DiversityNursing Blog

Nursing is the largest segment of the U.S. health care workforce. Who gets into nursing school, who feels they belong there, and who is standing at the front of the classroom shape what care looks like for millions of patients. Representation in nursing education is not a side conversation about optics. It is a patient safety, workforce, and health equity issue.

The pipeline shapes the profession

The workforce we have tomorrow is the student body we build today. The Institute of Medicine's landmark Future of Nursing report identified a lack of diversity as a challenge for the profession. It argued that a more diverse workforce would better meet current and future health care needs and provide more culturally relevant care, and that the most effective route is to diversify the pipeline of students entering nursing education. 

There has been real progress. AACN's Fall 2022 survey found that more than 40% of students in baccalaureate, master's, and DNP programs came from underrepresented racial and ethnic minority groups, though the figure for PhD programs was lower, at 35.8%. That is a meaningful shift from earlier decades. But the numbers also show where the pipeline narrows: the further up the educational ladder, the thinner representation becomes. Those PhD-prepared nurses are the researchers, faculty, and leaders who will shape the next generation.

Why it matters for patients

Trust and communication. Patients who see themselves reflected in their care team are often more comfortable sharing sensitive information, asking questions, and following through on care plans. Language concordance is the clearest example. A bilingual nurse can help prevent misunderstandings around medication instructions, consent, and discharge teaching that interpreters alone don't always catch.

Cultural humility in practice. Lived experience gives nurses an intuitive grasp of how culture, family structure, religion, and community history influence health decisions. This is not a replacement for training in cultural humility, which every nurse needs. But a classroom with diverse voices makes that training richer, because students learn from peers and not just from textbooks.

Reduced Disparities: Culturally responsive education equips future clinicians to address health inequities and improve care for marginalized communities.

Representation benefits students, too

Students who don't see themselves reflected in their program, whether in their cohort, their clinical instructors, or their leadership, are more likely to feel isolated. That isolation affects persistence and confidence, and ultimately who completes the program. Belonging is not a secondary consideration. It has measurable effects on student retention and NCLEX success.

Stronger Mentorship: Diverse faculty and peer groups provide relatable role models and guidance, which increases student confidence and success.

Higher Retention: Inclusive curricula and supportive academic leadership improve graduation and retention rates among minority nursing students.

Enhanced Collaboration: Working alongside diverse peers mirrors real-world multidisciplinary healthcare teams, improving workplace satisfaction and communication.

The faculty gap

Student diversity alone isn't enough. Students need to see nurse educators, preceptors, and deans who look like them and who understand the barriers they face. Faculty diversity has historically lagged well behind student diversity, and with a well-documented shortage of nurse educators, that gap compounds the problem. Nursing schools have turned away qualified applicants because of limited faculty capacity, so growing and diversifying the educator pool serves both access and equity.

Representation extends beyond race and ethnicity. First-generation students, veterans, rural students, students with disabilities, LGBTQ+ students, career changers, and others are all part of the picture. Each brings perspective the profession needs.

What nursing programs and health systems can do

• Recruit early. Build partnerships with high schools, community colleges, and community organizations, so nursing is visible as a career long before applications open.
• Review admissions holistically. Consider life experience, language skills, and service alongside GPA and test scores, and stay current on how legal and policy changes affect admissions practices in your state.
• Fund the path. Scholarships, emergency aid, and paid clinical placements can decide whether a student finishes.
• Invest in mentorship. Pair students with faculty and practicing nurses who can guide them through the hurdles no syllabus covers.
• Grow the educator pipeline. Support graduate education for diverse nurses, and create realistic pathways from bedside to classroom.
• Measure and share outcomes. Track admissions, retention, graduation, and licensure, and act on what the data shows.

A nursing workforce that reflects the country it serves is better equipped to build trust, communicate clearly, and deliver care that works for everyone. Representation in nursing education is where that work begins. It is a strategy for stronger patient care, a more resilient workforce, and a more equitable health system.

If you're in nursing education or health care leadership, ask what your program is doing to recruit, support, and retain the students who will shape the profession's future.

When you think of a nursing leader, what comes to mind?

Maybe it’s the nurse manager who keeps a busy unit running, the nurse educator helping new nurses find their confidence, or the chief nursing officer making decisions that affect thousands of patients and healthcare professionals.

But nursing leadership can take many forms.

Leadership in nursing isn't limited to a particular job title, degree, or corner office. Nurses lead every day through clinical decision-making, patient advocacy, mentoring, education, research, quality improvement, and the ability to bring people together around better ways of caring for patients.

For some nurses, that leadership journey begins at the bedside and eventually leads to the boardroom.

Why Do Nurses Want to Become Leaders?

Nurses often enter leadership because they want to make a difference beyond the individual patient encounter.

After years of working directly with patients, nurses see firsthand what works in healthcare and what doesn't. They notice staffing challenges, gaps in communication, barriers to care, inefficient processes, and the ways policies can affect both patients and the people caring for them.

That firsthand experience can create a desire to make things better.

Some nurses pursue leadership because they want to:

• Improve patient safety and quality of care
• Advocate for patients and nursing professionals
• Mentor and support other nurses
• Improve workplace culture
• Help solve staffing and workflow challenges
• Influence healthcare policies and practices
• Create better experiences for patients and families
• Expand access to equitable, high-quality care
• Have a greater voice in organizational decision-making
• Help shape the future of nursing

Leadership can provide nurses with an opportunity to take what they've learned through clinical experience and use it to create broader change.

Instead of helping one patient at a time, a nurse leader may have the opportunity to improve a process that affects hundreds or thousands of patients.

Nursing Leadership Doesn't Mean Leaving the Bedside Behind

One common misconception is that becoming a leader means stepping away from the part of nursing you love.

For some nurses, moving into leadership does mean transitioning away from direct patient care. For others, leadership happens while remaining deeply connected to clinical practice.

A charge nurse, for example, may still provide hands-on care while coordinating a team and helping make decisions about patient assignments and unit operations.

A clinical nurse specialist may combine advanced clinical knowledge with education, research, and quality improvement.

