Working With Vulnerable Populations as a Nurse Practitioner
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This article highlights the exceptional work of 10 nurse practitioners and educators in serving vulnerable populations.
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.
Identifying Vulnerable Populations
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:
- Economic stability
- Healthcare access and quality
- Social community
- Neighborhood and environment
- Education access and quality
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:
- Racial and ethnic minorities
- Economically disadvantaged
- Uninsured or underinsured
- Those with chronic health conditions including HIV, mental health condition, and obesity
- Children and youth
- Rural residents with poor access
- LGBTQ+ community
- Certain genders and the gender-nonconforming
- Sex-trafficked men and women
- Human-trafficked men and women
- Certain religious or cultural groups
- Patients with conditions considered "incompatible with life" and their families
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.
The Role of Nurse Practitioners in Caring for Vulnerable Populations
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.
Identification of a problem is only effective when you can raise awareness within areas of society that impact change. As healthcare shifts toward prevention, nurses can leverage public health awareness to promote change and safeguard the health and well-being of underserved populations.
The nursing role is becoming even more multidimensional, now including promoting healthcare awareness in society on top of performing typical hospital duties.
Nurses are raising awareness in the community, serving in Congress, and joining the ranks of journalists to tell the stories of vulnerable populations.
Education has been a large part of nursing since the birth of the profession. From frontline workers in acute care hospitals to caring for patients in their homes, nurses spend hours educating and teaching patients about their healthcare needs, treatments, and preventive care.
It is a natural progression to use those teaching skills to educate society and the greater medical establishment. Nurses can educate on vulnerable populations' humanity and needs, creating a bond between all people.
Nurse practitioners can begin by educating people in their local community and extend their reach to the state and nation through social media, support organizations, and the legislature.
Advocacy can take many forms. Nurse practitioners can advocate for their patients' healthcare needs with insurance companies and Medicaid. They can serve on advocacy boards that address the needs of underserved populations in schools, healthcare institutions, and communities.
Nurse practitioners are in a unique position to advocate for the health and well-being of their physician colleagues. Simply put, advocacy is any action that supports, defends, or argues on behalf of a cause or others.
Unfortunately, many vulnerable populations lack easy access to healthcare. A combination of poverty, poor insurance coverage, and living in rural areas impact access.
Additionally, prisoners, people with chronic illnesses, and those in the LGBTQ+ community may find it difficult to access compassionate and caring healthcare providers.
Nurse practitioners who develop these empathetic qualities may volunteer in community clinics, advocate for an expanded patient population in their practice, or seek legislative remediation for the issues.
Provision 8 of the ANA Code of Ethics states that nurses must protect human rights and reduce health disparities. This means advocating for all populations against factors that may impede their access to healthcare.
Nurses must uphold ethical standards if patients are unable to pay for care, or show signs of human trafficking or domestic violence.
Physical signs and symptoms must be assessed without bias. For example, if a young man presents with slurred speech, a NP should investigate stroke, low blood glucose, meningitis, and other such causes.
Nurse practitioners have a professional duty to set aside any bias or prejudice when treating their patients. Only by enforcing the ethical standards of nursing care can all patients receive the healthcare treatment they deserve.
The healthcare needs of vulnerable populations are complex and intersect with societal and economic conditions.
Nurse practitioners play an important and unique role in advocating for greater healthcare access, and educating those in the legislature with the power to effect change. Within their practice, they can help reduce healthcare inequities and develop systems that protect vulnerable populations.
Yet, nurses are often overworked, underpaid, and exploited in the healthcare arena. In 2022, Nursing ranked as the most trusted profession by Gallup polls for 20 consecutive years.
The healthcare system has depended on nursing ethics, advocacy, and treatment of people in their most vulnerable times in life, but does not provide nurses themselves with the resources to maintain this level of care long-term.
While nurses have been strong patient advocates from the beginning of the profession, changing and expanding societal roles demand greater time and energy. This places an added burden on an already strained profession.
It is essential that healthcare systems recognize societal changes and establish stronger support systems for nursing staff. Burnout takes a massive toll on nurses, which led to many leaving the profession, especially during the height of the COVID-19 pandemic.
Burnout has contributed to a growing nursing shortage, placing a heavy load on those still caring for patients. Patient care may be in a dangerous situation.
Hospitals and insurance companies can advocate for the advocates by ensuring they have the support systems needed to provide excellent patient care.
For example, nurses should have access to fresh and powerful mental health programs to help prevent burnout. Their salaries should be commensurate with the work they do and they should have time and resources for meaningful professional development.
By providing nursing staff with rest, resources, and reimbursement, healthcare systems benefit in innumerable ways. This includes improved patient care, greater recognition in the community, and better patient satisfaction.
These factors gauge the quality of services offered, and are essential to the financial and operational success of the organization.
Mahatma Gandhi once said, "The true measure of any society can be found in how it treats its most vulnerable members." By improving healthcare access to vulnerable and underserved populations, we can progress toward a better and brighter future.
These are resources nurses and nurse practitioners may explore to gain a better understanding of the vulnerable patient populations they serve.
- AMA code of ethics opinion on physicians treating family members. (2012). https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-opinion-physicians-treating-family-members/2012-05
- ANA calls for action in wake of police abuse of RN. (2017). https://www.nursingworld.org/news/news-releases/2017-news-releases/american-nurses-association-calls-for-action-in-wake-of-police-abuse-of-registered-nurse-9117/
- Attending to vulnerable populations through nurse advocacy on boards and public service (2019). https://pubmed.ncbi.nlm.nih.gov/31085660/
- Compatible with life? (2018). https://stanmed.stanford.edu/2018fall/genetic-disorders-incompatible-life-options.html
- COVID-19 pandemic highlights long-standing health iniquities in U.S. (n.d.).https://www.hsph.harvard.edu/news/hsph-in-the-news/covid-19-pandemic-highlights-longstanding-health-inequities-in-u-s/
- Gallup: nurses are most trusted profession for 20th straight year. (2022). https://nursing.yale.edu/news/gallup-nurses-are-most-trusted-profession-20th-straight-year
- History of NADS. (n.d.). https://www.nads.org/about-us/history-of-nads/
- Nurses serving in congress. (n.d.). https://www.nursingworld.org/practice-policy/advocacy/federal/nurses-serving-in-congress/
- Nursing shortage. (n.d.). https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage
- Patient satisfaction & HCAHPS reimbursement. (2020). https://www.relias.com/blog/how-do-patient-satisfaction-scores-affect-reimbursement
- Social determinants of health. (n.d.). https://health.gov/healthypeople/priority-areas/social-determinants-health
- Tips and resources for learning the basics of data journalism. (2022). https://healthjournalism.org/
- Too many doctors treat themselves, study finds. (2009). https://www.abc.net.au/news/2009-09-04/too-many-doctors-treat-themselves-study-finds/1416810
- Traumatized and tired, nurses are quitting due to the pandemic. (2021). https://www.cnn.com/2021/02/25/us/nurses-quit-hospitals-covid-pandemic-trnd/index.html
- View the code of ethics for nurses. (n.d.). https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
- Vulnerable populations. (2006). https://www.ajmc.com/view/nov06-2390ps348-s352
- Vulnerable populations in healthcare. (2013). https://pubmed.ncbi.nlm.nih.gov/23385323/
- What it was like to be a mental health patient in the early 1900s. (2022). https://historyofyesterday.com/what-it-was-like-to-be-a-mental-health-patient-in-the-early-1900s-5a65fb70dd0c
Page Last Reviewed: August 13, 2022
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