While nursing workforce issues nationwide, and especially in Maryland with its high density of health care organizations, have existed since long before 2020, the COVID-19 pandemic amplified the challenges, and demand for nurses has reached a fever pitch as the United States scrambles to fill vacancies. The 2022 Maryland Action Coalition (MDAC) Virtual Leadership Summit, hosted by the University of Maryland School of Nursing (UMSON) on May 23, took a deep dive into workforce challenges and opportunities with its theme “Optimizing Maryland’s Nursing Workforce.”

The content, offered through a full day of live virtual programming to about 150 attendees, focused on cultivating a diverse and skilled workforce, preparing nursing students to meet future health care needs, and exploring strategies for retention. Special emphasis was placed on the importance of addressing the social determinants of health, a key concept undergirding the National Academy of Medicine’s The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, a report that outlines a goal of achieving health equity in the United States over the next decade, based on strengthened nursing capacity and expertise.

It builds on the foundation set by the 2010 report The Future of Nursing: Leading Change, Advancing Health. MDAC was formed in 2011 in response to that report and serves as the driving force transforming health care through nursing in the state. Recognizing the important work already underway in Maryland and with a goal of long-term sustainable change, the coalition leads the way to improve the health of the population.

“Some of the key themes of The Future of Nursing 2020-2030 report include the need to address social determinants of health, reduce health disparities, and address inequities in our health system,” Jane M. Kirschling, PhD, RN, FAAN, the Bill and Joanne Conway Dean of the University of Maryland School of Nursing, said in her opening remarks. Kirschling serves as co-chair of MDAC with Patricia Travis, PhD, RN, CCRP, senior associate director of clinical trials at Johns Hopkins Medicine.

“These are not new challenges but were certainly brought into sharper focus as a result of the disparate impact of the COVID-19 pandemic on selected populations,” Kirschling added. “Another outcome of the pandemic has been the significant toll it’s taken on nurses and other health care providers throughout the country, particularly the level of moral distress and burnout experienced by nurses on the front lines of care delivery.”

Kirschling also acknowledged the state of Maryland’s “enormously successful” efforts to meet the goals of the previous report, including increasing the number of baccalaureate- and doctorally prepared nurses, establishing the Maryland Nursing Workforce Center to address the need for better workforce data, reducing practice barriers for advanced practice nurses, and increasing the diversity of the nursing workforce.

She then moderated a fireside chat, “Managing the Present, Creating the Future” with the chief nursing officers of the three largest health care systems in the state:

• Deborah Baker, DNP, APRN, NEA-BC, FAAN, senior vice president for nursing, Johns Hopkins Health System, and vice president for nursing and patient care services and chief nursing officer, Johns Hopkins Hospital
• Susan Eckert, MSN, RN, NEA-BC, senior vice president and chief nursing officer, MedStar Health
• Lisa Rowen, DNSc, RN, CENP, FAAN, chief nurse executive, University of Maryland Medical System.

The three responded to questions regarding leadership lessons from the COVID-19 pandemic, the dichotomy between autonomy and standardization, and efforts to address nurses’ moral distress and Maryland’s health inequities.

“I was struck when I read a Bureau of Labor Statistics report in December that projected that by 2030 we will be short in the United States 1.5 million nurses; that is a staggering number,” Rowen said. “In addition, last week, I learned from Vizient that in their recent study about nurse turnover across the country, they have noted a doubling of nurse turnover since 2019. So, between the nursing shortage and the rampant growth of turnover, we need to think as a profession about what we can do about many things, including the health and wellness of nurses, and how we can embed that into our cultures.”

After the fireside chat, a set of keynote speeches highlighted how nurses can play a role in advocacy beyond the bedside and in advancing health equity.

“Over the last 26-plus months since we have been affected by COVID, never has it been more important for nurses to be in leadership and advocacy roles than now,” said Ernest J. Grant, PhD, RN, FAAN, president of the American Nurses Association (ANA), delivering the morning keynote, “The Future of Nursing: Leadership, Advocacy, and Activism in Action.”

“We advocate for our patients and for public health when we’re in the workplace and in our communities, but legislative and political advocacy is no less important in advancing the profession and in patient care as well,” Grant said. “I think this pandemic has proven to nurses the importance of using their voice, to advocate for the resources that they need for their fellow man, for their communities, in order to help us get over this crisis that we are in.”

Grant said the pandemic shined a light on something nurses always knew existed but was exacerbated during the health crisis: health care disparities, which result in communities of color having higher rates of COVID-19 infection and related death.

“To remain silent is to be complacent,” Grant said. “We must bring health to health care.”

To that end, ANA has joined with other national nursing organizations to create the National Commission to Address Racism in Nursing. “We decided we needed to explore racism in nursing and to create a national action plan to guide diversity, equity, and inclusion efforts within the profession,” he explained.

Grant also encouraged nurses to use their voices and influence to educate others about systemic injustice, health, inequity, and health disparities and to advocate for their own mental, physical, and spiritual well-being.

In the afternoon keynote, “Poised for Impact: Nurses Advancing Health Equity,” Kupiri “Piri” Ackerman-Barger, PhD, RN, CNE, ANER, FAAN, associate dean of health equity, diversity, and inclusion and clinical professor at the University of California Davis Betty Irene Moore School of Nursing, praised The Future of Nursing 2020-2030 report for focusing on diversity, inclusion, and health equity, areas that were lacking in the 2010 report, she said.

“What the new Future of Nursing report is saying is that we have a moral and ethical obligation to begin to break down the structures that continually perpetuate the same outcomes year after year, decade after decade,” she said.

Health inequity manifests in many forms, from an inability to pay for health care, to a lack of transportation to get to appointments, to a lack of health care providers in particular communities. But don’t simply call these issues health disparities, Ackerman-Barger cautioned.

“I’m going to say that the term health disparity is really a euphemism,” she said. “What we’re looking at is structural violence. By people not having access to care that is available, we are allowing people to be harmed and to die over and over and over.”

Acknowledging there is no one solution, Ackerman-Barger said increasing diversity in the nursing workforce would be particularly helpful.

“We want to make sure that underheard voices are heard,” she said. “And so, we can use our voices to uplift the voices of those that are not heard. But even better than that is to use our voices to make sure that people are at the table with us so that their actual voices can be heard when those decisions are being made.”