Nursing Leaders Driving Health Equity - Part 1

In this episode, Dr. Steven Palazzo hosts Drs. Deborah Finn-Romero, Megan Jester, and Sara Kaylor to discuss their contributions to the book, Nursing Leaders Driving Health Equity: Tackling Social and Structural Determinants of Health. The book, developed by the inaugural NLN/Walden Social Determinants of Health & Social Change Leadership Academy cohort, offers practical tools for nurse educators and leaders to address health inequities. The guests stress the need to shift from cultural to structural competence and to empower nurses to drive systemic change through leadership and policy influence. Ultimately, the book serves as a practical, reflective resource for fostering inclusive, equity-driven nursing education and leadership.

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Transcript

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[Music][Music] Welcome to this episode of NLN podcast Nursing EDge Unscripted. I'm your host,  Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. In  this episode, we will discuss the book "Nursing Leaders Driving Health Equity Tackling Social  and Structural Determinants." My guests today are Dr. Deborah Finn-Romero, Dr. Sarah Kaylor,  and Dr. Megan Jester, three members of the inaugural NLN Walden University College of  Nursing Institute for Social Determinants of Health and Social Change who were contributors  to this book. This book can be purchased on the NLN website through the NLN bookstore.  I'd like to welcome my guests. Thank you very much Steven. Great to be here. We're happy to  have all three of you. So just to start with just please discuss the significance of your book. I  have a copy of it right here. That's it. I'll hold it up again so that everybody can see it. Well I guess I'll start and Sara and Megan will I'm sure jump in and have things to say  for sure. Actually, the work came out of our cohort with the NLN and Walden University and it really  was inspired by one of our our colleagues there that really felt like in order to encapsulate all  of the projects that were we were moving forward with and taking on to really address issues around  social determinants of health and health equity that we should just pull it together and create  a book. And so you know we were sitting in a room of expertise and really, really motivated and  passionate individuals and I'm really grateful to Phyllis Morgan. She's our colleague that  inspired this for putting it out on the table and we just really tapped each other's  expertise and wealth and came together in one collective voice to share it for the communities.  It, you know, there's so much going on out there that doesn't necessarily represent the the social  issues around health and this was something very specific for nursing, for nursing education, for  nursing leaders to help encapsulate some real usable tools to get out into our profession. I  absolutely agree. I think that at the time of our cohort with the leadership academy, you  know, we were kind of coming off of the pandemic and we know that pandemic did not create health  inequities but it certainly worked to expose those in ways that our group just could no longer  ignore. And so the book that came out of our cohort really was intended to meet that moment.  The book calls us to go beyond what we've always done, beyond just simply recognizing disparities  and really wanted to challenge and empower people to address the structures that produce  those disparities. So really it was meeting that moment, that shift from cultural competence to  structural competence that the book describes, is really where the work begins I feel like  because it's really not just about understanding our patients lives but also understanding and  challenging and changing the systems that shape those lives. And I would add on by saying that  we all came to that space from different parts of the country. We represented coast to coast. We  represented different backgrounds, different lived experiences and we came together to provide these  anchor points that we could disseminate to our broader nursing community and really laying the  foundation in this book for solutions-oriented approaches to tackling these issues. So making it  not just theoretical but actionable. Wonderful. Absolutely. I think, I think to piggyback off of  what Megan was saying, I think absolutely the work of this book and the work of the cohort was  100% tied to leadership. Our experiences in the academy really helped hone in and emphasize if  not develop a unique set of skills, those skills of advocacy, policy engagement, systems thinking, all  of these skills were kind of reflected throughout the book in a way that doesn't use those words  to mean that they're just buzzwords but instead they're competencies and that this book really  helps leaders build those competencies. Yeah and the process that we went through in the academy  had a lot of crucial conversations in it. It had us really engaged with the complexities as maybe  a little bit of a microcosm of what goes on in the broader range of society tackling uncomfortable  situations, uncomfortable topics to really dig into the nuance and reflect and hear one another to  come together as a collective, as one voice, and the book represents really what that one voice  is as a way to move forward in complexity around equity issues. Provide us with your insight on the  importance of the