use one of the following formats to cite this article in your essay, paper or report:

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Why I Want To Be A Nurse Essay

Applying for nursing school is an exciting step towards a rewarding career helping others. The nursing school essay, also known as a personal statement, is a critical part of the application. This is your chance to showcase your passion for the nursing profession and explain why you want to become a nurse.

This guide will show you exactly what admission committees are looking for in a strong nursing school application essay. Let’s walk through how to plan, write, and polish your “why I want to be a nurse” personal statement so it stands out from the competition.

What To Include In Your Nursing Essay

Writing a compelling nursing school essay requires advanced planning and preparation. Follow these tips to create an effective personal statement:

Plan Your Nurse Essay

The first step is to carefully conceptualize your nursing school admissions essay. Jot down some notes answering these key questions:

• Why do you want to go into nursing?
• What personal experiences or traits draw you to the field of nursing?
• How have you demonstrated commitment to caring for others?
• What are your academic and professional qualifications for nursing?

From here, you can start mapping out a logical flow of key points to cover in your nursing school application essay.

Show an Emotional Connection to the Profession

Admission committees want to see that you have genuine passion and empathy for the nursing career choice. Dedicate part of your personal statement to describing your intrinsic motivations and positive impacts for desiring to become a nurse.

Avoid cliché reasons like “I want to help people.” Instead, get specific by sharing a personal anecdote that emotionally moved you towards nursing.

Here’s an example of how you could open your nursing school entrance essay by highlighting a meaningful patient-care interaction:

“Holding Mrs. Wilson’s trembling hand, I watched her fearful eyes relax as I reassured her that the medical team would take excellent care of her. At that moment, providing empathetic comfort to calm her nerves despite the clinical chaos around us, I knew deep down that nursing was my calling.”

This introduction immediately establishes an emotional pull towards the human side of healthcare. From here, explain how this or similar experiences instilled a drive in you to become a nurse.

Show That You Care

Much of nursing is providing compassionate, person-centered care. Therefore, your “why I want to be a nurse” essay should emphasize your ability to be caring, empathetic, patient, and comforting to others.

Share examples that showcase your natural inclination for caregiving:

“Volunteering at the Red Cross shelter after the wildfires by comforting displaced families demonstrated my patience and attentiveness to those suffering. Even as some evacuees grew frustrated by the chaos, I calmly reassured them that we would do everything possible to assist with their recoveries and ensure they felt cared for.”

This example highlights key soft skills needed in nursing as a career, like compassion, active listening, the desire to help, and providing a calming presence under pressure.

Share Your Aspirations

A strong application essay will also articulate your goals and vision for contributing to the nursing field. What are you hoping to achieve through a career in nursing?

Here is an example of discussing aspirations in a nursing school personal statement:

“My long-term aspiration is to become a nurse leader by earning an advanced degree and management experience. I aim to leverage my organizational, communication and critical thinking skills to mentor junior staff, improve operational workflows, and advocate for policies that enhance quality of care. In nursing, I’ve found my true calling – to provide critical care, and help others by being a source of compassion and driving excellence in healthcare delivery.”

This type of self-motivated, forward-looking vision demonstrates maturity, strong goals, and natural leadership qualities.

Describe Your Nursing Skills and Qualifications

Finally, your nursing school entrance essay should summarize the skills; profession offers, and experience that makes you an excellent candidate for the nursing program. Highlight relevant strengths like:

• Academic achievements (science/healthcare courses, GPA, etc.)
• Extracurricular activities (volunteering, internships, etc.)
• Relevant work experience (patient care roles like CNA, medical assistant, etc.)
• Other transferable skills (communication, leadership, teamwork, critical thinking, etc.)

For example:

“My passion for science, healthcare experience as a CNA, and volunteering at a community health fair have prepared me to thrive in the intellectually stimulating and collaborative nursing curriculum. I bring dedication, attention to detail, and a strong work ethic as demonstrated by my 3.8 GPA studying Biology at the University of Michigan.”

With application essays, it’s all about showcasing why you would make an outstanding addition to the nursing program, making a difference through your qualifications and intangible traits.

How Do You Write an Introduction to a Nurse Essay?

Now that you’ve brainstormed content ideas, it’s time to turn them into a polished personal statement. Here are some tips for crafting an attention-grabbing introduction to your nursing school essay:

Hook the Reader with a Personal Story

One of the most engaging ways to start writing your essay is by recounting a brief personal story that illuminates your drive to become a nurse. This can immediately immerse the reader in your intrinsic motivations.

For example , you could open with an anecdote describing a meaningful instance of care and comfort you provided to someone in need:

“Tears streamed down Mrs. Hernandez’s face as she told me about losing her husband to cancer last year. As a hospice volunteer, I held her hand, listening intently to her painful story of grief and loss…”

This type of vivid introduction pulls the reader into the narrative straight away. From here, you can continue sharing details about the scenario and its influence on your desire to pursue nursing.

Illustrate the Human Impact of Nursing

Another compelling way to begin your nursing personal statement is by painting a picture of nursing’s profound impact on patients and their families. This highlights your understanding of the profession’s vital role.

For instance:

“Looking a trembling new mother in the eyes as she first held her newborn, relieved knowing both were safe and healthy after a complicated delivery – that is the human difference nurses make each and every day.”

This type of introduction emphasizes nursing’s profound emotional impact on patients during vulnerable yet joyful moments. It activates the reader’s empathy by bringing them into the vivid scene while showing your own insight into the medical field.

Articulate Passion for Helping Others

Finally, you can start your nursing application essay by asserting your resounding passion for caring for others. This clear expression allows you to succinctly introduce central values like empathy and compassion.

“Ever since I was a young volunteer candy striper in my local hospital, I’ve held an unwavering passion for helping those suffering through the profound act of nursing. I was born to care for others.”

This authoritative opening clearly states your emotional connection to nursing in a compelling yet concise way. You can then build on this assertion of passion through personal examples and further explanation.

No matter how you start your nursing school essay, the introduction should vividly showcase your motivation and why you chose nursing. Set the tone early with your authorship and emotion.

Why I Want To Be A Nurse Essay Examples 

Now let’s analyze some complete sample nursing personal statements for inspiration on crafting your own:

Why I Want to Be a Nurse at a Hospital: Essay

Essay on why i want to be a nurse assistant, 1000-word essay on why i want to be a nurse, essay on why i want to be a nurse, why i want to be a nurse: argumentative essay, mental health nursing personal statement, why i want to be a pediatrics nurse, why i want to be a nurse practitioner essay, writing a why i want to become a nurse essay.

To craft a standout nursing school application essay, prospective students should engage the reader with an emotional opening that illuminates their calling to the profession, whether through a compelling personal anecdote or vivid imagery expressing the profound impact of nursing. 

The conclusion should be resolved by painting an inspiring vision of how the writer’s skills, values, and determination will be channeled into excellence as a nursing student and future registered nurse, making an empathetic difference in patients’ lives.

With focused, mature writing that radiates passion and preparedness, a “why I want to become a registered nurse” personal statement can stand out amidst the competition as a window into a promising applicant’s commitment to this vital healthcare profession.

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

Chapter: 5 the role of nurses in improving health equity, 5 the role of nurses in improving health equity.

Being a nurse … in 2020 must mean being aware of social injustices and the systemic racism that exist in much of nursing … and having a personal and professional responsibility to challenge and help end them.

—Calvin Moorley, RN, and colleagues, “Dismantling Structural Racism: Nursing Must Not Be Caught on the Wrong Side of History”

When this study was envisioned in 2019, it was clear that the future of nursing would look different by 2030; however, no one could predict how rapidly and dramatically circumstances would shift before the end of 2020. Over the coming decade, the nursing profession will continue to be shaped by the pressing health, social, and ethical challenges facing the nation today. Having illuminated many

of the health and social inequities affecting communities across the nation, the COVID-19 pandemic, along with other health crises, such as the opioid epidemic ( Abellanoza et al., 2018 ), presents an opportunity to take a critical look at the nursing profession, and society at large, and work collaboratively to enable all individuals to have a fair and just opportunity for health and well-being, reflecting the concept of “social mission” described by Mullan (2017, p. 122) as “making health not only better but fairer.” This chapter examines health equity and the role of nursing in its advancement in the United States.

As stated previously, health equity is defined as “the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance” ( NASEM, 2017a , p. 32). While access to equitable health care, discussed in Chapter 4 , is an important part of achieving health equity, it is not sufficient. Health is affected by a wide range of other factors, including housing, transportation, nutrition, physical activity, education, income, laws and policies, and discrimination. Chapter 2 presents the Social Determinants of Health and Social Needs Model of Castrucci and Auerbach (2019) , in which upstream factors represent the social determinants of health (SDOH) that affect individuals and communities in a broad and, today, inequitable way. Low educational status and opportunity, income disparities, discrimination, and social marginalization are examples of upstream factors that impede good health outcomes. Midstream factors comprise social needs, or the individual factors that may affect a person’s health, such as homelessness, food insecurity, and trauma. Finally, downstream factors include disease treatment and chronic disease management.

Much of the focus on the education and training of nurses and the public perception of their role is on the treatment and management of disease. This chapter shifts that focus to nurses’ role in addressing SDOH and social needs, including their potential future roles and responsibilities in this regard, and describes existing exemplars. First, the chapter provides a brief overview of nurses’ role in addressing health equity. Next, it describes opportunities for nurses to improve health equity through four approaches: addressing social needs in clinical settings, addressing social needs and SDOH in the community, working across disciplines and sectors to meet multiple needs, and advocating for policy change. The chapter then details the opportunities and barriers associated with each of these approaches.

NURSES’ ROLE IN ADDRESSING HEALTH EQUITY

As described in Chapter 1 , the history of nursing is grounded in social justice and community health advocacy ( Donley and Flaherty, 2002 ; Pittman, 2019 ; Rafferty, 2015 ; Tyson et al., 2018 ), and as noted in Chapter 2 , the Code of Ethics for Nurses with Interpretive Statements, reiterated by American Nurses Association (ANA) President Ernest J. Grant in a public statement, “obligates nurses to be allies and to advocate and speak up against racism, discrimination, and injustice” ( ANA, 2020 ).

