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The purpose of this manuscript is to examine traditional models of leadership in nursing, and to provide a roadmap and specific recommendations for nurses at all levels to lead our profession through the next decade in achieving health equity. We examine current leadership frameworks in nursing and discuss ways to contemporize these frameworks to more explicitly center the expertise of clinicians and communities from historically marginalized backgrounds. Next, we examine the racial, gender, and able-bodied biases that impact nurses, and call upon nurses to examine and dismantle these biases. We discuss the roles of health systems and academic organizations in developing inclusive leaders, including through community engagement and true service-learning partnerships. Finally, we provide a set of recommendations for all nursing leaders across career stages to embrace inclusivity as they work to improve health equity., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients. Purpose: To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI. Methods: We conducted a sequential explanatory mixed-methods study of 252 (62 with SMI) Thrive participants discharged from an academic medical center from February 2021 to August 2023. Interviews of participants with SMI were analyzed using rapid qualitative analysis. Results: Participants with and without SMI experienced similar rates of 30-day readmissions, emergency room visits, and postdischarge follow-up visits, with these differences being nonsignificant. Participants with SMI were highly satisfied with Thrive's care coordination and attention to social needs, yet participants suggested stronger connections to behavioral health care. Conclusions: Participants with and without SMI benefit equitably from Thrive. [ABSTRACT FROM AUTHOR]

Background: Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery. Purpose: To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so. Methodology: We conducted focus groups and interviews of Black NPs (N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis. Results: Emergent themes included: Strategies Utilized to Address Health Inequities; Burnout & the Minority Tax; Risks & Rewards of Taking a Stance; and Uneven Promises of Organizational Engagement. Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, micro aggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles. Conclusions: Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care. Implications: The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery. [ABSTRACT FROM AUTHOR]

Nursing burnout remains a public health crisis. However, few stakeholders have considered the disproportionate toll of burnout among nurses of color, including nurses identifying as Black, Hispanic/Latino, or Native American. We convened a one-day conference, titled Solutions to Health Inequities and Nurses' Emotional Exhaustion (SHINE), to begin identifying contributing factors and solutions to burnout amongst nurses of color. SHINE included plenaries, small group discussions, and breakout sessions with nearly 40 expert stakeholders from around the country. We employed a deliberative dialogue (DD) methodology to identify key takeaways and implications for research, practice, and policy. High-priority solutions included: improving the work environment and nurse staffing, reducing stigma against nurses seeking mental healthcare, addressing workplace racism as a root cause of nurse burnout, and increasing support for nurses experiencing racism at work. Key priorities identified through SHINE offer a roadmap for nurse leaders to address burnout through an equity-centered lens. • Few stakeholders have considered the unique toll of burnout among nurses of color. • We held a 1-day convening to identify solutions to burnout among minoritized nurses. • SHINE participants identified contributing factors and actionable solutions. • SHINE offers a call to action for nurse leaders to address burnout with an equity lens. [ABSTRACT FROM AUTHOR]

Background: Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse practitioners (NPs) and physician assistants (PAs) or among prescription of nonopioid analgesic strategies. Purpose: To identify patient characteristics associated with opioid and nonopioid prescriptions among Veterans Affairs (VA) chronic pain patients by primary care physicians, NPs, and PAs. Methodology: We used data from the VA's Survey of Health care Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Outcomes included opioid and nonopioid analgesic prescriptions. Patient characteristics included race/ethnicity, gender, education level, age, and clinical characteristics (comorbidities, self-reported health, and self-reported mental health). Logistic regression was performed to test for associations of patient characteristics with outcomes. Results: Patients who were White, male, age 41-64 years, and with no postsecondary education had higher odds of receiving an opioid prescription (all p-values # .01), whereas patients who were Black, female, and <65 years old had higher odds of a nonopioid prescription (all p-values < .01). Having 5+ comorbidities and fair/poor self-reported health increased the odds of opioid and nonopioid prescriptions (all p-values < .01). Conclusions: Disparities in race, gender, and educational level significantly affect how primary care NPs, PAs, and physicians manage chronic pain. Implications: NPs and other primary care providers should pursue training opportunities to identify and mitigate potential biases that may affect their practice. Future research should take an intersectional lens in examining the source of chronic pain disparities. [ABSTRACT FROM AUTHOR]

Although more people than ever are seeking primary care, the ratio of primary care providers to the population continues to rapidly decline. As such, registered nurses (RNs) are taking on increasingly central roles in primary care delivery. Yet little is known about their characteristics, their work environments, and the extent to which they experience poor job outcomes such as nurse burnout. The purpose of this study was to examine the characteristics of the primary care RN workforce and analyze the association of the nurse work environment with job outcomes in primary care. Cross-sectional analysis of survey data representing N = 463 RNs who worked in 398 primary care practices, including primary care offices, community clinics, retail/urgent care clinics, and nurse-managed clinics. Survey questions included measures of the nurse work environment and levels of burnout, job dissatisfaction, and intent to leave. Approximately one-third of primary care RNs were burnt out and dissatisfied with their jobs, with the highest risk of these outcomes among RNs in community clinics. Community clinic RNs were also significantly more likely to be Black or Hispanic/Latino, hold a Bachelor of Science in Nursing, and speak English as a second language (all p <.01). Across all settings, better nurse work environments were significantly associated with lower levels of burnout and job dissatisfaction (both p <.01). Primary care practices must be equipped to support their RN workforce. Adequate nursing resources are especially needed in community clinics, as patients receiving primary care in these settings frequently face structural inequities. • Registered nurses (RNs) work in various primary care settings, such as office-based practices, clinics, and retail care. • RNs in community clinics had the highest rates of burnout, and were more likely to be Black or Hispanic/Latino (p<.01). • Compared to poor environments, RNs in better work environments had lower odds of burnout and higher odds of job satisfaction. [ABSTRACT FROM AUTHOR]