Racial and Ethnic Disparities in Health Care Essay

Racial and Ethnic Disparities in Health Care Essay

Racial and Ethnic Disparities in Health Care Essay

Nurse staffing ratios directly affect the quality and safety of patient care. Patient outcomes are usually a reflection of the nurse-to-patient ratios. When nurses are assigned more patients than the recommended, they get a high workload, leading to burnout and increasing the risk of missed nursing care. Unsafe nurse-to-patient ratios are associated with poor patient outcomes like complications, medical errors, falls, pressure ulcers, prolonged length of stay, and readmissions. Various approaches have been suggested and implemented to increase nurse staffing ratios and improve the quality of patient care. Mandate staffing ratios have been adopted in California, and policy proposals have been made in other states to have the same. Mandate public reporting is also used, whereby hospitals must report and disclose their nurse staffing patterns to the public. Some states also have mandated hospitals to avail their staffing plans for each area in patient care to the public, which forces them to improve their staffing ratios. Furthermore, staffing committees have been adopted to develop nurse staffing plans incorporating skill mix per patients’ needs.

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Background

Nurse staffing is the process of determining the number of nurses each unit in a hospital requires for optimal operations. The staffing process starts with evaluating the current staffing situation, including the qualifications and competence of the nurses available. One of the staffing models is the Nurse-Patient Ratio model, whereby the number of nurses per the number of patients or patient days determines the staffing levels (Mitchell et al., 2018). The number of nurses is allocated on a per-patient basis. Safe nurse staffing is vital to the nursing profession and health care system. Staffing levels affect nurses’ ability to deliver safe and quality care in all patient care settings. A growing body of evidence confirms that safe nurse staffing leads to enhanced patient outcomes and increased satisfaction for patients and nurses.

There is no one-size-fits-all regarding nurse-to-patient ratio since different patient care settings have different numbers of patients with varied healthcare needs. The decision on the optimal nurse-to-patient ratios for a particular hospital unit depends on various factors, including the number of admissions, discharges, and transfers during a shift, the intensity of patients’ needs, level of experience of nurses, unit layout, and availability of resources, like support staff and technology (Mitchell et al., 2018). Consequently, policies on mandate nurse staffing ratios have been rejected in most states in the US. California is the only state with mandatory nursing ratios; even so, the policy has not demonstrated any significant impact in improving patient outcomes (Dierkes et al., 2022). Legislators argue that mandated staffing ratios fail to identify the complexity and diversity of different healthcare environments.  

Impact of Nurse to Patient Ratio on Healthcare

The US health care system faces vast challenges that hinder the achievement of safe nurse-to-patient ratios. The greatest challenges in nursing staff shortages are caused by an increasingly aging population, cost-cutting decisions, increased patient care and needs complexity, and an aging nursing workforce. These factors contribute to unsafe ratios, which stress nurses’ working conditions and affect the quality of patient care and overall outcomes (McHugh et al., 2021). Furthermore, no federal mandates exist to regulate the number of patients a registered nurse (RN) can provide care to at one time. Consequently, RNs are time and again forced to care for more patients than is safe, which compromises patient care and negatively affects patient outcomes.

Various studies show that when nurses are forced to care for many patients at a time, there is an increased risk of avoidable complications, preventable medical errors, falls and injuries, pressure ulcers, prolonged length of stay, and readmissions. Furthermore, nurses experience high burnout rates and job dissatisfaction, which lead to high turnover rates causing more shortages. For instance, for every additional surgical patient in a nurse’s workload above the baseline ratio of 1:4, the chances of patient mortality within 30 days increase by 7% (McHugh et al., 2021). Besides, the turnover of nurses has financial implications for healthcare systems, with estimates for replacing a bedside nurse ranging from $20 561 to $88 000. Thus, eliminating unsafe nurse staffing ratios can significantly help provide better patient care. Safe nurse-to-patient ratios prevent nurses’ burnout and increase job satisfaction, lowering the turnover rate (Mitchell et al., 2018). This reduces spending on recruitment processes, hiring temporary nurses, and paying for overtime. In addition, safe nurse-to-patient ratios enhance the quality and safety of care, resulting in improved patient outcomes and reduced patient lengths of stay.

