How Do You Address Unconscious Bias?

I am honored to introduce this month’s guest blogger, Kenya V. Beard EdD, AGACNP-BC, NP-C, CNE, ANEF. Dr. Beard is a 2012 Josiah Macy Faculty Scholar and Associate Professor at The CUNY School of Professional Studies, 101 West 31st Street, New York, NY 10001. We met through a mutual colleague a few years ago and immediately began compelling dialogue about racism, diversity and inclusion, implicit bias, and healthcare disparities. Dr. Beard was our invited speaker at the Connecticut Nursing Collaborative-Action Coalition Statewide Summit in November 2016. Her presentation was inspiring, authentic and full of thought-provoking takeaways. Her blog contribution leaves us with thoughts to reflect on. Perhaps you will join the conversation! Dr. Beard can be reached at:





How Do You Address Unconscious Bias? – Dr. Kenya V. Beard

What would you do if you saw a large dog running toward you? Your response to that encounter would be largely influenced by your beliefs and attitudes (bias) about large dogs. Now replace the large dog with the word friend, enemy, overweight person, homeless person, Black male, elderly White male, Spanish-speaking teenager, or a middle-aged Muslim running toward you? How would you respond? Our brain is wired to make quick associations and categorize information in a way that allows us to quickly process and effectively respond to the environment. However, while conscious biases are dictated and controlled, unconscious biases are quick and automatic. Unfortunately, unconscious biases could trigger responses that deviate from your desire to support difference and respond in socially respectful ways. The National League for Nursing provides an example of unconscious bias in an article entitled Diversity and Cultural Competence. The scenario describes how a swift response could portray one who believes they are empathic and kind as someone who is uncaring and insolent.

Unconscious bias is not totally bad. These thoughts emerge quickly and trigger an emotional response that is designed to prevent your hand from being chomped off by the rather large dog that was mentioned above. However, sometimes unconscious bias results in a response that is harmful, unfavorable to others and fosters “-isms”. One dangerously disturbing and enduring “-ism” that permeates throughout the United States and is sustained by unconscious bias is racism. The devastating effects of race-based biases are well described in healthcare, education, and the criminal justice system. Race-based biases limit academic potential, contribute to poor health outcomes, prevent inclusivity and too often lead to a violent loss of life.

So how do you address unconscious bias if it is not clear, yet, automatically shows up in ways that foster “–isms” like racism, sexism, and ageism? First, unconscious biases must be acknowledged. Self-reflection, an enlightening process, can be used to help recall and address unconscious beliefs and attitudes. Self-reflection creates a space of deep and meaningful thought where you can explore your actions, become more intentional with your responses, and present yourself in ways that align values with responses. Secondly, the brain sees what it wants to see; it looks for affirmation. This means we must listen for a broader understanding rather than listen to uphold our own views or to inform others. Thirdly, it takes great courage to admit that your actions were hijacked by socially undesirable thoughts, albeit unconscious. To address unconscious bias requires bravery that supersedes the fear of sharing your unfavorable and marginalizing responses. And lastly, let’s “out unconscious bias”. Disseminate your narrative about unconscious bias and share what you are doing differently to move the needle towards social justice. While you can’t undo how your brain is wired to protect the body, you can undo racism and the beliefs that dictate how you quickly respond to others. Sharing your narrative will help form new neuronal circuits that are likely to generate an ethos that supports difference and allays fear.

In summary, Acknowledge your biases, seek a Broader understanding, be Courageous, and Disseminate your story. Only then will your actions truly transform homes, communities, institutions, and society in a more meaningful and sustainable way. So, will you share your encounter with bias and how you address unconscious bias in your world?



Nurses on Boards and Healthy Communities

healthy-communitiesHealthy communities require groups of people working together in  partnership toward shared goals. Concepts in population health challenge us to apply upstream thinking to build healthier communities. Building healthy communities certainly requires attention to explicit health indicators and also requires attention to many other health correlates. These correlates or determinants of health are readily available on the Healthy People 2020 website. The categories of health determinants listed in Healthy People 2020 include policy making, social factors, health services, individual behaviors, biology and genetics. This list describes a very broad range of factors that affect the health of individuals and communities. Clearly, health is a complex matrix!

The Robert Wood Johnson Foundation is promoting its vision of healthy communities in its Culture of Health framework. The framework focuses on 4 action areas: 1. Making health a shared value; 2. Fostering cross-sector collaboration; 3. Creating healthier, more equitable communities; and 4. Strengthening integration of health services. These 4 action areas and their specific drivers work in combination to achieve “improved population health, well-being and equity.”

