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: kenya.beard@cuny.edu

 

 

 

 

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?

                            

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

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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?

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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.

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