A nurse educator may influence an entire generation of nurses without routinely working at the bedside.

There are many ways to lead.

Nursing Leadership Career Paths

Charge Nurse

For many nurses, becoming a charge nurse is one of the first opportunities to formally step into leadership.

Charge nurses help coordinate the unit, support staff, manage patient assignments, communicate with other departments, and respond to problems as they arise.

This role can provide valuable experience in delegation, communication, conflict resolution, and decision-making.

Nurse Manager

Nurse managers oversee the daily operations of a nursing unit or department.

Their responsibilities may include staffing, scheduling, employee development, budgeting, performance management, quality improvement, and patient-care outcomes.

It's a significant transition because the nurse manager isn't simply responsible for their own work. They are responsible for helping an entire team succeed.

Clinical Nurse Leader

Clinical Nurse Leaders focus on improving patient care and outcomes at the point of care. They may coordinate care, analyze patient outcomes, identify risks, and work with interdisciplinary teams to improve healthcare delivery.

This can be an appealing path for nurses who enjoy clinical practice but also want to influence how care is delivered.

Nurse Educator

Nurse educators teach and mentor nursing students, new graduates, experienced nurses, and other healthcare professionals.

They may work in hospitals, colleges, universities, professional development departments, or other educational settings.

Their influence can extend far beyond one classroom. A strong nurse educator can help prepare hundreds of nurses to provide safer and more effective care.

Clinical Nurse Specialist

Clinical nurse specialists are advanced practice registered nurses who can focus on areas such as a particular patient population, disease process, or healthcare setting.

Their work may involve clinical expertise, education, consultation, research, and quality improvement.

They can serve as a bridge between clinical practice and organizational improvement.

Director of Nursing

A director of nursing typically has responsibility for multiple units, departments, or areas of nursing operations.

At this level, leadership becomes increasingly strategic. Directors may work on budgets, staffing strategies, quality metrics, regulatory requirements, employee development, and organizational goals.

Chief Nursing Officer

At the executive level, the Chief Nursing Officer (CNO) provides strategic leadership for nursing across an organization.

CNOs may participate in decisions involving patient safety, workforce planning, organizational strategy, quality, nursing practice, and healthcare policy.

This is where the "boardroom" part of the nursing leadership journey can become especially visible.

The nurse's clinical perspective can have a seat at the table where major organizational decisions are being made.

Nursing Leadership Beyond the Hospital

Leadership opportunities aren't limited to hospitals.

Nurses can move into leadership roles in:

• Public health
• Government and healthcare policy
• Nursing education
• Healthcare technology
• Research
• Quality improvement
• Case management
• Insurance and healthcare organizations
• Community health organizations
• Professional nursing associations
• Healthcare consulting
• Corporate healthcare
• Entrepreneurship

Some nurses also become healthcare executives, researchers, entrepreneurs, professors, policy advisors, or organizational consultants.

The possibilities can expand considerably as nurses gain experience and additional education.

Yes, Nursing Leadership Is Hard Work

Leadership can be incredibly rewarding, but it is not an easy career path.

A nurse leader may have to make difficult staffing decisions, manage conflict, address performance concerns, balance budgets, implement unpopular changes, respond to emergencies, and advocate for their team while also answering to organizational leadership.

Sometimes, there simply isn't a perfect solution.

Nurse leaders can find themselves caught between competing needs: what patients need, what nurses need, what an organization can afford, and what regulations require.

That can be exhausting.

Leadership also means accepting responsibility when things go wrong, even when the problem is bigger than any one person.

For nurses considering leadership, it's important to understand that a leadership title doesn't automatically make the job easier. In many cases, it comes with more responsibility, more complex decisions, and a much broader scope of accountability.

But Good Nursing Leadership Can Create Significant Change

That is also what makes Nursing leadership so meaningful. When it is practiced thoughtfully and effectively, its impact can extend far beyond any one nurse or patient.

A nurse leader may help implement a safer medication process, identify a pattern contributing to patient falls, or build a mentorship program that supports nurses as they transition into practice. They may advocate for stronger staff education, improve communication between departments, or recognize when a workplace issue is affecting both nurses and patient care and work with others to address the root cause.

Sometimes, leadership is as simple and as important as making sure nurses have a voice at the table, someone who understands what patient care actually looks like and can speak to what both nurses and patients need.

Leadership Starts Before the Job Title

You do not have to become a nurse manager to be a leader. Leadership often begins long before the title does.

It can start with speaking up when something is not safe, helping a new nurse build confidence in a difficult skill, or stepping forward to support a quality improvement effort. It may also mean serving on a committee, becoming a preceptor, participating in professional organizations, or advocating for a patient who needs someone in their corner.

Many nurses are already practicing leadership in these everyday moments, even if they have never described it that way. The formal title, if it comes, can come later.

From Bedside to Boardroom

The path from bedside nurse to healthcare leader does not look the same for everyone.

For one nurse, leadership may grow into a charge nurse role and later a nurse manager position. For another, it may involve advanced education and a move into teaching, research, policy, or executive leadership. And for others, leadership may remain grounded at the bedside throughout their careers.

There is no single way to define a nursing leader. At its core, nursing leadership is about using experience, judgment, compassion, and influence to help make care better.

It is also demanding work. It calls for patience, resilience, collaboration, and the willingness to make difficult decisions. But when nurses step into leadership with purpose, they can shape more than individual patient encounters. They can influence teams, organizations, systems, and the future of healthcare itself.

The boardroom may look very different from the bedside, but the goal can remain the same: better care for patients and a stronger future for nursing.

Healthcare workers are accustomed to dealing with emergencies, but a growing security threat known as swatting presents a different kind of challenge.

Swatting occurs when someone deliberately makes a false report of a serious emergency, such as an active shooter, hostage situation, or armed individual, to trigger a large law-enforcement response. The FBI identifies hospitals, schools, places of worship, and other public locations as potential targets.

