Meet a Champion of Nursing Diversity: Elaina Hall

Meet a Champion of Nursing Diversity: Elaina Hall

Elaina Hall, DNP(c), MSN, RN, MBA, NEA-BC, FACHE, is the chief quality officer of SnapCare, formerly SnapNurse, and an experienced healthcare executive in the areas of healthcare system operations, performance improvement, nursing practice, and leadership consulting. Hall’s passion is consistently delivering the ‘best and brightest’ for SnapCare clients. With a focus on opportunities for the clinician corps working with SnapCare, Hall has expertise in health system quality improvement and supporting clinicians in their journey to reskill and upskill for professional growth.meet-a-champion-of-nursing-diversity-elaina-hall

Hall graduated from Clemson University and extended her education in nursing, earning an MBA and MSN. She is currently pursuing her DNP. She also leads the Ventura/Santa Barbara Chapter of the Association of California Nurse Leaders. She is a Board-Certified Advanced Nurse Executive by the ANCC and an American College of Healthcare Executives Fellow.

 Hall’s significant contributions to the nursing field have been recognized in the prestigious Champions of Nursing Diversity Series 2024. This series is a platform that showcases healthcare leaders who are prominent figures in their organizations and are making substantial changes in the nursing field. Hall’s inclusion in this series is a testament to her impactful work and her status as a leader in promoting diversity and inclusion in nursing.

Meet Elaina Hall, DNP(c), MSN, RN, MBA, NEA-BC, FACHE, the chief quality officer of SnapCare.

Talk about your role in nursing.

As the Chief Quality Officer at SnapCare, I play a crucial role in driving performance improvement initiatives to optimize the efficiency and effectiveness of our staffing and workforce management processes. This involves analyzing data, identifying opportunities for improvement, and collaborating with cross-functional teams to implement solutions that enhance the overall quality of our services. In addition to clinical quality, I am also tasked with ensuring that SnapCare complies with all regulatory requirements and accreditation standards

How long have you worked in the nursing field? 

26 years.

Why did you become a nurse? 

I became a nurse because of my passion for caring for people and my deep-seated empathy for those in need. From a young age, I found fulfillment in providing comfort and support to others during times of vulnerability. Nursing allowed me to turn this passion into a meaningful career where I could make a positive difference in people’s lives every day.

Furthermore, as an advocate for diversity in healthcare, I recognized the importance of ensuring that all individuals receive equitable and compassionate care regardless of their background. Nursing allows me to advocate for inclusivity and cultural competence in healthcare delivery, ensuring that every patient is treated with dignity and respect, regardless of race, ethnicity, gender identity, or socioeconomic status.

In essence, becoming a nurse was not just a career choice for me but a calling driven by a desire to care for others, empathize with their struggles, and champion diversity and inclusivity in healthcare. It is a privilege to serve as a nurse, and I am committed to upholding the values of compassion, empathy, and advocacy throughout my nursing career.

What are the most important attributes of today’s nursing leaders? 

  • Visionary and innovative thinking to navigate the evolving healthcare landscape.
  • Strong communication and collaboration skills to foster teamwork and interdisciplinary approaches.
  • Emotional intelligence and empathy to support both patients and staff members.
  • Adaptability and resilience in the face of challenges.
  • Commitment to continuous learning and professional development.
  • Advocacy for patient-centered care and healthcare equity.

Tell us about your career path and how you ascended to that role.

Before obtaining my nursing degree, I began my journey in healthcare as a certified nursing assistant and patient care technician. These early roles provided me with invaluable experience in direct patient care and laid the groundwork for my future in nursing.

After earning my nursing degree, I embarked on a career as a bedside nurse, specializing in challenging areas such as Burn, trauma, ICU, and ED. I thrived in these high-intensity environments, gaining expertise and honing my skills while providing critical care to patients in need.

Throughout my career, I embraced opportunities for growth and development, working in various departments and even joining the float pool to broaden my experience. This flexibility and willingness to adapt allowed me to excel in different clinical settings and expand my knowledge base.

In 2006, I took a significant step forward by transitioning into my first manager role. This marked the beginning of my leadership journey, where I was entrusted with overseeing operations and guiding my team to deliver exceptional patient care. I embraced the challenge, using my clinical expertise and communication skills to drive positive outcomes and foster a collaborative work environment.

As the years passed, I continued to take on progressively complex roles within healthcare organizations, moving from community hospitals to academic health systems. Each new role presented its own challenges and opportunities for growth, and I approached them with determination and a commitment to excellence.

Today, I am proud to serve as the Chief Quality Officer of SnapCare, an AI-enabled workforce marketplace that serves the entire continuum of care. I can make a meaningful impact on healthcare delivery and champion a culture of continuous improvement.

My career path has been filled with challenges and triumphs, but through it all, I have remained dedicated to providing the best possible care to those in need. Reflecting on my journey, I am grateful for the experiences that have shaped me into the nursing leader I am today.

What is the most significant challenge facing nursing today?

One of the most significant challenges facing nursing today is the ongoing shortage of nurses, exacerbated by factors such as an aging population, increased demand for healthcare services, and burnout among healthcare professionals.

As a nursing leader, how are you working to overcome this challenge?

As a nursing leader, I am acutely aware of the significant challenges posed by the ongoing shortage of nurses, compounded by factors such as an aging population, increased demand for healthcare services, and burnout among healthcare professionals. Recognizing the critical need to address these challenges, I have been actively involved in implementing a clinician reskilling program to mitigate the effects of the nursing shortage and promote sustainability within our healthcare system.

The clinician reskilling program empowers healthcare professionals, including nurses, to expand their skill sets and take on new roles that align with emerging healthcare needs. By providing training and resources for upskilling and reskilling, we aim to optimize the utilization of existing clinical talent and alleviate some of the pressure caused by the nursing shortage.