Addressing social needs across the health system can improve health equity from the individual to the system level. The report Integrating Social Care into the Delivery of Health Care identifies activities in five complementary areas that can facilitate the integration of social care into health care: adjustment, assistance, alignment, advocacy, and awareness ( NASEM, 2019 ) (see Figure 5-1 and Table 5-1 ). In

TABLE 5-1 Definitions of Areas of Activities That Strengthen Integration of Social Care into Health Care

SOURCE: NASEM, 2019 .

the area of awareness, for example, clinical nurses in a hospital setting can identify the fall risks their patients might face upon discharge and the assets they can incorporate into their lives to improve their health. In the area of adjustment, telehealth and/or home health and home visiting nurses can alter clinical care to reduce the risk of falls by, for example, helping patients to adjust risks in their homes and learn to navigate their environment. And these activities can continue to the high level of system change through advocacy for health policies aimed at altering community infrastructure to help prevent falls.

In short, improving population health entails challenging and changing the factors and institutions that give rise to health inequity through interventions and reforms that influence the institutions, social systems, and public policies that drive health ( Lantz, 2019 ). It is important to note, however, that there are shortcomings in how evaluations of health equity interventions are carried out (see Box 5-1 ).

ADDRESSING SOCIAL NEEDS IN CLINICAL SETTINGS

Although the provision of clinical care is a downstream determinant of health, the clinical setting presents an opportunity for nurses to address midstream determinants, or social needs, as well. Screening for social needs and making referrals to social services is becoming more commonplace in clinical settings as part of efforts to provide holistic care ( Gottlieb et al., 2016 ; Makelarski et al., 2017 ; Thomas-Henkel and Schulman, 2017 ). Nurses may conduct screenings; review their results; create care plans based on social needs as indicated by those results; refer patients to appropriate professionals and social services; and coordinate care by interfacing with social workers, community health workers, and social services providers. Although the importance of screening people for social needs has led more providers to take on this role, it has yet to become a universal practice ( CMS, 2020 ; NASEM, 2016 ), as most physician practices and hospitals do not perform screenings for the five key domains of social need 1 : food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence ( CMS, 2020 ; Fraze et al., 2019 ). As trusted professionals that spend significant time with patients and families, nurses are well equipped to conduct these screenings ( AHA, 2019 ). Federally qualified health centers (FQHCs)—community-based health centers that receive funds from the Health Resources and Services Administration’s (HRSA’s) Health Center Program—often screen for social needs.

In many clinical settings, however, challenges arise with screening for social needs. Individuals may be hesitant to provide information about such issues as housing or food insecurity, and technology is required to collect social needs data and once obtained, to share these data across settings and incorporate them into

___________________

1 These five domains of social needs are part of the Centers for Medicare & Medicaid Services’ Accountable Health Communities Model ( Fraze et al., 2019 ).

nursing practice in a meaningful way. While nurses have an educational foundation for building the skills needed to expand their role from assessing health issues to conducting assessments and incorporating findings related to social needs into care plans, this focus needs to be supported by policies where nurses are employed. As the incorporation of social needs into clinical consideration expands, nurses’ education and training will need to ensure knowledge of the impact of social needs and SDOH on individual and population health (see Chapter 7 ). Communicating appropriately with people about social needs can be difficult, and training is required to ensure that people feel comfortable responding to personal questions related to such issues as housing instability, domestic violence, and financial insecurity ( Thomas-Henkel and Schulman, 2017 ). Finally, the utility of social needs screening depends on networks of agencies that offer services and resources in the community. Without the ability to connect with relevant services, screenings and care plans can have little impact. Consequently, it is important for health care organizations to dedicate resources to ensuring that people are connected to appropriate resources, and to follow up by tracking those connections and offering other options as needed ( Thomas-Henkel and Schulman, 2017 ).

ADDRESSING SOCIAL NEEDS AND SOCIAL DETERMINANTS OF HEALTH IN THE COMMUNITY

While interest in and action to address social needs in the clinical setting is rapidly expanding, nurse engagement in these issues in community settings has been long-standing. Nurses serving in the community often work directly to address social needs at the individual and family levels, and often work as well to address SDOH at the community and population levels. Public health nurses in particular have broad knowledge of health issues and the associated SDOH, as well as needs and resources, at the community level. Embedded within the community, they also are well positioned to build trust and are respected among community leaders. Also playing important roles in addressing social needs within the community are home visiting nurses. At the individual and family levels, home visiting nurses often represent the first line of health care providers with sustained engagement in addressing social needs for many individuals. They recognize and act on the limitations associated with social needs, such as the inability to afford transportation, or may work with an interdisciplinary team at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic to address food issues and other social needs. By connecting with individuals in their neighborhoods and homes, public health and other community-based nurses promote health and well-being for families within communities and engage in this work with partners from across social, health, and other services.

At the population health level, public health nurses work to achieve health equity within communities through both health promotion and disease prevention and control. They often work in municipal and state health departments and apply

nursing, social, epidemiology, and other public health sciences in their contributions to population health ( Bigbee and Issel, 2012 ; IOM, 2011 [see AARP, 2010 ]; Larsen et al., 2018 ). They offer a wide range of services to individuals and community members and are engaged in activities ranging from policy development and coalition building to health teaching and case management ( Minnesota Department of Health, n.d. ). Public health nurses serve populations that include those with complex health and social needs, frail elderly, homeless individuals, teenage mothers, and those at risk for a specific disease ( Kulbok et al., 2012 ). Their interventions may target specific health risks, such as substance use disorder, HIV, and tobacco use, or populations at risk for health problems, such as individuals with complex health and social needs. Specific knowledge and skills they bring to communities include the ability to perform assessments of individual, family, and community health needs; use data and knowledge of environmental factors to plan for and respond to public health issues in their community; provide community and health department input in the development of policies and programs designed to improve the health of the community; implement evidence-based public health programs; and develop and manage program budgets ( Minnesota Department of Health, n.d. ).

Public health nursing roles are characterized by collaboration and partnerships with communities to address SDOH ( Kulbok et al., 2012 ). Core to public health nursing is working across disciplines and sectors to advance the health of populations through community organizing, coalition building, policy analysis, involvement in local city and county meetings, collaboration with state health departments, and social marketing ( Canales et al., 2018 ; Keller et al., 2004 ). Yet, while the work of public health nurses is foundational to the health of communities, their work is rarely visible. Additionally, regarding measurable reductions in health disparities, little research is available that connects directly and explicitly to public health nursing roles ( Davies and Donovan, 2016 ; Schaffer et al., 2015 ; Swider et al., 2017 ).

Recent experiences with H1N1, Ebola, Zika, and COVID-19 underscore the importance of having strong, well-connected, well-resourced social services, public health, and health care systems, matched by an adequate supply of well-educated nurses. A 2017 report from the National Academies of Sciences, Engineering, and Medicine focused on global health notes that when infectious disease outbreaks occur, significant costs are often associated with fear and the worried-well seeking care ( NASEM, 2017b ). In their role as trusted professionals, and given their widespread presence in communities, incorporating public health nurses into community, state, and federal government strategies for health education and dissemination of information can help extend the reach and impact of messaging during infectious disease outbreaks and other public health emergencies. Nurses can serve as expert sources of information (e.g., on preventing infectious disease transmission within their communities) ( Audain and Maher, 2017 ). In the United States, for example, as Zika infections were

identified and spreading, one of the strategies used by the U.S. Department of Health and Human Services (HHS) was to work through nursing associations to reach nurses and through them, help reach the public with factual information and minimize unnecessary resource use ( Minnesota Department of Health, 2019 ). Given their expertise in community engagement and knowledge of local and state government health and social services assets, public health nurses are well positioned to link to and share health-related information with community partners to help reach underresourced populations, including homeless individuals, non-English-speaking families, and others.

WORKING ACROSS DISCIPLINES AND SECTORS TO MEET MULTIPLE NEEDS

As nurses work in concert with other sectors and disciplines, interventions that address multiple and complex needs of individuals and communities can have far-reaching impacts on health outcomes and health care utilization. Through partnerships, community-based nurses work to address an array of health-related needs ranging from population-level diabetes management to community-based transportation to enable low-income families to access health care services.

Because multiple factors influence individual and population health, a multidisciplinary, multisectoral approach is necessary to improve health and reduce health inequity. While an approach focusing on only one SDOH may improve one dimension of health, such as food insecurity, intersectional approaches that simultaneously address complex, holistic needs of individuals, families, and communities are often required. Commonly found across underresourced communities are layers of intersecting challenges impacting health, ranging from adverse environmental exposures to food deserts. Health care systems, community-based organizations, government entitities, nurses, and others are increasingly working together to design interventions that reflect this complexity ( NASEM, 2017a , 2019 ). Creative alliances are being built with for-profit and not-for-profit organizations, community groups, federal programs, hospitals, lending institutions, technology companies, and others ( NASEM, 2019 ).

Work to prioritize and address health disparities and achieve health equity is predicated on meaningful, often multidimensional, assessments of community characteristics. One key opportunity to inform multisectoral efforts lies in community health needs assessments. The Patient Protection and Affordable Care Act requires nonprofit hospitals to conduct these assessments every 3 years, with input from local public health agencies. These assessments are then used to identify and prioritize significant health needs of the community served by the hospital while also identifying resources and plans for addressing these needs. Conducting a community health needs assessment is itself a multisectoral collaboration as it requires engaging community-based stakeholders ( Heath, 2018 ). The results of the assessment present opportunities for multiple sectors to work

together. For example, a hospital may partner with public health and area food banks to address food insecurity. Or it may partner with a health technology company and a local school board to address digital literacy for underserved youth and their families, and also extend the reach of broadband to support health care access through telehealth technology and strengthen digital literacy. In assessing the community’s health needs, these hospitals are required to obtain and consider community-based input, including input from individuals or organizations with knowledge of or expertise in public health. The reports produced as part of this process are required to be publicly available ( IRS, 2020 ).

These and other community engagement efforts can involve nurses from a variety of clinical and community-based settings in any and all steps of the process, from design to implementation and evaluation of the assessments themselves or the processes and programs established to address identified priorities. For example, the Magnet recognition program of the American Nurses Credentialing Center requires participating hospitals to involve nurses in their community health needs assessments ( ANCC, 2017 ).

A variety of models feature nurses directly addressing health and social needs through multidisciplinary, multisectoral collaboration. Two illustrative programs are described below: the Camden Core Model and Edge Runner.