A very short list of components of healthy communities include:

  1. Easy access to healthcare services
  2. Available public transportation and roadways
  3. Access to healthy food choices
  4. Access to quality education
  5. Access to safe and healthy housing
  6. Safe parks and outdoor spaces
  7. Healthy recreation choices
  8. Access to social support services
  9. A sense of spirituality
  10. Freedom from crime
  11. A healthy natural environment

As nurse leaders, we are aware of these concepts and components as they relate to our patient groups. We know how important these components are in relation to the ability of our patients to be healthy, remain healthy, seek preventive healthcare and healthcare treatment. So how do the concepts of healthy communities relate to nurses’ roles in board governance?

Nurses on boards are in a unique position to focus boardroom discussions and decision making around the determinants of health that lead to and maintain healthier communities and healthier people. Even in organizations that are not specifically focused on healthcare, nurses can have influence over policies, processes, and goals that support health. For example, on youth development boards, nurses can use knowledge of age appropriate activities and health risks to shape decision making for programs. On sports boards, nurses can help frame discussions around risk management policies. Nurses can shape nutrition policies on school boards. Nurses can ensure that transportation committees focus on providing access to vulnerable populations. On community advisory boards, nurses can use their knowledge to promote safe outdoor spaces and access to healthy food choices. In the healthcare environment, nurses can influence governance decision making that places individuals and communities at the center of the mission and goals of the organization.  These are but a few examples.

Board leadership for nurses is an extension of nurses’ commitment to health and social justice (Sundean & Polifroni, 2016). Nursing knowledge is a key component of boardrooom discussions and decision making that affect the health of individuals and communities. In combination with board directors from other sectors, nurses help comprise the multi-sector stakeholder board groups that govern on behalf of organizations and communities they serve. Nurses’ board role is to ensure that decisions reflect the best interests of stakeholders that will lead to healthier communities and healthier people who live in those communities.

The concept of nurses on boards, at first glance, seems like a wandering from nursing. However, the metaparadigm of nursing tells us that nursing is essentially about nurse-environment-person-health (Fawcett, 1984). Advocating for programs, policies, processes, and structures that promote healthier communities is unequivocally a leadership role for nurses. It is incumbent on nurses to embrace the leadership role of nurses on boards along the continuum of our core role as health advocates. Nurse board leadership is not about straying from nursing, it is about leading communities toward population health as described by Healthy People 2020 and the Robert Wood Johnson Foundation Culture of Health framework. Advocating for health is a fundamental role for nurses whether at the bedside or in the boardroom. The power of the nursing voice in the boardroom is key for transformational change in healthcare and for building healthier communities.




Pushing the RESET Button for a Healthy New Year


Happy New Year to All!

New year, new goals, new deadlines, new President, new worries. While this time of year is surely one of quiet reflection, it is often also a time for mounting angst. And while it is frequently a time for meaningless resolutions, it is also a good time to start new routines. How will you quell the new year’s jitters? How about trying a new, healthy routine?

I know, I know… you’ve tried the gym-twice-a-day routine, the eat-only-grass-clippings routine, the drink only water-cayenne pepper-and-lemon juice routine. They all failed, I know. So what about something different? Here are a few ideas:

  1. Set a positive tone for each day. Wake up each morning and recognize a gratitude or something (however small) that you are excited about.
  2. Healthier eating. Try eating one new healthy food each week – and eliminate one not-so-healthy food. What kind of healthy food? Peruse your local fresh produce aisle for ideas.
  3. Get outside everyday. Go for a walk, a run, a bike ride, walk your dog, breathe deep. Ever consider a walking meeting? Your brain works well on activity and fresh air. Try scheduling your next meeting as an outdoor walking meeting – minutes can be taken by dictation into a smartphone. Appropriate shoe wear is a must. Winter weather? No problem! Dress for it!
  4. Begin a mindfulness practice – start with 10 minutes a day. There are plenty of apps to keep you on track. Headspace is one I particularly like:
  5. Sleep. Get it. Enough of it. Simply put, your mind and body needs adequate rest each day to function well.
  6. Life gets tough sometimes. Have a pocketful of affirmations to get you through those times: I can do it! That’s an easy one. How about: I’ve been through tough times before and I always come out of it better than I went in. Or simply: All will be well. Maybe: What’s the worst that can happen? How about this one: I am so excited about this challenge!  – Your brain responds to affirmations, so give them a try.

Try choosing 1,2 or 3 of these ideas – or a few of your own. They may not change the deadlines or challenges, but they might just help you manage the stress a little better. You might even find you have more energy and hope – which can translate to greater productivity in work and more time for play. Even leaders need to push the RESET button from time to time. Let this be your time. Here’s to a year of inspired health!