Literature Review

            Various studies have examined various approaches that can be employed to promote safe nurse-to-patient ratios. Han et al. (2021) examined whether alternative legislative interventions are effective in encouraging healthcare organizations to increase nurse staffing. One of the assessed approaches was staffing mandate, a policy that determines minimum nurse-to-patient staffing ratios for hospitals. To date, only California has a policy that mandates minimum staffing ratios for licensed nurses in all hospital units (Dierkes et al., 2022). The ratios are based on the type of patient care unit, which should reflect patient acuity. The policy allows hospitals in places with a low number of RNs to hire licensed practical nurses (LPNs) to provide basic nursing care and work under RN supervision.

Massachusetts also has mandated nurse staffing ratios, but the mandate only targets RNs in intensive care units. Studies on California’s staffing mandates demonstrate a positive effect of the mandates on RN and LPN staffing in hospitals with low nurse staffing. However, the approach has been associated with negative effects like challenges finding RNs due to inadequate supply, increased operational costs and budget cuts passed on to patients, and dismissal of ancillary staff (Dierkes et al., 2022). Besides, some studies have not found convincing evidence that the mandate in California has enhanced patient safety.

Another approach to promote safe nurse-to-patient ratios is mandating public reporting of nurse staffing levels. de Cordova et al. (2019) explain that mandate public reporting demands healthcare organizations to report and disclose their nurse staffing patterns to the public. Public reporting makes data about a hospital’s staffing comparable and readily available to patients, nurses, and hospital administrators. The data transparency that comes with this approach enables health consumers to make healthcare decisions based on hospital ratings. Dunt et al. (2018) found that public reporting may enhance care delivery as health providers can recognize underperforming areas, increase patients’ trust in the hospital, and support healthcare decision-making. In New Jersey, there was a slight increase in the number of RNs assigned to patients after implementing mandated reporting. However, there is inconsistent evidence on whether this approach improves patient safety and outcomes.

Enactment of a Patient Acuity Act is yet another approach that has been reviewed in the literature. Han et al. (2021) explain that this approach involves mandating a staffing plan available to the public for each area of patient care. The plan should be developed by a committee comprising at least 50% of bedside nurses. Besides, the committee should meet not less than twice a year to evaluate, review, adjust, and develop the staffing plan for each unit based on the typical patient population, staff factors, and unit and organizational factors. A staffing plan involves adjusting staffing by shift, based on the patient acuity and staff factors, to meet patients’ needs and desired outcomes (Han et al., 2021). Unlike mandate staffing, staffing decisions in this approach are made at the unit level, with participation from employees and leaders, to provide safe and the best possible patient care.

Another approach is creating a staffing committee, which involves healthcare organizations creating a committee comprising at least 50% direct care RNs. The approach also includes developing a nurse staffing plan incorporating a skill mix per the patients’ needs. The skill mix is usually measured as the ratio of RNs to the total licensed nurse staffing (Blankenhorn, 2018). Unlike mandate staffing ratios that assume all hospital units are the same, this approach appropriately addresses staffing levels. Besides, the frontline RNs take part in planning and deciding the skill mix and patients’ needs in different settings. Blankenhorn (2018) explains that the advantage of adopting the staffing committee approach is that it considers skill mix and patient needs in various healthcare settings. Furthermore, the staffing committees advocate for the rights of patients by insisting on safe staffing from the hospitals’ leadership. Nevertheless, the staffing committee approach may not result in higher RN staffing since this outcome depends on the nurses’ power within the healthcare organization.