introductory chapter. You know, I ask guests who come frequently to the podcast how  do we use your information? How do we practically use it in the classroom? Because there's a lot of  great ideas out there and a lot of, like you said, buzzwords and information, but we sometimes lose  that just like in the clinical space, right. We use that translational piece from the research  and then to the actual implementation. What I think is so great about this book is that,  especially the first chapter and going back to the introduction, is what I want you to speak  to, but the first chapter and we'll get to that in the next question, is how practical it is as a  tool to develop curriculum and use it to generate outcomes for student learning in these subject  matters. And you get great examples and things like that. So the first question is basically talk about  the introductory chapter and the importance of setting that up and then the usefulness of this  in the classroom for the the instructor or the professor who wants to use the information. Sure.  I'd love to tackle that first part and then I'll bounce it to a colleague for the second part, but  I think, you know, the first sentence of the book is it, you know, "This [chapter] focuses on  the interconnectedness between the individual, the family, and the community..." And I think that that  right there, that interconnectedness, is the heart of social and structural determinants of health.  These are not just isolated issues; instead they are very layered, multi-faceted, complex and often  invisible issues to those who benefit from the way that things are. I feel like that sentence  of that first chapter really sets the stage then for the book in terms of why the book centers on  collaboration. Collaboration not just in a cohort of leaders who are writing and collaborating on  the project together, but collaboration on ... it's not just nursing versus medicine or versus public  health, it's all of us. It's interdisciplinary. It's interprofessional. It's intersectional. And  that's also why I think advocacy has a theme in every chapter of the book as well because nurses  have always been advocates. It's what we do. But here the book calls us to scale that advocacy up  to the institution, to the state, and to the national level. And I'll speak to the  key terms in the introduction because we really thoughtfully reflected on what we needed in this  book beginning in the introduction to establish that shared vocabulary around these challenging  and complex concepts to really operationalize these concepts and provide that evidence-based  background to define these so that reader can really understand the why behind these definitions  as they go on to the subsequent chapters. Process that theoretical information and then also process  those case studies and reflect on how they can turn around and use these case studies to apply  in their classroom, but also scale up to meet the needs of their communities. Yeah and just to follow  with that a little bit Megan and Steven. The way that the book is structured is outlined in the  introduction and so it talks about call to action. So they're usable tools as Megan's speaking of.   We give examples of case studies. We give ways that that the topics have been implemented in  communities. So we have the first chapter, as you referred to, on curriculum. So these are some usable  ways that you can build into a classroom how you want to start tackling these concepts and bringing  these issues forward to the student body. There's a chapter on administration. There's a chapter on  clinical partnerships. There's a chapter on research and dissemination of knowledge and  then clinical practice. There's one specifically on clinical practice. So all of these chapters really  represent real life experience that has been brought forward as examples of ways that it can  be carried out in whatever field of nursing that the nursing leaders are participating in. Well expand on a little bit of that. What I really wanted to expand on is talking a little bit more  about, too, the how nurse education can use this book. So segueing into that because I'm actually  considering using it as my book, my textbook for my leadership course that will be a new course  that we developed that will be starting this fall. I think it's an interesting leadership course  in Florida, you know, we have to be careful about the language we use for course titles.  So it's leadership for systems care. You know, the word equity is not in the title so there are  challenges right now with the current political climate of some of the buzzwords and how we can  use and facilitate this type of curriculum in more challenging environments. Boy that sounds like a  Sarah and Megan question. You know, Sacramento State is all in on doubling down on use of DEI.  We're quite public about it. We're quite open about it, but I know Megan and Sarah are in states  that are bit a little bit less open to those terms right now so. And I'm in Florida yeah. So you  are too. Yeah. Yeah. So what do you think, Megan and Sarah? How do you want to address these issues? I think it's a challenge that we're going to see unfold. It's unfolding and continue to unfold and  it's not something that can have a very simple and easy fix. In terms of how to use the book,  you know, whether you're a faculty member or you know a practice partner, I almost see individuals  using the book as a companion particularly in that faculty role. If you're using this, you know use it  as a course companion. The book can serve as a lens to help revise curriculum. It can be used  as a lens to help review policies and also to help individuals just rethink their assumptions.  