Working With Vulnerable Populations as a Nurse Practitioner

Nurses are on the front lines of treating vulnerable populations and dealing with the consequences of healthcare disparities. As such, they play a unique and vital role as advocates for the health and well-being of their patients.

The COVID-19 pandemic highlighted healthcare inequities that have existed in the United States for many years. Poor working conditions, language barriers, and lack of access to healthcare contributed to higher death rates in underserved populations.

Vulnerable populations struggle with medical conditions, rising costs, and timely access to care. This worsens their poor understanding of their diagnosis and treatment, and increases risk of declining health and contracting communicable diseases.

The first step is identifying the types of vulnerable populations a nurse may encounter at work or in the community. Next, we describe the role nurse practitioners play in caring for vulnerable patients, and the specific responsibilities that fall under the purview of a nurse practitioner.

Populations made vulnerable by historical, socioeconomic, and medical biases have always been a part of the healthcare system. Historically — and in some cases currently — the care and attention underserved populations received was deplorable.

As recently as the 1960s, children born with Down’s Syndrome were institutionalized from birth, or their parents were forced to take them home without support. Likewise, roughly 70% of people with mental health conditions were involuntarily hospitalized in asylums.

In these institutions they lived in overcrowded rooms, with poor nutrition and insufficient hygiene. Staff locked the rooms. There were bars on the windows. Patients were at risk of sexual abuse from caretakers. Patients were also lobotomized, put into a coma, or submerged in ice baths as “treatments” for their condition.

Today, the medical community frowns on these living conditions and “treatments.” Yet they were an everyday nightmare for the patients who endured them. While the contemporary treatment of vulnerable people is not quite as barbaric, it begs the question of how future society will remember current care methods in another 50 years.

Vulnerable populations are at risk for healthcare inequities because of cultural, gender, racial, ethnic, health, or economic characteristics. Yet, caring for vulnerable populations is intrinsic to nursing. Using experiences and knowledge of patient care, wellness, and cost containment, nurses can influence policy.

There are five social determinants of health that significantly impact a person’s health and quality of life. These include:

These determinants arise from factors such as air, water, and environmental pollution, racism and discrimination, language and literacy barriers, and access to nutritious food.

Promoting healthy lifestyle choices is not enough to support the needs of vulnerable populations if those populations lack access. Vulnerable populations include, but are not limited to:

It may be surprising, but in many situations, physicians show up on this list. Yes, physicians have greater access to resources such as education and finances, but some doctors do not have their own physicians, which may make them vulnerable to ill health and burnout.

The AMA code of ethics states that physicians should not treat themself or family members. One survey found that many doctors do not have their own doctor.

This increases the risk that physicians have poor health, which affects the patients they treat. Healthy doctors can be role models for their patients, and are not likely to retire early.

Nurse practitioners have an influence on the healthcare providers with whom they work, including physicians. Be a good role model, encourage your colleagues to seek quality healthcare.

Nurses and nurse practitioners are first responders. They may not be in harm’s way as frequently as police officers and firemen, but they are first responders nonetheless. Yet there are times when standing up for the rights of vulnerable people places nurses at odds with society.

In 2017, the American Nurses Association was publicly outraged when a nurse in Salt Lake City, Utah, was handcuffed after refusing to draw the blood of an unconscious patient. The patient had been in a car accident and police were requesting a blood sample.

The nurse followed both the employer policies and the law; since the patient was not under arrest, there was no warrant, and the patient could not consent. The patient was vulnerable and the nurse acted with advocacy to protect the patient’s rights.

This was an unusual situation, but illustrates the necessity of advocating for vulnerable patients. Nurses and nurse practitioners are in a unique position to identify vulnerabilities, develop creative interventions, and champion quality care with patients and within the legislature.

These are only some of the steps NPs can take to protect their patient populations. Below are a few specific ideas for how to do so.

These are resources nurses and nurse practitioners may explore to gain a better understanding of the vulnerable patient populations they serve.

Page Last Reviewed: August 13, 2022