Han et al. (2021) assert that neither staffing committee nor public reporting alone is associated with statistically significant increased nurse-to-patient ratios. However, public reporting seemed to have a positive impact on LPN staffing. One of the reasons why the staffing committee policy may not contribute to higher RN staffing links to the probable differences in nurses’ power within healthcare organizations. The policy does not give staffing committees control over the organization’s budget. If the hospital has limited resources, a committee may be driven to plan cuts on recruitment instead of increases.

Recommended Improvements In The Health Care Delivery System

Hospitals can achieve safe nursing staffing ratios by reducing nursing turnover rates to avoid shortages. Recommendations that hospitals can implement to reduce nursing turnover include limiting mandatory overtime, adopting current technology to improve workflow, delegating paperwork to ancillary staff to reduce nursing workload, and providing competitive compensation to nurses. In addition, I would recommend hospitals establish a staffing committee to allow them to take a collaborative approach to staffing (Blankenhorn, 2018). The committee should be given the mandate to provide input on scheduling procedures in the hospitals and staffing policies and make sure that these standards are constant across the entire hospital.

In addition, I would recommend hospitals develop a formal staffing plan that supports the standardization of care in each hospital unit. It also ensures that every patient is cared for by the nurse with the most appropriate skills for their condition. With a formal staffing plan, hospitals can ensure that they make staffing decisions that address the most common factors like the number of admissions and discharges, patient acuity, and nurses’ level of expertise (Dunt et al., 2018). Leaders should consult the direct-care nurses when developing the staffing plan since they have the best insight into patient flow and care delivery in the different hospital units. Bedside nurses can provide information on scheduling issues and offer suggestions for improved processes since the managers who create the staffing plan may not be aware of the unexpected events in the units.

Reflection On APN Competencies Related To Nurse To Patient Ratio 

The APN competencies related to nurse-to-patient ratio include clinical and professional leadership, expert coaching and advice, consultation, research skills, collaboration, and ethical decision-making skills. The APN can demonstrate clinical and professional leadership competency by leading and interacting with other nurses to identify ways the hospital can achieve better nurse-to-patient ratios (Schober et al., 2020). In addition, the APN can demonstrate expert coaching and advice by tailoring evidence-based interventions that can improve nurse staffing to meet patients’ needs. The consultation competency can be exhibited by the APN using knowledge from nursing-related disciplines to develop a comprehensive approach that will help improve nurse-to-patient ratios in respective hospitals. The research skills competency is demonstrated by the ability of the APN to intervene in researching interventions that can help increase nurse staffing levels (Schober et al., 2020). The APN should be part of the research team and help the team develop the evidence-based intervention. Besides, the APN should utilize evidence-based literature to influence the intervention to promote safe staffing ratios.

            The APN can demonstrate the competency in collaboration by partnering with other nurses to identify ways an organization can increase staffing levels to promote better care delivery. Lastly, the APN should exhibit competency in ethical decision-making skills by identifying potential areas that raise ethical concerns surrounding patient care caused by unsafe nursing staffing (Schober et al., 2020). The APN should advocate for interventions to be implemented to address these areas.

Conclusion

Safe nurse staffing is vital to the nursing profession and the overall health care system as it directly impacts the quality and safety of patient care. Staffing levels influence nurses’ ability to provide safe and quality care in all patient care settings. Unsafe staffing levels are associated with adverse outcomes like increased complications, medical errors, patient falls and injuries, pressure ulcers, prolonged length of stay, and readmissions. The identified approaches from the literature used to address nurse-to-patient ratios include mandating staffing ratios, mandating public reporting of nurse staffing, mandating a staffing plan, and adopting staffing committees. The APN should demonstrate competencies in clinical and professional leadership, expert coaching and advice, consultation, research skills, collaboration, and ethical decision-making skills to address the issue of nurse staffing.

