According to the AACA, in 2022, 80% of nurses in the United States were white/caucasian. With nurse burnout already a problem nationwide, being a minority in the industry can create even more unique challenges. That includes things like racism from patients or co-workers, discrimination, and even economic hurdles depending on your background and where you grew up.
All nurses must care for themselves and infuse wellness into their daily work. However, it might be even more essential for minority nurses to integrate holistic approaches into their careers.
With that in mind, let’s explore the importance of a holistic approach in healthcare and provide actionable insights you can use to enhance patient well-being and improve overall nursing effectiveness.
What Is Holistic Nursing?
As a nurse, you may be tempted to scroll past the ideas of holistic healthcare practices. But, holistic practices have been used for centuries to help people look inward for physical and mental wellness. Holistic nursing combines Western medicinal practices alongside complementary and alternative care solutions. Holistic nurses go beyond the physical and physiological aspects of medicine and focus on the values and beliefs of their patients. Nurses who practice holistic care also hold themselves to an extremely high standard and lean into five core values of practice:
Holistic philosophy and education;
Holistic ethics, theories, and research;
Holistic self-care;
Holistic communication;
Holistic caring process.
Paying attention to a person’s entire being can make a big difference in how they feel, especially when in a compromising medical situation. It’s one reason more midwives are taking holistic approaches to pregnant women. A holistic nursing approach can also help to improve your entire department, especially if you’ve been struggling with issues as a minority nurse. When holistic practices are implemented, people will start to look at you as a whole person and value your well-being rather than focusing solely on race identity.
Planning Healthy Holistic Practices
If you want to integrate more holistic practices into your career, it starts by leading a more holistic lifestyle yourself. Changing lifestyle habits and career practices, as well as even influencing your department, can feel overwhelming at first. One of the best ways to start taking a holistic approach to your work and life is to set goals for yourself. SMART goals can keep you motivated and help you recognize when you’ve hit milestones and achievements. SMART goals are:
Specific;
Measurable;
Attainable;
Relevant;
Time-Bound.
For example, if you want to focus on specifics, ask yourself what you want to achieve with holistic practices. Why is it essential to make a change, and who will you involve?
You’ll be able to measure your goals through achievements. Maybe you’ll start to feel better, personally. Perhaps you’ll see a change in work culture or the challenges you typically face as a minority. You might even begin to see your patients differently, which can help you fight back against burnout and find more joy in your daily interactions.
As you set goals and develop a strategy for holistic approaches, keep in mind that holistic medicine doesn’t have to somehow diminish your medical knowledge. Rather, it should serve as a complementary approach beyond basic treatment. A holistic approach to healthcare can inspire you to integrate more holistic practices into your daily routine on and off the clock.
Holistic Practices That Can Make a Difference
When you look within to begin your holistic integration, it starts with self-care. Again, this is essential for all nurses. But, when you face some of the unique challenges of being a minority nurse, self-care becomes even more necessary to maintain your mental and physical well-being. Thankfully, these practices don’t require much extra time or effort. Integrate some of the following into your everyday routine:
Prioritizing sleep;
Eating a healthy diet;
Journaling;
Connecting with colleagues;
Deep breathing;
Showing self-compassion.
Daily affirmations can also make a difference, especially when you’re heading into a long shift or dealing with difficult co-workers. Say things like, “I choose to trust my skills and abilities,” or “I know I am a skilled and compassionate nurse.” It might take some time to get comfortable with affirmations, but they will go a long way in improving your overall mindset. When you are kind and compassionate with yourself, you’re more likely to pass on that care to your patients.
Practicing mindfulness is another excellent way to lead a more holistic life and career. Mindfulness can help you manage stress and anxiety and keep you focused on the present. You’ll be less tempted to think about something a patient or co-worker might have said that bothered you or worry about the “what ifs” of your next shift.