Through this program, we offer opportunities for nurses to acquire additional certifications, pursue advanced training in specialized areas, and transition into roles that complement their existing skill sets. This helps address staffing shortages in critical areas and enhances the overall quality of patient care by ensuring that healthcare professionals are equipped with the necessary skills and expertise to meet evolving patient needs.

What nursing leader inspires you the most and why?

Beverly Malone, Ph. D., inspires me the most and stands as a beacon of inspiration in nursing leadership. As the CEO of the National League for Nursing and a former president of the American Nurses Association, Dr. Malone has dedicated her career to advocating for nurses and ensuring culturally competent care for diverse patient populations.

Her impact extends beyond the borders of the United States. As the first Black general secretary of the Royal College of Nursing in the United Kingdom, she broke barriers and paved the way for diversity and inclusion within the profession. Her global achievements include representing the U.K. delegation at the World Health Assembly, where she advocated for nursing and healthcare on an international platform.

Dr. Malone’s dedication, innovation, and unwavering commitment to advancing the nursing profession inspire nurses worldwide. Her tireless advocacy for equitable and compassionate care has left an indelible mark on the healthcare landscape, and her legacy will continue to inspire future generations of nurses to strive for excellence in their practice.

What inspirational message would you like to share with the next generation of nurses?

You are the heart and soul of healthcare, the guardians of healing, and the champions of hope. Embrace the privilege and responsibility of caring for others with humility and empathy. Your journey will be filled with moments of joy, challenges, and triumphs. Stay true to your values, never stop learning, and remember that every interaction is an opportunity to make a difference. Your passion and dedication will transform lives and leave a lasting legacy. Dream big, work hard, and always believe in the power of nursing to change the world!

From Public Health Advisor to Congressional Candidate: Meet Lauren Underwood

From Public Health Advisor to Congressional Candidate: Meet Lauren Underwood

Lauren Underwood, former Public Health Advisor for President Obama and current Congresswoman from Illinois’s 14th congressional district, is featured on Springer Publishing’s new health care podcast series, Conversations About Health Care Delivery in the United States. Underwood has gone from congressional candidate to congresswoman. To get you all caught up and ready for her guest appearance, this story is a repost of her interview with Minority Nurse from 2018.from-public-health-advisor-to-congressional-candidate-an-interview-with-lauren-underwood

Last issue’s health policy column highlighted nursing’s increased engagement in the public policy arena. To continue this conversation, this column highlights a registered nurse running for Congress to help champion access to affordable health care. Yes, Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois is running for Congress to represent the 14th Congressional District of Illinois.

Underwood’s Journey to Pursuing an Elected Position

Underwood is steadfast and fiercely committed to helping shape policies and programs focused on ensuring that everyone has access to affordable health care. She is a registered nurse who received her BSN from the University of Michigan and her MSN/MPH from Johns Hopkins University. Her nursing experiences include service as a health policy advisor, research fellow, senior director, and research nurse at the National Institutes of Health Clinical Center. Her passion for public policy was heightened while serving as a health policy advisor in the Office of the Secretary at the Health and Human Services in Washington, DC initially under the leadership of Secretary Kathleen Sebelius followed by the leadership of Secretary Sylvia Burwell. In this capacity, Underwood worked on private insurance reform, summary of insurance benefits, health care quality in the Medicare program, the Agency for Health care Research and Quality, and preventive services (free screenings, immunizations, and contraceptive coverage) for four and a half years from 2010-2014.

 Lauren Underwood, MSN/MPH, RN

Democratic Candidate for Congress, 14th Congressional District of Illinois

Tell us about working for the Obama administration.

Got a call the week that Mr. [Thomas Eric] Duncan was in the hospital in Dallas with ­Ebola asking if I would be willing to join the President’s team to help with disaster response, so I transferred over to ASPR, the Assistant Secretary for Preparedness and Response, at HHS. We worked on emerging infectious diseases (e.g., Ebola, Zika Virus, Middle East Respiratory Syndrome virus, or MERS), we also did national disasters (e.g., wildfires, hurricanes, floods) and then bioterror (small pox, anthrax) and worked with drug companies to develop vaccines, treatments, and diagnostics. I stayed in the administration until the very end, the last day. And so, when the election happened in 2016 we were working on the water crisis in Flint. I was surprised, and I thought that Hillary Clinton’s team was going to win and that we were going to hand off our work on health reform and on Flint to people who cared and wanted to continue the process. And then we got the Trump team who made it very clear they wanted to do away with health care coverage. And that’s not why I went into nursing or why I did this work. So, I knew I could stay in government and help them do that. I wanted to continue the work and so I came back home to Illinois because Illinois is a state that expanded Medicaid. I got a job working for a Medicaid managed care company in Chicago as the Senior Director for Strategy and Regulatory Affairs for a company called Next Level Health.

Are you still there?

I left my job about six weeks ago. The primary campaign was about eight months. I worked full time six and a half months; you know you have to do that. I am a young person, not someone of particular means or whatever, so it was necessary. And then it was like “Lauren, you could really win if you put your time and energy into the campaign.” And so that was an easy choice to transfer to full time.

So, you are now devoting full time to the campaign?

Yes.

This reflects your journey. Describe in a few words what really made you run for an elected position.