So a lot of times that work can happen behind the scenes. We know ... we know we're promoting  the work that we're doing without having to explicitly call it things that you know might be  frowned upon at certain institutions. But a group of faculty members could certainly use this as a  companion when they're looking at their policies to determine which policies support equity, what  might be unintentionally maintaining barriers for admissions. I think one of the examples provided  in the book does look at holistic admissions and speaks to making sure that there aren't  unintentional structural barriers that might be at play. I also think it's so important as nurses  in all areas of practice to be very mindful of the ever-changing landscape not just within your  local or state communities but across the country. We really, in some states where we do have state  legislation or executive orders that are are targeting words. We have to phone a friend in  another state for additional resources, additional training and we hope that this book can be that  resource. And it really begins with us at an individual level. So looking at the end of  the introduction chapter ... and subsequent chapters, there's reflection questions  and you can use those as an individual to really look at your own bias, your own assumptions, your own  privilege and transform that mindset, but also using it in your classroom, you know.  For example, I think the reflection questions at the end of the introductory chapter are a  great way to have a conversation at the end of a clinical day in post-conference with your clinical  group or at the pre-licensure level but also scaffolding it to the graduate level if you are  rounding and you have driven a few hours to see a student like you would in my state  and spend some time with them and talk about the work that they are doing in that local community  and thread those reflection questions in. And there are ways to be that you can be strategic,  being mindful of the state you live in. Whether you can say the words out loud or you just you  have to be strategic with how you say that, but it really doesn't take, it's not taking away from the  work that we are doing. We are just having to pivot for the time being to meet the needs. Yeah.  It's such an integral part of nursing is to provide care for all people and I think that  it is so challenging in our current political climate to stand as nurses in that position  of what our work is, but yet it's a crucial component. And I really want to just take a  minute to acknowledge Sarah and Megan and my colleagues that are in states that have this  at the state level, not just the federal level of what we're currently looking at, and there's  you know, the pressure on universities right now is big. And to respond to that in a way that  doesn't harm academic freedom, that doesn't harm the integrity of a discipline  and a profession has to be done with care and thoughtfulness. And I really in some ways I  feel real fortunate where I'm at, but in other ways there's a whole other set of potential  consequences for the position that we take. But the bottom line is is as nurses, as nursing educators,  we have a duty to our population. We have a duty to our patients. We have a duty to our communities  no matter what. And I think that our cohort fully stands behind that regardless of what's happening  in any level of society outside of health care. We're going to be here for all people.  And the book really gives us, it gives educators, it gives the community a roadmap on how to engage  with those communities and whatever language is necessary to utilize to still fulfill that purpose  that will have to be navigated. But the actual implementation of it is available in the book.  We have tangible tools in here too and I love the fact that Megan talked about the reflection  questions because even if you're in a group and you're trying to figure out how to grapple with  these concepts where we're getting such conflicted messages from other parts of society, this is a  way to have a conversation around these crucial necessary happenings in our society.  I'm looking for the right word to describe this. You can see Sarah's like, "Yeah I can hear it Deb."  But the complexity of what we're living in today. Right, right. All right. Well, what a ... that's a great  way to end the conversation is we have a duty. And this book, you know, I found it very useful reading  through it and very engaging and offering lots of opportunities for us to figure out how to use  our language to incorporate this into our our classes and courses when we're talking from  the perspective of a student in a university setting or college setting. And so I want to thank  you for joining us so much for this important conversation. I really appreciate your time and  your expertise and helping us understand your work and how we can actually start using  some of your work in our own institutions. And to our listeners, please, please look for the book,  "Nursing Leaders Driving Health Equity Tackling Social and Structural Determinants," on the NLN  website. And I want to thank everyone for joining us today. Thank you so much Steven.[Music]