Nurses can’t choose who they care for.

Q I’ve become increasingly concerned by the growing number of patients experiencing homelessness who’ve been coming to our clinic. How can I get involved to offer a nurse’s perspective and expertise to support these patients and find solutions for the unhoused population in my community?

A Nursing care for people who are unhoused is complex and challenging and requires that nurses understand not only the scope of the issue but also the barriers to care these individuals’ experience. Lack of transportation, clean water, and electricity, as well as discrimination, poverty, and inadequate access to and trust in healthcare providers contribute to the increased risk of poor health, disease, and death associated with being unsheltered.

The Department of Housing and Urban Development defines homeless as an “individual or family who lacks a fixed, regular, and adequate nighttime residence.” Individuals who stay in a shelter or sleep in a place not meant for human habitation, such as a car, may be considered homeless. Unfortunately, homelessness continues to rise. In January 2023, over 650,000 people were unhoused on a given night, compared to approximately 580,000 in January 2022—a 12% increase in just 1 year.

Provision 8 of the Code of Ethics for Nurses with Interpretive Statements (the Code) considers patients living without housing through the lens of human rights and social justice and encompasses social determinants of health and human dignity (nursingworld.org/coe-view-only). As nurses, we instinctively advocate for our patients no matter our workplace or practice specialty. Doing so requires that we pay special attention to the rights of vulnerable populations, such as the elderly, the mentally ill, prisoners, refugees, children, and patients experiencing homelessness.

Some nurses may feel they lack agency to make a difference—not so! Our credibility and expertise enable us to lead and collaborate with colleagues from across healthcare on issues such as addressing health disparities and removing barriers to care. Optimizing nurses’ scope of practice and fighting to ensure that we practice to the full extent of our licensure will facilitate access to healthcare for people who are unhoused.

To be effective, we must embrace opportunities to partner with organizations, churches, and community groups, supporting their efforts to find solutions for unsheltered populations. Provision 9 of the Code explores how nurses, “through our professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.” Professional nursing associations work to enhance their advocacy efforts by engaging nurses in these initiatives at all levels of government.

As nurses, we’re uniquely qualified and poised to offer expertise, collaboration, and leadership that advance health and human rights and reduce disparities among unsheltered individuals and other vulnerable populations.

— Response by Annmarie Muñana, DNP, MSN, MJ, RN, member of the ANA Ethics and Human Rights Advisory Board

American Nurse Journal. 2024; 19(12). Doi: 10.51256/ANJ122428

References

Centers for Disease Control and Development. About homelessness. May 6, 2022. cdc.gov/orr/homelessness/about.html

Centers for Disease Control and Development. Homelessness and health. April 17, 2023. cdc.gov/orr/homelessness/index.html

McWilliams L, Paisi M, Middleton S, et al. Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness. J Adv Nurs. 2022;78(11): 3587-3606. doi:10.1111/jan.15387

Morris G. Nursing care for patients experiencing homelessness: Tips & resources. NurseJournal. March 28, 2024. nursejournal.org/articles/nursing-care-homeless-patients

National Alliance to End Homelessness. State of homelessness – Archives. September 22, 2022. endhomelessness.org/resource/archived-state-of-homelessness

U.S. Department of Housing and Urban Development. Criteria and recordkeeping requirements for definition of homelessness. January 2012. hudexchange.info/resource/1974/criteria-and-recordkeeping-requirements-for-definition-of-homeless