Camden Core Model

The Camden Coalition, based in Camden, New Jersey, is a multidisciplinary, nonprofit organization that works across sectors to address health and social needs. The Coalition’s formation was based on the recognition that the U.S. health care system far too often fails people with complex health and social needs. These individuals cycle repeatedly through multiple health care, social services, and other systems without realizing lasting improvements in their health or well-being. The Coalition employs multiple approaches that include using faith-based partnerships to deliver health services and encourage healthy choices; sharing data among the criminal justice, health care, and housing sectors to identify points of intervention; and building local and national coalitions to support and educate others interested in implementing this model ( Camden Coalition, n.d. ). One of the Coalition’s best-known programs is the Camden Core Model. This nationally recognized care management intervention is an example of a nurse-led care management program for people with complex medical and social needs. It applies the principles of trauma-informed care and harm reduction with the aim of empowering people with the skills and support they need to avoid preventable hospital use and improve their well-being ( Finkelstein et al., 2020 ; Gawande, 2011 ). The model uses real-time data on hospital admissions to identify “superutilizers,” people with complex health issues who frequently use emergency care. An interprofessional team of registered nurses (RNs) and licensed practical nurses (LPNs), social workers, and community health workers engage in person

with these individuals to help them navigate their care by connecting them with medical care, government benefits, and social services ( Camden Coalition, n.d. ; Finkelstein et al., 2020 ). With federal funding, similar versions of the model have been extended to cities outside of Camden ( AF4Q, 2012 ; Crippen and Isasi, 2013 ; Mann, 2013 ).

Camden Coalition partnerships optimize the use of nurses in the community in several ways. An interprofessional team of nurses, social workers, and community health workers visits program participants, helps reconcile their medications, accompanies them to medical visits, and links them to social and legal services. Critical to the model’s success is recruiting nurses who are from the local community, capitalizing on their cultural and systems-level knowledge to facilitate and improve access to and utilization of local health and social services. The culture of the Camden Coalition model has been key to its success. The uniform commitment of nurses, staff, and leadership to addressing people’s complex needs has created a supportive work environment in which each team member’s role is optimized. Care Team members have accompanied people to their meetings and appointments for primary care, helped with applications for such public benefits as food stamps, provided referrals to social services and housing agencies, arranged for medication delivery in partnership with local pharmacies, and coordinated care among providers.

The Camden Coalition focuses on “authentic healing relationships,” defined as secure, genuine, and continuous partnerships between Care Team members and patients. This emphasis has evolved into a framework for patient engagement known as COACH, which stands for C onnect tasks with vision and priorities, O bserve the normal routine, A ssume a coaching style, C reate a backward plan, and H ighlight progress with data. An interprofessional team of nurses, social workers, and community health workers visits participants in the community. Team members are trained to problem solve with patients to achieve the program goals of helping them manage their chronic health conditions and reducing preventable hospital admissions.

Early evidence of the program’s effect in a small sample showed a 56 percent reduction in monthly hospital charges, a roughly 40 percent reduction in monthly visits to hospitals and emergency departments, and an approximately 52 percent increase in rates of reimbursement to care providers ( Green et al., 2010 ), although later evidence from a randomized controlled trial (RCT) indicated that the Camden Core Model did not reduce hospital readmissions ( Finkelstein et al., 2020 ). Other RCTs, conducted in Philadelphia and Chicago, showed that similar social care programs using case management and community health workers can reduce hospital admissions and save money in addition to improving health and quality of health care. Kangovi and colleagues (2018) conducted an RCT in Philadelphia to assess Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention addressing unmet social needs across three health systems ( Kangovi et al., 2018 ). After 6 months, patients

in the intervention group compared with controls were more likely to report the highest quality of care and spent fewer total days in the hospital (reduced by about two-thirds), saving $2.47 for each dollar invested by Medicaid annually ( Kangovi et al., 2020 ). The RCT in Chicago assessed the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical conditions and found a 29 percent reduction in hospitalizations and a 24 percent reduction in emergency department visits ( Sadowski et al., 2009 ).

Edge Runner

The American Academy of Nurses’ Edge Runner initiative identifies and promotes nurse-designed models of care and interventions that can improve health, increase health care access and quality, and/or reduce costs ( AAN, n.d.a ). As of February 2020, 59 such programs had been evaluated against a set of criteria and designated as part of this initiative. Many Edge Runner programs are built around the needs of underserved communities and seek to improve health through holistic care that addresses social needs and SDOH, including a range of upstream, midstream, and downstream determinants. Mason and colleagues (2015) assessed 30 Edge Runner models identified as of 2012, finding four main commonalities that illustrate these programs’ broad and encompassing approach to health.

A holistic definition of health. Across the programs, health was defined broadly to include physical, psychological, social, spiritual, functional, quality-of-life, personal happiness, and well-being aspects. Additionally, the definition of health was based on the values of clients and shaped around their preferences. Typically, programs were grounded in SDOH to inform their design of individual- and community-level interventions.

Individual-, family-, and community-centric design. Most programs prioritized individual, family, and community goals over provider-defined goals through a “participant-led care environment” and “meeting people where they are.” Thus, interventions were tailored to the values and culture present at each of these three levels.

Relationship-based care. The programs reflected the importance of building trusting relationships with individuals, families, and communities to help them engage in ways to create and sustain their own health.

Ongoing group and public health approaches to improving the health of underserved populations. The nurses who designed the programs viewed serving underserved populations as a moral imperative. Through peer-to-peer education, support groups, and public health approaches, they sought to empower clients, give them a sense of control, build self-care agency, and increase resilience.

An in-depth study of three Edge Runner programs (the Centering Pregnancy model, INSIGHTS, and the Family Practice and Counseling Network) revealed particular lessons: the essential role of collaboration and leaders who can col-

laborate with a wide range of stakeholders, the need for plans for scalability and financial sustainability, and the importance of social support and empowerment to help people ( Martsolf et al., 2017 ). In these and other models, the capacity and knowledge associated with building meaningful, sustained partnerships across sectors is a key dimension of nursing practice that impacts health equity. The Edge Runner programs emphasize how, in the pursuit of improving care, lowering costs, and increasing satisfaction for people and families, nurses are actively working to achieve person-centered care that addresses social needs and SDOH and focusing on the needs of underserved populations to promote health equity ( Martsolf et al., 2016 , 2017 ; Mason et al., 2015 ). However, evidence directly linking the programs to decreases in disparities is generally not available. Two examples of Edge Runner programs are described in Box 5-2 .

As models continue to evolve and be disseminated, it is critical to establish an evidence base that can help understand their impact on health and well-being and their contribution to achieving the broader aim of health equity. For care management programs incorporating social care, it is important to consider a broad array of both quantitative and qualitative measures beyond health care utilization ( Noonan, 2020 ). Although RCTs generate the most reliable evidence, this evidence can be limited in scope. For example, the RCTs cited above assessed neither the multidimensional nature of care management/social care models that might be reflected in such outcomes as client self-efficacy, satisfaction, or long-term health outcomes nor their potential social impacts. Also important to note is that care management models incorporating social care are limited by the availability of resources in the community, such as behavioral health services, addiction treatment, housing, and transportation. Programs that connect clients to health and social

services are unlikely to work if relevant services are unavailable ( Noonan, 2020 ). Important to underscore in the context of this report is that multisector engagement, as well as health care teams that may involve social workers, community health workers, physicians, and others engaging alongside nurses, all are oriented to a shared agenda focused on improving health and advancing health equity.

ADVOCATING FOR POLICY CHANGE

Public policies have a major influence on health care providers, systems, and the populations they serve. Accordingly, nurses can help promote health equity by bringing a health lens to bear on public policies and decision making at the community, state, and federal levels. Informing health-related public policy can involve communicating about health disparities and SDOH with the public, policy makers, and organizational leaders, focusing on both challenges and solutions for addressing health through actions targeted to achieving health equity.

When nurses engage with policy change as an upstream determinant of health, they can have a powerful and far-reaching impact on the health of populations. In the National Academy of Medicine’s Vital Directions series, Nancy Adler and colleagues (2016) note that “powerful drivers of health lie outside the conventional medical care delivery system…. Health policies need to expand to address factors outside the medical system that promote or damage health.” Because health inequities and SDOH are based in social structures and policies, efforts to address them upstream as the root of poor health among certain populations and communities need to focus on policy change ( NASEM, 2017a ). Nurses alone cannot solve the problems associated with upstream SDOH that exist outside of health care systems. However, by engaging in efforts aimed at changing local, state, or federal policy with a Health in All Policies approach, 2 they can address SDOH that underlie poor health ( IOM, 2011 ; NASEM, 2017a ; Williams et al., 2018 ). Whether nurses engage in policy making full time or work to inform policy part time as a professional responsibility, their attention to policies that either create or eliminate health inequities can improve the underlying conditions that frame people’s health. Nurses can bring a health and social justice lens to public policies and decision making at the community, state, and federal levels most effectively by serving in public- and private-sector leadership positions. Much of this work is discussed in Chapter 9 on nursing leadership, but it is noted in this chapter given the substantial

2 Health in All Policies (HiAP) is a collaborative approach that integrates health considerations into policy making across sectors. It recognizes that health is created by a multitude of factors beyond health care and in many cases, beyond the scope of traditional public health activities. In accordance with HiAP, for example, decision makers in the health care sector should consider transportation, education, housing, commerce, and other sectors impacting communities. HiAP stresses the need to work across government agencies and with private partners from these different sectors to achieve healthy and safe communities. It also encourages partnerships between the health care sector and community developers, for example ( CDC, 2016 ).

influence that policy decisions have on health equity. Nurses can and should use their expertise to promote policies that support health equity.

For example, a nurse in Delaware was influential in getting the state’s legislature to pass legislation to implement a colorectal cancer screening program that has increased access to care and reduced disparities in morbidity and mortality from colorectal cancer (see Box 5-3 ). While individual nurses, often through their workplace and professional associations, engage in upstream efforts to impact health equity, there have been repeated calls from within the nursing community for more nurses to engage in informing public policy to improve health outcomes for individuals and populations.

