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.
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 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.”
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.
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.
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.
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.
Meet Kimberly Williams, DNP, MSN, RN, NE-BC, Director of Nursing Operations at The Bass Center for Childhood Cancer and Diseases at Stanford Medicine Children’s Health.
Talk about your role in nursing.
I am the director of nursing operations at The Bass Center for Childhood Cancer and Diseases at Stanford Medicine Children’s Health. As the director of nursing operations at a world-class pediatric hospital, I hold a multifaceted role encompassing numerous responsibilities. My role extends beyond the provision of patient care and involves strategic decision-making and ensuring the overall efficiency and effectiveness of the Center’s nursing operations. To do so effectively, I partner with over 180 nurses throughout the Bass Childhood Cancer Center’s various departments, including hematology, oncology, stem cell transplant, and the Center for Definitive and Curative Medicine. We deliver compassionate, high-quality care to our young patients and their families.
As the chair of the Patients and Families Committee on the house-wide Diversity, Equity, and Inclusion Council, I actively address health disparities, advocate for culturally sensitive care, and promote diversity, equity, and inclusivity within the healthcare system. I also mentor aspiring nurses, guiding and empowering them to pursue their dreams and overcome obstacles.
Tell us about your career path and how you ascended to this role.
My path progressed with a series of fits and starts. As a parent, I had to juggle motherhood, a full-time job, and my academics, so it took me roughly six years to obtain my BSN. Upon graduating from Texas Christian University in 2001, I settled into my first nursing role at Cook Children’s Healthcare System on the medical/surgical floor. Still, I always had my eyes on becoming a PICU nurse. After a year there, I transferred to the PACU to get some experience in intubation and sedation. I then transferred to the PICU, where I worked as a nurse and a charge nurse. There, I got the desire to return to school and obtain my master’s. I completed my MSN in 2010 from the University of Phoenix. Afterward, I accepted a job as a nurse manager, where I spent eight years before taking a leap of faith and accepting a position at Stanford Medicine Children’s Health as a patient care manager for The Bass Center for Childhood Cancer and Diseases. I worked in that role for about two years before taking the interim role of director of nursing operations. I have now been in that role for a little over three years.
It’s been a long journey, beginning as a Black, economically disadvantaged girl from a small town outside Pittsburgh, Pennsylvania. Growing up, I faced numerous challenges that could have hindered my progress. However, I was fueled by a burning desire to make a difference, overcome limitations, and pursue my dream of becoming a nurse. I rose above my circumstances to succeed in nursing, and my experience culminated in a leadership position at Stanford Medicine Children’s Health, serving as a testament to determination, resilience, and the power of education.
How long have you worked in the nursing field? Why did you become a nurse?
Sometimes, others can see something within us that we may not recognize.
I have been in nursing for almost 25 years and came into this field by happenstance. I was a single mother of three rambunctious boys at the time, working as a clerk in a children’s hospital. One of the physicians I worked with recognized that I had the qualities and potential to excel as a nurse. She would often tell me I should consider going to nursing school. For over a year, she kept encouraging me and was determined to get me to take one class. I finally agreed. I will never forget the first class I took, Psychology 101. I received an ‘A’ in that course. All I needed to confirm that I could do anything I put my mind to. I owe a lot of gratitude to that doctor. Her encouragement motivated me to pursue a new path and passion, creating a better future for myself and my family. Looking back, I feel that my journey is a true testament to the transformative power of mentorship.
What are the most important attributes of today’s nursing leaders?
I want to be intentional in answering this question from the lens of a Black nurse and DE&I advocate. I feel the most essential attributes of today’s nursing leaders include cultural competency, advocacy, mentorship, and community engagement.
To truly provide equitable, compassionate care, we must recognize and respect the unique cultural dynamics and challenges faced by the diverse communities we serve. As leaders, we must be attuned to these nuances through cultural learning, which equips us to deliver holistic care, meeting each patient’s and their family’s psychological, emotional, spiritual, cultural, and individual needs.
Advocacy is a crucial attribute for leaders in the nursing profession today. We can promote patient rights, ensure patient safety, empower patients with the needed information to make informed decisions, and more through advocacy.
As I mentioned before, mentorship has the power to change lives. When I came into the field, few Black nurses were in any leadership roles. I was often the only Black leader in more rooms than I’d like to remember. And this was the catalyst for my commitment to promoting and supporting up-and-coming nurses and diversity within the profession.
The last attribute I’d like to touch on is the importance of community engagement. People don’t know what they don’t know. As the eyes and ears of some of our most vulnerable populations, we must embed ourselves within our communities to promote community health initiatives, provide educational resources, and collaborate with community leaders to address health disparities and promote health equity.
What is the most significant challenge facing nursing today?
One of the most significant challenges facing nurses today is the persistent disparities and inequities in healthcare access and outcomes among marginalized populations. One key challenge is the need for more diversity within the nursing profession. While progress has been made, nursing continues to struggle with achieving a workforce that reflects the racial, ethnic, and cultural diversity of our communities. A homogenous nursing workforce can limit patients’ ability to connect with and receive culturally sensitive care from healthcare providers who understand their unique needs and backgrounds.
Additionally, biases and discrimination persist within the healthcare system, impeding equitable care delivery. Implicit biases can influence decision-making, communication, and patient interaction, leading to disparities in treatment and outcomes. Moreover, the challenge of healthcare access persists for marginalized populations, including racial and ethnic minority groups, low-income individuals, LGBTQ+ communities, and those with limited English proficiency. These populations face significant barriers, including lack of health insurance, geographic disparities, and social determinants of health, contributing to healthcare inequity.