I am going to tell you a story. Last spring when I returned home, I went to congressman Randy Hultgren’s one and only public event. It was a moderated event hosted by the League of Women Voters. And during that evening, he made a promise and said that he was only going to support a version of Obamacare repeal that allowed people with preexisting conditions to keep their coverage. That’s important to me as a nurse. I also know how critical it is for people with chronic illness to have access to medications and procedures that they need. Obviously, I worked to implement the Affordable Care Act so I read the law and I know that it works. I know that we can fix what does not work. We do not have to throw the whole thing away. Like so many Americans, I have a preexisting condition myself. I have a heart condition, SVT (supraventricular tachycardia), and it is well controlled. As you know, it is a preexisting condition, so I would not be able to get coverage under these repeal scenarios. And so, when the congressman made that promise I believed him.

And then a week to ten days later he went and voted for the American Health Care Act, which is a version of repeal that did the opposite. It made it cost prohibitive for people like me to get coverage. And so, I was upset not at the vote itself, but because he did not have the integrity to be honest the one time he stood before our community. That’s not what a representative is supposed to do. A representative is supposed to be transparent, accessible, and honest. And we deserve better. I said, “you know what, it’s on! I’m running” and launched my campaign in August and just won the primary on March 20th. I was in a field of seven—the only woman running against six men—and I won 57% of the vote.

Were you the only African American?

Yes.

I know you are concerned about overall access to care and have a deep commitment to utilizing your expertise and experience while working in the Obama administration.

I believe that health care is the number one issue in this election across the country and in our district, and we need a solution to make health care more affordable for American families. It is not enough for families to rake together money for their premiums and have an insurance card in their pockets and cannot afford the coverage.

I believe that a lot of the conversation in the last several years has been political in nature and undoing President Obama’s legacy and not on at all focused on trying to lower costs and make health care accessible for American families. That’s my objective! I want to work on drug prices. I want to work on this opioid drug crisis so that loved ones can get the treatment that they so desperately need. And so, I believe there is a lot of value in having a nurse at the negotiation tables when we are making these decisions and passing policies that will transform our health care system. I am excited about the opportunity to be a leading voice on Capitol Hill on these important issues.

What do you think are the most pressing issues impacting nursing and health care?

Affordability. Any program that is starved of resources will fail. The ACA has been intentionally sabotaged and as a result, we see extraordinary high premiums that are unaffordable for most families. That is not how the program was designed to work and so I think there are technical fixes we can do to make the program more affordable. We can do things like negotiate drug prices, it can be done, we need to take a strong position on this opioid drug addiction crisis. We need to implement reforms like how we pay for rehab and how we award funds to municipalities in order to create a pathway for lasting change. And then there are opportunities to expand coverage so we will have fewer uninsured Americans. What we are seeing now in order to resuscitate it takes 2-3 doses of Narcan because the drugs are so strong. Municipalities who have received Narcan grants are running out of Narcan. A Narcan only solution is not a solution. Law enforcement only solution is not a solution. Addiction is an illness and we need to treat it as such. We need to send people to treatment so they can have a shot at recovery. We could have an evidence-based policy solution. We know treatment can be effective.

What do you think is the most pressing issue affecting nursing today?

I think there are a few things. The high cost of our education. We have not really seen increases in funding. What we have seen are marginal increases or flat funding. I think that this is unacceptable, in particular in the context of what we are seeing in higher education more broadly. And not just at the federal level. In higher education, many states have reduced putting money into public education, shifting the responsibility to families and individuals and with that coupled with flat funding for nursing education we are seeing a generation of nursing students with significant debt. And that is going to be a barrier, I believe, to our profession being able to grow. Right now, we have an economic situation where we are not seeing the shortage that we saw ten years ago. But it’s very easy to get back to that point if the economics of going into nursing shifts when you graduate from a BSN program with $100,000 in debt and are limited in your initial salary. Loan repayment programs are not that plentiful as they used to be. The economics of it makes it tough. Because we are talking about middle class folks who are not able to take on that debt. And when it is becoming increasingly attractive to become an APRN, that is all debt to be able to get the master’s to become a nurse practitioner or a nurse midwife. We are going to need some serious advocacy and a plan to deal with the cost of our education.

What are your thoughts about safe staffing?

It is so interesting. Safe staffing has been a legislative priority for decades. We have not been able to pass these bills. I think the approach needs to be more balanced with safe staffing committees in these hospitals. Moving away from these ratios and having hospitals have safe staffing committees that would take into consideration the circumstances that facilities and the region when staffing levels. On these committees, nurses would serve so a legislative body is not dictating it. I think that this is an appropriate approach coupled with compelling Medicare participating facilities to set staffing levels and monitor outcomes.

When elected, what would you do to go about helping to ensure equitable access to health care?

That’s like the question! For me, equitable access to health care allows everyone to get health care. Health care is a human right. Human rights have been fundamental to my nursing practice. It is written in our Code of Ethics—this idea that everyone should have health care—and I think our policies should reflect that. For me, that includes fixing the Affordable Care Act to ensure affordable coverage; and making sure we have clinics, hospitals, and facilities in communities so that the burden is not on low-income people or people with transportation challenges or resource limitations so that people are able to get the care and services they need. We have so much innovation, technology, and so many improvements now in a way we are able to provide care whether it’s telemedicine or individualized health care. It is a shame if all of that innovation and all of those improvements are seen in resource communities. We need to be focused in these conversations about reform and transforming our system to ensure that it is serving everyone—rural, urban, low income, and elderly.

What advice would you give to aspiring policy advocates who may be considering a run for public office?

Your country needs you! There are too few nurses in policy positions. Seek a County Board position. The County Board supervises the local Department of Health. Run for state legislator, they address scope of practice issues. Run for Congress! There are many opportunities to serve and lead. Step forward!

Tune into Springer Publishing’s new monthly health care podcast series, Conversations About Health Care Delivery in the United States, featuring discussions with prominent experts, innovators, and leaders in the health sector available on Spotify, Apple Podcasts, and Amazon Music.

