Nurses Hold the Key to Solving Health Inequity

Nurses Hold the Key to Solving Health Inequity

The United States spends $3.5 trillion on health care each year. That is more than any other country on Earth. And yet Americans die younger, have more preventable diseases, and face wider gaps in care based on race and income than people in virtually every other wealthy nation (Schneider et al., 2021). Something is broken. But the fix may not come from doctors, insurers, or politicians. According to a landmark report from the National Academy of Medicine, the people best positioned to repair this system are the ones already trusted most: nurses.

The report, "The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity," was released in May 2021, at the tail end of a pandemic that had killed hundreds of thousands of Americans and exposed every fault line in the country's health infrastructure (Hassmiller & Wakefield, 2022). The authors, Susan B. Hassmiller and Mary Wakefield, do not mince words. They argue that nurses are not just frontline workers. They are the single most underused resource for dismantling health inequity in America.

Why Nurses Are the Right People for This Job

The case starts with a simple fact. Nurses are the most trusted profession in the United States. Year after year, Gallup polls put them at the top. People trust nurses more than doctors, more than teachers, more than scientists. That trust matters because health inequity is not just about access to care. It is about who people will listen to, who they will open up to, and who they will believe when told that their living conditions are making them sick.

Nurses are also the first point of contact for most people seeking health care (Pittman, 2019). They work in schools, community health centers, workplaces, and homes. They see patients not just in hospital beds but in the contexts where health actually happens. A doctor might see a patient for fifteen minutes in an exam room. A nurse might spend an hour with that same patient, learning about their housing, their job, their stress, their access to food.

The report argues that this position gives nurses a unique vantage point. They can see the social determinants of health up close. They know which families are struggling, which neighborhoods lack grocery stores, which patients are skipping medications because they cannot afford them. And they are trained to do something about it.

The Scope of Practice Problem

Here is where the frustration sets in. Nurses in the United States are often legally barred from doing the very things they are trained to do. State and federal laws, insurance policies, and hospital regulations restrict what nurses can prescribe, diagnose, and treat. This is called scope of practice restrictions, and it varies wildly by state.

The report calls for these restrictions to be permanently removed. Why? Because the evidence is clear that nurse practitioners provide care that is comparable to physicians in quality, and they are more likely to care for vulnerable populations, including people in rural areas and communities of color (Perloff et al., 2019; Yang et al., 2020). They are also less expensive to employ, which means they can expand access without breaking the budget.

About 70 to 80 percent of advanced practice nurses work in primary care, including pediatrics, adult practice, gerontology, and nurse midwifery (Barnes et al., 2018). Meanwhile, the number of physicians entering primary care has stagnated or declined. The math is simple. If you want more people to see a provider when they need one, you let nurses practice to the full extent of their education and training.

During the COVID-19 pandemic, many states temporarily lifted scope of practice restrictions. The result was that nurse practitioners could quickly step in to fill gaps in care. Patients got seen. The system did not collapse. The report argues that these emergency measures should become permanent.

The Diversity Problem in Nursing

Here is an uncomfortable truth that the report does not shy away from. The nursing workforce in the United States is roughly 80 percent white. That is a problem when you are trying to care for a diverse population. Patients of color often have better health outcomes when they are treated by providers who share their racial or ethnic background. They are also more likely to trust those providers and to follow their advice.

The report calls for a massive diversification of the nursing workforce. This is not just about fairness. It is about effectiveness. Nurses of color report experiencing racism within their own workplaces, and they are more likely to leave the profession as a result (Iheduru-Anderson, 2021). The report recommends that nursing schools and health systems actively recruit and retain students and nurses from underrepresented backgrounds. It also calls for addressing the institutional barriers that keep people of color out of nursing education, including financial barriers, lack of mentorship, and biased admissions processes.

The authors point out that the nursing profession has a history of exclusion. For decades, Black nurses were barred from many nursing schools and hospitals. That legacy persists today. The report calls for a reckoning with that history and for concrete steps to build a workforce that reflects the population it serves.

How Nurses Can Actually Reduce Health Inequity

The report lays out specific roles that nurses can play. These are not abstract ideas. They are concrete actions backed by evidence.

First, nurses can screen patients for social needs. This means asking about housing, food security, transportation, and safety. It means connecting patients to social services, not just prescribing medication. Studies show that when nurses do this, patients have better health outcomes and lower rates of hospitalization.

Second, nurses can work in schools. There are roughly 50 million children in U.S. public schools, and many of them do not have access to a school nurse. The report notes that school nurses are critical for managing chronic conditions, catching developmental delays, and providing mental health support. They also serve as a point of contact for families who might otherwise fall through the cracks of the health system.