References

Blankenhorn, A. (2018). Staffing committees: A safe staffing solution that includes engagement: With nurse input, this hospital strives for staffing satisfaction. American Nurse Today, 13(3), 56-58.

de Cordova, P. B., Pogorzelska-Maziarz, M., Eckenhoff, M. E., & McHugh, M. D. (2019). Public Reporting of Nurse Staffing in the United States. Journal of nursing regulation, 10(3), 14–20. https://doi.org/10.1016/S2155-8256(19)30143-7

Dierkes, A., Do, D., Morin, H., Rochman, M., Sloane, D., & McHugh, M. (2022). The impact of California’s staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis. Nursing Outlook, 70(2), 219–227. https://doi.org/10.1016/j.outlook.2021.09.007

Dunt, D., Prang, K. H., Sabanovic, H., & Kelaher, M. (2018). The Impact of Public Performance Reporting on Market Share, Mortality, and Patient Mix Outcomes Associated With Coronary Artery Bypass Grafts and Percutaneous Coronary Interventions (2000-2016): A Systematic Review and Meta-Analysis. Medical care, 56(11), 956–966. https://doi.org/10.1097/MLR.0000000000000990

Han, X., Pittman, P., & Barnow, B. (2021). Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing. Medical care, 59(10 Suppl 5), S463. https://doi.org/10.1097/MLR.0000000000001614

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-1913. https://doi.org/10.1016/S0140-6736(21)00768-6

Mitchell, B. G., Gardner, A., Stone, P. W., Hall, L., & Pogorzelska-Maziarz, M. (2018). Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature. Joint Commission journal on quality and patient safety, 44(10), 613–622. https://doi.org/10.1016/j.jcjq.2018.02.002

Schober, M., Lehwaldt, D., Rogers, M., Steinke, M., Turale, S., Pulcini, J., … & Stewart, D. (2020). Guidelines on advanced practice nursing.

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Racial and Ethnic Disparities in Health Care

Abstract
Racial and ethnic disparities are common in the healthcare systems. The inequality is attributed to different social economic status, level of education, occupation, cultural practices, and lack of comprehensive insurance coverage to some groups of people. In the United States, more people from the minority groups are less likely to get quality healthcare services due to discrimination and lack of enough income compared to the individuals from the majority groups. Racial and ethnic disparities may also arise as a result in differences in geographic locations. In some regions, people are less likely to get effective medical care due to poor accessibility. Racial and ethnic disparities in the healthcare system are a reflection of the societal problems. Therefore, the transformation of the entire healthcare system views and belief may lead to the significant reduction in the disparities experienced in the healthcare systems. Given that disparity in healthcare is sometimes attributed to the poor income from the minorities, it is always necessary for the healthcare actors to consider providing effective comprehensive insurance coverage to minority groups. Ethnicity and racism in the healthcare systems often leads to poor quality in the delivery of healthcare even though the factors such as insurance status may be under control.