CONCLUSIONS

In the coming decade, the United States will make substantial progress in achieving health equity only if it devotes resources and attention to addressing the adverse effects of SDOH on the health of underresourced populations. As 2030 approaches, numerous initiatives to address health equity are likely to be launched at the local, state, and national levels. Many of these initiatives will focus on health care equity. Yet, while expanding access to quality care is critical to reducing disparities and improving health outcomes, such efforts need to be accompanied by additional efforts to identify and change the social institutions, dynamics, and systems underlying health inequities from the local to the national level. Nurses can contribute to reshaping the landscape of health equity over the coming decade by serving in expanded roles, working in new settings and new ways, and partnering with communities and other sectors beyond health care. Some nurses are already working in roles and settings that support health equity and are engaged in educating about and advocating for health equity through their professional associations. Nonetheless, broader engagement as a core activity of every nurse will help advance health equity nationwide. To achieve this aim will require

• support for and the willingness of the nursing workforce to take on new roles in new settings in the community;
• consistency in nurses’ preparation for engaging in downstream, midstream, and upstream strategies aimed at improving health equity by addressing issues that compromise health, such as geographic disparities, poverty, racism, homelessness, trauma, drug abuse, and behavioral health conditions;
• more experiential learning and opportunities to work in community settings throughout nursing education to ensure that nurses have skills and competencies to address individuals’ complex needs and promote efforts to improve the well-being of communities;
• nursing education that goes beyond teaching the principles of diversity, equity, and inclusion to provide sustained student engagement in hands-on community and clinical experiences with these issues;
• funding to support new models of care and functions that address SDOH, health equity, and population health; and
• evaluation of models to build the evidence needed to scale programs and the policies and resources necessary to sustain them.

These issues are discussed in the chapters that follow. Programs described in this chapter, such as the Camden Coalition and the Edge Runner initiatives, are exemplars of the kind of multidisciplinary, multisector efforts that will be necessary to address the complex needs of individuals and communities and make a lasting impact by eliminating health disparities, with the goal of achieving health equity. Central to these future efforts, however, are parallel efforts that evaluate

and provide the evidence base on which to determine the effectiveness of models. One of the greatest challenges this committee faced was finding evidence directly linking the efforts of nurses to address social needs and SDOH to reductions in health disparities that would signal improved population health outcomes and health equity. Such evidence is essential to informing payment policy decisions that can ensure the sustainability of and nurse engagement in these models (discussed further in Chapter 6 ). Through evidence, the nursing profession can leverage its own potential, and the public, other professionals, and other sectors can understand the impact and value of such nursing engagement.

Conclusion 5-1: Nurses are in a position to improve outcomes for the underserved and can work to address the structural and institutional factors that produce health disparities in the first place.

Conclusion 5-2: Nurses can use their unique expertise and perspective to help develop and advocate for policies and programs that promote health equity.

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The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions.

A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone.

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

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National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): National Academies Press (US); 2021 May 11.

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

• Hardcopy Version at National Academies Press

5 The Role of Nurses in Improving Health Equity

Being a nurse … in 2020 must mean being aware of social injustices and the systemic racism that exist in much of nursing … and having a personal and professional responsibility to challenge and help end them. —Calvin Moorley, RN, and colleagues, “Dismantling Structural Racism: Nursing Must Not Be Caught on the Wrong Side of History”

Health equity is achieved when everyone has a fair and just opportunity to be as healthy as possible. Nurses are well positioned to play a major role in addressing the underlying causes of poor health by understanding and recognizing the wide range of factors that influence how well and long people live, helping to create individual- and community-targeted solutions, and facilitating and working with interdisciplinary and multisector teams and partners to implement those solutions. Nurses have the potential to reshape the landscape of health equity over the next decade by expanding their roles, working in new settings and in new ways, and markedly expanding efforts to partner with communities and other sectors. But for the United States to make substantial progress in achieving health equity, it will need to devote resources and attention to the conditions that affect people’s health and make expanded investments in building nurse capacity. And nursing schools will need to shift education, training, and mindsets to support nurses’ new and expanded roles.

When this study was envisioned in 2019, it was clear that the future of nursing would look different by 2030; however, no one could predict how rapidly and dramatically circumstances would shift before the end of 2020. Over the coming decade, the nursing profession will continue to be shaped by the pressing health, social, and ethical challenges facing the nation today. Having illuminated many of the health and social inequities affecting communities across the nation, the COVID-19 pandemic, along with other health crises, such as the opioid epidemic ( Abellanoza et al., 2018 ), presents an opportunity to take a critical look at the nursing profession, and society at large, and work collaboratively to enable all individuals to have a fair and just opportunity for health and well-being, reflecting the concept of “social mission” described by Mullan (2017 , p. 122) as “making health not only better but fairer.” This chapter examines health equity and the role of nursing in its advancement in the United States.

As stated previously, health equity is defined as “the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance” ( NASEM, 2017a , p. 32). While access to equitable health care, discussed in Chapter 4 , is an important part of achieving health equity, it is not sufficient. Health is affected by a wide range of other factors, including housing, transportation, nutrition, physical activity, education, income, laws and policies, and discrimination. Chapter 2 presents the Social Determinants of Health and Social Needs Model of Castrucci and Auerbach (2019) , in which upstream factors represent the social determinants of health (SDOH) that affect individuals and communities in a broad and, today, inequitable way. Low educational status and opportunity, income disparities, discrimination, and social marginalization are examples of upstream factors that impede good health outcomes. Midstream factors comprise social needs, or the individual factors that may affect a person’s health, such as homelessness, food insecurity, and trauma. Finally, downstream factors include disease treatment and chronic disease management.

Much of the focus on the education and training of nurses and the public perception of their role is on the treatment and management of disease. This chapter shifts that focus to nurses’ role in addressing SDOH and social needs, including their potential future roles and responsibilities in this regard, and describes existing exemplars. First, the chapter provides a brief overview of nurses’ role in addressing health equity. Next, it describes opportunities for nurses to improve health equity through four approaches: addressing social needs in clinical settings, addressing social needs and SDOH in the community, working across disciplines and sectors to meet multiple needs, and advocating for policy change. The chapter then details the opportunities and barriers associated with each of these approaches.

NURSES’ ROLE IN ADDRESSING HEALTH EQUITY

As described in Chapter 1 , the history of nursing is grounded in social justice and community health advocacy ( Donley and Flaherty, 2002 ; Pittman, 2019 ; Rafferty, 2015 ; Tyson et al., 2018 ), and as noted in Chapter 2 , the Code of Ethics for Nurses with Interpretive Statements, reiterated by American Nurses Association (ANA) President Ernest J. Grant in a public statement, “obligates nurses to be allies and to advocate and speak up against racism, discrimination, and injustice” ( ANA, 2020 ).

Addressing social needs across the health system can improve health equity from the individual to the system level. The report Integrating Social Care into the Delivery of Health Care identifies activities in five complementary areas that can facilitate the integration of social care into health care: adjustment, assistance, alignment, advocacy, and awareness ( NASEM, 2019 ) (see Figure 5-1 and Table 5-1 ). In the area of awareness, for example, clinical nurses in a hospital setting can identify the fall risks their patients might face upon discharge and the assets they can incorporate into their lives to improve their health. In the area of adjustment, telehealth and/or home health and home visiting nurses can alter clinical care to reduce the risk of falls by, for example, helping patients to adjust risks in their homes and learn to navigate their environment. And these activities can continue to the high level of system change through advocacy for health policies aimed at altering community infrastructure to help prevent falls.

Areas of activity that strengthen integration of social care into health care. SOURCE: NASEM, 2019.

Definitions of Areas of Activities That Strengthen Integration of Social Care into Health Care.

In short, improving population health entails challenging and changing the factors and institutions that give rise to health inequity through interventions and reforms that influence the institutions, social systems, and public policies that drive health ( Lantz, 2019 ). It is important to note, however, that there are shortcomings in how evaluations of health equity interventions are carried out (see Box 5-1 ).

Shortcomings of Evaluations of Health Equity Interventions.

• ADDRESSING SOCIAL NEEDS IN CLINICAL SETTINGS

Although the provision of clinical care is a downstream determinant of health, the clinical setting presents an opportunity for nurses to address midstream determinants, or social needs, as well. Screening for social needs and making referrals to social services is becoming more commonplace in clinical settings as part of efforts to provide holistic care ( Gottlieb et al., 2016 ; Makelarski et al., 2017 ; Thomas-Henkel and Schulman, 2017 ). Nurses may conduct screenings; review their results; create care plans based on social needs as indicated by those results; refer patients to appropriate professionals and social services; and coordinate care by interfacing with social workers, community health workers, and social services providers. Although the importance of screening people for social needs has led more providers to take on this role, it has yet to become a universal practice ( CMS, 2020 ; NASEM, 2016 ), as most physician practices and hospitals do not perform screenings for the five key domains of social need 1 : food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence ( CMS, 2020 ; Fraze et al., 2019 ). As trusted professionals that spend significant time with patients and families, nurses are well equipped to conduct these screenings ( AHA, 2019 ). Federally qualified health centers (FQHCs)—community-based health centers that receive funds from the Health Resources and Services Administration’s (HRSA’s) Health Center Program—often screen for social needs.

In many clinical settings, however, challenges arise with screening for social needs. Individuals may be hesitant to provide information about such issues as housing or food insecurity, and technology is required to collect social needs data and once obtained, to share these data across settings and incorporate them into nursing practice in a meaningful way. While nurses have an educational foundation for building the skills needed to expand their role from assessing health issues to conducting assessments and incorporating findings related to social needs into care plans, this focus needs to be supported by policies where nurses are employed. As the incorporation of social needs into clinical consideration expands, nurses’ education and training will need to ensure knowledge of the impact of social needs and SDOH on individual and population health (see Chapter 7 ). Communicating appropriately with people about social needs can be difficult, and training is required to ensure that people feel comfortable responding to personal questions related to such issues as housing instability, domestic violence, and financial insecurity ( Thomas-Henkel and Schulman, 2017 ). Finally, the utility of social needs screening depends on networks of agencies that offer services and resources in the community. Without the ability to connect with relevant services, screenings and care plans can have little impact. Consequently, it is important for health care organizations to dedicate resources to ensuring that people are connected to appropriate resources, and to follow up by tracking those connections and offering other options as needed ( Thomas-Henkel and Schulman, 2017 ).