While reliable national data on hospital-specific swatting incidents is limited, evidence suggests the broader threat has grown. The International Association for Healthcare Security and Safety Foundation (IAHSSF) cites estimates that swatting incidents increased from about 400 in 2011 to more than 1,000 in 2019. In 2025, the FBI issued a nationwide warning about multiple recent swatting incidents.

Why Are Hospitals Vulnerable?

Hospitals are complex, 24-hour environments with large numbers of patients, visitors, and employees. A false report can quickly create confusion and potentially dangerous circumstances.

A swatting incident may:

• Trigger an armed law-enforcement response
• Disrupt patient care and hospital operations
• Require lockdowns or evacuations
• Put patients, nurses, and other employees at risk
• Divert emergency resources
• Cause significant emotional distress for staff

A 2025 incident at Loma Linda University Medical Center in California illustrates the potential impact. A false report of an armed individual prompted a major law-enforcement response and an evacuation before authorities determined the threat was a hoax.

What Should Nurses Know?

Nurses should never be expected to determine whether a reported threat is real or a swatting attempt. That responsibility belongs to hospital security and law enforcement.

However, nurses play a critical role in protecting patients during an emergency.

Know your hospital's emergency procedures. Be familiar with your facility's policies for active threats, lockdowns, evacuations, and shelter-in-place situations.

Take emergency alerts seriously. Even if a threat seems unusual or may be a hoax, follow your hospital's instructions until authorities determine otherwise.

Know your patients' needs. Nurses may need to protect patients who cannot independently evacuate, including patients requiring oxygen, ventilators, IV medications, or other critical care.

Report concerning behavior. Threats, suspicious activity, or threatening communications should be reported according to hospital policy.

Don't confront a suspected threat. Follow established security and emergency procedures and prioritize your own safety and the safety of your patients.

What Can Health Systems Do?

Swatting should be incorporated into hospitals' broader workplace violence and emergency preparedness plans.

Health systems can:

• Develop specific protocols for suspected swatting incidents
• Establish communication procedures with local law enforcement
• Train security personnel and frontline staff
• Conduct emergency drills that include false active-threat scenarios
• Maintain reliable emergency communication systems
• Review evacuation and shelter-in-place procedures for vulnerable patients
• Provide post-incident support for employees

The IAHSSF recommends that healthcare organizations prepare for swatting as part of their overall security and emergency-management programs.

Preparing for the Unexpected

Swatting is ultimately a reminder that hospital safety extends beyond traditional workplace violence and cybersecurity concerns. A false emergency call can have very real consequences for nurses, patients, families, and first responders.

Nurses don't need to become experts in identifying swatting. They do need to know their hospital's emergency procedures, understand their role in protecting patients, and be prepared to respond when a serious security threat is reported.

Hospitals may not be able to prevent every swatting attempt, but preparedness, communication, training, and coordination with law enforcement can help minimize the impact.

Sources

• International Association for Healthcare Security and Safety Foundation — Mitigating Swatting Events in the Healthcare Sector
• FBI — Threat Actors Use Swatting to Target Victims Nationwide
• OSHA — Workplace Violence in Healthcare
• National 911 Program — Public Safety Information on Swatting
• CBS News Los Angeles — Loma Linda University Medical Center Swatting Incident

For many patients and their families, leaving the hospital can feel overwhelming. They may receive pages of discharge instructions, medication changes, follow-up appointments, and home care guidance all at once. Even when nurses provide thorough education, patients may still leave unsure about what they need to do next.

That's where health literacy makes all the difference.

A recent nurse-led quality improvement initiative highlighted by the American Association of Critical-Care Nurses(AACN) demonstrated that tailoring discharge education to a caregiver's health literacy level significantly improved understanding, increased satisfaction, and even reduced hospital readmissions.

What Is Health Literacy?

Health literacy is a person's ability to find, understand, and use health information to make informed decisions about their care. It goes beyond simply being able to read. It includes understanding medical terminology, following medication instructions, recognizing warning signs, and knowing when to seek medical attention.

According to research, limited health literacy is associated with poorer health outcomes, increased emergency department visits, and higher hospital readmission rates.

A Nurse-Led Initiative That Made a Difference

Nurses in the Pediatric Cardiothoracic Intensive Care Unit at Loma Linda University Children's Hospital recognized that many caregivers struggled to understand complex discharge instructions following pediatric heart surgery.

Rather than assuming every family needed the same educational materials, the nursing team implemented a personalized approach.

Within 24 hours of admission, caregivers completed a brief health literacy assessment available in both English and Spanish. This helped nurses identify each family's educational needs early in the hospitalization instead of waiting until discharge day.

The results showed that more than one-third of caregivers had limited or low health literacy, reinforcing the need for individualized education.

Personalized Education Improves Understanding

After assessing health literacy, nurses used educational materials designed for different literacy levels. These resources included:

• Plain language instead of complex medical terminology
• Visual aids such as pictures and illustrations
• Step-by-step instructions
• Easy-to-follow take-home packets

Before discharge, nurses reviewed five essential areas of care:

• Medication administration
• Wound care
• CPR basics
• Nutrition
• When to seek additional medical care

Most importantly, nurses used the teach-back method, asking caregivers to explain the information in their own words. This simple communication technique confirms understanding and allows nurses to clarify misconceptions before patients go home.

The Results Speak for Themselves

The initiative produced measurable improvements.

Caregiver satisfaction with nurse communication increased dramatically. In follow-up surveys one week after discharge, families reporting that nurses explained things in an easy-to-understand way improved from 80% to 100% over the course of the project. The hospital also saw a reduction in 30-day readmission rates following pediatric heart surgery.

These findings reinforce what many nurses already know: effective communication is just as important as clinical expertise.

Practical Ways Nurses Can Improve Discharge Education

Whether you work in acute care, outpatient clinics, long-term care, or home health, there are simple strategies that can make discharge teaching more effective.

Use Plain Language

Replace medical jargon with everyday words whenever possible.

Instead of saying:

"Administer this medication twice daily."

Try:

"Take one pill in the morning and one before bed."

Small language changes can dramatically improve understanding.

Don't Ask, "Do You Understand?"

Most patients will say "yes" even if they are confused.