Racial and Ethnic Disparities in Health Care
Literature Review
Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical care, 54(2), 140. The article addresses racial and ethical disparities in the healthcare system and how the utilization of the Affordable Care policy can be used to reduce the cases of disparities especially among minorities.
Buchmueller, T. C., Levinson, Z. M., Levy, H. G., & Wolfe, B. L. (2016). Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage. American journal of public health, 106(8), 1416–1421. https://doi.org/10.2105/AJPH.2016.303155. The article reveals that the changing nature of insurance amongst Latinos, Blacks and Whites. The revelation supports the fact that racial inequities still exist in the healthcare insurance sector in the nation.
Howell, E. A., Brown, H., Brumley, J., Bryant, A. S., Caughey, A. B., Cornell, A. M., … & Mhyre, J. M. (2018). Reduction of peripartum racial and ethnic disparities: a conceptual framework and maternal safety consensus bundle. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(3), 275-289. The article addresses the existing racially-oriented deaths in maternal care caused by disparities in healthcare. According to the article, more Black women are more likely to die from childbirth compared to white women.
Admon, L. K., Winkelman, T. N., Zivin, K., Terplan, M., Mhyre, J. M., & Dalton, V. K. (2018). Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012–2015. Obstetrics & Gynecology, 132(5), 1158-1166. The article addresses the maternal morbidities amongst minority populations as caused by healthcare disparities.
Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice. Burlington, MA: Jones & Bartlett Learning. The book addresses, among other things, the competence of nurses regarding healthcare disparities.
Clementz, L., McNamara, M., Burt, N. M., Sparks, M., & Singh, M. K. (2017). Starting with Lucy: Focusing on human similarities rather than differences to address health care disparities. Academic Medicine, 92(9), 1259-1263. The articles provide the strategies that one can use to address healthcare disparities in the minority populations.
Goodman, M. S., Gilbert, K. L., Hudson, D., Milam, L., & Colditz, G. A. (2017). Descriptive analysis of the 2014 race-based healthcare disparities measurement literature. Journal of racial and ethnic health disparities, 4(5), 796-802. The article reveals healthcare disparities by comparing minority and majority populations using statistics.
Jackson, C. S., & Gracia, J. N. (2014). Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health. Public health reports (Washington, D.C. : 1974), 129 Suppl 2(Suppl 2), 57–61. https://doi.org/10.1177/00333549141291S211. The article addresses the role that nurses and other healthcare workers can play to address disparities.
Jain, J. A., Temming, L. A., D’Alton, M. E., Gyamfi-Bannerman, C., Tuuli, M., Louis, J. M., … & Howell, E. (2018). SMFM special report: putting the “M” back in MFM: reducing racial and ethnic disparities in maternal morbidity and mortality: a call to action. American journal of obstetrics and gynecology, 218(2), B9-B17. The article specifically targets the reduction of healthcare disparities amongst minority mothers.
Mitchell, J. A., Williams, E. D. G., Li, Y., & Tarraf, W. (2020). Identifying disparities in patient-centered care experiences between non-Latino white and black men: results from the 2008-2016 Medical Expenditure Panel Survey. BMC Health Services Research, 20(1), 1-9. The articles examines the existing patient-centered care, which is an aspect of disparity, amongst white and black men.
Norton, J. M., Moxey-Mims, M. M., Eggers, P. W., Narva, A. S., Star, R. A., Kimmel, P. L., & Rodgers, G. P. (2016). Social determinants of racial disparities in CKD. Journal of the American Society of Nephrology, 27(9), 2576-2595. The social determinants of health are used to reveal the existence of healthcare disparities.
Rumball-Smith, J., & Bates, D. W. (2018). The electronic health record and health it to decrease racial/ethnic disparities in care. Journal of Health Care for the Poor and Underserved, 29(1), 58-62. The use of technology to address the disparity is addressed in this article

