When the American Nurses Association (ANA) published the fourth edition of Nursing: Scope and Standards of Practice (ANA, 2021), one of the previous standards was updated to Standard 9: Respectful and Equitable Practice. This standard states that “The registered nurse practices with cultural humility and inclusiveness” (ANA, 2021, p. 93). In addition, this standard is a requirement for all ANA-associated specialty standards.
Some of the competencies in this standard address the nurse’s responsibility to demonstrate respect and equity in all interactions, reflect upon personal and cultural values and beliefs, address the effects and impact of discrimination within and among diverse groups, serve as a role model for cultural humility, and advocate for policies that promote health among diverse healthcare consumers. This issue of ANA-Ohio News Journal focuses on respectful and equitable practice, a core ethical principle of nursing practice. Contributing authors have addressed aspects and examples of respectful and equitable practice.
Cultural humility refers to recognizing diversity and power imbalances among individuals, groups, or communities. Responses to those imbalances are open, self-aware, egoless, flexible, respectful, and supportive. Cultural humility is a process of critical self-reflection, resulting in mutually positive outcomes (Foronda, 2020). Cultural humility goes beyond cultural competence and includes a commitment to lifelong learning and providing dignity and respect to all individuals regardless of race, sexual orientation, background, or socioeconomic status. Inclusion means creating environments where everyone feels valued, respected, and empowered.
In today’s healthcare environment, equity, diversity, and inclusion (EDI) principles are more relevant than ever in nursing practice. Nurses, who serve as frontline caregivers, educators, researchers, managers, administrators, and in other roles, encounter individuals from a wide range of cultural, social, and economic backgrounds. Further, nursing leaders must act to ensure a diverse nursing workforce, “creating a workplace that embraces diversity” (ANA, 2023). Integrating EDI principles into daily practice ensures high quality care and fosters a respectful and equitable environment for both patients and colleagues.
The ANA Code of Ethics (ANA, 2015) calls for respect of human dignity and the commitment to social justice. The nine provisions of the code describe “the ethical values, obligations, duties, and professional ideals of nurses individually and collectively” (ANA, 2015 p. viii). The provisions address the nurse’s values, commitment, and accountability to self and others, as well as obligations at the societal level. Acknowledging and addressing health disparities, advocating for underserved populations, and confronting implicit biases are essential to upholding these values.
Further, ANA-Ohio has prioritized equity, diversity, and inclusion as one of the values identified in the strategic plan, defined as three interconnected principles that aim to create a fairer and more supportive environment in organizations, communities, and society (T. Bukoffsky, personal communication, November 16, 2024). ANA-Ohio also has a standing committee focused on EDI, which is charged with strategizing to promote EDI within the ANA-Ohio organization, leading the creation of position statements to address EDI, reviewing evidence, and proposing actions to address issues around EDI in healthcare (ANA-Ohio, 2024).
Respect is not only a cornerstone of equity, diversity, and inclusion, but it is also an imperative in social justice. As nurses, we need to honor our social contract with society by addressing the social determinants of health (SDOH) and providing nonjudgmental care to all individuals with whom we interact. Social determinants of health, such as housing, education, and access to nutritious food, significantly influence well-being. Nurses who act on these determinants contribute to reducing health disparities and promoting overall community health.
As nurses, we need to acknowledge our implicit biases (unconscious attitudes or stereotypes) and recognize how they may influence interactions with others and potentially create inequities in care. Respectful and equitable practice requires ongoing commitment and actions. Nurses must challenge themselves to confront biases, advocate for systemic change, and embrace diversity in their patients and peers.
Respectful and equitable practice is not a destination, but a journey of continuous growth. By embracing EDI, nurses can lead the way in creating a healthcare environment where every individual is valued, disparities are reduced, and inclusion is celebrated.
References
American Nurses Association. (2015). Code of ethics with interpretive statements. American Nurses Association; Nursebooks.org. https://NursingWorld.org
American Nurses Association. (2021). Nursing: Scope and standards of practice. (4th Ed.). American Nurses Association; Nursebooks.org. https://NursingWorld.org
American Nurses Association. (2023). How nurse leaders can promote diversity in nursing. Retrieved from https://www.nursingworld.org/content-hub/resources/workplace/promote-diversity-in-nursing/
ANA-Ohio (2024) ANA-Ohio Bylaws. (Article VI, Section 1. d.) Retrieved from https://ana-ohio.org/About-us
Foronda, C. (2020). A theory of cultural humility. Journal of Transcultural Nursing, 31(1), 7-12. https://doi.org/10.1177/1043659619875184