Instead, ask:

• "Can you show me how you'll change this dressing?"
• "Can you tell me when you'll take this medication?"
• "What symptoms would make you call your healthcare provider?"

These questions encourage patients to demonstrate understanding rather than simply agreeing.

Start Education Early

Discharge teaching should not begin the hour before a patient leaves.

Introducing education throughout the hospital stay gives patients and caregivers time to absorb information, ask questions, and practice skills.

Use Visual Resources

Pictures, diagrams, medication schedules, and illustrated handouts often improve comprehension more than text-heavy documents alone.

Include Family and Caregivers

Many patients rely on family members after discharge. Including caregivers in education sessions helps ensure everyone understands the care plan.

Health Literacy Is a Patient Safety Issue

Poor communication can lead to medication errors, missed follow-up appointments, preventable complications, and unnecessary readmissions.

By recognizing that every patient learns differently, nurses can create safer transitions from hospital to home while building confidence in patients and families.

Health literacy isn't about simplifying care. It's about making sure patients have the knowledge and confidence they need to successfully manage their health after discharge.

As this nurse-led initiative demonstrates, a few thoughtful changes in how education is delivered can have a lasting impact on patient outcomes, caregiver satisfaction, and overall quality of care.

Every July, the United States observes National Minority Mental Health Month, a time dedicated to raising awareness about the unique mental health challenges experienced by racial and ethnic minority communities. The observance also highlights the importance of improving access to culturally responsive mental health care and reducing disparities that continue to affect millions of Americans.

Originally established in 2008 and inspired by the legacy of author and mental health advocate Bebe Moore Campbell, National Minority Mental Health Month encourages healthcare professionals, organizations, and communities to recognize the barriers that many people face when seeking mental health support. These barriers may include stigma, discrimination, language differences, financial limitations, and a shortage of culturally competent providers.

Why Mental Health Equity Matters

Mental health is an essential part of overall health. It influences how people think, feel, manage stress, build relationships, and make decisions. Mental health conditions are common and treatable, yet many individuals do not receive the care they need.

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 4 U.S. adults lives with a mental illness, but people from racial and ethnic minority groups often face greater challenges accessing quality mental health services. These disparities can contribute to delayed diagnoses, untreated conditions, and poorer long term health outcomes.

Understanding Mental Health Disparities

Mental health disparities are influenced by many factors beyond an individual's symptoms. Social determinants of health, historical inequities, and systemic barriers all play important roles in shaping mental health outcomes.

Some common challenges include:

• Limited access to affordable mental health services
• Lack of insurance coverage or financial resources
• Shortages of providers who understand cultural backgrounds and lived experiences
• Language and communication barriers
• Fear of stigma within families or communities
• Experiences of racism, discrimination, and trauma

The National Institute on Minority Health and Health Disparities (NIMHD) notes that National Minority Mental Health Month is an opportunity to recognize these challenges while promoting education, awareness, and emotional well-being across diverse communities.

The Importance of Culturally Responsive Care

Culturally responsive mental health care recognizes that culture, identity, values, and lived experiences influence how individuals experience mental illness and seek treatment.

Healthcare organizations can improve outcomes by:

• Recruiting and supporting a diverse behavioral health workforce
• Offering interpreter and translation services
• Providing culturally informed training for clinicians
• Building trust through community partnerships
• Addressing bias and discrimination within healthcare systems

Patients who feel understood and respected are often more likely to seek care, remain engaged in treatment, and achieve better health outcomes.

Reducing Stigma Through Education

One of the greatest barriers to mental health care remains stigma. In some communities, mental illness may be misunderstood or viewed as a personal weakness rather than a medical condition.

Education plays a critical role in changing these perceptions. Open conversations about anxiety, depression, trauma, substance use disorders, and other mental health conditions can encourage individuals to seek help earlier.

Healthcare professionals, employers, educators, and community leaders all have opportunities to normalize discussions about mental health and promote available resources.

How Nurses and Healthcare Professionals Can Help

Nurses are often among the first healthcare professionals to recognize signs of emotional distress. Their ability to build trusting relationships places them in a unique position to support patients from diverse backgrounds.

Healthcare professionals can make a difference by:

• Screening patients for mental health concerns during routine visits
• Listening without judgment
• Respecting cultural beliefs and preferences
• Connecting patients with community resources and behavioral health specialists
• Advocating for equitable access to mental health services

Small actions can help create healthcare environments where every patient feels safe, heard, and valued.

Supporting Minority Mental Health Beyond July

National Minority Mental Health Month serves as an important reminder that mental health equity requires year round commitment. Expanding access to care, reducing stigma, supporting culturally responsive services, and addressing social barriers are all essential steps toward improving health outcomes for everyone.

By working together, healthcare organizations, providers, policymakers, and communities can help ensure that every individual has the opportunity to receive compassionate, high quality mental health care regardless of race, ethnicity, language, or background.

Resources

• National Institute on Minority Health and Health Disparities: https://www.nimhd.nih.gov/
• Centers for Disease Control and Prevention Minority Mental Health Resources: https://www.cdc.gov/minority-health/features/minority-mental-health.html
• National Institute of Mental Health: https://www.nimh.nih.gov/

It is early on a Thursday morning in Philadelphia's Kensington neighborhood. A Nurse Practitioner finishes packing her medical bag and steps outside. She is not heading to a hospital or a clinic. She is heading to the streets, looking for a patient named Michael who has been avoiding care for weeks. When she finally spots him pushing a child's wheelchair loaded with his belongings, she calls out to him by name. "I've been looking for you, how've you been?"

That moment, ordinary and extraordinary at once, is street medicine in its purest form: a Nurse showing up, knowing her patient's name, and choosing to meet him exactly where he is.

For Nurses who feel pulled toward something more, something rawer and more human than a traditional clinical setting can offer, street medicine may be exactly what they have been searching for. This guide covers what street medicine is, how it came to be, why Nurses are essential to its future, and how to decide whether it belongs in yours.

What Is Street Medicine?