• ADDRESSING SOCIAL NEEDS AND SOCIAL DETERMINANTS OF HEALTH IN THE COMMUNITY

While interest in and action to address social needs in the clinical setting is rapidly expanding, nurse engagement in these issues in community settings has been long-standing. Nurses serving in the community often work directly to address social needs at the individual and family levels, and often work as well to address SDOH at the community and population levels. Public health nurses in particular have broad knowledge of health issues and the associated SDOH, as well as needs and resources, at the community level. Embedded within the community, they also are well positioned to build trust and are respected among community leaders. Also playing important roles in addressing social needs within the community are home visiting nurses. At the individual and family levels, home visiting nurses often represent the first line of health care providers with sustained engagement in addressing social needs for many individuals. They recognize and act on the limitations associated with social needs, such as the inability to afford transportation, or may work with an interdisciplinary team at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic to address food issues and other social needs. By connecting with individuals in their neighborhoods and homes, public health and other community-based nurses promote health and well-being for families within communities and engage in this work with partners from across social, health, and other services.

At the population health level, public health nurses work to achieve health equity within communities through both health promotion and disease prevention and control. They often work in municipal and state health departments and apply nursing, social, epidemiology, and other public health sciences in their contributions to population health ( Bigbee and Issel, 2012 ; IOM, 2011 [see AARP, 2010 ]; Larsen et al., 2018 ). They offer a wide range of services to individuals and community members and are engaged in activities ranging from policy development and coalition building to health teaching and case management ( Minnesota Department of Health, n.d. ). Public health nurses serve populations that include those with complex health and social needs, frail elderly, homeless individuals, teenage mothers, and those at risk for a specific disease ( Kulbok et al., 2012 ). Their interventions may target specific health risks, such as substance use disorder, HIV, and tobacco use, or populations at risk for health problems, such as individuals with complex health and social needs. Specific knowledge and skills they bring to communities include the ability to perform assessments of individual, family, and community health needs; use data and knowledge of environmental factors to plan for and respond to public health issues in their community; provide community and health department input in the development of policies and programs designed to improve the health of the community; implement evidence-based public health programs; and develop and manage program budgets ( Minnesota Department of Health, n.d. ).

Public health nursing roles are characterized by collaboration and partnerships with communities to address SDOH ( Kulbok et al., 2012 ). Core to public health nursing is working across disciplines and sectors to advance the health of populations through community organizing, coalition building, policy analysis, involvement in local city and county meetings, collaboration with state health departments, and social marketing ( Canales et al., 2018 ; Keller et al., 2004 ). Yet, while the work of public health nurses is foundational to the health of communities, their work is rarely visible. Additionally, regarding measurable reductions in health disparities, little research is available that connects directly and explicitly to public health nursing roles ( Davies and Donovan, 2016 ; Schaffer et al., 2015 ; Swider et al., 2017 ).

Recent experiences with H1N1, Ebola, Zika, and COVID-19 underscore the importance of having strong, well-connected, well-resourced social services, public health, and health care systems, matched by an adequate supply of well-educated nurses. A 2017 report from the National Academies of Sciences, Engineering, and Medicine focused on global health notes that when infectious disease outbreaks occur, significant costs are often associated with fear and the worried-well seeking care ( NASEM, 2017b ). In their role as trusted professionals, and given their widespread presence in communities, incorporating public health nurses into community, state, and federal government strategies for health education and dissemination of information can help extend the reach and impact of messaging during infectious disease outbreaks and other public health emergencies. Nurses can serve as expert sources of information (e.g., on preventing infectious disease transmission within their communities) ( Audain and Maher, 2017 ). In the United States, for example, as Zika infections were identified and spreading, one of the strategies used by the U.S. Department of Health and Human Services (HHS) was to work through nursing associations to reach nurses and through them, help reach the public with factual information and minimize unnecessary resource use (Minnesota Department of Health, 2019 ). Given their expertise in community engagement and knowledge of local and state government health and social services assets, public health nurses are well positioned to link to and share health-related information with community partners to help reach underresourced populations, including homeless individuals, non-English-speaking families, and others.

• WORKING ACROSS DISCIPLINES AND SECTORS TO MEET MULTIPLE NEEDS

As nurses work in concert with other sectors and disciplines, interventions that address multiple and complex needs of individuals and communities can have far-reaching impacts on health outcomes and health care utilization. Through partnerships, community-based nurses work to address an array of health-related needs ranging from population-level diabetes management to community-based transportation to enable low-income families to access health care services.

Because multiple factors influence individual and population health, a multidisciplinary, multisectoral approach is necessary to improve health and reduce health inequity. While an approach focusing on only one SDOH may improve one dimension of health, such as food insecurity, intersectional approaches that simultaneously address complex, holistic needs of individuals, families, and communities are often required. Commonly found across underresourced communities are layers of intersecting challenges impacting health, ranging from adverse environmental exposures to food deserts. Health care systems, community-based organizations, government entitities, nurses, and others are increasingly working together to design interventions that reflect this complexity ( NASEM, 2017a , 2019 ). Creative alliances are being built with for-profit and not-for-profit organizations, community groups, federal programs, hospitals, lending institutions, technology companies, and others ( NASEM, 2019 ).

Work to prioritize and address health disparities and achieve health equity is predicated on meaningful, often multidimensional, assessments of community characteristics. One key opportunity to inform multisectoral efforts lies in community health needs assessments. The Patient Protection and Affordable Care Act requires nonprofit hospitals to conduct these assessments every 3 years, with input from local public health agencies. These assessments are then used to identify and prioritize significant health needs of the community served by the hospital while also identifying resources and plans for addressing these needs. Conducting a community health needs assessment is itself a multisectoral collaboration as it requires engaging community-based stakeholders ( Heath, 2018 ). The results of the assessment present opportunities for multiple sectors to work together. For example, a hospital may partner with public health and area food banks to address food insecurity. Or it may partner with a health technology company and a local school board to address digital literacy for underserved youth and their families, and also extend the reach of broadband to support health care access through telehealth technology and strengthen digital literacy. In assessing the community’s health needs, these hospitals are required to obtain and consider community-based input, including input from individuals or organizations with knowledge of or expertise in public health. The reports produced as part of this process are required to be publicly available ( IRS, 2020 ).

These and other community engagement efforts can involve nurses from a variety of clinical and community-based settings in any and all steps of the process, from design to implementation and evaluation of the assessments themselves or the processes and programs established to address identified priorities. For example, the Magnet recognition program of the American Nurses Credentialing Center requires participating hospitals to involve nurses in their community health needs assessments ( ANCC, 2017 ).

A variety of models feature nurses directly addressing health and social needs through multidisciplinary, multisectoral collaboration. Two illustrative programs are described below: the Camden Core Model and Edge Runner.

Camden Core Model

The Camden Coalition, based in Camden, New Jersey, is a multidisciplinary, nonprofit organization that works across sectors to address health and social needs. The Coalition’s formation was based on the recognition that the U.S. health care system far too often fails people with complex health and social needs. These individuals cycle repeatedly through multiple health care, social services, and other systems without realizing lasting improvements in their health or well-being. The Coalition employs multiple approaches that include using faith-based partnerships to deliver health services and encourage healthy choices; sharing data among the criminal justice, health care, and housing sectors to identify points of intervention; and building local and national coalitions to support and educate others interested in implementing this model ( Camden Coalition, n.d. ). One of the Coalition’s best-known programs is the Camden Core Model. This nationally recognized care management intervention is an example of a nurse-led care management program for people with complex medical and social needs. It applies the principles of trauma-informed care and harm reduction with the aim of empowering people with the skills and support they need to avoid preventable hospital use and improve their well-being ( Finkelstein et al., 2020 ; Gawande, 2011 ). The model uses real-time data on hospital admissions to identify “superutilizers,” people with complex health issues who frequently use emergency care. An interprofessional team of registered nurses (RNs) and licensed practical nurses (LPNs), social workers, and community health workers engage in person with these individuals to help them navigate their care by connecting them with medical care, government benefits, and social services ( Camden Coalition, n.d. ; Finkelstein et al., 2020 ). With federal funding, similar versions of the model have been extended to cities outside of Camden (AF4 Q, 2012 ; Crippen and Isasi, 2013 ; Mann, 2013 ).

Camden Coalition partnerships optimize the use of nurses in the community in several ways. An interprofessional team of nurses, social workers, and community health workers visits program participants, helps reconcile their medications, accompanies them to medical visits, and links them to social and legal services. Critical to the model’s success is recruiting nurses who are from the local community, capitalizing on their cultural and systems-level knowledge to facilitate and improve access to and utilization of local health and social services. The culture of the Camden Coalition model has been key to its success. The uniform commitment of nurses, staff, and leadership to addressing people’s complex needs has created a supportive work environment in which each team member’s role is optimized. Care Team members have accompanied people to their meetings and appointments for primary care, helped with applications for such public benefits as food stamps, provided referrals to social services and housing agencies, arranged for medication delivery in partnership with local pharmacies, and coordinated care among providers.

The Camden Coalition focuses on “authentic healing relationships,” defined as secure, genuine, and continuous partnerships between Care Team members and patients. This emphasis has evolved into a framework for patient engagement known as COACH, which stands for C onnect tasks with vision and priorities, O bserve the normal routine, A ssume a coaching style, C reate a backward plan, and H ighlight progress with data. An interprofessional team of nurses, social workers, and community health workers visits participants in the community. Team members are trained to problem solve with patients to achieve the program goals of helping them manage their chronic health conditions and reducing preventable hospital admissions.

Early evidence of the program’s effect in a small sample showed a 56 percent reduction in monthly hospital charges, a roughly 40 percent reduction in monthly visits to hospitals and emergency departments, and an approximately 52 percent increase in rates of reimbursement to care providers ( Green et al., 2010 ), although later evidence from a randomized controlled trial (RCT) indicated that the Camden Core Model did not reduce hospital readmissions ( Finkelstein et al., 2020 ). Other RCTs, conducted in Philadelphia and Chicago, showed that similar social care programs using case management and community health workers can reduce hospital admissions and save money in addition to improving health and quality of health care. Kangovi and colleagues (2018) conducted an RCT in Philadelphia to assess Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention addressing unmet social needs across three health systems ( Kangovi et al., 2018 ). After 6 months, patients in the intervention group compared with controls were more likely to report the highest quality of care and spent fewer total days in the hospital (reduced by about two-thirds), saving $2.47 for each dollar invested by Medicaid annually ( Kangovi et al., 2020 ). The RCT in Chicago assessed the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical conditions and found a 29 percent reduction in hospitalizations and a 24 percent reduction in emergency department visits ( Sadowski et al., 2009 ).

