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Addressing health inequities requires integrating structural competency into nursing education. Today, nurse educators must prepare future nurses to understand how social, economic, and political structures contribute to health inequities and influence health outcomes. Leading organizations such as the National Academy of Medicine, the American Medical Association, and the American Nurses Association's (2005) Code of Ethics emphasize the importance of this competency in transforming nursing education. Nurses need both academic knowledge and practical experience to assess and address determinants of health through collaboration, advocacy, and active engagement (Drevdahl, 2018; National Advisory Council on Nursing Education and Practice [NACNEP], 2019; Robichaux & Sauerland, 2021; Thornton & Persaud, 2018).
Structural competency is the trained ability to recognize, analyze, and respond to health outcomes as products of broader social, economic, and political structures (Metzl & Hansen, 2014). Unlike cultural competency, which centers on individual beliefs and behaviors, structural competency focuses on systemic forces, such as structural racism, income inequality, housing insecurity, and health care access, that shape population health (Metzl et al., 2020; Robichaux & Sauerland, 2021). Nurses, positioned at the intersection of health care and community life, are uniquely equipped to identify and challenge these structural barriers. By cultivating structural awareness and critical thinking, nursing programs can prepare students not only to recognize health inequities but also to advocate for systemic change through both clinical practice and health policy (Drevdahl, 2018; Robichaux & Sauerland, 2021; Thornton & Persaud, 2018). Despite growing interest in structural approaches to health, structural competency remains inconsistently integrated into nursing curricula (Woolsey & Narruhn, 2018). Integrating structural concepts and advocacy training into nursing education is essential for equipping future nurses to challenge inequitable systems and advance health equity.
Despite nursing's long-standing commitment to health equity, few studies have examined structural competency in nursing education. The Future of Nursing 2020–2030 report calls for curricular reforms addressing social determinants of health, health care economics, and systemic inequities to prepare nurses for diverse and complex health care environments (Hassmiller & Wakefield, 2022). Integrating structural competency in both academic and clinical experiences is essential but presents challenges due to a lack of standardized pedagogical strategies (Robichaux &...