Background
Healthcare system is meant to provide quality services to all citizens irrespective of their race, family background, and level of education, ethnicity, religion, and age. However, due to the cases of racism and inequality in some regions, the population cannot equally enjoy the provision of quality medical services that should be provided. Today, more Whites are more likely to get quality healthcare compared to the black minority. Even though there are significant advances in the treatment and diagnosis of most of the chronic diseases, there is still evidence that ethnic and racial minorities continue to receive low quality of care compared to the nonminority. As a result, patients from the minority groups often tend to experience mortality and morbidity from different chronic diseases as compared to the non-minorities (Goodman et al., 2017). According to the Institute of Medicine, racial and ethnic inequalities in healthcare continues to worsen, and since they are associated to the worst outcomes in many cases, the situation has become unacceptable and most healthcare professionals and policymakers are on the verge of determining the best strategies to reduce the cases of discrimination in the treatment processes (Norton et al., 2016). Also, the Institute of Medicine define healthcare disparities as the ethnic or racial differences when it comes to the delivery of quality healthcare system that are not due to access clinical needs, appropriateness of interventions, and preferences. From the Institute of Medicine reports, there has been interest for the healthcare actors to understand the sources of disparities through the identification of the contributing factors, as well as the designing and evaluation of the effective interventions to eliminate the ethnic disparities in the healthcare system.
Whereas there are several sources of racial and ethnic disparity in healthcare, studies have identified the lack of insurance as the major contributing factor. The IOM report on health disparities in healthcare based on race demonstrates that one in eight Latinos did not have health insurance coverage. The report further revealed that Whites were more likely to have employer facilitate insurance while the Latinos would only do so via Medicaid. Moreover, a 2017 report revealed that the life expectancy of African-Americans was shortest during birth in comparison to other ethnicities (Mitchell, Williams, Li, & Tarraf, 2020). Indeed, the life expectancy amongst the blacks was eleven years’ shorter compared to Caucasian. The report attributed the presence of such life expectancies to health disparities caused by lack of access to insurance coverage and access to healthcare services, which reduce the quality of care hence life of African-Americans. Ethnic minorities also registered twice the death rates of their Caucasians counterparts while their statistics on access to usual source of care was grim compared to their white colleagues in the United States (Mitchell, Williams, Li, & Tarraf, 2020). Therefore, some examples of racial and ethnic differences in healthcare include lack of access of effective or appropriate insurance cover, geography, language barrier or communication differences between the healthcare providers and the patients, cultural barriers, stereotyping on the part of the healthcare workers, and lack of healthcare access due to inadequate facilities in some regions.
Impacts of Racial and Ethnic Disparities in Healthcare
Different research outcomes indicate that ethnicity and racism in the healthcare systems often leads to poor quality in the delivery of healthcare even though factors such as insurance status may be under control. In the United States and in other countries where there are levels of racisms, Caucasian people are more likely to obtain quality care compared to people of color. Racism and ethnicity is a common phenomenon in the society, as a result it has always been translated into different sectors from healthcare systems, businesses and education. Also, it is a vice that continues to threaten the healthcare system despite the progress or advances that has been made in medicine for many years (Jain et al., 2018). Different hospitals and healthcare centers have effective models that should favor everyone despite their races; however, due to persistent disparities in race and ethnicities that continue to affect the American society, these models cannot be employed. As such, the minority populations continue to suffer in terms of healthcare quality and access.
The sources of ethnic and racial disparities are not only rooted in the nation’s dysfunctional healthcare system but also in different societal determinants that have become threats to the country’s social order. A person’s environment, level of education, income and other related factors has major impacts on individual healthcare status (Clementz et al., 2020). If the disparities as well as the racial differences are to be effectively addressed, the government must always make efforts towards improving the stressors that exist both within and out of the healthcare system.
Some other sources of racial and ethnic differences in healthcare include lack of access of effective or appropriate insurance cover, geography, language barrier or communication differences between the healthcare providers and the patients, cultural barriers, stereotyping on the part of the healthcare workers, and lack of healthcare access due to inadequate facilities in some regions. Plans to control disparities in healthcare may become a very difficult and multifaceted task. While some studies suggest that reducing the disparities in healthcare is possible through the provision of inclusive insurance coverage as well as better medical plans, higher incomes, adequate communication skills, and continuous healthcare assistance, there is still a lot that needs to be done including transformation of the perception of people in the society and providing education on the need for social integration (Admon et al., 2018). Factors such as stereotyping, uncertainty, and biases need to be continuously explored.