Edge Runner

The American Academy of Nurses’ Edge Runner initiative identifies and promotes nurse-designed models of care and interventions that can improve health, increase health care access and quality, and/or reduce costs ( AAN, n.d.a ). As of February 2020, 59 such programs had been evaluated against a set of criteria and designated as part of this initiative. Many Edge Runner programs are built around the needs of underserved communities and seek to improve health through holistic care that addresses social needs and SDOH, including a range of upstream, midstream, and downstream determinants. Mason and colleagues (2015) assessed 30 Edge Runner models identified as of 2012, finding four main commonalities that illustrate these programs’ broad and encompassing approach to health.

A holistic definition of health. Across the programs, health was defined broadly to include physical, psychological, social, spiritual, functional, quality-of-life, personal happiness, and well-being aspects. Additionally, the definition of health was based on the values of clients and shaped around their preferences. Typically, programs were grounded in SDOH to inform their design of individual- and community-level interventions.

Individual-, family-, and community-centric design. Most programs prioritized individual, family, and community goals over provider-defined goals through a “participant-led care environment” and “meeting people where they are.” Thus, interventions were tailored to the values and culture present at each of these three levels.

Relationship-based care. The programs reflected the importance of building trusting relationships with individuals, families, and communities to help them engage in ways to create and sustain their own health.

Ongoing group and public health approaches to improving the health of underserved populations. The nurses who designed the programs viewed serving underserved populations as a moral imperative. Through peer-to-peer education, support groups, and public health approaches, they sought to empower clients, give them a sense of control, build self-care agency, and increase resilience.

An in-depth study of three Edge Runner programs (the Centering Pregnancy model, INSIGHTS, and the Family Practice and Counseling Network) revealed particular lessons: the essential role of collaboration and leaders who can collaborate with a wide range of stakeholders, the need for plans for scalability and financial sustainability, and the importance of social support and empowerment to help people ( Martsolf et al., 2017 ). In these and other models, the capacity and knowledge associated with building meaningful, sustained partnerships across sectors is a key dimension of nursing practice that impacts health equity. The Edge Runner programs emphasize how, in the pursuit of improving care, lowering costs, and increasing satisfaction for people and families, nurses are actively working to achieve person-centered care that addresses social needs and SDOH and focusing on the needs of underserved populations to promote health equity ( Martsolf et al., 2016 , 2017 ; Mason et al., 2015 ). However, evidence directly linking the programs to decreases in disparities is generally not available. Two examples of Edge Runner programs are described in Box 5-2 .

Examples of Edge Runner Programs.

As models continue to evolve and be disseminated, it is critical to establish an evidence base that can help understand their impact on health and well-being and their contribution to achieving the broader aim of health equity. For care management programs incorporating social care, it is important to consider a broad array of both quantitative and qualitative measures beyond health care utilization ( Noonan, 2020 ). Although RCTs generate the most reliable evidence, this evidence can be limited in scope. For example, the RCTs cited above assessed neither the multidimensional nature of care management/social care models that might be reflected in such outcomes as client self-efficacy, satisfaction, or long-term health outcomes nor their potential social impacts. Also important to note is that care management models incorporating social care are limited by the availability of resources in the community, such as behavioral health services, addiction treatment, housing, and transportation. Programs that connect clients to health and social services are unlikely to work if relevant services are unavailable ( Noonan, 2020 ). Important to underscore in the context of this report is that multisector engagement, as well as health care teams that may involve social workers, community health workers, physicians, and others engaging alongside nurses, all are oriented to a shared agenda focused on improving health and advancing health equity.

• ADVOCATING FOR POLICY CHANGE

Public policies have a major influence on health care providers, systems, and the populations they serve. Accordingly, nurses can help promote health equity by bringing a health lens to bear on public policies and decision making at the community, state, and federal levels. Informing health-related public policy can involve communicating about health disparities and SDOH with the public, policy makers, and organizational leaders, focusing on both challenges and solutions for addressing health through actions targeted to achieving health equity.

When nurses engage with policy change as an upstream determinant of health, they can have a powerful and far-reaching impact on the health of populations. In the National Academy of Medicine’s Vital Directions series, Nancy Adler and colleagues (2016) note that “powerful drivers of health lie outside the conventional medical care delivery system…. Health policies need to expand to address factors outside the medical system that promote or damage health.” Because health inequities and SDOH are based in social structures and policies, efforts to address them upstream as the root of poor health among certain populations and communities need to focus on policy change ( NASEM, 2017a ). Nurses alone cannot solve the problems associated with upstream SDOH that exist outside of health care systems. However, by engaging in efforts aimed at changing local, state, or federal policy with a Health in All Policies approach, 2 they can address SDOH that underlie poor health ( IOM, 2011 ; NASEM, 2017a ; Williams et al., 2018 ). Whether nurses engage in policy making full time or work to inform policy part time as a professional responsibility, their attention to policies that either create or eliminate health inequities can improve the underlying conditions that frame people’s health. Nurses can bring a health and social justice lens to public policies and decision making at the community, state, and federal levels most effectively by serving in public- and private-sector leadership positions. Much of this work is discussed in Chapter 9 on nursing leadership, but it is noted in this chapter given the substantial influence that policy decisions have on health equity. Nurses can and should use their expertise to promote policies that support health equity.

For example, a nurse in Delaware was influential in getting the state’s legislature to pass legislation to implement a colorectal cancer screening program that has increased access to care and reduced disparities in morbidity and mortality from colorectal cancer (see Box 5-3 ). While individual nurses, often through their workplace and professional associations, engage in upstream efforts to impact health equity, there have been repeated calls from within the nursing community for more nurses to engage in informing public policy to improve health outcomes for individuals and populations.

Delaware Cancer Consortium.

• CONCLUSIONS

In the coming decade, the United States will make substantial progress in achieving health equity only if it devotes resources and attention to addressing the adverse effects of SDOH on the health of underresourced populations. As 2030 approaches, numerous initiatives to address health equity are likely to be launched at the local, state, and national levels. Many of these initiatives will focus on health care equity. Yet, while expanding access to quality care is critical to reducing disparities and improving health outcomes, such efforts need to be accompanied by additional efforts to identify and change the social institutions, dynamics, and systems underlying health inequities from the local to the national level. Nurses can contribute to reshaping the landscape of health equity over the coming decade by serving in expanded roles, working in new settings and new ways, and partnering with communities and other sectors beyond health care. Some nurses are already working in roles and settings that support health equity and are engaged in educating about and advocating for health equity through their professional associations. Nonetheless, broader engagement as a core activity of every nurse will help advance health equity nationwide. To achieve this aim will require

• support for and the willingness of the nursing workforce to take on new roles in new settings in the community;
• consistency in nurses’ preparation for engaging in downstream, midstream, and upstream strategies aimed at improving health equity by addressing issues that compromise health, such as geographic disparities, poverty, racism, homelessness, trauma, drug abuse, and behavioral health conditions;
• more experiential learning and opportunities to work in community settings throughout nursing education to ensure that nurses have skills and competencies to address individuals’ complex needs and promote efforts to improve the well-being of communities;
• nursing education that goes beyond teaching the principles of diversity, equity, and inclusion to provide sustained student engagement in hands-on community and clinical experiences with these issues;
• funding to support new models of care and functions that address SDOH, health equity, and population health; and
• evaluation of models to build the evidence needed to scale programs and the policies and resources necessary to sustain them.

These issues are discussed in the chapters that follow. Programs described in this chapter, such as the Camden Coalition and the Edge Runner initiatives, are exemplars of the kind of multidisciplinary, multisector efforts that will be necessary to address the complex needs of individuals and communities and make a lasting impact by eliminating health disparities, with the goal of achieving health equity. Central to these future efforts, however, are parallel efforts that evaluate and provide the evidence base on which to determine the effectiveness of models. One of the greatest challenges this committee faced was finding evidence directly linking the efforts of nurses to address social needs and SDOH to reductions in health disparities that would signal improved population health outcomes and health equity. Such evidence is essential to informing payment policy decisions that can ensure the sustainability of and nurse engagement in these models (discussed further in Chapter 6 ). Through evidence, the nursing profession can leverage its own potential, and the public, other professionals, and other sectors can understand the impact and value of such nursing engagement.

Conclusion 5-1: Nurses are in a position to improve outcomes for the underserved and can work to address the structural and institutional factors that produce health disparities in the first place. Conclusion 5-2: Nurses can use their unique expertise and perspective to help develop and advocate for policies and programs that promote health equity.

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These five domains of social needs are part of the Centers for Medicare & Medicaid Services’ Accountable Health Communities Model ( Fraze et al., 2019 ).

Health in All Policies (HiAP) is a collaborative approach that integrates health considerations into policy making across sectors. It recognizes that health is created by a multitude of factors beyond health care and in many cases, beyond the scope of traditional public health activities. In accordance with HiAP, for example, decision makers in the health care sector should consider transportation, education, housing, commerce, and other sectors impacting communities. HiAP stresses the need to work across government agencies and with private partners from these different sectors to achieve healthy and safe communities. It also encourages partnerships between the health care sector and community developers, for example ( CDC, 2016 ).

• Cite this Page National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): National Academies Press (US); 2021 May 11. 5, The Role of Nurses in Improving Health Equity.
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How to Become a Registered Nurse Explicatory Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Unfortunately, the role of nurses is often underestimated, despite the fact that these healthcare professionals must have a great number of skills and competences such as excellent knowledge of medicine, ability to communicate with people of various backgrounds, leadership, quick decision-making and, most importantly, compassionate attitude toward the patient.

Without these qualities, one definitely should not start a nursing career, as it will be a disaster both for him and his patients. This paper aims to discuss those standards and expectations that registered nurses (RN) have to meet on a daily basis. Furthermore, it is necessary to show the steps which a person should take, if he/she wants to become an RN.

In order to write this essay, I have interviewed Kathie Shankley, a close friend of mine and a practicing nurse. She agreed to speak about her work in a community hospital. She believes that the most difficult thing for her is the wide scope nurse’s duties. My friend says, “It sometimes seems to me that I must do more than ten things at a time”.