Street medicine is a model of healthcare delivery built on a simple but radical premise: rather than waiting for patients to come to the system, providers bring care directly to people where they live, whether that is a park bench, a highway underpass, a tent encampment, or a doorway.

The populations served are primarily people experiencing homelessness, though programs also reach individuals living in deep poverty, those involved in survival sex work, people navigating addiction and mental illness, and others who have been failed by or fallen out of conventional healthcare. 

Street medicine is not just urgent care under an open sky. It is primary care, chronic disease management, wound care, harm reduction, mental health support, addiction medicine, and social services navigation, all delivered through a lens of trauma-informed, culturally humble practice. A street medicine encounter might involve dressing a wound, prescribing medications for hypertension, administering naloxone, connecting someone to housing services, or simply sitting with a patient long enough to build the kind of trust that eventually allows them to accept help.

The interdisciplinary team typically includes Physicians or Nurse Practitioners, Registered Nurses, social workers, and community health workers, often including people with lived experience of homelessness themselves. Nurses occupy a central role on these teams, often serving as the primary point of care during outreach and as the relational anchor that keeps patients engaged over time.

How Street Medicine Has Grown and Evolved

Street medicine as a formal practice traces its roots to Pittsburgh, Pennsylvania, in 1992. Dr. Jim Withers, a Physician at Pittsburgh Mercy Hospital, was troubled by the way the medical system turned away the people who needed it most. One night, he put on worn clothes and walked the streets of Pittsburgh alongside a formerly homeless man named Mike Sallows. What he found changed his career entirely.

"It opened up my eyes, how many people were out there, how sick they were," Withers recalled. "Pretty soon I realized I have to take a backpack with medicine and start treating people. And then Nurses heard about it. They started volunteering. Pretty soon we had a health system under the bridges."

That grassroots effort became Operation Safety Net, one of the country's first full-time street-based medical programs. By 1993 it had formalized as a nonprofit, and over the following decades it became the template for a global movement. Withers went on to found the Street Medicine Institute in 2009, providing training and support for programs around the world.

Today, street medicine has expanded to more than 200 cities across six continents. The Street Medicine Institute hosts an annual International Street Medicine Symposium, where clinicians, Nurses, social workers, and advocates gather to share knowledge and strengthen the field. What began as one Doctor and one guide walking the streets of Pittsburgh at night has become a worldwide practice.

Several forces have accelerated the field's growth. The opioid crisis brought urgent, visible healthcare needs to the streets of cities large and small, demanding a more proactive response than traditional clinics could provide. The COVID-19 pandemic pushed the expansion further still, as mobile units became essential for vaccine outreach and infection control among unsheltered populations. At the same time, a growing body of research has demonstrated that street medicine reduces emergency department visits, improves chronic disease management, and lowers overall healthcare costs, drawing the attention of hospital systems, federally qualified health centers (FQHCs), and academic medical programs.

The field is also maturing professionally. Street medicine fellowships, academic curricula, and dedicated Nursing roles are proliferating. Nurses Kelly Thompson and Kiera Connelly, who volunteer with Denver's Yahweh Health Clinic street medicine program, have presented at international symposiums specifically on the role of Nurses in street medicine, advocating for expanded Nurse-led outreach. Their message: the field has been too Physician-centric, and that needs to change.

Why Street Medicine Needs Nurses

Nursing has always been defined by its commitment to meeting patients where they are, physically, emotionally, and socially. That is not a metaphor in street medicine. It is the literal job description.

The skills that define great nursing, thorough assessment, skilled wound care, medication management, patient education, crisis de-escalation, advocacy, and above all, the ability to build trust with people who have every reason not to trust the healthcare system, are precisely the skills that street medicine runs on. In resource-limited, unpredictable field settings, Nurses' clinical flexibility and comfort with improvisation are indispensable.

Registered Nurses in street medicine programs take on expanded, autonomous roles that many Nurses never access in traditional settings. They conduct initial assessments at encampments and alongside outreach workers. They perform wound care, administer medications, and conduct testing for sexually transmitted infections and bloodborne illnesses. They serve as care coordinators, connecting patients to FQHCs, mental health programs, detox services, and housing resources. And they serve as the consistent, trusted faces that patients return to over time.

That relational dimension may be the most important contribution Nurses make. People who are unhoused often experience profound distrust of healthcare systems that have dismissed or failed them. A Nurse who shows up repeatedly, who learns someone's name and history, who does not flinch at difficult circumstances, can gradually become the bridge back to care.

Workforce demand in the field is growing. Programs like Hennepin County's Health Care for the Homeless in Minneapolis are actively recruiting Registered Nurses with experience in street outreach, specifically to address public health crises like HIV outbreaks among people experiencing unsheltered homelessness. As more hospital systems, community health organizations, and academic medical centers launch or expand street medicine programs, the need for Nurses who are trained and ready to do this work will only increase.

Is It the Right Career Move for You?

Street medicine is not for everyone, and the best Nurses for the work are usually the ones honest enough to think it through carefully before committing.

For experienced Nurses considering a pivot, the question to sit with is whether your sense of professional purpose has been narrowing or expanding. Many Nurses who find their way to street medicine describe a feeling of distance in clinical settings, a sense of treating diagnoses rather than people, of documenting more than listening. If that resonates, street medicine offers something different: the chaos is real, the resources are limited, but the human connection is direct and unmediated in a way that is genuinely rare in healthcare.

The challenges are equally real. Street medicine environments are unpredictable. Documentation happens on phones and tablets in parking lots. Supplies are often donated and limited. Patients may be in acute psychiatric crisis, in active withdrawal, or hostile toward clinicians. Success looks different, sometimes it means a patient accepts a wound dressing after months of refusals, and learning to measure it that way takes adjustment. The emotional weight of the work is significant, and programs vary widely in the support they offer staff.

For nursing students, street medicine exposure is increasingly recognized as one of the most valuable clinical experiences you can seek out. Working in street medicine builds competencies in trauma-informed care, harm reduction, social determinants of health, and interdisciplinary collaboration that will make you a stronger clinician in any setting you eventually choose. Some schools of nursing, including Oregon Health and Science University, have developed formal street nursing curricula and outreach clinical rotations. Seeking out that experience early, whether through a school partnership, a volunteer program, or an FQHC internship, sets you apart and shapes the kind of Nurse you become.