There is no question that being a minority nurse comes with a few obstacles. However, by integrating holistic approaches in your life and career, you can reduce personal stress, improve patient care, and change the course of your department and practice.
Nurses put a priority on keeping their patients safe and Patient Safety Awareness Week, which takes place March 10-16 this year, helps focus attention on this important part of any healthcare provider’s job. No matter how much attention nurses give to patient safety, there is always room to make improvements.
But there’s more to patient safety than knowing and following procedures and protocols, says Kathy Wire, JD, MBA, CPPS, CPHRM, FASHRM, executive director of the Center for Patient Safety. The complexities of patient safety and how it is incorporated, monitored, and managed in any healthcare organization are real. Patient safety isn’t just limited to healthcare providers–it also involves the patient and the patient’s loved ones, too.
The overall organizational culture often sets the tone around patient safety. “A culture develops as a result of attitudes and related behaviors,” says Wire. “The underlying components of safety culture are well known. Some require action from senior leadership; others fit nicely in unit-based efforts. For example, supervisors can encourage non-punitive responses to errors, focusing on addressing underlying system issues and acknowledging human fallibility.”
Nurses often look to leadership to implement processes in which questioning a decision or a process is supported. If nurses push back on something that appears unsafe, they need to know they will have a manager’s support, she says. And this kind of transparency is in the best interests of any organization as patient safety is often tied to nurse safety. “A lack of patient safety can lead to errors and near misses that any conscientious nurse will find disturbing,” says Wire. “Even minor events can trigger this ‘second victim’ phenomenon. Many provider organizations have developed programs to address this trauma in their staff, but isn’t it better to prevent the issue in the first place?” And in the high-stress situations when loved ones are concerned about the care being given, anger and fear can spark threats to nurses, so open communication is essential, she says.
A patient’s family and loved ones contribute immensely to patient safety, says Wire. As nurses need to feel comfortable about being vocal about safety, loved ones also need to be heard and feel they can raise questions safely. Nurses also can trust that those closest to the patient can be advocates and have information the nurse might not. “Helping them understand planned nursing interventions and treatments while encouraging them to ask questions will establish that relationship,” says Wire. “We must let them know that an additional, dedicated set of eyes and ears can help busy nurses provide the best care. For example, family members can often recognize subtle changes in the patient’s condition that may be more difficult for a nurse to see.”
Even the best environment can’t prevent all errors. “Good safety culture tells us that people make mistakes and can drift from the ‘standard,'” says Wire. “Reporting mistakes and errors helps the organization learn about gaps in policy and how well it is supporting its nurses, and it also helps all nurses benefit from the learning that a reported event can generate.”
The highly tuned ability that nurses have in assessing a situation and evaluating the needs in the current moment can also help reveal problems, even problems that were never there before. “It can also bring mistakes and near misses to light, avoiding unnecessary injury to patients,” says Wire. “They must know that safety is not a condition or a statistic. Patient safety is an ongoing set of activities, and a state of mind focused on recognizing risk and generating improvement. It doesn’t care what you did last week.”
What we all feared just happened when Claudine Gay, the first Black president of Harvard University, announced that she was stepping down after only six months on the job—the shortest stint ever for the university’s president position.
The latest news about Claudine Gay admittedly dredged up some all too familiar and saddening experiences for me and many executives like me when I heard the news. While writing this, I just saw a news report about the inauguration of the first female mayor of Philadelphia, Cherelle Parker, who is only the fifth Black woman to run one of America’s largest cities. They highlighted parts of her speech about shattering the glass ceiling and opening up opportunities for more women and POCs to walk through.
Is that really the case?
We felt the same hope, promise, and determination when we first heard of Dr. Gay’s appointment. And yet, six months later, here we are. Her interim replacement looks and sounds like nothing of that promise or the person who just vacated that position.