Building Bridges, Not Walls: Promoting Cultural Competence & Humility in Nursing

Building Bridges, Not Walls: Promoting Cultural Competence & Humility in Nursing

Given the diversity in our world today, take a moment and ask yourself: Are you a culturally competent nurse or nursing student? Do you demonstrate cultural humility?promoting-cultural-competence-humility-in-nursing

You may have explored the concepts of cultural competence and humility in nursing school, but let’s take it a step further and consider how to apply these concepts in everyday interactions with members of diverse groups and communities.

Whether working in a hospital, walking into a local store, or interacting with neighbors, cultural competence and humility are cornerstones of building strong relationships. Practically speaking, this isn’t a skill you check off your to-do list once. Instead, developing cultural competence and humility is a lifelong process and journey involving continuous reflection, learning, and unlearning. It makes the individuals and groups we interact with feel seen, heard, and valued.

What is Cultural Competence vs Cultural Humility?

Cultural competence is about equipping yourself with knowledge of diverse cultural practices and beliefs, which enables you to provide respectful and appropriate care to patients from varied backgrounds. According to the American Academy of Nursing, cultural competence includes integrating knowledge, attitudes, and skills to facilitate intercultural communication and interactions between people from different racial, ethnic, socio-economic, and religious backgrounds. It’s understanding different cultural customs, traditions, beliefs, and behaviors and utilizing this knowledge to communicate effectively with others.

Here’s what cultural competency as a nurse might look like:

  • Using appropriate words and phrases that are familiar to the individual
  • Respecting an individual’s choices and preferences (e.g., diet, treatment)
  • Refraining from labeling an individual who comes from a particular group
  • Advocating for an interpreter to translate to facilitate informed decision-making
  • Acknowledging what is acceptable and not acceptable to say or do with an individual  from another culture/background

Cultural humility, a new concept introduced more than thirty years ago, embraces the idea that we must all critically explore and critique ourselves as the first step to learning from and about others. It’s more than being knowledgeable about other cultures and practices. Cultural humility is being ‘others-oriented’ instead of “me-oriented” and recognizing that our understanding of different cultures constantly evolves. It’s a lifelong process of critical self-reflection and an openness to learning from the experiences of others. Humility acknowledges the power imbalances, emphasizing the importance of being receptive to learning from those who may not look, act, or believe in the same things we do.

  • Demonstrating cultural humility can include:
  • Participating in cultural competency training
  • Actively listening to an individual’s beliefs and practices without judgment
  • Respecting individual autonomy and cultural values when making decisions
  • Asking open-ended questions to understand an individual’s cultural preferences
  • Customizing healthcare delivery to align with the individual’s cultural, religious, or linguistic needs

These examples above, rooted in an attitude of openness and self-reflection, can lead to strengthening and maintaining effective relationships built on trust, respect, and collaboration.

How Do I Become More Culturally Competent and Demonstrate Cultural Humility? 

Being culturally competent and demonstrating cultural humility takes time to happen. It is also not about choosing cultural humility over cultural competence or vice versa. Instead, it’s about cultivating and enabling both to work in unison.

Here’s how you can begin your journey towards cultural competence and humility.

1. Examine your ‘Blind Spots’

Start by examining and reflecting on your biases, assumptions, attitudes, and values and how they may influence your interactions with others. Identify any implicit bias that might be at play. Implicit biases are those unconscious stereotypes and attitudes you’ve learned and carried toward specific groups of people. These biases are like “blind spots”—you aren’t aware they exist unless you intentionally look!

Identifying your blind spots may involve asking yourself:

  • Am I tolerant enough to learn from others?
  • Are there privileges that I have that others don’t?
  • What do I think about other cultures that are different from my own?
  • Do I actively seek out perspectives or experiences that differ from my own?
  • Do I recognize and challenge my assumptions about people different from me?
  • Do I refrain from having deep conversations about social issues? If I do engage in dialogue, am I listening with intent or just talking?

Once we can identify our blind spots, the work can begin to address those stereotypes and attitudes. We can start unraveling, challenging, and correcting our learned biases.

2. Consider Others’ Point of View

Putting ourselves in another person’s shoes, or “shoe-shifting,” helps us begin to consider the experiences and perspectives of others. Cultural humility and competence require us to avoid being distracted by what we think we know. It’s asking ourselves whether there is anything we ought to know and framing our interactions with others as a partnership. So next time you’re interacting with someone who may appear different than you or may hold different  beliefs and values, ask yourself, “What else should I know?” instead of “What do I know?” Be intentional about incorporating humility into your interactions – listening more than speaking, feeling comfortable with not knowing or understanding everything, and demonstrating genuine curiosity. Although we know empathy and compassion are the right things to do, it can be challenging to put these into practice when faced with our stereotypes and implicit biases. Why, though? Perhaps because to truly put ourselves in another person’s shoes, we must be willing and able to remove our shoes first!

3. Get to Know People Different From You

It’s easy to get along with people who are similar to us. Seriously, think about those people who are closest to you, and more than likely, many of them will resemble….well, you! But if you want to develop cultural competence and humility, you’ve got to stretch a little and step outside your backyard. This involves active and intentional efforts to experience others.

  • Reading books (e.g., autobiographies) to gain new perspective/appreciation
  • Volunteering or participating in organizations that serve diverse communities
  • Attending community/multicultural events to promote direct dialogue and interaction
  • Listening to podcasts with hosts/guests who have different lived experiences or beliefs

When we stretch ourselves this way, we can challenge our stereotypes and attitudes toward others and begin to value their unique experiences. We can create meaningful connections built on respect, appreciation, and a deeper understanding beyond superficial interactions. These proactive strategies allow you to enhance cultural competence and humility and contribute to more inclusive and united communities.