Literature Search
There are various sources of information that elaborate on the racial and ethnic disparities within the healthcare system. These literary sources provide the result of different research and perspectives of various individuals on the increasing cases of racial and ethnic disparities in the healthcare system. The article, “Racial and Ethnic Disparities in Health Care Access and Utilization under the Affordable Care Act.” By Chen et al. (2016) addresses racial and ethical disparities in the healthcare system and how the utilization of the Affordable Care policy can be used to reduce the cases of disparities especially among minorities. As a policy formulated to fix the healthcare system in the United States, the ACA revealed the gapping inequalities between whites and the minority populations in the United States. The article paints a picture of the racial and ethnic inequalities that the ACA attempted to fix. According to the authors, physician visits, uninsured rates, and healthcare access amongst the minority populations are fundamental aspects of disparities in the United States. Therefore, the article helps to reveal the fact that whereas efforts have been made to address the issue of healthcare disparity; they still exist amongst the minority population. As such, their access to quality healthcare services is hampered.
In the article “Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage” is another ideal source of information for the healthcare issue in question. Specifically, the authors state that 25.8% of Blacks and 40.5% of Latinos did not have health insurance in 2013. However, the percentage was 14.8% amongst the Whites, which reinforced the existent disparities in the system within the United States. According to the article, racial and ethnic diversity in healthcare arise from differences in the levels of income. Most of the minority groups such as the people from the black communities are denied quality healthcare services because they cannot afford. Affordable Healthcare Insurance coverage can therefore reduce the issues of discrimination in healthcare systems and the society at large. Thus, the article reveals that despite the presence of the ACA, inequalities in healthcare coverage and access still persist in the United States. The presence of such inequalities despite efforts to eradicate them points to the deep-rooted nature of the issue as revealed by the article.
Howell et al. (2018) in their journal, “Reduction of Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle” link racial and ethnic disparities in healthcare system to the wider problem in the society. According to the authors, more people from the minority groups are more likely to die due to the low quality of healthcare delivery that they are exposed to. The article reveals that racial and ethnic disparities are present in both healthcare quality and perinatal outcomes. Indeed, they assert “For example, black women are 3 to 4 times more likely to die from pregnancy-related causes and have more than a 2-fold greater risk of severe maternal morbidity than white women” (Howel et al., 2018). In order to counter the widespread ethnic oriented inequality, the authors offered providers with insights into ethnic and racial disparities as related to maternal outcomes. The article revealed that the incidences of inequality exist even in the noble maternal sector, which is why maternal morbidities and mortalities continue to be registered in the United States. The object of the articles therefore enabled the present author to understand that that even healthcare worker require education on the nature and types of these disparities so as to formulate effective interventions.
Reflection
Racial and ethnic disparities are widespread in the healthcare system in the United States. The absence of diversity has ensured that these disparities continue to afflict the sector thus denying individuals access to quality health care. As such, racial and ethnic diversity is one of the major concerns that need to be addressed through the advanced nursing practice (ANP). There is also the need for evidence-based practices to ensure quality service delivery to all. The translation of research regarding the issue may ensure that incidences of disparity are addressed through the formulation of effective policies. Moreover, evidence-based practice is part of the Advanced Nursing practice that ensures the quality of life for all the patients. Some of the required improvements in the healthcare settings include training processes to ensure that healthcare professionals develop competencies in while dealing with the multicultural groups in the treatment processes. Also, there is the need to organize for continuous workshops so as to educate healthcare professionals on the ways of reducing cases of racial and ethnic diversities in the treatment process.
Some of the ANP competencies in addressing the issue may include ability to work with the multicultural groups through the implementation of the required policies in reducing the cases of morbidity due to lack of quality healthcare system. The acquisition of cultural competency by APNs is a key component when it comes to addressing healthcare disparities. Moreover, increasing the diversity of the healthcare workforce will also ensure that they have the requisite cultural competence to handle the issue (Jackson & Gracia, 2014). An additional necessary competence entails the presence of evidence-based practice knowledge. This will enable an APN to handle disparities using empirical evidence. It will allow them to formulate empirically derived cultural knowledge regarding populations and people so as to guide their practice as well as research (Butts & Rich, 2018). Further, the APNs need to have the competence to transform systems that will in turn address health disparities and social justice.