This is not about Dr. Gay’s congressional testimony, and let’s set aside the plagiarism allegations for now. We continue to witness and experience this trend for people of color. When we finally think that we’ve made it and there is finally a path for distributive power, another (one) bites the dust, or another door closes and closes tightly with little expectation for the change we hoped to see. The quote by David Thomas, president of Morehouse College, that “… (this situation) does put in relief the vulnerability of Black female leaders. When they do ascend to these positions — there will be people who come after them” is real and jarring.
The evidence is quite clear that we have work to do not only with diversifying the nursing profession but with diversifying nursing leadership even more. According to a study by the National Center For Education Statistics, Black women have been obtaining degrees at a consistently high rate for the past 11 years, obtaining more associate, bachelor’s, master’s, and doctorate degrees. And yet, a health affairs study found that “historical legacies of sexism and racism, dating back to the division of care work in slavery and domestic service,” even though Black women are more overrepresented than any other demographic group in healthcare.
Nurses of color represent fewer than 20% of U.S. leadership roles in nursing administration, education, and professional organizations. A 2023 scoping review revealed that Black nurse leaders face obstacles and challenges with entering into or remaining in leadership roles, along with limited and inadequate research on Black nurses in leadership roles.
For many of us who have supposedly “made it” as nurse leaders of color, the fight to hold on has a weathering effect. The path is long and winding, with a constant need to justify your position with the stress of constantly overperforming, outworking, outproducing, and over-justifying why you belong in your role. I vividly recall my first experience of this when, with my first major promotion to an executive role, a position I was offered and didn’t even apply for.
After I received the unexpected and exciting news of my promotion, I was told by my then-boss, the CNO, that one of the surgeons (who was white) felt that he still needed to be convinced that I was qualified (I was overqualified with dual master’s degrees). She insisted that I stop by his office to meet with him, only to be subjected to degradation and veiled threats that he was watching me and he had the power to bring me down if I didn’t prove I was worthy of the role. My joy of being promoted suddenly turned into fear. I adopted the familiar methodology of being the first in and last to leave during my entire career there as I struggled, which also impacted my family and finances. Even that was not enough, or I didn’t know what enough was. It was an unclear and constantly moving target.
Back to the shattered glass analogy. This continuing trend is evidence that the shards of glass from glass ceilings that are figuratively shattered when people of color are appointed to these positions are never thoroughly picked or cleaned up. The shards remain littered in paths for people of color in these leadership positions to step over and avoid cutting themselves carefully. We’ve all literally seen the effects of broken glass, and shards tend to spread far, go wide, and hide. Even the most meticulous cleaning reveals a piece of glass days, months, or weeks later, which may have been missed, causing a cut or becoming embedded in limbs, causing harm when and where you least expect it. These injuries can also cause permanent damage – in this case, spirit murder.
When are we enough? Is it ever enough? And, once we get into these prized positions and the celebratory “being the first” honeymoon phases are over, what is enough? For all the Claudine Gays in nursing and other careers that have been loved, lifted, and are now lost or are fighting to hold on, it’s tough to play the game when you don’t know the rules when they are unwritten and constantly changing. A friend of mine sent me a quote that we continuously have to be “twice as good to get half as far” as some of our counterparts. This is not the way we wanted to start the year 2024.
If you can’t attend, we’ve got you covered in advance as we sat down with Debbie Hatmaker, PhD, RN, FAAN, the Chief Nursing Officer at the American Nurses Association (ANA)Enterprise, to discuss the ANA’s role in addressing the nurse staffing crisis and how nurses can use the Magnet model to better their careers.
What follows is our interview, edited for length and clarity.
American Nurses Association (ANA) Chief Nursing Officer, Debbie Hatmaker, PhD, RN, FAAN
-Earlier this year, the ANA urged Congress to address the nurse staffing crisis and the work environment issues. Can you discuss the need for a national dialogue and ongoing collaboration between nurses, Congressional leaders, and other key stakeholders to support our nursing workforce, patients, and our nation’s health and well-being?