Every day something more or less kills me with delight ~ Mary Oliver


Lead By Truth


Three things cannot be hidden long – the sun, the moon, and the truth   ~ Buddha

Lead by truth. It seems so obvious but our current political climate demonstrates popular, untested beliefs and wants have a way of obfuscating the truth. Yes, we must honor the needs of our citizens, our clients, our patients, our staff, our colleagues -AND- we must do so within the context of truth backed by evidence and data. Leadership guidelines in a post-truth era will require a strong sense of fortitude.

Rule #1: Commit unrelentingly to the truth. Sometimes it is hidden. Do the digging necessary to unearth the truth. Sometimes it does not want to be heard. Let the truth be heard over other voices.

Rule #2: Question all assumptions. Sound decisions cannot be based on faulty assumptions and half-truths. Recognize that assumptions and truth can change over time. For example, the earth is not flat, margarine is not a healthy alternative to butter, and pressure ulcers are not an acceptable consequence of hospitalization. We must be open and humble, yet critical and discerning about assumptions that underlie truth.

Rule #3: Demand data and evidence, both quantitative and qualitative. Build an accurate picture of a situation from which decisions can be made. Stay open to the emergence of new truths based on solid evidence.

Rule #4: Understand counter-arguments. Consider alternative perspectives and points of view. Understand their genesis and logic or lack thereof. Engage in the civil discourse needed to uncover and uphold what is true. Call out falsehoods – yours and those of others.

Rule #5: Situate healthcare leadership within the context of social justice and principles of equity. Ask the questions: Whose truth is this? Does it hold true for all? Who is advantaged or disadvantaged by this truth? Will decisions based on this truth support and advance health equity and social justice or will decisions based on this truth lead to inequities and disparities?

Rule #6: Base decision making on truth and not popular beliefs. Stand firmly on truth to guide decisions. Popularity is wildly overrated. Truth endures.

As nurse leaders we are charged with upholding enduring truths and engaging in critical analysis and discourse to confirm what is true about any situation or strategy. A new year is just ahead and it requires us to double down on leadership through truth, to question assumptions, demand evidence and data, understand counter-arguments, situate leadership on principles of social justice and equity, and finally, to base decisions on enduring truths. Healthcare transformation relies on strong leaders, nurses and others, to guide our nation and world toward health and well-being for the long term. It is our obligation to lead healthcare transformation on the foundation of truth and to navigate the insidious seduction of falsehoods with fortitude and commitment to facts and accuracy. Onward and upward in 2017!

Courageous Conversations for Nurse Board Leaders

courageLeadership requires the willingness to engage in courageous conversations. Courageous conversations serve a variety of purposes but always provide us with opportunities to reflect, evaluate, create new understandings, and shift perspectives. Certainly, the recent Presidential election has prompted many courageous conversations – and many, many more to come. When we fail to have courageous conversations, we fail to communicate fully and we fail to make decisions based on wholistic perspectives. Courageous conversations expose competing and synergistic needs, and pave the way toward mutually beneficial solutions and advancements.

As nurse leaders, we are obligated to engage in courageous conversations with the people in our care, on behalf of the people in our care, on behalf of our profession, our co-workers, our students, and our staff. These conversations may take place at the individual level, the organizational level, at state, regional, and national levels. As nurse board leaders, we are in positions to engage in courageous conversations about strategic direction of organizations – Who benefits from policy decisions and who is disadvantaged by the same decisions? Why do certain processes exist and for whom? What issues are accepted as normal and why is status quo normalized? Why are certain metrics never discussed? Why are funds allocated the way they are and what could be the outcome of a shift in allocations? The list goes on… Considering the fiduciary responsibilities inherent in governance and the obligations inherent in nursing to advocate and act for social justice, the ability to engage in cogent and articulate courageous conversations is a key skill set for all nurse board leaders (in fact, all nurse leaders and all board leaders regardless of profession).

Engaging in these essential conversations may be uncomfortable, especially if we are unaccustomed to exposing controversial issues and championing critical issues. However, if we are guided by fiduciary principles and the values of nursing, we create a pathway to engage confidently and courageously. The conversations are extensions of our roles, positions, and responsibilities. And it bears stating that when we are on the receiving end of courageous conversations, we are equally obligated to prioritize fiduciary guiding principles and nursing values over personal needs and emotions, to make considerations in the best interests of the people and organizations we serve.

