Recently, some groups have challenged various initiatives related to diversity, equity, inclusion, and belonging (DEI), with so called ‘culture wars’ pushing these issues front and center on the national stage. However, there should be nothing political about ensuring equitable access to healthcare or encouraging diversity and an atmosphere of excellence that is both authentic and inclusive. These are ideals that likely motivated us all to join the world of healthcare and neurocritical care, and the establishment of the Henderson Equity and Research on Disparities (HEARD) Center exemplifies a dedicated effort to address these issues and eliminate disparities within neurocritical care.​

The HEARD Center, established in honor of Dr. Galen Henderson, embodies a mission to eradicate disparities in neurocritical care. As indicated on the HEARD Center website, its aim to lift up the voices of healthcare professionals from underrepresented communities is central to the goal of reflecting diversity and recruiting practitioners who look like and understand the communities they serve, helping us make progress in improving healthcare for people from all walks of life. While the words ‘diversity,’ equity,’ and ‘inclusion’ might be hot button words these days, with many now fearful of the impact of these words on funding, it is my belief that now is precisely the time to double down on these concepts.

In my opinion, the practice of neurocritical care involves more than our daily routines in the neuro ICU and should include a more holistic approach to patient care. Nurses can have unique opportunities to contribute to such a holistic approach, such as identifying and addressing social determinants of health that can contribute to health inequities. Their close interactions with patients enable the assessment of factors such as socioeconomic status, education, and environmental conditions that influence health outcomes. By understanding these social determinants of health, nurses can advocate for resources and interventions that can mitigate health risks, with the goal of preventing neurocritical illness. For example, nurses can organize community education programs on stroke prevention to decrease the incidence of neurocritical illness. These programs could include blood pressure screenings, smoking cessation clinics, and stroke education classes.

‘Equity pauses’ are a practice I have introduced in my role as an academic. Equity pauses are intentional moments when all discussion is paused, allowing us as a team to think carefully about the impact of the decision being considered. The equity pause requires us to consider whether any group is disenfranchised or disproportionately affected compared to another group because of the proposed decision. Similarly, equity pauses can be incorporated into every nurse’s clinical practice. Every day, nurses should reflect on what social determinants of health may be at work in their panel of patients. Questions nurses might pose when caring for patients include:

• Did financial constraints contribute to the patient’s hospitalization?
• Does the patient have adequate social support to promote optimal health?
• Is there any evidence of low health literacy?
• Have any medications or treatments been ordered that might be difficult for this patient to obtain or implement once discharged?

This is not an exhaustive list of questions that might address issues of equity. However, these are questions that begin to help nurses think about issues that disproportionately affect marginalized communities. Patients’ families should also be considered when posing these and other questions. They can prompt nurses to pursue interventions that help eliminate barriers to care, such as referrals to social work, case management, and other services that may help prevent rehospitalization, recurrent neurocritical illness, or other complications. Importantly, these are all nursing interventions that do not require any specific physician order.

Additionally, promoting equity in healthcare includes addressing language barriers. While political interventions focused either on assessing patients’ immigration status or establishing English as the official language may be in vogue in certain political environments, these issues have nothing to do with healthcare. Many hours could be spent debating issues such as immigration or language policy, but these are best reserved for other forums. When clinicians of all disciplines have a patient before them, these sociopolitical concerns—and our personal beliefs about them—must be set aside. Our sole concern should be providing the care necessary to best serve our patients. This includes providing language services to ensure patients and their families can fully participate in their care.

I believe these are concrete steps that nurses can take every day, and they are all aligned with the mission and vision of the HEARD Center. In the face of evolving challenges to DEI, nurses remain indispensable in promoting equity and removing barriers to care. By aligning with organizations like the HEARD Center, nurses can amplify their impact, ensuring that all individuals have access to the quality neurocritical care they deserve. I encourage nurses both within and outside NCS to join the society in supporting the HEARD Center as a concrete step to promote health equity.