Educating Nurses as Leaders Who Promote Health Equity through Social Change

Monday, 9 November 2015

Catherine Y. Read, PhD, RN
Debra M. Pino Betancourt, MA, BS
Connell School of Nursing, Boston College, Chestnut Hill, MA, USA

Nurse educators have a responsibility to prepare graduates as leaders whose actions will contribute to the achievement of health equity. The Social Change Model (SCM) can provide a framework for a lifelong developmental process of leadership identity that is congruent with nursing’s social policy agenda. The SCM asserts that leadership is a collaborative, service-oriented, values–based process that is about effecting change on behalf of society. It posits that leadership includes people in positional and non-positional roles, views leadership as a process rather than a position, and promotes equity, social justice, self-knowledge, service and collaboration. The seven values of the SCM cluster across individual (consciousness of self and others, congruence, commitment), group (collaboration, common purpose, controversy with civility), and societal (citizenship) domains.

When societal health equity is at stake, participation of underrepresented and underresourced students is a key to the ultimate effectiveness of leadership development initiatives. A climate of inclusivity within the university and a broad definition of diversity are essential components of meaningful programs. At the program level, best practices should include open discussions about definitions of labels and the underlying assumptions about student aptitudes. The seeds of leadership for social change need to be planted early and cultivated throughout a nurse’s education. Activities need to be sequenced to meet student’s developmental needs over time and consider specific influences that may vary by race, ethnicity, gender, sexual orientation, age, and socio-economic status. It is important to recognize that a student’s leadership self-efficacy can be nurtured through activities beyond those of “positional leadership.” Equally important is the notion that leadership is important for all nurses- not just those in formal leadership roles.

Leadership development initiatives should extend into co-curricular and extracurricular activities that are supervised or mentored by faculty and nurse leaders. Evidence suggests that high-impact practices that can shape college students’ capacities for socially responsible leadership fall into four categories: sociocultural conversations, mentoring relationships, community services and membership in off-campus organizations. These categories, grounded in the tenets of the Social Change Model, provided guidance for the activities in our nursing student leadership development program. Specific examples include:

 1) Sociocultural conversations: small group meetings where nurse leader, faculty, alumnae/i and staff facilitators address how all nurses can advocate for the vulnerable and underserved to influence health and social policy agendas and facilitate dialogue around socio-cultural issues in the clinical settings; required written reflections and blogposts about program activities; opportunities for language and cultural immersion; student participation in the school’s diversity advisory activities; open classroom and clinical discussions on sociocultural issues; alliances with multicultural organizations on campus.

 2) Mentoring relationships: required meetings with assigned faculty mentor with follow up written reflection; developmental mentoring experience whereby upperclassmen are guided as they provide mentorship for underclassmen; leverage other mentoring opportunities on campus, such as research fellowships and student organization involvement.

 3) Community service: involve students in local health fairs/flu clinics; encourage participation in service immersion opportunities; seek clinical placements in nontraditional clinical settings within the community.

 4) Membership in off-campus organizations: State and National Student Nurses Association and local chapters of the National Black Nurses Association, National Association of Hispanic Nurses, Asian American and Pacific Islander Nurses Association, et al. are eager to engage students and provide opportunities for networking, professional growth, and sociocultural reflection. Other organizations receptive to student involvement include the Institute for Healthcare Improvement, Peer Health Exchange, American Red Cross, etc.

Social change is an active, long term process that begins with insight and is realized through skills that can be taught and developed in a nursing program and carried forward in one’s career and as a citizen of society. Nurse educators are in a prime position to cultivate leadership for social change through intentional student programs that recognize the developmental nature and need for inclusivity in student formation. The next challenge will be to define and track specific outcomes that would demonstrate the long-term effectiveness of socially responsible leadership development programs; those outcomes should reflect the participants’ activities that are aimed at reducing health disparities, promoting social justice, and contributing to the betterment of society.