How does social justice relate to nursing?

Social justice is practically inherent to nursing. In fact, Provision 8 of the Nursing Code of Ethics declares that “the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.”¹ From a historical perspective, many of the gains in nursing as a medical field have come out of efforts to improve the health of the community or vulnerable populations. From the 19th century focus on sanitation and hygiene to foster healthier conditions especially in poorer neighborhoods to public health projects during the COVID-19 pandemic to ensure access to care, testing and vaccines for marginalized groups, nursing consistently intersects with social justice topics, typically within the scope of health equity.

Social justice and health equity

Defined by the Encyclopedia Britannica as “the fair treatment and equitable status of all individuals and social groups within a state or society,” the term social justice is also applied to “social, political, and economic institutions, laws, or policies that collectively afford such fairness and equity and is commonly applied to movements that seek fairness, equity, inclusion, self-determination, or other goals for currently or historically oppressed, exploited, or marginalized populations.”² Health equity, or, the state in which everyone has a fair and just opportunity to attain their highest level of health, is essentially social justice in action when it comes to health care.

The Department of Health and Human Services explains that achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.³ These disparities can generally be categorized into the different social determinants of health (SDOHs): economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.

Nursing Code of Ethics on social justice

Nursing, like many health care professions, operates by a code of ethics to serve as a moral compass for workers in the field. The Code of Ethics for Nurses with Interpretive Statements (Code of Ethics) was developed in the 1950s and has been amended over time to include technological advances, societal changes and other developments in the field.⁴ The Code of Ethics includes clear provisions about caring for patients but it also asks nurses to think beyond the bedside and consider their responsibility to advancing health care and social justice by developing ethical awareness.

The American Nurses Association (ANA) categorizes the principles found in the Code into four groups: autonomy, beneficence, justice and nonmaleficence. These four principles work in concert to treat patients and their choices and values with respect, fairly and impartially treat patients regardless of age, ethnicity, economic status, religion, or sexual orientation and to avoid and minimize harm.⁴

Provision 8 of the Nursing Code of Ethics states “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy and reduce health disparities.” The provision is further divided into four points to hone in on these crucial responsibilities:¹

1. Health is a Universal Right: This point aligns with the United Nations, the International Council of Nurses and human rights treaties across the world. It affirms the fundamental human right to access to health care, emergency care, sanitation, health education, treatment, and prevention.
2. Collaboration for Health, Human Rights and Health Diplomacy: Acknowledging the unique and essential role of nurses, this point encourages nurses to connect health care with legislation, policies, projects and programs to improve health. As the ANA states, “Ethics, human rights, and nursing converge as a formidable instrument for social justice and health diplomacy that can be amplified by collaboration with other health professionals.”
3. Obligation to Advance Health and Human Rights and Reduce Disparities: This point declares, “Nurses should collaborate to create a moral milieu that is sensitive to diverse cultural values and practices.” It encourages innovation in solutions to health disparities and dismantling of unjust structures and processes. It also pushes taking action with health legislation and public education.
4. Collaboration for Human Rights in a Complex, Extreme, or Extraordinary Practice Settings: This part of the provision stresses the importance of upholding human rights in all scenarios, even when practicing in extreme settings like war, in pandemics, political turmoil, and environmental or natural disasters. It also encourages nurses to be aware of their moral justifications of all of their actions.

Having an expectation of upholding ethical standards within your profession in the name of social justice can feel like a weighty responsibility. But it also is helpful to have a clearly defined vision for equality that can be used as a guide when determining how to proceed when put into complex situations as a health care professional.

Contemporary social justice efforts in nursing

Today, achieving health equity is at the core of countless not-for-profits, community clinics, public health efforts, and the missions of many large health institutions. Some topics of focus for these efforts include:

• Reducing the rate of Black maternal mortality
• Syringe Services Programs
• Health care for immigrants
• Access to care, especially for minority race populations and lower income neighborhoods and for the LGBTQ+ community
• Ample care and resources for people with disabilities

What nurses can do to further social justice

Like all individuals, nurses can be change agents by responding to racism when they experience or see it occur. There are also many ways both in a clinical context and non-clinical that nurses can take action.

Clinical social justice methods

While working with patients, nurses can screen for social needs and attempt to address determinants of health that might be lacking in a patient’s life. That way they can help connect the patient with social services or create care plans to address their needs. It’s also important for nurses to become educated on the populations they serve and be sure to have an understanding of diverse cultures, how those groups interact with medical personnel and how their beliefs might require different types of treatment or language used and how to foster trust. Of course nurses can also work on or lead the clinical arms of public health efforts like harm reduction, community outreach and more.