The nurse staffing crisis continues to demand a national dialogue with nurse-led approaches to help ease the enduring work environment challenges that nurses face across numerous specialties and healthcare settings. We support enforceable minimum nurse-to-patient ratios that reflect key factors such as patient acuity, intensity of the unit practice setting, and nurses’ competency, among other variables. And this is just one part of a larger solution to solve this.
We continue to work on addressing other challenges that have significantly made the nurse staffing issue worse, such as burnout, workplace violence, mandatory overtime, and barriers to full practice authority.
Nearly 400 ANA members convened at the U.S. Capitol, representing the nation’s more than 4 million registered nurses, to petition Congress to address the national nurse staffing crisis this summer. In addition to advocating, ANA is also advancing solutions from the 2022 Nurse Staffing Think Tank2022 in partnership with other leading organizations, which produced a series of actionable strategies that healthcare organizations could implement within 12 – 18 months.
We continue to advocate on behalf of nurses and remain a collaborative partner. Our goal is to empower nurses and position them for success. We continue calling on Congress to enact meaningful legislation and policies that improve nurse staffing and work environments.
–How can nurses use the Magnet Model to better their nursing leadership and shared decision-making?
The Magnet process fosters a collaborative culture that spurs shared decision-making. Magnet organizations are even provided with a multiyear framework for quality improvement and a structured way to engage staff in decision-making. This tool can help energize and motivate teams. In fact, team building, collaborating across disciplines, regular open community, and building staff engagement, while difficult to quantify, are often what happens during the Magnet process.
-What are some questions to ask before accepting a job at a Magnet hospital? Can you offer some tips for helping nurses choose which Magnet hospital to work in?
Each Magnet-recognized organization will have its own hiring standards, so each nurse should review those as they apply for or accept a position. But they should know that whatever role they fill, a Magnet organization will invest in them and their potential. At ANCC, we’ve created a free resource for nurses looking for select practice environments and interview questions to ask.
Magnet Recognition means education and development through every career stage, which leads to greater autonomy at the bedside. A Magnet organization supports opportunities for nurses to pursue new skills and professional development, champions them in those pursuits, and rewards them for advancing in their profession.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
In a time of great competition in the post-pandemic healthcare marketplace, hospitals and other facilities are smart to find ways to differentiate themselves from the many choices consumers can access. We all vote with our feet and wallets when it comes to how we spend our healthcare dollars, and poor treatment at a hospital or clinic is a high likelihood that we’ll seek care elsewhere.
Likewise, employees also vote with their feet, and we can’t retain nurses when, despite special labels like Magnet, we allow bullying and other aberrant behaviors to thrive within a negative workplace culture.
Designations like Magnet status are ways healthcare organizations can demonstrate their striving for excellence. But what happens when an unhealthy or toxic organization hides behind something like a Magnet designation, ignoring systemic issues that fancy words, plaques, and awards won’t fix?
A Fox in the Magnet Henhouse
I recently spoke with a dedicated, well-educated, experienced, intelligent, and successful nurse who, up until earlier this year, worked for a Magnet facility somewhere in the U.S. The Magnet designation is designed to be a magnet for high-quality nurse clinicians, and this nurse is a person of great integrity and professionalism whom this employer was lucky to have on staff.
During her work on several hospital units, this individual was targeted by what we might call a “queen bully.” The bully nurse was highly experienced, had worked for the organization for many years, and was seen as a leader and an indispensable employee by the administration.
Tragically, the nurse I spoke with was psychologically traumatized by the bully and the other employees who colluded with her behavior. This nurse’s reports of being harassed were dismissed and ignored, and she eventually had to take a leave of absence to pursue psychological treatment for post-traumatic stress. Meanwhile, the bully kept her job and faced no consequences whatsoever.
Based on her egregious bullying behavior, this nurse bully should have been fired years ago. Still, managers and executives were likely scared to death of her, and if a union was involved, firing her might have proven a highly challenging avenue they were hesitant to pursue.