If you are curious about getting started, there are several practical pathways. Many cities have volunteer street medicine programs that welcome Nurses on weekend outreach shifts, no long-term commitment required. FQHCs that serve homeless populations often employ outreach Nurses and represent a more traditional employment pathway with benefits and institutional support. The Street Medicine Institute's website is a good starting point for locating programs by region, and nursing CE providers have begun offering street medicine coursework as the field grows.

Street medicine is not a niche or a novelty. It is a growing, evidence-based approach to healthcare that serves some of the most vulnerable people in our communities, and it needs Nurses to lead it.

If you have ever found yourself wishing you could spend more time with a patient than your schedule allows, or felt frustrated that the system cannot seem to reach the people who need it most, or wondered whether your skills could matter more somewhere else, that pull is worth listening to.

Street medicine exists to change that. And Nurses, more than perhaps any other clinician, are built for the work.

Starting your first nursing job is one of the most exciting and terrifying experiences of your professional life. Nursing school prepares you for the clinical skills, the pharmacology, the care plans, and the critical thinking. What it does not prepare you for is everything else. The culture, the hierarchy, the unspoken expectations, and the lessons that only come from actually being on the floor.

Every seasoned Nurse has a mental list of things they wish someone had told them on day one. Consider this your cheat sheet.

Your Coworkers Can Make or Break Your Experience

You will spend more waking hours with your colleagues than almost anyone else in your life. The relationships you build on your unit matter enormously. Be the Nurse who shows up ready to help, who offers to grab a supply for a teammate mid-procedure, and who never says "that's not my patient" when someone clearly needs a hand.

Nursing is a team effort, and the Nurses who thrive are the ones who invest in their team early and often. Do not underestimate the power of simply being kind and reliable.

Ask Questions, But Be Mindful of the Timing

There is no shame in not knowing something. In fact, asking questions is one of the most important habits of a safe Nurse. However, learning when and how to ask is an art form.

Pulling aside a Charge Nurse mid-crisis to ask something you could have looked up is going to land differently than waiting for a calm moment or using your resources first. Show that you have made an effort before asking, and your colleagues will respect you far more for it.

Documentation Is Your Best Friend and Your Protection

New Nurses are often so focused on patient care that documentation feels like an afterthought. It is not. If it was not documented, it did not happen. This is not just a saying, it is your legal protection.

Chart in real time whenever possible. Be thorough, be accurate, and never document something you did not do. It can feel tedious, especially during a busy shift, but your future self will thank you every single time.

The Charge Nurse Is a Resource, Not Just a Boss

Many new Nurses are intimidated by the Charge Nurse and avoid them unless absolutely necessary. This is a missed opportunity. A good Charge Nurse has seen almost everything, and they can be your greatest ally when things get hard.

Build that relationship early. Let them know where you are with your patients, flag concerns before they become emergencies, and never try to hide that you are struggling. Charge Nurses would always rather help you manage a situation than find out something went sideways because you were too nervous to speak up.

Patients and Families Are Watching Everything

Even when you think no one is paying attention, someone is. The way you speak to a colleague across the hall, the expression on your face when you walk into a room, the energy you bring to a routine task. Patients and their families notice all of it.

You do not have to be cheerful every moment of a twelve-hour shift. But being present, respectful, and communicative with the people in your care goes a long way. A patient who feels seen and heard is far less likely to press the call button every five minutes and far more likely to trust your judgment.

Learn the Hierarchy, Even If You Do Not Love It

Every unit has a pecking order, and pretending it does not exist will not serve you well. This does not mean you have to be a pushover or that the hierarchy is always right. It means you need to understand the culture you are working in before you start challenging it.

Earn trust first. Once you have established yourself as competent and collaborative, you will have far more credibility when you want to advocate for change.

Your Instincts Are Worth Something

Nursing school teaches you to rely on data, assessments, and evidence-based practice. All of that is right and important. But do not completely discount that feeling you get when something seems off about a patient, even if the numbers look fine.

Experienced Nurses call it "Nurse's intuition," and it is really just pattern recognition built over time. As a new Nurse, your gut feeling is less refined, but it is not meaningless. If something feels wrong, keep looking. Ask questions. Advocate for your patient. You are allowed to trust yourself.

Mistakes Will Happen, and How You Handle Them Matters

This one is hard to hear, but it is true. You will make mistakes. Every Nurse does. The goal is to create habits and systems that minimize errors, but no amount of preparation makes you immune.

When something goes wrong, the worst thing you can do is hide it. Report the error, follow your facility's protocol, be honest with your supervisor, and learn from what happened. Nurses who try to cover up mistakes put patients at risk and their own licenses on the line. Nurses who handle mistakes with transparency and accountability grow into the safest practitioners on the floor.

Self-Care Is a Clinical Skill

You cannot pour from an empty cup, and in nursing, an empty cup has real consequences for patient safety. Eating during your shift, staying hydrated, using the bathroom when you need to, and actually taking your breaks are not luxuries. They are part of doing your job well.

Beyond the shift itself, protecting your sleep, your mental health, and your life outside of work is what makes a long nursing career sustainable. Burnout is real, it is common, and it starts earlier than most new Nurses expect. Take it seriously from day one.

This Career Will Change You, in the Best Possible Way

Nursing will test you in ways you never anticipated. You will have shifts that bring you to your knees and moments of connection with patients that you will carry with you for the rest of your life. You will grow in confidence, in compassion, and in your ability to stay calm when everything around you is anything but.

The unwritten rules are really just the wisdom that gets passed down from one generation of Nurses to the next. Now you have a head start.

Welcome to the profession. It is hard, it is humbling, and it is absolutely worth it.

The United States is projected to face a shortage of more than 250,000 Registered Nurses by 2028, making the nursing shortfall difficult to ignore. It is dominating headlines, shaping policy discussions, and reflected in the experiences of anyone who has waited hours in an understaffed emergency department. Yet, despite this attention, we are not sufficiently examining the underlying causes of this crisis.