Non-clinical social justice methods

As lifelong learners, nurses can also further their understanding of implicit and unconscious bias, as well as cultural competency in health care through continuing education efforts. They can also act as leaders within their own institutions to develop cultures of inclusivity both on the staff and for the patients. Nurses also play a crucial role as educators both professionally and as trusted voices in social settings. Additionally, nurses can advocate for policies at the local, state, and national level that address health equity, which will not only improve well-being now, but also continue to lay the foundation for better health in the future.

Nursing’s history of social justice

Prior to the Civil Rights Movement in the 1960s, discrimination based on race, gender, and more was both legal and accepted as the cultural norm of society. The actions, policies and beliefs from that time have certainly had a hand in the health disparities nurses work against today. But the concept of promoting social justice through nursing is nearly as old as the profession itself. From the early days of nursing, people like Florence Nightingale, Mary Seacole, Clara Barton and Lavinia Dock were advocates for improving the health disadvantaged groups. Two distinct and related examples are how nurses worked to further both the Civil Rights Movement and the social justice efforts of the 2020s.

Nursing and the Civil Rights Movement

Until 1964, hospitals were like most other institutions and were segregated based on race. Even hospitals in the North, although not formally segregated, prevented Black physicians from holding attending privileges at white hospitals and often encouraged Black patients away from the facilities to see Black doctors instead. Even once hospitals became more integrated, Black patients and nurses were often treated poorly. Highly-educated Black nurses were relegated to elementary tasks and Black patients were regarded by white doctors with disrespect.⁵

Looking back at the time following the passing of the Civil Rights Act, some people credit nurses with really pushing through change as they acted as vigilant whistleblowers against hospitals and facilities that weren’t complying with integration orders. In an article from Minority Nurse Magazine David Barton Smith, PhD, author of Health Care Divided: Race and Healing a Nation, details the constant struggles to actually enact integration within hospitals:⁵

If a hospital tried to circumvent the inspections, nurses would get on the telephone and call either the NAACP, one of its local chapters, the Office of Civil Rights or the Office of Equal Health Opportunity in Washington, Smith explains. In other instances, inspectors would meet secretly with Black nurses the day before inspections to get briefed about floor plans with segregated locations, such as nurses’ changing rooms or lunch rooms. Otherwise, hospital tours could be very selective, he says.

Some facilities tried to get away with what Smith calls “the HEW (Department of Health, Education and Welfare) shuffle.” For example, he says, hospital employees would temporarily integrate infant bassinets so that when inspectors came through the nurseries “they would see little Black faces and white faces next to each other. Then, as soon as the inspectors left, they’d pick them up and separate them again…”

Black nurses also led social justice efforts when it came to desegregating nursing schools (at OCU we have an annual celebration of one of these nurses, Opaline Deveraux Wadkins) and even the ANA. To be a member of the ANA, nurses also needed to be members of their state nursing association, many of which prohibited Black membership. Efforts by the National Association of Colored Graduate Nurses as well as encouragement from the national level of the ANA eventually led to dissolution of “color bans” in state associations and therefore the organization itself.⁵

Nursing and the 2020 social justice movement

After months of stress, uncertainty and fear from the COVID-19 pandemic, the summer of 2020 boiled over with unrest after a series of unjust murders of Black people by police officers in the United States. This marked a critical point in history as Black Lives Matter became a household phrase illustrated by sustained protests, removal of historical monuments considered pillars of racism, and a renewed consideration of police misconduct and systemic racism by individuals and organizations across the globe.

Health care and nursing were not excluded from this reckoning and on August 4, 2020, the American Academy of Nursing (Academy) and the ANA issued a statement on the urgent need for social justice to address prevalent racism and discrimination. Citing Provision 8 from the Nursing Code of Ethics, the Academy and ANA declare that, “The profession’s code exemplifies our promise to advocate for safe and healthy communities. This advocacy extends to all individuals..[and requires that] nurses “practice with compassion and respect for inherent dignity, worth, and unique attributes of every person.”⁶ It also acknowledges that health care institutions have historically been a part of the problem and that change has to start with every individual person, “We must remove areas of bias that perpetuate negative behaviors and reinforce harmful stereotypes and stigmas. This extends to those biases held by nurses and other health care providers. Working together, health professionals, public health officials, health care and industry leaders, system administrators, and policy makers, can confront and directly address these behaviors along with the unfair practices that lead to discrimination…”⁶

Choose a university that shares your passion for a healthy future

Nursing is a field with tremendous potential to make a difference–both within your own community and across the globe. Make your impact go further when you earn an advanced degree in nursing at a university committed to social justice. Oklahoma City University’s online RN-BSN, RN-MSN and MSN programs are led by faculty with experience in affecting change through efforts to achieve health equity. Talk to an Admissions Advisor to learn more.