Third, nurses can work in community health centers. Federally qualified health centers serve more than 30 million patients, many of whom are uninsured or underinsured. These centers rely heavily on nurse practitioners and other advanced practice nurses. Expanding their role in these settings could dramatically improve access to care for underserved populations.

Fourth, nurses can advocate for policy change. The report calls on nurses to use their expertise to push for policies that address the social determinants of health, such as affordable housing, living wages, and paid sick leave. Nurses have credibility. When they speak up, people listen.

What the Research Does Not Prove

It is important to be clear about what this report does not claim. It does not say that nurses can solve health inequity on their own. The authors are explicit that nurses need to work in partnership with other health professionals, social workers, community organizations, and policymakers. Health inequity is a structural problem. It requires structural solutions.

The report also does not prove that removing scope of practice restrictions will automatically eliminate disparities. The evidence shows that nurse practitioners provide high quality care and expand access, but access alone is not enough. People also need affordable housing, healthy food, safe neighborhoods, and living wages. Nurses can help connect patients to these resources, but they cannot create them.

Finally, the report does not address the question of whether the current nursing education system is adequately preparing nurses for these expanded roles. The authors call for changes to nursing curricula, but they acknowledge that more research is needed to determine which educational approaches are most effective.

The Burnout Crisis Nobody Is Talking About

Here is the paradox at the heart of the report. Nurses are being asked to do more, but they are already exhausted. The pandemic pushed many nurses to the breaking point. They worked double shifts. They watched patients die alone. They experienced moral injury from being unable to provide the care they knew was needed. And they did all of this while facing shortages of personal protective equipment and inadequate support from their employers.

The report is blunt about this. It says that prioritizing nurse well being is paramount to advancing any of the other recommendations. You cannot ask burned out nurses to take on new roles in health equity if they are barely surviving their current ones.

The data is stark. Studies have found that nurses who experience poor physical and mental health are more likely to make errors and to leave the profession (Melnyk et al., 2018). The nursing shortage was already a problem before the pandemic. It is worse now. The report calls for health care organizations to create cultures that support nurse well being, including adequate staffing, mental health resources, and opportunities for professional growth.

This is not just about being nice to nurses. It is about the bottom line. When nurses leave, hospitals have to spend money recruiting and training replacements. Patients suffer. And the system becomes less capable of addressing health inequity.

What Needs to Change

The report makes nine major recommendations. They fall into four broad categories.

First, remove barriers to care. This means eliminating scope of practice restrictions, expanding telehealth, and ensuring that nurses can practice across state lines. It also means addressing the financial barriers that prevent people from seeing a provider in the first place.

Second, value nurses' contributions. This means paying nurses fairly, giving them a seat at the table in decision making, and protecting them from burnout. It also means recognizing that nurses are not just task completers. They are professionals with expertise that should be respected.

Third, prepare nurses to tackle health equity. This means changing nursing education to include training on social determinants of health, cultural competence, and health policy. It means giving nurses the tools they need to address the root causes of illness, not just the symptoms.

Fourth, diversify the workforce. This means actively recruiting and retaining nurses from underrepresented backgrounds. It means addressing the racism that persists within nursing education and practice. And it means creating pathways for advancement so that nurses of color can move into leadership positions.

What This Actually Means

Here is the bottom line. This report is not a gentle suggestion. It is a blueprint for action. Here is what it means in practice.

• ▸If you are a state legislator, remove scope of practice restrictions for nurse practitioners. The evidence is clear that this expands access to care without reducing quality. It is one of the most cost effective policy changes available.

• ▸If you run a hospital or health system, invest in nurse well being. That means adequate staffing, competitive pay, mental health support, and a culture that values nurses as professionals, not just bodies to fill shifts.

• ▸If you are a nursing educator, redesign your curriculum to include training on social determinants of health, health equity, and community engagement. Nurses need to know how to ask about housing and food security, not just how to take blood pressure.

• ▸If you are a nurse, use your voice. You are the most trusted profession in the country. That trust gives you power. Advocate for policies that address the root causes of poor health. Speak up about the conditions in your workplace. And support your colleagues who are struggling.

• ▸If you are a patient or a community member, pay attention to who is caring for you. Support policies that let nurses do their jobs. And recognize that health is not just about what happens in a doctor's office. It is about where you live, what you eat, how much stress you carry, and whether you have someone you trust to help you navigate it all.

The report ends with an aspirational vision. It imagines a future where health equity is not just a goal but a reality. That future will not happen on its own. It will require changes to laws, to institutions, to education, and to culture. But the starting point is clear. The people who can lead this change are already in the room. They are wearing scrubs. And they are ready to work.