In addition to the bedside nursing shortage, there is a widening gap in Advanced Practice Providers, Clinical Educators, and Nurse leaders who direct care delivery and guide teams. These professionals are responsible for educating and mentoring the next generation of Nurses, and without sufficient numbers of them, the talent pipeline will slow dramatically.

Data from the American Association of Colleges of Nursing show, in the most recent academic year, more than 65,000 qualified applicants were denied admission to nursing programs, primarily because institutions did not have enough faculty to instruct them. 

The national nursing faculty vacancy rate is currently close to 7%, leaving nearly 1,700 positions unfilled. More than one-third of nursing faculty members are over age 60, and an accelerating wave of retirements is further intensifying the shortage. 

At the same time, faculty compensation lags behind clinical salaries by 20% to 30%, making it challenging to recruit and retain doctoral-prepared Nurses in academic roles when they can earn substantially more in direct patient care.

This dynamic creates a self-perpetuating cycle: too few educators lead to too few seats in nursing programs, which in turn produce too few graduates entering the workforce. If unaddressed, the bedside shortage will continue to deepen. Disrupting this cycle requires expanding access to graduate nursing education — for both the Nurses seeking advanced degrees and the faculty needed to teach them. Well-designed online graduate programs offer one of the most effective ways to achieve both goals.

For Nurses seeking to advance their careers, whether through a Master’s degree, a Doctor of Nursing Practice, or a specialized certification, traditional, campus-based graduate programs often pose significant obstacles. Many are working full time, caring for families, or living in rural communities far from academic medical centers. Faculty members face similar constraints. By easing the demands of frequent travel and rigid schedules, we can better recruit and retain experienced educators and make the profession more accessible and appealing to the next generation.

Online graduate programs eliminate many of these barriers while maintaining academic thoroughness. The most effective models do this not by replacing hands-on learning, but by integrating it thoughtfully. A hybrid design works best, pairing high-quality online coursework with structured on-campus experiences such as direct faculty mentorship and simulation-based training. This approach gives students the flexibility they need without sacrificing the experiential learning required for safe, competent clinical practice.

Online graduate nursing programs are not a temporary fix. They function as a powerful workforce development strategy, broadening access for students, reducing logistical burdens on faculty, and preparing future clinicians to navigate telehealth and digital care workflows before they enter practice. 

Addressing the nursing workforce crisis requires more than increasing the number of new graduates, it demands strategic investment in the current nursing workforce and the creation of accessible pathways to advanced degrees, leadership positions, and academic careers. 

Academic institutions must prioritize the development and sustained funding of online graduate programs, while accrediting bodies should focus on evaluating these programs based on outcomes rather than delivery format. Online graduate education has been evolving toward this role for years; now is the time to invest in, expand, and recognize it as one of the most effective tools available to address the nursing workforce crisis.

Discover the extraordinary women whose courage, innovation, and advocacy transformed healthcare and paved the way for modern nursing excellence.

Pioneers Who Established Nursing as a Profession

The foundations of modern nursing rest on the shoulders of visionary women who transformed caregiving from an unregulated practice into a respected profession.

Florence Nightingale, often called the founder of modern nursing, revolutionized healthcare during the Crimean War by implementing sanitation practices that dramatically reduced mortality rates. Her establishment of the first scientifically-based nursing school at St. Thomas' Hospital in London in 1860 set standards for nursing education that rippled across the globe. Nightingale's emphasis on evidence-based practice, meticulous record-keeping, and patient-centered care laid the groundwork for the professional standards we uphold today.

In the United States, pioneers like Clara Barton and Dorothea Dix broke barriers during the Civil War era. Barton, who founded the American Red Cross in 1881, demonstrated that Nurses could lead large-scale humanitarian efforts and disaster response initiatives. Her work established nursing as essential not just in hospitals, but in communities during times of crisis.

Meanwhile, Mary Eliza Mahoney became the first African American Registered Nurse in 1879, graduating from the New England Hospital for Women and Children. Mahoney's achievement was a watershed moment for diversity in nursing, and she spent her career advocating for equal opportunities for Nurses of color, co-founding the National Association of Colored Graduate Nurses in 1908.

These early trailblazers faced significant resistance in male-dominated medical establishments, yet their persistence and dedication proved that nursing required specialized knowledge, critical thinking, and professional training. They established the core values of compassion, competence, and advocacy that continue to define our profession.

Champions of Public Health and Community Care

While hospitals became centers of medical advancement, visionary Nurse leaders recognized that true health equity required reaching people where they lived.

Lillian Wald, founder of the Henry Street Settlement in New York City in 1893, pioneered the concept of public health nursing. She and her colleagues provided healthcare to immigrant families in their homes, addressing not just illness but also the social determinants of health like poverty, housing, and education. Wald's holistic approach to community wellness established the model for modern community health nursing and demonstrated that Nurses could be powerful advocates for social justice.

Margaret Sanger, a public health Nurse working in New York's Lower East Side in the early 1900s, witnessed firsthand the devastating impact of unwanted pregnancies and unsafe abortions on women's health. Despite facing arrest and fierce opposition, she opened the first birth control clinic in the United States in 1916 and founded what would become Planned Parenthood. Her advocacy for reproductive health education and women's access to family planning services transformed maternal and child health outcomes and empowered countless women to make informed decisions about their bodies and futures.

Mary Breckinridge brought sophisticated healthcare to one of America's most underserved populations when she founded the Frontier Nursing Service in rural Kentucky in 1925. Recognizing that geographic isolation created severe health disparities, she trained Nurse-Midwives to provide maternal and child healthcare in remote Appalachian communities. Breckinridge's model demonstrated that advanced practice Nurses could deliver high-quality care in areas without Physicians, significantly reducing maternal and infant mortality rates. Her work laid the foundation for modern Nurse-Midwifery and rural health nursing, proving that innovative care delivery models could address healthcare access challenges.

