Many do not know that hospitals with the highest number of paying patients are the most viable economically. The hospitals care for large amounts of patients, considered the working poor, unemployed, no health insurance, documented immigrants, mentally ill, and Medicaid patients who are either public or nonprofit (Nickitas et al., 2020). The vulnerable populations fall into groups of people that are at a higher risk of receiving imbalanced medical care on status as well of: finances, age, race, gender, culture, sexual orientation, disability, social status, or their current insurance status (Bhatt & Bathija, 2008). The Americans living amongst us over a million are vulnerable and urban communities and healthcare institutions that build organizations and providers to continue providing care to the vulnerable population in the world today. They ensure every day by providing care equitable and culturally competent (Bhatt & Bathiaja). All facilities need to be culturally diverse and train staff accordingly to provide proper care and patient needs. It is an essential part of delivering health care diligently and having a better understanding of the background of the patients. Addressing the social determinants of health (SDOH) and having proper screening for the patients with these issues will help by providing the necessary services these individuals need and benefit from appropriate resources. If it means providing them information to the local clinics and community-based organizations and referring them to these programs, they can help them in their healthcare. One advancement is utilizing telehealth services to better meet the needs by having accessible, immediate consultations that are necessary, communicating with the physician without leaving their home, less expensive, and more convenient for this population (Bhatt & Bathiaja, 2018). Healthcare is drastically evolving daily, and the importance is increasing for health facilities and providers to collaborate with local stakeholders who can facilitate healthcare needs to the vulnerable communities by ensuring they have continued support and are given proper care. The stakeholders need to establish routine meetings to identify the potential barriers regarding the population to achieve good health and ways to work together in helping them achieve a healthy outcome (Bhatt & Bathiaja, 2018).

There are six factors in which nurses need to consider while working in an acute care setting stated by the Institute of Medicine (IOM), which aim for changes in the healthcare system. According to the IOMs website, having safe, effective, patient-centered, timely, efficient, and equitable care is always the goal to achieve when considering the patient (IOM, 2020). As nurses, we have become the frontline providers in todays healthcare. The nurses are at the bedside and get to know the patient daily. Nurses are the ones who care for and comfort patient when they are at vulnerable times of their lives. Aiming to achieve the goal of the six factors efficiently when providing healthcare should be a nurses priority. On the other hand, some obstacles can impact whether this is accomplished. One of the issues is adequate staffing which has been an ongoing issue for a long time in healthcare. When nurses are rundown, juggling too many things with patient care, being short-staffed, and not having enough of themselves to adequately provide patient care can negatively affect all six aims.

Giving the education to nurses on being culturally competent and have the completed culture training in helping to know and understand diversity. This diversity helps close racial and ethnic gaps within healthcare accomplishing equitable care to all patients. Assuring care is centered around the patient and respecting their choices when the nurses give efficient and timely care to ensure it is delivered appropriately in a quality mannerhaving the patient safety mechanism in place to prevent any unnecessary injuries and have the training provided on ways to improve patient safety. Communication is a key to meeting the IOMs six factors that ensure physical comfort and provide emotional support to the patient, their family, and friends at the bedside.

As nurses, we all do our best to provide quality care to our patients. We perform safe maintenance through patient identifiers, effective, timely, and efficient through time management. Providing patient-centered and equitable care to all patients is the key and goal. Reaching the goal is to have enough nurses to go around for the patients to help meet the six aims.

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