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!
Incivility in nursing education has become an increasingly bothersome problem; however, it has especially become a nuisance in online education. Suplee, Lachman, Siebert, and Anselmi (2008) indicated that a faculty witnesses daily encounters in classes and clinical settings. Incivility is defined as behavior that is unprofessional, rude, and disrespectful. It can result in burnout and psychological and physiological distress for the parties on the receiving end, especially if left unaddressed (Butler & Strouse, 2022).
Another term that has especially been seen in the online realm is bullying, which can occur student-to-faculty and faculty-to-student. Unfortunately, it can also occur in faculty-to-faculty (Butler & Strouse, 2022). There has been an increase seen in student-to-faculty students’ displeasure with their achieved grades.
We must evaluate the reasons that the behavior is happening.
Stress from many walks of life can be the culprit, including working too many hours, mismanagement of work-life balance, stressful work assignments, financial strains, relationship strains, biases, and so on. Butler and Strouse (2022) also indicated that burnout and demanding workloads contribute to the greatest stressors. Personally, I have observed these behaviors displayed when providing constructive criticism. How can we, the faculty, help to ease the burden and create the traditional professional environment that many of us were able to participate in our educational journey?
As a part of a nursing faculty for ten years, I feel it is my calling. I enjoy helping deploy educated and competent novice nurses and advanced practice nurses into the workforce. However, the stress and incivility sometimes make one feel burned out. Many of us ponder going back into the clinical setting, feeling unappreciated and undeserved.
Caputi (2015) reported that the faculty can assist students in engaging in constructive evaluation of themselves and others. One factor is professional maturity, which can allow the students to analyze their own performance. As a faculty, providing feedback that is useful in the workplace and not hurtful can be helpful for growth and development. Self-reflection and guided introspection can be useful (Caputi, 2015). Discussing values, morals, attitudes, and the AACN essentials, pertaining to professionalism and leadership can be useful in developing students with incivility and assisting students in understanding (Caputi, 2015). However, the most important element is support from the administration and the appropriate follow-up and disciplinary actions.
In the world of nursing, consistent rates of students graduating from nursing programs, becoming licensed, and successfully entering the workforce are critical to the long-term viability of the nursing profession and the healthcare system itself. As the true lifeblood of healthcare delivery, nurses are central to patient care, from long-term and public health to acute care and home health. In that regard, nursing education is a pipeline to the future.
Nursing School Capacity
In May 2023, the American Association of Colleges of Nursing (AACN) released data showing that student enrollment in entry-level baccalaureate nursing programs
decreased by 1.4% in 2022, the first decrease in 20 years. Overall, 844 colleges and universities offer a BSN education, and many turned away thousands of qualified candidates due to a lack of clinical training sites and faculty. In 2022, 66,261 candidates were rejected, and in 2021 applications by 76,140 candidates were turned down.
Alongside these disappointing numbers in the entry-level BSN category, the AACN identified other factors:
Enrollment in RN to BSN bridge programs has been declining over the last 4 years.
Master’s programs have seen a 9.4% decrease since 2021.
Nursing PhD program enrollment shrank 4.1% from 2021 to 2022.
DNP program enrollment is at a virtual standstill.
When it comes to nursing school capacity, there’s plenty of evidence that something isn’t right. This statement from an October 2021 article by National Public Radio says a great deal about one major hurdle: “One of the biggest bottlenecks in the system is long-standing: There are not enough people who teach nursing. Educators in the field must have advanced degrees yet typically earn about half that of a nurse working the hospital floor.”
Becker’s Hospital Review reported in August 2023 that the California Hospital Association and the Service Employees International Union (SEIU) have teamed up to introduce a bill that would hold community colleges accountable for reserving 15% of enrollment slots for healthcare workers looking to advance their education and move into higher-paying career tracks like nursing. Whether this bill can make it through Congress and become law is unknown.
The U.S. Department of Labor has issued $78 million in grants to expand nursing school enrollment in 17 states. The state of Maryland has awarded its nursing program grants to boost schools and address the long-standing and worrisome nursing shortage. New Mexico is also expanding its nursing school capacity through support for increased enrollment.
While legislation, grants, and expanding nursing school capacity are all valuable strategies to increase the nursing workforce, we can also keep more grassroots efforts in our sights.
In families from many different backgrounds, a multigenerational tradition of service in the nursing profession is often the norm. Aunts, mothers, fathers, siblings, and others can profoundly influence younger generations’ career choices. When the value of being a nurse is communicated from generation to generation, a familial line of nurses can extend over many decades as additional family members join the profession.
As nurses, speaking proudly of the profession and our work can generate interest in those considering their options. While twenty-first-century nursing and healthcare have enormous challenges, we can also tell the story of how nursing provides endless opportunities and flexibility. Of course, there is the potential to travel and see other parts of the country and see one’s education through to a terminal degree such as a PhD or DNP.
In communicating about the possibilities to be found in nursing, we can point out that, contrary to what the public and the media might think, not all nurses work in the hospital. There are expanding opportunities in the pharmaceutical, biotech, and medical device industries; public health; informatics; nurse entrepreneurship; medical writing; legal nurse consulting; nurse coaching; research; and many other fascinating areas. In the interest of our profession’s growth, we paint an expansive picture for those who think of nursing as solely hospital based.
Pipeline to the Future
Whether a new graduate nurse eventually becomes an operating room nurse, a biotech research nurse, or a self-employed legal nurse consultant, the nursing school remains the pipeline through which that individual must pass to realize their dream. No matter how one person’s professional journey unfolds, it all begins with admission to an accredited nursing program, successfully graduating and passing the NCLEX®, and then receiving a license to practice. The nursing school is the funnel for future nurses of every stripe and interest.
When nursing school capacity is hobbled, our profession and society suffer. Decreased graduation rates translate to a shrinking nursing workforce, staffing shortages, nurses working under stress, and the potential for compromised patient safety and outcomes. Burned-out nurses are more likely to leave the profession and less likely to encourage younger generations to pursue the same career path.
Addressing decreased nursing school capacity is paramount, and we can use our collective genius to find solutions, whether through grants, legislation, and public relations or the direct recruitment of faculty through the offer of increased salaries and improved work conditions.
We must use every available means to secure the flow of fresh talent through the pipeline to the future. Our society and the lives of those within it depend on the quality and quantity of the nursing workforce, and it’s our responsibility to see that the pipeline remains filled with the talented nurses of tomorrow.
