Testimony of the American Organization for Nursing Leadership Prepared for the National Academy of Medicine’s Committee on the Future of Nursing 2020-2030

“Integrating Social Determinants of Health into Nursing Education, Research and Practice”

June, 7 2019


I am Mary Beth Kingston, president of the American Organization for Nursing Leadership (AONL), formerly known as the American Organization of Nurse Executives. I appreciate the opportunity to testify.

AONL is the national professional association of the more than 9,800 nurse leaders working in hospitals, health systems, academia and other settings across the care continuum. AONL is the voice of nursing leadership and a subsidiary of the American Hospital Association.

As health care transitions to a value-based system, the emphasis moves from treating illness to promoting health and wellness. This requires a systematic approach to the core challenges facing patient populations and building a diverse and inclusive nursing workforce, reflective of the community and patients served. Diversity and inclusion are critical to achieving health equity and reducing disparities in health care.

Role of the Nurse Leader

Recognizing and utilizing its unique contributions and perspectives, nursing has a mandate to transform care delivery across the continuum. The role of the nurse leader is to set the vision for nursing practice and foster an inclusive and diverse culture of innovation and transformation. Through strong nursing leadership, nurses will drive innovation - improving quality and patient outcomes, broadening access and reducing the cost of health care.

Nurse leaders support diversity and inclusion by advocating for the resources to meet the needs of their diverse patient populations. Practicing cultural humility and becoming culturally sensitive are critical components in reducing health care disparities and assuring a knowledgeable and competent workforce.

In addition to working to recruit and retain a diverse nursing workforce, nurse leaders create awareness of the social determinants of health, promote education and research initiatives. Improving the care we provide to diverse communities begins with understanding patient’s lives beyond where they access health care.

Partnering with Patients, Families and Communities

As patient advocates and trusted professionals, nurses are uniquely positioned to link patients to better health. Nurses in many hospitals and health systems are already screening patients for socio-economic risk factors and needs, and connecting patients and loved ones to community resources.

It is important nurses are aware of the cultural sensitivities and social inequalities people experience within their community. Nurses need to know how programs, practices and policies affect the health of individuals, families and communities, as well as the relevant agencies who can help. Nurses are solution-oriented, equipped with valuable knowledge and able to offer great insight.

Using Data-Driven Strategies

Understanding data related to the social determinants of health – including educational level, employment, transportation, problems related to home and work environments – is critical to improving the health of communities. Nurses need to refine their assessments to include the social factors affecting health and wellness in order to plan and implement effective interventions. By collecting and utilizing data, nurses will advance population health and improve clinical decision-making and the patient experience at lower costs.

As the focus of care moves to health and wellness, nurse leaders serve as agents of change in this strategic effort. They advocate for community health needs as well as the patient populations they serve. Championing data collection on how the social determinants of health affect a community, nurse leaders can help create the foundation of any program designed to improve the health outcomes of entire populations.

Engaging in Performance Improvement

As a personal example of the importance of engaging nurses in performance improvement, I can point to my own health system, Advocate Aurora Health, where I serve as chief nursing officer. Four of our hospitals implemented a nurse-led nutrition screening and education program for adult patients at risk for malnourishment that led to better outcomes and lower costs. This program reduced hospital readmission rates, lengths of stays and achieved over $4.8 million in savings.

Through evidence-based practice, nurse leaders use performance management tools to improve outcome measures, enhance the patient experience and reduce costs. Nurses are instrumental in achieving health equity and reducing disparities in health care.