Conclusion

As you strengthen your cultural competency and humility skills, consider yourself and the individuals you live, learn, and work with. Every interaction with an individual is an opportunity to practice, demonstrate, and enhance these skills.

Cultural competency says, ‘I’m the expert.’

Cultural humility says, ‘You’re the expert.’  

Whose expertise will you prioritize next?

References

Canada International Royal Arts College (2023). 10 Questions to challenge your implicit biases.

Gradellini, C., Gómez-Cantarino, S., Dominguez-Isabel, P., Mecugni, D., & Ugarte-Gurrutxaga, M. I. (2021). Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review. Front Psychol, 12(1).

Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Rushton, C., . . . Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28-33.

McDaniel, V. P. (2021). Cultural Humility in Nursing Building the Bridge to. Virginia Nurses Today, 29(2), 12-14.

Stubbe, D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (Am Psychiatr Publ), 18(1), 49–51.

Embracing Cultural Competence and Cultural Safety

Embracing Cultural Competence and Cultural Safety

Cultural competence and cultural safety are crucial to delivering effective care. They are also key to creating working environments where everyone feels valued and able to function at the highest level. If we invest time and energy in understanding and implementing these concepts, the dividends can be invaluable, both individually and collectively.embracing-cultural-competence-and-cultural-safety

Defining Cultural Competence and Cultural Safety

Dr. Raj Sundar is a physician, community organizer, and the Healthcare for Humans podcast host. As a healthcare leader, Dr. Sundar uses various platforms to bring a human scale to care delivery. In his view, the importance of cultural competence and safety cannot be overstated.

“Understanding cultural competence and safety is crucial when working with diverse cultures,” Dr. Sundar shares. “However, the definitions of cultural competence have evolved from diverse perspectives. One definition that’s commonly used is the following: having the capacity to function effectively within the context of diverse cultural beliefs, behaviors, and needs, as highlighted by the CLAS Standards (culturally and linguistically appropriate services).”

 He continues, “On the other hand, cultural safety goes beyond individual competency, focusing on creating environments where everyone feels safe and respected, particularly addressing historical and structural causes of inequity. It builds upon cultural humility, which involves recognizing personal biases while understanding and respecting others’ perspectives.”

 Where Does Cultural Competence Fall Short? 

However well-meaning cultural competence initiatives can be, they don’t always hit the mark. Dr. Sundar explains, “Competence-focused approaches can sometimes overlook individual differences, leading to stereotyping and neglecting unique experiences.” He continues, “Additionally, while cultural competence training is valuable, it often emphasizes surface-level cultural differences, neglecting deeper issues such as systemic biases and power dynamics.”

Sundar uses his cultural background and experience to illustrate how cultural competence can fall short. “My identity as an Indian-American from North Carolina who likes lacrosse, sweet tea, and country music illustrates the complexity [of individual experience] beyond cultural identity. Individual differences always matter, but my history and values are deeply connected to my Indian ancestry.”

A study published by the National Library of Medicine adds to this idea.

“A plethora of training is designed to expose providers to different cultures and expand their understanding of the beliefs, values, and behavior, thus achieving competence. Although this intention is commendable, training providers to become competent in various cultures presents the risk of stereotyping, stigmatizing, and othering patients and can foster implicit racist attitudes and behaviors.

“Further, by disregarding intersectionality, cultural competence training tends to undermine provider recognition that patients inhabit multiple social statuses that potentially shape their beliefs, values, and behavior.”

Parallel Concepts

When it comes to other concepts that parallel cultural competence, Sundar adds that two other terms to be familiar with are cultural humility and responsiveness.” He describes them thus: “Cultural humility is an attitude or mindset characterized by an ongoing willingness to engage in self-reflection, self-critique, and lifelong learning about one’s own cultural biases and the cultural backgrounds of others. It emphasizes recognizing the limitations of one’s perspective and being open to learning from diverse experiences and perspectives.”

He states, “Cultural responsiveness involves recognizing, respecting, and integrating individuals’ cultural backgrounds, values, and beliefs into designing and delivering services and interventions. It goes beyond cultural competence by emphasizing the importance of engaging with communities, co-creating solutions, and adapting practices to meet diverse populations’ specific needs and preferences.”

Strategies and Tools for Increasing Cultural Competence

There are many strategies and tools for increasing cultural competence. Dr. Sundar shares, “While insufficient, cultural awareness training can be essential opportunities to connect with peers to reflect on conflicts, tension, or care pathways that can be improved.” His examples include asking questions like:

  • Why does our Russian community have the lowest mammogram rate?
  • When a Jehovah’s Witness refuses blood in a life-threatening situation, are we all aware of what to do and have the support we need?
  • When families come together to care for an individual, can we navigate that context in our highly individualistic environment?

Sundar adds, “It’s often essential to have cultural liaisons, which allows for collaboration with community leaders and organizations serving diverse populations.” This strategy can provide insights into cultural norms and various practices and behaviors that community members engage in when seeking healthcare.”

As a community organizer, Sundar has other recommendations. “Building relationships with your community is helpful. Part of my podcasting journey with Healthcare for Humans is building relationships with local immigrant and refugee communities, amplifying their voices, and caring for them in the way they want in the context of their history and structural inequities.”

Patients’ perspectives must also be taken into consideration. “It can be beneficial to actively seek patient input about cultural preferences, needs, and concerns,” Sundar advises. “Take time to listen attentively and respectfully to patients’ perspectives and incorporate their feedback into your approach to care. Ask, ‘How can I be a better advocate and caregiver for your community?’”