Judging from this statement, one can assume that a registered nurse must be able to prioritize the tasks in terms of their importance and urgency. Moreover, a nurse must be able to keep ones composure in critical moments. In Kathie’s view, a person, who does not have these abilities, “should think twice or even thrice” whether he wants to pursue a career in medicine or not. The thing is that there are moments when you have to act on the spur of the moment, and not everyone can do it.

Another thing, which Kathie finds particularly challenging, is the necessity to find an approach to every patient. She points out that “language barrier can really be a great obstacle sometimes”. According to Kathie, if a person is bilingual, he/she will really have an advantage over others.

Thus, it is quite possible to argue that cross-cultural education is of great importance for all medical workers, not only nurses. This is one of the reasons why medical students should study a foreign language. This is particularly relevant for such country as the United States, where people can speak Spanish, Italian, Russian and so forth. The knowledge of foreign language can be of great avail for an RN, although this is not a must.

Moreover, a registered nurse must be well-aware of the most recent research findings as this knowledge can greatly improve the quality of patient care. The thing is that treatment methods constantly evolve, a healthcare professional must always read books and academic journal in order to “stay in the forefront and be in the know”, as Kathie noted.

She also urged future nurses not to overlook their math classes because a RN has to know how to analyze statistical data. This is one of those skills, which one has to acquire, if he/she intends to take this career path. Kathie says that many nurses fail to achieve professional growth, because they do not take much interest in the on-going medical research.

Although, being a registered nurse is very prestigious, one must bear in mind that the responsibilities of these people are much heavier because they work in intensive care units and operation rooms and supervise the activities of other nurses. To become an RN, one should obtain Master’s or at least Bachelor’s degree.

Again, as it has been mentioned before, a nurse must be versed in many areas of study: medicine, psychology, chemistry, pharmacology statistics and so forth. Without appropriate academic background, one can hope of becoming an RN. Kathie believes that the would-be students should carefully evaluate the training programs, offered by various schools of nursing as this choice can greatly impact their professional growth as well as salary.

During our conversation, I have also asked Kathie about the rewards of this profession or those things which bring joy and satisfaction. I intentionally avoided asking questions about monetary compensation, as I was more interested in the reasons why people decide to pursue the career of a nurse.

I am not quite sure that Kathie’s answer was very elaborate; she said, “I just wanted to help people who are ill, and I’m really glad when they recover”. After a moment of hesitation she added “You know, it’s one of those things that are very difficult to explain”. Therefore, we can presume that an RN ought to feel compassion for the patient, and this is one of those in-born qualities which can be neither acquired nor elaborated.

In this paper I have tried to single out those skills, competencies and psychological traits that a student must have in order to become a registered nurse. There are as follows: 1) excellent knowledge of various interrelated disciplines; 2) ability to communicate with people of various cultural and ethnic origins; 3) cool-headedness; 4) willingness to improve one’s professional skills and 4) genuine desire to help other people. One can hardly imagine an RN or other healthcare giver without these properties.

• Areas of Potential Liability for the Advanced Practice Nurse
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• Chicago (A-D)
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IvyPanda. (2018, September 7). How to Become a Registered Nurse. https://ivypanda.com/essays/how-to-become-a-registered-nurse/

"How to Become a Registered Nurse." IvyPanda , 7 Sept. 2018, ivypanda.com/essays/how-to-become-a-registered-nurse/.

IvyPanda . (2018) 'How to Become a Registered Nurse'. 7 September.

IvyPanda . 2018. "How to Become a Registered Nurse." September 7, 2018. https://ivypanda.com/essays/how-to-become-a-registered-nurse/.

1. IvyPanda . "How to Become a Registered Nurse." September 7, 2018. https://ivypanda.com/essays/how-to-become-a-registered-nurse/.

Bibliography

IvyPanda . "How to Become a Registered Nurse." September 7, 2018. https://ivypanda.com/essays/how-to-become-a-registered-nurse/.

• Systematic Review
• Open access
• Published: 30 August 2024

A scoping review of stroke services within the Philippines

• Angela Logan 1 , 2 ,
• Lorraine Faeldon 3 ,
• Bridie Kent 1 , 4 ,
• Aira Ong 1 &
• Jonathan Marsden 1  

BMC Health Services Research volume  24 , Article number:  1006 ( 2024 ) Cite this article

Metrics details

Stroke is a leading cause of mortality and disability. In higher-income countries, mortality and disability have been reduced with advances in stroke care and early access to rehabilitation services. However, access to such services and the subsequent impact on stroke outcomes in the Philippines, which is a lower- and middle-income countries (LMIC), is unclear. Understanding gaps in service delivery and underpinning research from acute to chronic stages post-stroke will allow future targeting of resources.

This scoping review aimed to map available literature on stroke services in the Philippines, based on Arksey and O’Malley’s five-stage-process.

Summary of review

A targeted strategy was used to search relevant databases (Focused: MEDLINE (ovid), EMBASE (ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO (ebsco); broad-based: Scopus; review-based: Cochrane Library, International Prospective Register of Systematic Reviews (PROSPERO), JBI (formerly Joanna Briggs Institute) as well as grey literature (Open Grey, Google scholar). The searches were conducted between 12/2022-01/2023 and repeated 12/2023. Literature describing adults with stroke in the Philippines and stroke services that aimed to maximize well-being, participation and function were searched. Studies were selected if they included one or more of: (a) patient numbers and stroke characteristics (b) staff numbers, qualifications and role (c) service resources (e.g., access to a rehabilitation unit) (d) cost of services and methods of payment) (e) content of stroke care (f) duration of stroke care/rehabilitation and interventions undertaken (g) outcome measures used in clinical practice.

A total of 70 papers were included. Articles were assessed, data extracted and classified according to structure, process, or outcome related information. Advances in stroke services, including stroke ready hospitals providing early access to acute care such as thrombectomy and thrombolysis and early referral to rehabilitation coupled with rehabilitation guidelines have been developed. Gaps exist in stroke services structure (e.g., low number of neurologists and neuroimaging, lack of stroke protocols and pathways, inequity of stroke care across urban and rural locations), processes (e.g., delayed arrival to hospital, lack of stroke training among health workers, low awareness of stroke among public and non-stroke care workers, inequitable access to rehabilitation both hospital and community) and outcomes (e.g., low government insurance coverage resulting in high out-of-pocket expenses, limited data on caregiver burden, absence of unified national stroke registry to determine prevalence, incidence and burden of stroke). Potential solutions such as increasing stroke knowledge and awareness, use of mobile stroke units, TeleMedicine, TeleRehab, improving access to rehabilitation, upgrading PhilHealth and a unified national long-term stroke registry representing the real situation across urban and rural were identified.

This scoping review describes the existing evidence-base relating to structure, processes and outcomes of stroke services for adults within the Philippines. Developments in stroke services have been identified however, a wide gap exists between the availability of stroke services and the high burden of stroke in the Philippines. Strategies are critical to address the identified gaps as a precursor to improving stroke outcomes and reducing burden. Potential solutions identified within the review will require healthcare government and policymakers to focus on stroke awareness programs, primary and secondary stroke prevention, establishing and monitoring of stroke protocols and pathways, sustainable national stroke registry, and improve access to and availability of rehabilitation both hospital and community.

What is already known?

Stroke services in the Philippines are inequitable, for example, urban versus rural due to the geography of the Philippines, location of acute stroke ready hospitals and stroke rehabilitation units, limited transport options, and low government healthcare insurance coverage resulting in high out-of-pocket costs for stroke survivors and their families.

What are the new findings?

The Philippines have a higher incidence of stroke in younger adults than other LMICs, which impacts the available workforce and the country’s economy. There is a lack of data on community stroke rehabilitation provision, the content and intensity of stroke rehabilitation being delivered and the role and knowledge/skills of those delivering stroke rehabilitation, unmet needs of stroke survivors and caregiver burden and strain,

What do the new findings imply?

A wide gap exists between the availability of stroke services and the high burden of stroke. The impact of this is unclear due to the lack of a compulsory national stroke registry as well as published data on community or home-based stroke services that are not captured/published.

What does this review offer?

This review provides a broad overview of existing evidence-base of stroke services in the Philippines. It provides a catalyst for a) healthcare government to address stroke inequities and burden; b) development of future evidence-based interventions such as community-based rehabilitation; c) task-shifting e.g., training non-neurologists, barangay workers and caregivers; d) use of digital technologies and innovations e.g., stroke TeleRehab, TeleMedicine, mobile stroke units.

Peer Review reports

Introduction

In the Philippines, stroke is the second leading cause of death, with a prevalence of 0·9% equating to 87,402 deaths per annum [ 1 , 2 ]. Approximately 500,000 Filipinos will be affected by stroke, with an estimated US$350 million to $1·2 billion needed to meet the cost of medical care [ 1 ]. As healthcare is largely private, the cost is borne out-of-pocket by patients and their families. This provides a major obstacle for the lower socio-demographic groups in the country.

Research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs in the Philippines have been cited as priorities [ 3 , 4 ]. Prior to developing, implementing, and evaluating future context-specific acute stroke management services and community-based models of rehabilitation, it was important to map out the available literature on stroke services and characteristics of stroke in the Philippines.

The scoping review followed a predefined protocol, established methodology [ 5 ] and is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews Guidelines (PRISMA-ScR) [ 6 , 7 ]. Healthcare quality will be described according to the following three aspects: structures, processes, and outcomes following the Donabedian model [ 8 , 9 ].The review is based on Arksey and O'Malley’s five stages framework [ 5 ].

Stage 1: The research question:

What stroke services are available for adults within the Philippines? The objective was to systematically scope the literature to describe the availability, structure, processes, and outcome of stroke services for adults within the Philippines.

Stage 2: Identifying relevant studies:

The following databases were searched. Focused: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO; broad-based: Scopus; review-based: Cochrane Library, Prospero, JBI (formerly Joanna Briggs Institute); Grey literature: Herdin, North Grey, Grey matters, MedRxiv, NIHR health technology assessment, Department of Health Philippines, The Kings Fund, Ethos, Carrot2. Additionally, reference lists of full text included studies were searched.