Sadly, this nurse was allowed to “rule the roost” for years as a frightening and controlling fox willingly set loose in the hen house, and the nurse whom I spoke with had been one of her main targets for months.
A bully can bring down the morale of an entire or multiple units. If bullies can thrive and spin their nasty webs throughout a facility or organization, the entire workplace ecosystem and culture can be poisoned.
Confronting the Shadows
In the final analysis, a Magnet designation doesn’t make an organization great. Magnet status is also not a magic bullet or blanket blessing from the authorities that deems a facility perfect and free from flaws.
Creating a just, civil, highly functional, and effective organization may be enhanced by designations or awards like Magnet status. Yet, the hard work of making a healthcare institution a safe and happy place to work doesn’t stop when the plaque goes on the wall.
When weeding out bad actors like bullies, the administration must have the will and the backbone to confront the issue head-on. Likewise, employees must feel safe to document and report such issues without fear of retaliation or having their complaints dismissed out of hand.
No matter if a bully is a great clinician with years of experience — there must be zero tolerance for aberrant behavior, and consequences must be swift, decisive, and universally applied.
Every employee deserves to feel supported in doing their best work. They likewise need to be able to trust that they will be protected from those who would do them harm. No staff member should live in fear of bullying, discrimination, harassment, or any other type of negative treatment, and it is the responsibility of the organization to create a culture that affirms positivity and trust and rejects anything less than perfect civility and kindness.
The work of achieving Magnet status is a lovely ideal with very real-world applications when truly operationalized. However, every workplace has a shadow, and it is from confronting that shadow and cleansing the organization’s darkest corners that a more civil, functional, and effective institution arises.
Magnet status is something to reach for, but only in the context of the hard work it takes to create a workplace to be proud of that is safe for all who walk through its doors.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
Hospitals designated through the Magnet Recognition Program® live up to their name—they attract and keep nurses thanks to the nursing-focused strategies at the organization’s operations’ foundation.
Since the American Nurses Credentialing Center (ANCC) launched its inaugural Magnet pilot program in Seattle in 1994, the designation has become the highest recognition for a hospital’s nursing department. The rigorous application process comes only after organizations commit to the highest quality of nursing and patient care with established initiatives and programs.
Nurses who work in Magnet hospitals are supported throughout their careers and given the skills and opportunities needed to move up the career ladder, says Susan Fisher, DNP, APN-C, ACNS-BC, CNOR, NE-BC, and director of the Clinical Excellence & Magnet Program at Jefferson Health. “Magnet wants nurses
at the table,” she says. “It is not a top-down approach. They have to include bedside nurses at the project-planning level.”
Fisher says Magnet hospitals differ for many reasons, including an approach to nursing practice and standards that expect nurses at every level to practice at the full span of their licensure. With a nursing model that is based on both collaboration and autonomy, nurses find they work within a structure that lets them use their experience and education to assess and treat patients based on standing orders and provides an environment where peers and leadership model career advancement and lifelong learning. And it’s not a one-and-done approach—Magnet hospitals only hold the designation for four years, after which they need to reapply.
Once organizations are Magnet-designated, keeping the status is important because healthcare consumers and professionals recognize it. “A Magnet-recognized organization is one in which the continued education and development of its nurses is highly valued, leading to improved patient outcomes and care,” says Rebecca Graystone, vice president of the Magnet Recognition Program and Pathway to Excellence Program® at the ANCC. “Magnet recognition is not merely an award or a badge of honor. It is steadfast proof of a hard-earned commitment to excellence in healthcare, with contented, valued, and inspired nurses at its heart.”