Dr. Sundar reminds us that we must also reflect on our cultural biases, assumptions, and privileges. “If we consider how these factors influence our interactions with patients and colleagues from diverse backgrounds, that self-awareness is a step toward becoming a more culturally aware healthcare professional.”

A Learning Process

In the end, Dr. Sundar has specific recommendations for nurses.

Nurses should recognize cultural awareness as a continual learning process rather than a static achievement. For example, it’s been a journey for me to realize how to incorporate the values of the Native Hawaiians and Pacific Islander community in my care. I have had to be intentional about how I say hello and talk about suffering to meet the community where they are. It takes time and building relationships to realize this.”

Dr. Sundar believes that achieving health equity requires ongoing self-reflection and that we remain open to diverse perspectives.

“Health equity is the idea that everyone should have the same opportunities to be as healthy as possible, regardless of their circumstances, and we must be committed to it. Doing this work isn’t always easy, but it’s worth the effort and will always be needed in our diverse world.”

Meet a Champion of Nursing Diversity: Kendra Coles

Meet a Champion of Nursing Diversity: Kendra Coles

Kendra Coles, DNP, RNC-OB, C-EFM, NEA-BC, is a seasoned nursing leader with over 20 years of experience in the field. For 17 years, she has been dedicated to women’s services and has a wealth of knowledge in managing inpatient and outpatient obstetric care. She also has a knack for communication and team empowerment. Coles is known for optimizing performance and outcomes for obstetric and neonatal populations, achieved through fostering collaboration and building multidisciplinary teams.meet-a-champion-of-nursing-diversity-kendra-coles

Since 2019, Coles has been Director of Women’s & Children’s Services at the University of Maryland Baltimore Washington Medical Center (UM BWMC). In this role, she oversees a team of 125 FTEs across various units, including Labor & Delivery, Postpartum, Pediatrics, and Special Care Nursery. Coles is responsible for strategic planning, equity, diversity, and inclusion initiatives and developing nurse leaders. She is committed to achieving organizational goals while maintaining fiscal responsibility and ensuring the highest quality and safety standards for patients and staff.

She’s highly skilled in change management and program development, which has been critical in introducing obstetric and newborn care services. Her expertise and leadership have made her a trusted figure in the field.

Coles’ contributions to the nursing field have earned her a spot in the Champions of Nursing Diversity Series 2024. This series highlights healthcare leaders who are prominent figures in their organizations and making significant changes in the nursing field.

Meet Kendra Coles, DNP, RNC-OB, C-EFM, NEA-BC, Director of Women’s and Children’s Services at the UM BWMC.

Talk about your role in nursing.

As the Director of Nursing for Women’s and children’s services, my responsibilities include the operations of obstetrics, newborns, and pediatric care. In this role, I have the honor of impacting the care that women receive during pregnancy and delivery, a newborn’s early days of life, and sick children who require hospitalization. The role requires leading health initiatives such as hypertension and hemorrhage management, safe sleep, and pediatric respiratory illness management.

As a health equity leader and advocate, I have led initiatives to reduce maternal morbidity and mortality and served on the Anne Arundel County Maternal Infant Health Task Force. I co-chair the Equity, Diversity & Inclusion Council at UM BWMC and train other nursing teams in leadership, communication, and staff empowerment to optimize performance and patient outcomes.

How long have you worked in the nursing field?

I have over 26 years of nursing experience and have been a nursing leader for 20 years. My clinical experiences include caring for patients in Labor and Delivery, Mother, Baby, and Nursery. I also have expertise in the operations of inpatient and outpatient care.

Why did you become a nurse?

I became a nurse because I genuinely wanted to care for others. I was raised in a family of five kids and watched my mom always care for someone in the home or family. Nursing is a noble and humbling profession that allows interpersonal reward.

What are the most important attributes of today’s nursing leaders? 

Resilience, compassion, innovation, and grace. Today’s nurse leaders must be resilient as they face daily changes in healthcare. Compassion is needed to care for the patients, but it is also required for the care of the staff caring for others. Nursing leaders must develop and embrace new technologies and advances in clinical practices in a rapidly evolving healthcare system. As the nursing leader supports innovation, it’s through grace that you allow forgiveness and create an environment where learning occurs for team members. Grace can also be given to patients who desire to improve their health status and may not always have the resources to make the healthiest choices. We offer our patients new opportunities to be informed and empowered in their care through grace.

What does being a nursing leader mean to you, and what are you most proud of?

As a nursing leader, my task is helping others to help others. Nursing leaders can ensure our patients have the best outcomes by leading a team of professionals to their highest potential and encouraging their growth as caregivers. Nursing leaders drive changes that change lives. I’m most proud of starting an obstetric program at UM BWMC in 2009 and participating in its ongoing growth to improve maternal and newborn care in Anne Arundel County.

Tell us about your career path and how you ascended to that role.

My nursing career started in 1997 at the University of Maryland Medical Center, the University of Maryland Medical Systems’ academic hospital in downtown Baltimore, serving in Labor & Delivery. I simultaneously worked at another hospital in the region in the Mother Baby Unit. I found myself excited about the nursing profession and joined a nursing agency where I took on a variety of nursing contracts caring for obstetric and newborn patients. My interest in leadership began as a charge nurse at UMMC and grew into a senior clinical nurse role. I was offered an opportunity for frontline leaders to obtain a Master of Science in Healthcare Leadership & Management. I completed my Master of Science in Nursing in 2009 as UM BWMC started recruiting for their new OB program leadership and staff. As a brand-new manager, I recruited a phenomenal team to open the Pascal Women’s Center. In 2018, following the retirement of the director at the time and a national recruitment effort, I was chosen to advance into the Director of Nursing role.

What is the most significant challenge facing nursing today?