The targeted search strategy, developed in consultation with an information scientist, was adapted for each database (see supplemental data). Search terms were peer reviewed using the PRESS (Peer Review of Electronic Search Strategies) checklist [ 10 ].

The key search concepts from the Population, Concept and Context (PCC) framework were ≥ 18 years with a stroke living in the Philippines ( population ), stroke services aiming to maximize well-being, participation and function following a stroke ( concept ) and stroke services from acute to chronic including those involving healthcare professionals, non-healthcare related personnel or family or friends ( context ). Search tools such as medical subject headings (MESH) and truncation to narrow or expand searches were used. Single and combined search terms were included (see supplemental data). The search was initially conducted over two weeks in December 2022 and re-run in December 2023.

Studies were selected if they described stroke care in the Philippines in terms of one or more of the following: (a) patient numbers and stroke characteristics (b) staff numbers, qualifications and role (c) service resources (e.g., number of beds/access to a rehabilitation unit, equipment used) (d) cost of services and methods of payment (UHC, Insurance, private) (e) content of stroke care (f) duration of stroke care (hours of personnel contact e.g., Therapy hours per day); interventions undertaken (g) outcome measures used in clinical practice.

Additional criteria:

Context: all environments (home, hospital, outpatients, clinic, academic institute).

Date limits: published between 2002 onwards. This is based on the Philippines Community Rehabilitation Guidelines published in 2009 that would suggest that papers earlier than 2002 may not reflect current practice [ 11 ].

Qualitative and quantitative studies including grey literature.

Language: reported in English or Filipino only.

Publication status: no limit because the level of rigor was not assessed.

Type of study: no limit which included conference abstracts, as the level of rigor was not assessed.

Studies were excluded if they were in non-stroke populations or the full text article could not be obtained. Conference abstracts were excluded if there were insufficient data about methods and results.

Searches of databases were performed by one researcher (JM) and searches of grey literature were performed by one researcher (AO). All retrieved articles were uploaded into Endnote X9 software™, and duplicates identified and removed before transferring them to Rayyan [ 12 ] for screening.

Stage 3: study selection

The title and abstract were selected using eligibility criteria. Two pairs of researchers independently screened abstracts and titles;(Databases: JM and AL and grey literature by AO and LF). Where a discrepancy existed for title and abstract screening, the study was automatically included for full text review and discussed among reviewers.

Two reviewers (JM and AL) undertook full-text screening of the selected studies. Discrepancies were resolved through consensus discussions without the need for a third reviewer. There were no discrepancies that required a third reviewer. Reason for exclusion were documented according to pre-determined eligibility criteria. References of included full text articles were screened by each reviewer independently and identified articles were subjected to the same screening process as per the PRISMA-ScR checklist (Fig.  1 ).

PRISMA-ScR flow diagram

Stage 4: Charting the data

Two reviewers independently extracted the data using a piloted customized and standardized data extraction form including (1) Structure: financial (e.g., costs, insurance, government funding), resources (structure and number of stroke facilities, staff (number, profession/specialism, qualifications etc.), stroke characteristics (2) Process: duration of care, content of stroke care within acute, secondary care, community, outcome measures used; (3) Outcome: survival, function, patient satisfaction, cost (admission and interventions), and (4) year of publication, geographical location (including if Philippines only or multiple international locations) and type of evidence (e.g., policy, review, observational, experimental, clinical guidelines). Critical appraisal of included studies was not undertaken because the purpose of the review was to map available evidence on stroke services available within the Philippines.

Stage 5: Collating, summarising and reporting the results

The search identified 351 records from databases and registers. A total of 70 records are included and reasons for non-inclusion are summarized in Fig.  1 .

Study descriptors

The characteristics of included studies are shown in Supplementary Material Table 1. Of the 70 included studies, 36 were observational with most being based on a retrospective review of case notes ( n  = 31), two were audits, eight were surveys or questionnaires, four were consensus opinion and/or guideline development, three were randomized controlled trial (RCT) or feasibility RCT, 1 was a systematic review, two were policy and guidelines, 11 were narrative reviews or opinion pieces, two were case series or reports and one was an experimental study.

Of the 70 studies, 32 (45.7%) were based in a single tertiary hospital site. There were only three papers based in the community (4.3%). Papers that were opinion pieces or reviews were classified as having a national focus. Of the 22 papers classified as having a national focus, 10 (45.5%) were narrative reviews/ opinion pieces (Table 1 ).

The primary focus of the research studies (excluding the 11 narrative reviews and 2 policy documents) were classified as describing structure ( n  = 8, 14%); process ( n  = 21,36.8%) or outcomes ( n  = 29, 49.2%). The structure of acute care was described in seven studies out of eight studies ( n  = 7/8 87.5%) whilst neurosurgery structures were described in one out of eight studies (12.5%). Acute care processes were described in 11 out of 21 studies ( n  = 11/21 52.3%) whilst rehabilitation processes were described in six out of 21 studies (28.6%), with three out of 21 studies primarily describing outcome measurement (14.3%). The primary focus of the outcomes were stroke characteristics (25 out of 28 papers, 89.2%) in terms of number of stroke (prevalence), mortality or severity of stroke. Measures of stroke quality of life were not reported. Healthcare professional knowledge was described in two studies ( n  = 2/28 7.1%) whilst risk factors for stroke were described in one study ( n  = 1/28, 3.6%). Carer burden was described in one study ( n  = 1/28, 3.6%).

A summary of the findings is presented in Table 2 .

This scoping review describes the available literature on stroke services within the Philippines across the lifespan of an adult (> 18 years) with a stroke. The review has identified gaps in information about structures, processes and outcomes as well as deficits in provision of stroke services and processes as recommended by WHO. These included a low number of specialist clinicians including neurologists, neuro-radiographers and neurosurgeons. The high prevalence of stroke suggests attention and resources need to focus on primary and secondary prevention. Awareness of stroke is low, especially in terms of what a stroke is, the signs/symptoms and how to minimize risk of stroke [ 25 ]. Barriers exist, such as lack of healthcare resources, maldistribution of health facilities, inadequate training on stroke treatment among health care workers, poor stroke awareness, insufficient government support and limited health insurance coverage [ 22 ].

The scoping review also highlighted areas where further work is needed, for example, descriptions and research into the frequency, intensity, and content of rehabilitation services especially in the community setting and the outcome measures used to monitor recovery and impairment. PARM published stroke rehabilitation clinical practice guidelines in 2012, which incorporated an innovative approach to contextualize Western clinical practice guidelines for stroke care to the Philippines [ 42 ]. Unfortunately, availability and equitable access to evidence-based rehabilitation for people with stroke in the Philippines pose significant challenges because of multiple factors impacting the country (e.g., geographical, social, personal, environmental, educational, economic, workforce) [ 25 , 40 , 43 ].

The number of stroke survivors with disability has not been reported previously, thus, the extent and burden of stroke from acute to chronic is unknown. The recent introduction of a national stroke registry across public and private facilities may provide some of this data [ 82 ]. The project started in 2021 and captures data on people hospitalized for transient ischemic attack or stroke in the Philippines. National stroke registries have been identified as a pragmatic solution to reduce the global burden of stroke [ 83 ] through surveillance of incidence, prevalence, and outcomes (e.g., death, disability) of, and quality of care for, stroke, and prevalence of risk factors. For the Philippine government to know the full impact and burden of stroke nationally, identify areas for improvement and make meaningful changes for the benefit of Filipinos, the registry would need to be compulsory for all public and private facilities and include out of hospital data. This will require information technology, trained workforces for data capture, monitoring and sharing, as well as governance and funding [ 83 ].

This scoping review has generated a better understanding of the published evidence focusing on availability of stroke services in the Philippines, as well as the existing gaps through the lens of Donabedian’s Structure , Process and Outcome framework. The findings have helped to inform a wider investigation of current stroke service utilization conducted using survey and interview methods with stroke survivors, carers and key stakeholders in the Philippines, and drive forward local, regional and national policy and service changes.

Conclusions

This scoping review describes the existing evidence-based relating to structure, processes and outcomes of stroke services for adults within the Philippines. The review revealed limited information in certain areas, such as the impact of stroke on functional ability, participation in everyday life, and quality of life; the content and intensity of rehabilitation both in the hospital or community setting; and the outcome measures used to evaluate clinical practice. Developments in stroke services have been identified however, a wide gap exists between the availability of stroke services and the high burden of stroke in the Philippines. Strategies are critical to address the identified gaps as a precursor to improving stroke outcomes and reducing burden. Potential solutions identified within the review will require a comprehensive approach from healthcare policymakers to focus on stroke awareness programs, primary and secondary prevention, establishing and monitoring of stroke protocols and pathways, implementation of a compulsory national stroke registry, use of TeleRehab, TeleMedicine and mobile stroke units and improve access to and availability of both hospital- and community-based stroke rehabilitation. Furthermore, changes in PhilHealth coverage and universal credit to minimize catastrophic out-of-pocket costs.

Limitations

Although a comprehensive search was undertaken, data were taken from a limited number of located published studies on stroke in the Philippines. This, together with data from databases and grey literature, may not reflect the current state of stroke services in the country.

Availability of data and materials

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We acknowledge the TULAY collaborators: Dr Roy Francis Navea, Dr Myrna Estrada, Dr Elda Grace Anota, Dr Maria Mercedes Barba, Dr June Ann De Vera, Dr Maria Elena Tan, Dr Sarah Buckingham and Professor Fiona Jones. We are grateful to Lance de Jesus and Dr Annah Teves, Research Assistants on the TULAY project, for their contribution to some of the data extraction.

This research was funded by the NIHR Global Health Policy and Systems Research Programme (Award ID: NIHR150244) in association with UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK’s Department of Health and Social Care.

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Conceptualisation, methodology and setting search terms, AL, LF, AO, JM, BK. Searches and screening, AL, JM, LF, AO. Data extraction, AL, LF, AO, JM, LdJ, AT. Original draft preparation, AL, JM. All authors provided substantive intellectual and editorial revisions and approved the final manuscript.

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Logan, A., Faeldon, L., Kent, B. et al. A scoping review of stroke services within the Philippines. BMC Health Serv Res 24 , 1006 (2024). https://doi.org/10.1186/s12913-024-11334-z

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Received : 20 March 2024

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DOI : https://doi.org/10.1186/s12913-024-11334-z

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