Ethics is concerned with the suffering humans cause one another and the related capacity of humans to recognize and address this suffering through the empathetic virtues of sympathy, compassion, and caring (Roberts, 1996). Much suffering throughout history can be related to the problem of "unacceptable" diversity among individuals or groups. Remembering the cruelties of the Nazi exterminations of Jews, slavery in the United States, and discrimination against homosexuals jolts us to awareness of the suffering of those who are "different." A task of ethics, then, is to include, rather than exclude (Post, 1995). One approach to an ethics of diversity for healthcare professionals is a call for intimate listening to the stories of those who are different, who may be unseen, marginalized, and excluded in our health care systems.

ethics and diversity

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Disparities in health and health care have been around for more than two centuries. Evidence suggests that health disparities in ethnic and racial minorities continue to be problematic, with little progress made to eliminate them over time. Ethnic and racial disparities exist for multiple and complex reasons. However, new solutions are needed to resolve some of these old problems. Framing the debate and discussion around the distinctiveness related to disparities in health and health care is a necessary beginning in eliminating unequal burdens in health status. Focusing efforts to eliminate unequal burdens can strengthen existing solutions and policy formation related to this issue. This article defines disparities in health and health care, describes current health disparities impacting ethnic/racial groups, reviews historical factors associated with existing disparities in ethnic/racial groups, and concludes with challenges and solutions to alleviate these disparities.

health disparities --- diversity --- ethnic and racial minorities --- unequal burden

The historical experience of African Americans in our country has been shaped by the institution of slavery, dehumanization of blacks, segregation, pursuit of civil rights, and racism in contemporary American society. Disparities in health care provide compelling evidence that issues of race or skin color for the descendants of slaves and other ethnic minorities persist in the 21st century. Nurses providing care for African Americans must bridge the racial divide and incorporate culturally relevant content in the health history. As an integral aspect of their professional growth as culturally competent health care providers, they must incorporate the idea of race consciousness which is described as an awareness of the historical journey of the group, knowledge of disparities in health care for the people, and a self appraisal of one’s attitudes and biases toward the group.

institution of slavery --- racial inferiority --- segregation --- disparities in health --- racism --- race consciousness --- cultural competence

During 2002, the 107th Congress passed landmark legislation, the Nurse Reinvestment Act, P.L. 107-205. This article discusses the specific provisions of P.L. 107-205 within the context of the contemporary literature and the experience of the nursing shortage. The authors ask nurses to examine what the Nurse Reinvestment Act means for their career development. In laying out the anatomy of the Nurse Reinvestment Act, title by title, and section by section, the article presents the Congressional plan for addressing the two faces of the shortage: Nurse Recruitment, Title I, and Nurse Retention, Title II. Under Title I, Nurse Retention, Section 101 presents Definitions used in the public law. Section 102, promotes the development of Public Health Service Announcements about the nursing profession. In the last section of Title I, Section 103, Congress establishes a National Nurse Service Corps. Title II, Nurse Retention, Section 201, is directed toward Building Career Ladders and Retaining Quality Nurses. In Section 202, the development of Comprehensive Geriatric Education is encouraged. Section 203 establishes a Nurse Faculty Loan program, while the last section of Title II, Section 204, mandates reports from the General Accounting Office. The 107th Congress adjourned in November 2002 without acting on the appropriation bill that would have made the Nurse Reinvestment Act a reality. Before the new Congress meets in January 2003, nurses must join with their colleagues to assure adequate funding for P.L. 107-205. The websites of the American Nurses Association (www.nursingworld.org), the National League for Nursing (www.nln.org), The American Association of Colleges of Nursing (www.aacn.org), and the Specialty Nursing Organizations (www.aspanlorg/Spec) provide direction in approaching members of Congress. However, because of the importance of the Nurse Reinvestment Act, nurses must also align themselves with representatives from the many groups who supported the legislation. Readers of this Online Journal in Nursing article should be empowered to contact the American Hospital Association, the Catholic Hospital Association, the American Association of Retired Persons, the American Medical Association, the National Association for Home Care, and the Service Employees International Union for their assistance and the support of their membership in the passage of the FY 2002 Labor/HHS/Education Appropriations Bill.

Nurse Reinvestment Act --- nursing shortage --- nurse recruitment --- nurse retention --- working conditions for nurses --- faculty for schools of nursing --- enrollment in nursing programs --- nursing education --- National Nurse Service Corps --- scholarship and loan repayments --- public image of nurses --- schools of nursing --- stereotypes of nurses --- women in health professions --- workplace culture --- hospital staffing --- healthcare legislation --- Public Law 107-205