The most significant challenge facing nursing is staffing shortages. Like many industries, especially health care, COVID-19 changed the workforce. Nurses experienced compassion fatigue, burnout, and difficulty finding work-life balance. They began to leave the bedside, searching for a less stressful environment or more profitable opportunities. Subsequently, the nursing shortage grew, and we continue to rebuild the nursing workforce.

As a nursing leader, how are you working to overcome this challenge?

Developing and introducing new nurses into the profession is an ongoing challenge. As a nurse leader, I have embraced programs such as the Academy of Clinical Essentials, an initiative developed and spearheaded by the UMMS Chief Executive Officer, which allows nursing students to partner alongside one of our experienced nurses and have early exposure to the art of nursing. We have modified our nursing preceptor program to enable our most experienced nurse to focus on a core group of new hires. We have customized our nurse residency program for the OB, Neonatal, and Pediatric specialties. We have integrated simulations as a core training component in team building and communication skills in high-risk situations. To help our teams address fatigue and burnout, we offer flexible staffing, relaxation rooms, and RISE support resources.

What nursing leader inspires you the most and why?

Rose L. Horton, MSM, RNC-OB, NEA-BC, FAAN, the Founder and CEO of #Notonmywatch Consulting Partners, inspires me. She is a Women & Infant health care executive leader at Emory Decatur Hospital, who believes nurses can change maternal morbidity and mortality. Horton called nurses to action by encouraging them to use their voices to support and advocate for others. She has been a strong influence for improving care during her tenure as the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) president and while serving on the Synova leadership Board of Directors. I’m really inspired by her dedication to raising awareness about issues compounding black maternal health and how she successfully advocates for change.

What inspirational message would you like to share with the next generation of nurses?

No matter how hard your shift may seem, never forget why you became a nurse. Take every opportunity to serve and care for someone else because you never know the difference you make.

Meet a Champion of Nursing Diversity: Barbara Bosah

Meet a Champion of Nursing Diversity: Barbara Bosah

Barbara Bosah, MS, RN, PCCN, is a highly skilled nurse manager in the thoracic and surgical intermediate care unit and vascular progressive care unit at the University of Maryland Medical Center (UMMC), downtown campus in Baltimore, MD. meet-a-champion-of-nursing-diversity-barbara-bosah

With over 14 years of experience leading care teams for patients with complex medical conditions, she is passionate nursing leader who fosters dynamic and supportive work environments that encourage continuous learning and professional growth.

Bosah has been recognized for leading several important nursing initiatives at UMMC that have positively impacted quality and patient experience. 

She is particularly proud of her role as a founding leader for the Academy of Clinical Essentials initiative. This revolutionary academic-practice partnership model has been implemented at the University of Maryland Medical System (UMMS) and has resulted in intentional support for new graduate nurses as they prepare for and transition into clinical practice.

Bosah’s contributions to the nursing field have earned her a spot in the Champions of Nursing Diversity Series 2024. This series highlights healthcare leaders who are making significant changes in the nursing field and are prominent figures in their organizations

Meet Barbara Bosah, MS, RN, PCCN, nurse manager in the thoracic and surgical intermediate care unit and vascular progressive care unit at the University of Maryland Medical Center. 

Talk about your role in nursing.

I am the Nurse Manager for the Surgical and Thoracic Intermediate Care & Vascular Surgery Progressive Care units. Our unit specializes in providing care for some of the sickest patients within the Maryland region. These patients are admitted to our unit after undergoing surgery. As a Nurse Manager, I lead our team of dedicated nurses. Our primary focus is to provide high-quality and patient-centric care. This involves ensuring that all staff members are well-trained and equipped to handle the complex needs of our patients.

Additionally, I oversee the allocation of staff and financial resources to ensure the effective operations of our unit. By carefully managing these resources, we can maintain a safe environment for our patients while delivering exceptional care. Our team is committed to staying up-to-date with the latest surgical and thoracic care advancements. We regularly participate in professional development activities and collaborate with other healthcare professionals to provide the best possible outcomes for our patients. My role as the Nurse Manager involves overseeing our unit’s day-to-day operations and creating an environment that promotes collaboration, excellence, and compassionate care. 

How long have you worked in the nursing field?

Nursing is my second career. Before pursuing nursing, I obtained my Bachelor of Science in Business Administration with a focus in Marketing and a minor in International Business from the University of Louisville in Louisville, KY. Following my passion for healthcare, I furthered my education and earned a Bachelor of Science in Nursing from Bellarmine University in Louisville, KY.

In 2005, I began my nursing career at UMMC as a new graduate nurse in the Surgical Intermediate Care Unit. Over the past 19 years, I have dedicated my professional life to serving patients at UMMC, gaining valuable experience, and honing my nursing skills. I take great pride in my journey from business administration to nursing and the diverse skillset it has provided me. Through my years of experience at UMMC, I have developed a deep understanding of the healthcare industry and a genuine passion for delivering high-quality care to those in need.

Why did you become a nurse?

I choose to pursue a career in nursing because I find fulfillment in assisting patients and their families during difficult times. I thrive in situations where the outcomes are unpredictable, and I can provide the necessary support and guidance. It is gratifying to ensure that their journey through the hospital is as seamless as possible, and I strive to treat each patient and their family with utmost respect and care. 

My approach involves delivering high-quality, empathetic, and compassionate services. Moreover, I believe in establishing a personal connection with them and valuing them as individuals rather than just patients. They become part of my extended family in my care, and I am committed to meeting their needs and advocating for their well-being.

What are the most important attributes of today’s nursing leaders?