With all the programs and initiatives necessary elements of Magnet recognition, nursing in these organizations is much more than a job. “Magnet-designated organizations are recognized for the phenomenal work their nurses are doing for the profession, clinical outcomes, and for their nursing practice,” says Angelina Fakhoury-Siverts, chief nursing officer at City of Hope, a hospital that received its third Magnet re-designation in January with exemplar status in 12 categories. “It’s not just some recognition that doesn’t mean anything. We don’t want people to strive to be Magnet; we want people to strive to do the work Magnet recognizes.”
Because Magnet encourages nurses in their immediate role and with an eye to their future potential, nurses are frequently expected to see how their work fits into the organization’s processes holistically. “Magnet lends itself to the ability to be innovative and not just task masters,” says Fakhoury-Siverts. “You start to think of nursing differently.”
Although Magnet organizations are known for having high hiring standards, including a standard practice of hiring nurses with a BSN, Fakhoury-Siverts says nurses without a BSN shouldn’t be discouraged from applying for positions in Magnet hospitals. Graystone agrees, saying, “The Magnet Recognition Program provides a framework and encourages organizations to have 80 percent of their nurses attain BSN registration, but a BSN is not a hiring requirement set by the Magnet Recognition Program; each organization decides that. Magnet’s 80 percent BSN goal aligns with the Institute of Medicine’s Future of Nursing Initiative.”
Because Magnet hospitals are focused on lifelong learning and continuing to improve a nurse’s knowledge and practice, supporting continuing education is part of the core Magnet approach and something nurses are encouraged to pursue. “The Magnet Recognition Program provides a roadmap to nursing excellence, which benefits the whole of an organization,” says Graystone, noting that only 10% of hospitals in the U.S. are Magnet-designated. “Every organization is unique and different, but what we can say about the culture of Magnet organizations is that there is a commitment to excellence and an accountability for improved patient outcomes that is embraced by the whole nursing body.”
The pathways to career advancement may look slightly different for every nurse, but at Magnet organizations, there is a roadmap for making that advancement a reality. The novice nurse is supported in a Magnet organization on all fronts—with residencies to help them transition to practice, educational opportunities, peer support, and role modeling that encourages their success. As a veteran nurse, earning an advanced degree, gaining certification, or moving into a leadership role are all encouraged and mapped out with planned pathways to help that happen. The mix of nursing experience brings a valuable perspective and ensures a diverse hiring practice.
Even if a nurse has never worked in a Magnet hospital, there are some ways to prepare and conduct a job interview that will show a personal investment in the nursing profession. Asking questions directly related to Magnet principles, including support for career-boosting continuing education or certification, will help the hiring managers see a candidate as someone already committed to the rigorous, evidence-based practices so important in their organization.
“Ask what the nursing care model is, if they have shared governance, and if they have opportunities to be part of a unit-based council. You should also ask how the organization supports evidence-based practice and how nurses impact key decisions,” says Fakhoury-Siverts. “Those kinds of questions will resonate highly at Magnet organizations.”
The supportive and forward-thinking model is critical to Magnet hospitals as it helps prevent burnout and increases job satisfaction, says Graystone. “Working in a Magnet organization is also different for nurses because these organizations are committed to a framework for excellence that sets goals and requires evidence-based measurements and outcomes,” she says.
Fisher advises nurses to look at any potential employer carefully, even if they don’t have a Magnet designation.
“Don’t just look at the money,” she says. “Look at what comes with the money. Will they support you?” Nurses can think about how a nursing practice can grow when they’re not just encouraged but expected to contribute experiences and opinions to the daily operation—no matter what the experience level. “As CNO, I can’t make decisions on nursing practice if I don’t know what is happening at the bedside,” says Fakhoury-Siverts. “That bedside nursing is front-line nursing.”
Magnet designation is more than recognition of a job well done. Fisher puts it simply, saying, “I would want nurses to know that coming to a Magnet hospital means they will be practicing nursing the way nursing is meant to be practiced.”
Read the October issue of Minority Nurse focusing on the MSN and Magnet Hospitals here.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