Based on my research, improvements in healthcare are necessary and mandatory. To this end, it would be important for the introduction of technology which aims at improving access to the quality medical care, increasing patient engagement and reduction of costs to occur. The reduction of costs can greatly reduce the cases of racism while dealing with different patients as it will increase access to services.
Over the years, health insurers, federal government, as well as other relevant stakeholders have always taken an increased interest in addressing the healthcare disparities among the minority groups. For example, the Healthy People 2010 initiative, whose main aim is to improve care, continues to work towards the elimination of the racial and ethnic health disparities as one of the major objectives in the new few decades. To reduce the impacts of ethnicity and racism in healthcare system, there is always the need to start from the societal perception and encourage a sense of integration.
Given that disparity in healthcare is sometimes attributed to the poor income from the minorities, it is always necessary for the healthcare stakeholders to consider providing effective comprehensive insurance coverage to the minority groups. The above case is possible through providing all the citizens or legal residents with affordable health insurance. As in the case of Obama Care or Affordable Care Policy, effective insurance coverage will enable many people despite the level of income to access healthcare services and acquire equal treatment. The introduction of the Affordable Care Act has altered the processes of healthcare provision across different countries and within the United States of America (Rumball-Smith & Bates, 2018). The Affordable Care Act has exposed the employers to a new set of challenges across the medical spectrum and on the other hand, it has brought numerous opportunities.
Moreover, there is the need for equal treatment when it comes to the delivery of quality care. Healthcare system was established for everyone and every person has the right to be treated with dignity as per the consent. Therefore, despite the diversity in income, nationality, gender, age, education level, culture, religion or disability, everyone should be treated with utmost care. Also, it is the responsibility of the healthcare workers to ensure lack of racism and ethnicity in the treatment process through facilitation of diversity. In other words, nurses and healthcare professionals need to adhere to the ethical standards which include the provision of quality care and respect for human dignity and concerns by effectively communicating to all patients irrespective of their ethnicity. As such, there is need for the government to establish a medical training system that is based on the free care delivery and the eradication of ethnic and racial perceptions.
Given the persistent racism , healthcare professionals need to acknowledge the sources of these vices through understanding the cultural, informational and linguistic needs of the patients. In other words, there is the need to strengthen health literacy among the ethnic and racial minorities in a linguistically and culturally sensitive fashion. Educating nurses on how to eradicate racism is one factor that will address the issues of healthcare disparities. Given the fact that doctors, physicians, nurses and all healthcare professionals are a product of the society, they need to be included in the processes geared towards reducing healthcare disparities on the basis of race and ethnicity. Also, patients need to be included in the process. Physicians should always remain sensitive to the cultural differences and the effects they create in the healthcare system. The process of treatment should remain inclusive and everyone should be treated with high level of competency. Transforming the healthcare perceptions in the healthcare system may also enable the society reduce the rising cases of racism as witnessed in different cities and states across the United States of America.
Conclusion
Racial and ethnic disparity in the healthcare system is one of the major issues that need to be addressed to ensure quality healthcare delivery for all the people in the society. Racism and ethnicity in healthcare settings are attributed to different factors arising from the perceptions in the society. The negative perceptions towards the minority such as people of color facilitated by the media have led to the increased racism, aggression and even economic disadvantages among black people. The negative perception and biases often enhanced by the media towards black people are distressing to the country and its culture. It leads racism which causes tremendous cultural, economic and moral suffering to a country. Different hospitals and healthcare centers have effective models that should favor everyone despite their race; however, due to persistent racism that continues to affect the society, these models cannot be employed, hence, the minority continues to suffer in terms of healthcare quality.

References
Admon, L. K., Winkelman, T. N., Zivin, K., Terplan, M., Mhyre, J. M., & Dalton, V. K. (2018). Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012–2015. Obstetrics & Gynecology, 132(5), 1158-1166.
Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice. Burlington, MA: Jones & Bartlett Learning.
Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical care, 54(2), 140.
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