Advocates Who Transformed Healthcare Policy and Patient Rights

Throughout history, Nurses have leveraged their frontline perspective to advocate for policy changes that protect patients and improve healthcare systems.

Lavinia Dock, a pioneering nursing leader and women's suffrage activist, recognized that Nurses needed political power to effect meaningful change. She argued passionately that Nurses must have a voice in healthcare policy and labor rights, helping to establish professional nursing organizations that could collectively advocate for the profession. Her work in the late 1800s and early 1900s connected nursing advancement to broader social justice movements, establishing a tradition of Nurse activism that remains vital today.

During World War II, African American Nurses faced discriminatory policies that prevented them from serving in the military or restricted them to caring only for Black soldiers and prisoners of war. Mabel Staupers, executive secretary of the National Association of Colored Graduate Nurses, led a tireless campaign to end these discriminatory practices. Her advocacy efforts, which included meetings with First Lady Eleanor Roosevelt and public pressure campaigns, resulted in the integration of the Army and Navy Nurse Corps in 1945. Staupers' work was a crucial victory for civil rights and demonstrated how organized Nurse advocacy could dismantle systemic racism in healthcare institutions.

In more recent decades, Nurses like Beverly Malone and Joyce Clifford have shaped healthcare policy at national levels. Malone, who served as President of the American Nurses Association, has been a powerful voice for nursing workforce issues, patient safety, and healthcare reform. Clifford pioneered the primary nursing model at Beth Israel Hospital in Boston, fundamentally changing how nursing care is organized and delivered. Her work demonstrated that Nurse-led care models improve patient outcomes and Nurse satisfaction, influencing healthcare policy and hospital administration practices nationwide.

Innovators Who Advanced Clinical Practice and Education

Innovation in nursing practice and education has consistently been driven by women who questioned conventional approaches and developed better ways to care for patients.

Virginia Henderson, often called the 'First Lady of Nursing,' revolutionized nursing theory and education in the mid-20th century. Her definition of nursing, helping individuals gain independence in meeting fundamental needs, shifted the profession's focus toward holistic, patient-centered care. Henderson's work in developing nursing curricula and her prolific writing educated generations of Nurses worldwide, emphasizing that nursing is both an art and a science requiring continuous learning and critical thinking.

Sister Callista Roy developed the Roy Adaptation Model, a theoretical framework that views patients as adaptive systems responding to environmental changes. Her work, which began in the 1960s and continues to evolve, has influenced how Nurses assess patients, plan interventions, and evaluate outcomes across diverse healthcare settings. Roy's emphasis on adaptation is particularly relevant for today's Nurses managing patients with chronic conditions, navigating telehealth technologies, and addressing the psychological impacts of illness, challenges that require adaptive thinking and innovative care strategies.

Ildaura Murillo-Rohde founded the National Association of Hispanic Nurses in 1975, recognizing that culturally competent care requires understanding patients' cultural backgrounds and that the nursing workforce should reflect the diversity of the communities it serves. Her advocacy for increasing Hispanic representation in nursing and her work in psychiatric nursing advanced both diversity in the profession and clinical understanding of mental health across cultures. Murillo-Rohde's legacy continues through ongoing efforts to recruit and support Nurses from underrepresented backgrounds, addressing the critical need for workforce diversity that improves patient outcomes and health equity.

The innovations of these leaders demonstrate that nursing excellence requires both honoring evidence-based traditions and embracing change. Whether you're a nursing student learning fundamental skills, a bedside Nurse implementing new protocols, or an experienced Nurse pursuing advanced certification, you're part of this continuum of innovation. The challenges you face today, from burnout and staffing shortages to emerging health threats and technological disruption, require the same courage, creativity, and commitment to excellence that these trailblazers embodied. Their stories remind us that every Nurse has the potential to innovate, lead, and transform healthcare for future generations.

For the 24th year in a row, Nurses have been rated as the most honest and ethical profession, a remarkable streak of trust that speaks volumes about the heart of the nursing profession.

In the most recent Gallup poll released January 12, 75% of Americans say Nurses have “very high” or “high” honesty and ethical standards, more than any other profession surveyed. In comparison, medical Doctors and Pharmacists earned majority positive ratings (57% and 53%, respectively), but still fell well behind Nurses.

A Legacy of Trust

Nurses first appeared on Gallup’s honesty and ethics list in 1999, and with one rare exception, firefighters in 2001 after the 9/11 attacks, they’ve held the top spot ever since.

This long-running recognition reflects how deeply the public values Nurses’ commitment to patient care. Whether in hospitals, clinics, or community settings, Nurses are often the professionals people see most frequently during vulnerable moments, earning their trust through compassion, accountability, and ethical practice.

Ratings Have Shifted Since the Pandemic

Interestingly, while Nurses remain the top-ranked profession for ethical standards, their score in this latest poll is slightly lower than recent highs. The current 75% is near the lower end of their historical range and about 14 percentage points below the record high seen in 2020 during the height of the COVID-19 pandemic.

Other professions tracked in the poll also showed declines from pandemic-era peaks, indicating that overall public confidence across many fields has softened in recent years.

How Nurses Compare

In contrast to Nurses’ strong rating:

• Medical Doctors and Pharmacists remain respected but notably behind in honesty and ethics scores.

• Professions such as telemarketers, members of Congress, and car salespeople ranked at the bottom with very low “high ethics” ratings.

Only four professions, including Nurses, Veterans, medical Doctors, and Pharmacists, earned majority positive ratings for high ethical standards.

Why This Matters

For Nurses, this poll isn’t just a statistic, it’s a reflection of the everyday realities of the profession:

• Ethical responsibility is core to nursing practice, embodied in codes of ethics that guide decision-making and patient advocacy.

• Nurses often serve as the primary point of contact for patients and families, building trust through communication, care, and consistency.

• That trust matters, it’s foundational to effective patient care, improved outcomes, and strong therapeutic relationships.

This year’s Gallup results remind us that, even in complex times, the nursing profession continues to stand out in the public mind as a beacon of ethics and honesty. That reputation has been forged over decades of compassionate care, and it endures even when public confidence in other professions wavers.