Courageous conversations usher in opportunities for broadened perspectives, collaborative decision making, and advanced initiatives to improve health and healthcare (or whatever the topic at hand). Conversely, failure to engage in courageous conversations are opportunities lost. As nurse leaders, when we accept the responsibility to engage in strategic courageous conversations, we create an environment of possibility to move beyond status quo and toward advancements in health, healthcare, and social justice. A key skill set for nurse board leaders, courageous conversations align with the values of nursing and transfer directly to advocacy in the C-suite, on the unit, in the department, in the community, and in the boardroom.

Health, Well-Being and Social Justice at the Center of Nurse Leadership


As nurse leaders, it is easy to become lost in the forest of process, operations, regulations, and metrics and to lose sight of why and for whom we walk the walk in the first place. Let us always keep the faces of the needy, the vulnerable, and the sick at the forefront of all we do. Let our actions reflect their needs – and let us be guided by our deep conviction for health, well-being, and social justice. That is nursing and that is what we must stay committed to.

A colleague recently asked me about a potential direction for nursing research. My response was “Can you articulate this research directly within the metaparadigm of nursing? If yes, go for it. If not, think long and hard before leaping in the name of nursing.” The same is true as we become strong partners and leaders in healthcare transformation. Are our actions, initiatives, and partnerships articulated within the metaparadigm of nursing – nurse, environment, person, health – or have these activities strayed insidiously to support other agendas? While I do believe nursing must continue to evolve and respond to arising needs, new technologies, and also to make way for new partners, the core of our professional practice must rest on the commitments to health, well-being and social justice.

Leadership requires us to question assumptions, analyze direction and goals, and critically assess strategies. If our actions are based on misaligned assumptions, we risk straying from the core endeavor of nursing. No organizational hierarchy, research agenda, fiscal goals, or ill-advised initiatives should pull us from our core values and commitment as nurses. Leadership is just that – leadership; not followership. As a nurse leader colleague once said to me, “Sometimes you just need to get it done and say afterward, ‘Yeh, I happen to be a nurse’.”

Marching on as leaders in healthcare transformation, I hope we keep the needy, the vulnerable, and the sick at the forefront of our decisions and actions. I hope we lead by our commitment to health, well-being, and social justice. And I hope we always situate our leadership decisions within the metaparadigm of nursing.

Show Me The Money

Nonprofit board leadershipphilanthopy is typically a pay to play/give or get proposition. Nurses often ask me about this – the philanthropy of board leadership. As board leaders of nonprofit organizations, it is important to understand the mechanisms of philanthropy. To begin, nonprofit organizations rely on a combination of philanthropy, grants, and revenue generation to survive. There is a myth on the street that nonprofit organizations cannot generate profits. Actually, laws allow nonprofit organizations to generate profits as long as a percentage of the profits are re-invested in the organization. That’s a good thing. It allows nonprofits to grow, re-vitalize, and continue to meet the changing needs of their stakeholders. If nonprofit organizations continuously ran in the red; debt-ridden with no profits at all – they would not survive. So profits are good!

Nonprofit boards of directors are the role models of nonprofit organizations. They are loyal, obedient, and care about the mission as it relates to stakeholders/constituents/individuals served by the organization. As role models, board members must set the example to provide philanthropic funds in support of the mission. In fact, many grant making entities will not provide grants to nonprofit organizations unless there is clear demonstration of 100% philanthropic donations from board members. If the board is not vested in the organizations, why should anyone else invest?

That is the premise behind pay to play/give or get. Pay to play literally means if you want to be on the board, you must make the promise of philanthropy. Somewhat different, but very similar, is give or get – meaning board members are either required to give philanthropic donations or get donations from their networks. Both can be powerful sources of funds for organizations. Nurses who serve on boards should consider both sources of philanthropic funding. If personal funds are tight, a donation that is personally prudent is acceptable if funds can also be solicited and secured through other sources. Together, these philanthropic sources can add up and make a difference for a nonprofit organization.

What sources of funding can be considered in the give or get model? Family and friends are always a first line of inquiry. If you are vested in an organization, perhaps  you can convince your family and friends to support the organization, too. What about friends and family who own or work in for-profit companies? Do those companies have philanthropic foundations? Many do and look for good causes to donate to. Approach them about donating to the organization you care most about – the one whose board you serve on. What about your great-Aunt So-and-So who always saved and now has a large sum of money to donate to a good cause? Maybe the organization on whose board you serve is just the cause.  Approach her about the organization. Describe the mission, great outcomes, and people whose lives are changed by the mission. Invite her to visit and see the mission in action – and let her know you would like her to consider a donation – no need to create mystification. Be upfront about philanthropy. Philanthropy is a good thing!

