“I had become fed up”: A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout

Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery.To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so.We conducted focus groups and interviews of Black NPs ( N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis.Emergent themes included: Strategies Utilized to Address Health Inequities ; Burnout & the Minority Tax ; Risks & Rewards of Taking a Stance ; and Uneven Promises of Organizational Engagement . Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles.Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care.The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.