As the nation continues to grapple with the wide-ranging effects of racism, the nursing industry continues to take steps to address disparities, inequalities, and racism. Last summer, the Academy of Medical-Surgical Nurses (AMSN) ramped up the AMSN DEI Campaign, motivated by the killing of George Floyd.

Terri Hinkley, EdD, MBA, BSN, RN, and chief executive officer  of the Academy of Medical-Surgical Nurses (AMSN) and Medical-Surgical Nursing Certification Board (MSNCB), says Floyd’s killing troubled her deeply, leading her to question if she had done everything she could to make the world as safe and inclusive as possible. Hinkley spoke with the presidents of AMSN and MSNCB and with her family and then wrote, My Reckoning, an op-ed expressing her commitment to actively working to combat racism.

“We then launched a call to end racism and opened it up to our community to join us in committing to doing our parts to end racial injustice,” says Hinkley. “It grew from there to be a full initiative looking at diversity, equity, and inclusion for our patients, our colleagues, and within the AMSN organization.”

While the program helps nurses learn about DEI, it’s also a way for them to build competence, says Hinkley, especially in areas they may not be familiar with or have a deeper understanding of. “We do not understand the norms, practices, and requirements of cultures we did not grow up with or in,” she says. “By focusing on building competency, we are striving to take away the ‘blame and shame’ that often surrounds these issues and discussions. Let us start with the basic principle that everyone wants to be respectful of others and build on that to help them understand and be able to take action to make that happen.”

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Results from a survey sent to members in the fall of 2020, only confirmed what Hinkley knew was important and what she noted matches a recent ERCI survey that lands racial and ethnic health disparities at the top of a patient safety concern list.

  • 75% of the nurses that completed the survey reported that they wished to have a better understanding of topics related to diversity, equity, and inclusion.
  • 92% reported that it is important for their national professional association to take action regarding diversity, equity, and inclusion and lead efforts for its members.
  • 46% reported experiencing harassment or discrimination because of issues of race, class, gender, age, religion, culture, sexuality, or ability.
  • 63% witnessed harassment or discrimination.

DEI work is sometimes uncomfortable, as Hinkley noted, and that’s why it’s important to give nurses the tools to have discussions around difficult topics. “We genuinely believe that we, as nurses, start from a position of caring and compassion,” she says. “We believe that every nurse wants the best possible outcome for their patient, and for their teammates to be respected and supported as an integral part of the team.”

As nurses learn more and become more intentional with their DEI work, they can more effectively advocate for those around them—whether teammates or patients. “DEI isn’t a one and done initiative,” says Hinkley. “It is a journey that will only have its beginning in the first 18 to 24 months. This is a lifelong learning initiative, one that AMSN is embracing and committing to.”

Hinkley says AMSN is committed to making this process inclusive and developed several different activities intended to help nurses be able to identify their own biases, or those within their institutions, and develop solutions to combat them.

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Members can participate in a six-module educational certificate program in which the first module (the first module is offered at no cost to members) will focus on why the program is important. The remaining modules will allow deep dives into the areas of greatest discrimination, such as race, sexual orientation and gender identity, disabilities, age, and culture and religion, says Hinkley.

As nurses begin to move through the process and gain a new understanding, Hinkley says stepping back for the big picture is essential. “AMSN wants to build a culture of inquiry, where our nurses can start to question why we do things the way we do, or why I believe the things I believe,” she says. “Is there a different perspective that might shape how I approach a situation, or patient, or problem? Am I intentional in my actions, or am I just doing what I was taught and the way it has always been done? It is all about opening conversations, with yourself and others.”

Gaining competence and new perspectives will transfer into better nursing practice, higher nursing standards, and patient care in very specific ways, she says, including

  • as individual employees who remain competitive and effective in a changing workforce
  • as employees of organizations who will be DEI ambassadors to their organizations after completing the certificate program
  • as members of the largest segment of the healthcare workforce who will increase DEI competence across the healthcare sector
  • as primary providers of patient care in the nation whocan address the inequities in patient care

Hinkley noted that even with a DEI focus, real-life experiences can be uncomfortable. “I would like to share an example I experienced recently,” she says. “Someone I know came out as non-binary, changed their name (I will call them Storm), and their pronouns. Another friend (I will call Alice) was so distressed she would not be able to remember Storm’s pronouns because we have spent a lifetime of only having binary choices: he/him or she/her. ‘They’ sounds odd and feels odd, and we have a lifetime of using ‘they’ for more than one person. That results in dissonance and is incredibly challenging from a cognitive perspective. Alice is doing her best to be supportive and respectful and was so worried that she was going to forget and say the wrong pronoun. I tried to help Alice understand that if it were an honest mistake, Storm would understand, and they would not be offended. I tried to stress that Storm understands that we are all doing our best to be supportive and, in turn, have new things to learn as a result.”

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As Hinkley notes, overnight change isn’t expected, but there are things nurses can do to help themselves move forward. “I think it is important to understand that no one expects perfection, they just expect the same respect and value that everyone else is given. What helped me was practicing. I practice using inclusive pronouns at every opportunity. I also challenge myself not to use binary pronouns, but rather to collectively refer to individuals I do not know as ‘they’ until I learn their preferred pronouns. I am not always successful, and just the other day I said ‘he or she’ when referring to a nurse in an example to a point I was making. I was gently corrected to ‘they’ and the conversation continued. Life-long learning is a hallmark of the nursing profession, and we embrace that in every other area of our lives, so why not this one?”

As nurses’ DEI work grows stronger, Hinkley says it will have a pervasive effect on nurses’ work, patient care, and the workplace in general. “Having the opportunity to improve health for all individuals would be the best possible outcome of this initiative and would bring me personal and professional joy,” says Hinkley. “I also feel very strongly about doing my part to contribute to the work environment for all nurses. I am keenly interested in issues regarding the work environment, and the human cost of caring to nurses and healthcare providers. There are so many wonderful aspects to nursing and being in the caring profession, but we do not all have the same experience at work, and I am excited to be able to improve the work experience for all nurses.”

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Julia Quinn-Szcesuil
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