I firmly believe that nursing leaders are crucial in addressing staffing challenges. They need key attributes to be effective. First, they must be transformational leaders who inspire and empower their staff. A clear vision is essential for navigating complex situations and guiding teams towards success. Accessibility promotes open communication and collaboration. Empathy fosters a supportive work environment. 

Lastly, a passion for mentoring and developing nurses is essential for continuous growth. By embodying these attributes, nursing leaders can lead their teams, inspire excellence, and drive growth.

What does being a nursing leader mean to you, and what are you most proud of?

I am honored to serve as a nurse leader, particularly as a minority nurse leader, at UMMC. I have the privilege of contributing to the future growth and development of new nurses entering the profession and mentoring experienced nurses to strive for advancement in their careers, whether as a clinical nurse, an Advanced Practice Provider, or a nurse leader. 

While I thoroughly enjoy working with patients and their families, I am incredibly proud of the exceptional team I work with on the Surgical & Thoracic IMC and Vascular Surgery PCU. Our team demonstrates remarkable resilience and delivers outstanding patient care while supporting one another. The collaboration and teamwork within our team are truly impressive, as we care for some of the most critically ill patients in the Maryland Region. I am inspired to come to work each day because of the unwavering dedication of this remarkable team, as each staff member contributes to the mission and vision of UMMC. I am incredibly proud and humbled to be their leader.

Tell us about your career path and how you ascended to that role.

I started my career as a new graduate nurse in the Surgical Intermediate Care Unit. Initially, I was still determining what my career path would be. However, I approached each day with dedication and focused on providing the best possible care to my patients. Although I was unsure if there was room for growth as a nurse then, I was determined to make the most of my past experiences and leverage my background in business and marketing. I set goals and developed a vision for my career to ensure that I had a clear direction. One area that I had always been passionate about was quality and performance improvement. 

Fortunately, my nurse leader, Cindy Dove, MSN, RN, Director at UMMC, recognized my passion and took me under her wing. She became my mentor and played a crucial role in my leadership development. Thanks to her guidance and support, I was able to advance through the Professional Advancement Model (PAM) from Clinical Nurse I to Senior Clinical Nurse II, and I currently hold the position of Nurse Manager. 

This journey has spanned 19 years, during which I have continuously grown professionally and personally. Looking back, I am grateful for the opportunities to expand my horizons and make a difference in nursing. I am excited to see what the future holds and how I can continue contributing to nursing.

What is the most significant challenge facing nursing today?

One of the most critical issues currently confronting the nursing profession is the persistent problem of staffing constraints and burnout. This challenge has been further exacerbated after the COVID-19 pandemic, which has left nurses exhausted and overwhelmed. The shortage of qualified nursing staff has put immense pressure on healthcare systems, leading to increased workloads and reduced quality of patient care. The demanding nature of nursing work, coupled with the long hours and high stress levels, has dramatically increased burnout rates among nurses. This not only affects the well-being and job satisfaction of nurses but also directly impacts patient outcomes and overall healthcare system effectiveness.

Therefore, addressing staffing constraints and burnout is of utmost importance to ensure the sustainability and effectiveness of nursing care in the present and future. Efforts should be made to implement strategies such as increasing the recruitment and retention of nurses, improving working conditions, and providing adequate support and resources to prevent burnout and promote the well-being of nurses. By addressing these challenges, we can create a more resilient and robust nursing workforce that can deliver high-quality care to patients and contribute to the overall improvement of healthcare systems.

As a nursing leader, how are you working to overcome this challenge?

As a nurse leader, overcoming the challenges in nursing has been quite difficult. It requires a lot of patience, as sometimes it may seem like no end in sight. However, it is important to remain hopeful and continuously review the current best practices to combat these constraints effectively.

One way to address these challenges is by actively listening to the concerns and needs of the bedside staff. We can create a more supportive and empowering work environment by advocating for their needs and ensuring that their voices are heard. Additionally, reviewing and implementing wellness programs specifically designed to support the staff is crucial. Encouraging participation from the entire team by forming task forces can help us successfully enact these changes.

Furthermore, it is essential to focus on the recruitment and retention of nurses. By actively promoting the profession and fostering a healthy work environment, we can attract and retain talented individuals passionate about providing high-quality care. This can ultimately contribute to our nursing practice’s overall success and improvement.

What nursing leader inspires you the most and why?

The saying “It takes a village to raise a child” resonates with me as I reflect on my journey from being a new graduate nurse 19 years ago at UMMC. Throughout my career, I have been fortunate to have the support and guidance of numerous UMMC leaders who have inspired me. Being a nurse goes beyond the technical aspects of the job; it involves working with phenomenal stakeholders and partners across various departments such as Rehab (Physical Therapy & Respiratory), Case Management, Hospital Operations, and Pastoral Care. However, I must highlight the significant impact that the Surgery and Neuroscience division’s nurse managers, Cindy Dove and Ruth Lee (VP of Patient Care Services), have had on me. Their leadership and dedication have been a constant source of inspiration, and I consider them part of my extended family within the hospital.

What inspirational message would you like to share with the next generation of nurses?

As a proud member of Delta Sigma Theta, Inc., the quote by our dynamic Soror Nikki Giovanni resonates with me, and I hope it will inspire you!

“A lot of people resist transition and therefore never allow themselves to enjoy who they are. Embrace the change, no matter what it is; once you do, you can learn about the new world you’re in and take advantage of it.” – Nikki Giovanni

Is there anything else you’d like to share with our readers?

I am incredibly grateful and deeply honored to have this fantastic opportunity to share my journey with you. It fills my heart with immense joy to connect with you and inspire you. I want to emphasize the importance of staying true to yourself and embracing self-love. Remember, you can shape your destiny and create the life you desire. Cherish every moment of your journey, and let your inner light guide you towards greatness.

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