(Guest opinion from a nurse practitioner and educator.)

I am deeply concerned by recent legislative actions in my home state of Utah and a number of other states that undermine the foundational principles of diversity, equity, and inclusion (DEI) in publicly funded higher education. While I am fortunate to teach at an institution not subject to these restrictions, I am a proud alum of Utah’s state university system, which educates the vast majority of our nurses and nurse practitioners.

Utah’s “Equal Opportunity Initiatives” law (H.B. 261), which took effect on July 1, 2024, prohibits DEI practices, programs, policies, and initiatives in higher education and government employment. As a result, DEI offices and cultural centers have been dismantled at institutions such as the University of Utah, Southern Utah University, Utah State University, and Weber State University. Eliminating these initiatives threatens the quality and integrity of nursing education and undermines our commitment to culturally competent care.

The loss to patient care and workplace diversity.

It has been shown that more diverse and culturally competent nurses achieve better patient outcomes, including improved satisfaction, treatment adherence, and overall health. DEI initiatives help train nurses to recognize implicit biases and reduce health disparities. Furthermore, these efforts support the recruitment and retention of underrepresented groups in nursing, ensuring a workforce that better reflects and serves diverse patient populations.

It is still early to measure the full impact of these legislative changes, but initial reports suggest negative consequences, particularly for certain subgroups of students. The shuttering of the Black Cultural Center, the Women’s Resource Center, The LGBTQ+ Resource Center, and the Center for Equity at the University of Utah has left many students without essential support systems. The loss of these resources will likely impact student mental health and could contribute to declining enrollment among marginalized communities, including in nursing programs.

The misrepresentation of DEI initiatives.

One fundamental problem is the deliberate misinterpretation of DEI initiatives by some conservative commentators, who claim these policies unfairly disadvantage white men or compromise standards by favoring diversity over merit. In reality, DEI is not about quotas or special treatment—it is about ensuring that everyone has equal access to opportunities and support. For instance, young parents in need of affordable childcare and individuals like my daughter—who, despite thriving with a prosthetic, occasionally require additional accommodations—illustrate that the inclusive approach encompassed by DEI initiatives and regulations can ultimately benefit us all, including those who might be assumed to benefit less.

Utah’s crackdown on academic freedom may also discourage top educators from teaching in the state, mirroring what has happened in states with restrictive abortion policies, where many OB/GYNs have left. The American Association of Colleges of Nursing (AACN) reports that thousands of qualified nursing school applicants are turned away each year due to a shortage of faculty. Utah’s new policies may exacerbate this crisis, making it even harder to train the next generation of nurses.

AACN core competencies and DEI principles.

The AACN and its accreditation branch, the Commission on Collegiate Nursing Education (CCNE), explicitly incorporate DEI principles into their core competencies for nursing graduates, emphasizing culturally competent care. These competencies require addressing health inequities, structural racism, and systemic disparities. For example:

Domain 4 underscores the unique nurse–patient relationship as a vehicle for providing optimal care and tackling these disparities.
Domain 6 highlights the role of DEI in team-based communication.
Domain 8 stresses the need for equitable informatics and technology practices.

Removing DEI initiatives hinders students’ ability to meet these accreditation standards, potentially affecting the quality of nursing education and patient care outcomes.

To put it another way, nursing education as currently defined by leading national accreditation bodies inherently includes training on implicit bias, structural racism, and providing culturally competent care. Removing these initiatives will hinder students’ ability to meet accreditation standards. If these national nursing bodies decide to acquiesce to avoid falling afoul of a political movement, they risk damaging their reputation and impacting the quality of nursing education and patient care outcomes for years if not decades to come.

The danger of further reducing the nursing workforce.

Nursing is already facing a severe workforce shortage. Removing DEI efforts risks creating unwelcoming environments for students and professionals from diverse backgrounds, further shrinking the pipeline of qualified registered nurses and nurse practitioners (NPs). It could also potentially worsen the nursing faculty shortage, making it difficult to attract and retain talented professors and clinical instructors who may fear their teaching would come under scrutiny just for upholding the values baked into nursing core competencies.

What can nurses and nursing organizations do?

National nursing organizations must take a stronger stance against these policies. A passive statement on a website is not enough. These organizations should consider stronger actions, such as leveraging accreditation standards to ensure nursing programs maintain DEI principles. As the most trusted professionals, nurses have a powerful voice. It is imperative that we use it to advocate for the future of our profession and the well-being of our patients.

To the readers of this publication, I also call upon you to act. Zalon, Ludwick, and Patton (2024) in “Strengthening Nurses’ Influence in Health Policy” emphasize that “nurses should be prepared to consistently speak up, speak out, and be involved in policy.” Advocacy takes many forms. If you are a speaker, engage with your legislators. If you are a creator, raise awareness through social media. If you have the drive, run for office. We must do more than serve at the bedside—we have so much more to offer.

Elizabeth Hanna, DNP, PMHNP, AGACNP, is an NP, educator, clinician, and activist dedicated to transforming health care. She earned a DNP in acute care from the University of Utah (2019), a postgraduate certificate in mental health from the University of Cincinnati (2024), and an MSc in health policy from the London School of Economics (2002). She splits her time between teaching, research, and her clinical practice as a mental health care provider with a focus on bariatrics. As a professor on the NP program at Westminster University, she strives to empower future health care leaders to bridge research, policy, and practice. A passionate storyteller, she believes that creative writing and narrative medicine allow us to better understand ourselves and the world by exploring difficult issues and experiences.

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