Some boards require large annual donations. Other boards are less intensive about philanthropy. However, all nonprofit organizations expect their board members to give or get/pay to play. As nurses, we often shun the money talk – after all, we are about the caring, right? Well, yes, and to serve on boards of directors we must shift our sometimes-negative relationship with money. Understanding philanthropic expectations is a critical conversation to have as part of the board nominations process – reduce the mystification! If you cannot meet the expectation, ask about attracting funding from others in lieu of personal giving. If that is not an option and you cannot meet the philanthropic expectations, politely bow out of the nominations process. There are plenty of boards with different expectations for philanthropic giving. You can find one that fits your budget. But you must expect to give or get/pay or play if you want to serve.

If you are considering engaging in board leadership, inventory your philanthropic capacity first. What amount can you afford to donate? What about philanthropic capacity of your networks? Are there sources of funding you have not yet considered? Perhaps now is the time to engage in these conversations with family, friends and other contacts. Broadening your influence through philanthropy development is a key skill for board members. It’s never too soon to start!


What do boards have to do with nursing?


Lisa J. Sundean, RN, MSN, MHA, PhD Candidate

In 2010, The Institute of Medicine released The Future of Nursing: Leading Change Advancing Health outlining recommendations for nurses to robustly engage in the transformation of healthcare. Among its cogent recommendations was for nurses to engage in leadership on boards of directors – boards. I was serving on a hospital board when the IOM report was released and I was acutely aware of being the lone nurse on the board. This acute awareness sparked my academic interests and activist inclinations to study and research the subject of nurses on boards. Two masters degrees, a doctorate education, and a couple of board positions later, I am still surprised by nurses who a. do not understand what is meant by nurses on boards, and b. do not connect with the term ‘board’ and how it relates to nursing. Let me explain.

Boards of directors – boards – are the group of people who exercise governance leadership for an organization, either a corporation or nonprofit organization. Boards of directors set organizational mission, vision, values, strategy, and executive compensation. Board members have fiduciary responsibilities or legal obligations to act in the best interests of the organization, as stewards for its stakeholders (communities, employees, shareholders), and to act in accordance with laws and regulations. Together these are known as fiduciary duties of care, loyalty, and obedience. It’s a serious responsibility that requires commitment, integrity, and skill sets to provide governance oversight and to ensure that an organization is lawfully and prudently achieving its mission to serve its stakeholder group.

So how does this relate to nursing? How is all this business and legal talk possibly relate to the work of nurses? How is the idea of nurses on boards significant for nursing?

As a board member, a nurse is in a key position to influence decisions that affect healthcare policies, allocation of resources, and strategic direction. Based on nursing knowledge, perspectives, and understandings about the health and healthcare needs of individuals, populations, and communities, the nurse board member offers critical contributions to inform board decisions. These decisions can have far-reaching impact. Board decisions can determine, for instance, access to healthcare in medically underserved areas and access to healthcare for minority populations. Board decisions can determine specific services an organization offers and may support communities or leave them at a distinct disadvantage. Board decisions can determine resources that are allocated in support of quality care or can stretch a budget so thin that quality care is jeopardized. Board decisions can determine and influence policies that impact the culture of an organization and the health of communities. In each example, a nurse can provide the educated voice to ensure that decisions are made in support of care, caring, social justice, and healthy outcomes. Certainly, all board members, through their fiduciary duties, should come to the right conclusions to support prudent decision making. Nurses are not the only board members who can illuminate the issues. However, nurses have unique and relevant professional experiences, education, and perspectives to contribute to healthcare governance leadership decisions.

Are you still confused about the significance of nurses on boards? Consider contemporary discussions about population health and applications of upstream thinking. This is the concept of addressing the root of a problem rather than addressing the consequences; prevention vs. intervention. Nurses on boards provide the upstream thinking to address organizational strategies, policies, and resources to promote health, well-being, and quality outcomes thus reducing costly healthcare utilization and negative outcomes. Sounds a lot like the Triple Aim, right? Nursing leadership at the governance level through board service is directly related to patient care and promotion of health by applying nursing concepts to organizational decision making to support quality care, health, and well-being of patients and populations.

So, are you ready to join a board? Take the Healthcare Board Competency Survey for Nurses. This survey will help you identify your strengths and opportunities for professional development to prepare for board service.

If you are interested in more information, check out this book by the late Connie Curran: Nurse on Board: Planning Your Path to the Boardroom.

If you serve on a board, be counted on the Nurses on Boards Coalition database. If you are not currently serving, but you are interested in serving, you can also log into the database. Together, our voice is stronger. And together, we can transform healthcare.

So… a board is not a board. A board is a place for nurses to exercise their professional voices and obligations to support quality healthcare and to promote health through nursing leadership, knowledge, and expertise.