As a nurse leader, how are you working to overcome this challenge?
As a Black nurse leader, I strive to create inclusive and welcoming healthcare environments.
While often difficult to navigate, we can overcome many challenges by advocating for policies and practices that address these systematic barriers.
Nurses can foster culturally sensitive, competent care by actively listening to patients’ concerns, promoting patient autonomy, and respecting patients’ values and beliefs. As mentioned earlier, I am chair of the Patients and Families Committee on the house-wide Diversity, Equity, and Inclusion Council at Stanford Medicine Children’s Health. In this role, I advocate for inclusive policies and practices that value and support diversity, prevent discrimination, and cultivate an inclusive workplace that celebrates different perspectives and ensures equitable opportunities for professional growth. Through organizational partnerships, Stanford Children’s is addressing some of these challenges by developing nursing-focused education programs that emphasize DE&I as fundamental components of the curriculum. This ensures that our workforce, especially nurses, are clinically skilled and culturally educated. Ongoing diversity training, mentorships, and continued education opportunities can promote nurses’ understanding of diverse patient populations and foster inclusive practices.
Despite the numerous obstacles within our profession, I am confident that with continued education and systemic support, nurses can play a vital role in advancing health equity and reducing disparities in healthcare.
What nursing leader inspires you the most and why?
There are so many who inspire me. When I look at the history of Black nurse leaders, the first person that comes to mind is the remarkable contributions of Mary Eliza Mahoney. Mary Eliza Mahoney (1845-1926) was the first African American registered nurse in the United States. Mahoney’s resilience and dedication to overcoming significant adversity in pursuit of her nursing career during a time of racial discrimination and inequality had a lasting impact on nursing and continue to inspire nurses of all backgrounds to this day.
However, the nurse leader who inspires me the most is my sister-in-law, Dr. Shakyryn Napier, DHS, RN, CPN, NEA-BC, LSSYB, and the Director of the Heart Center at Cook Children’s Healthcare System. Dr. Napier is one of the few Black nurse leaders I’ve enjoyed working alongside for most of my career. She possesses exceptional humility, demonstrating intense sincerity in her interactions with others. What sets her apart is her unwavering commitment to professional and personal mentorship. She invested her time and energy into me and was one of a few Black nurse leaders who recognized my potential, even when I doubted it myself. She believed in me and played an integral role in my leadership development.
Is there anything else you would like to share with our readers?
I want to share a personal experience reaffirming that I am truly walking in my purpose.
Four months ago, my father was diagnosed with stage IV lung cancer that metastasized to his bones and spine. About a month after his diagnosis, my 35-year-old son underwent an above-the-knee leg amputation. The experience of sitting on the other side of healthcare as a daughter and a mother has profoundly touched me and deepened my understanding of humility, compassion, mercy, and grace. As I provide support to my father and son during these difficult times, I am witnessing firsthand the physical, emotional, and psychological toll that illness and disability can have on families. This experience has enabled me to approach my role as a nurse leader with an even greater depth of compassion and understanding. Humility is a crucial quality in healthcare, as it allows us to recognize our limitations and biases while respecting the diverse perspectives and needs of those we care for. My experience has humbled me, reminding me of life’s vulnerability and fragility. Through my experience, I hope to provide a comforting presence, lend support, and cultivate stronger connections with patients and families navigating their difficult journeys.
Lastly, I’d like to emphasize the importance of self-care. Please seek support when needed, as our careers and personal lives can also affect our well-being. When prioritizing well-being, we can provide better compassionate care and leadership to those who need it.
Kimberly Cook, RN, BSN, is a highly accomplished nurse leader with a 30-year career in the healthcare industry. She graduated from the University of Virginia with a nursing degree and became a nurse in the Army early in her career. During wartime, Cook showed her dedication and commitment to patient care, which instilled in her a profound sense of duty, resilience, and an unwavering ability to thrive under pressure.
Throughout her career, Cook has held various management positions where she consistently demonstrated exceptional leadership qualities. She rose through the ranks quickly, earning the respect and admiration of her colleagues, staff, and executive team. Her visionary mindset has enabled her to drive positive change and implement innovative strategies within healthcare.
Cook holds the Director of Nursing Administration Staffing position at the University of Maryland Capital Region Health, a member organization of the University of Maryland Medical System. In this role, Cook leads a team of dedicated professionals, tirelessly ensuring that the right resources and personnel are available to deliver quality patient care.
Meet Kimberly Cook, RN, BSN, Nurse Director, Nursing Admin/Staffing at the University of Maryland Capital Region Health.
Talk about your role in nursing.
As the Director of Nursing Administration/Staffing, I hold a key leadership position responsible for overseeing the nursing administration and staffing functions within UM Capital Region Health. My key responsibilities include the following:
Provide strong leadership and guidance to the nursing administration and staffing team.
Develop and implement strategic goals, objectives, and policies related to nursing administration and staffing.
Foster a positive and collaborative work environment that promotes teamwork, respect, and professional development.
Develop and execute staffing plans to ensure optimal allocation of nursing staff across all departments and shifts.
Collaborate with unit managers to monitor and maintain appropriate staffing levels based on acuity and workload demands.
Implement effective scheduling practices to ensure adequate coverage and adherence to the Collective Bargaining Agreement and budgeted financial targets.
Prepare and manage the nursing administration and staffing budget, ensuring efficient resource allocation.
Manage and assess daily productivity and labor management.
Monitor and control staffing-related expenditures, identifying cost savings without compromising patient care.
Monitor and evaluate staff performance, providing regular feedback, coaching, and recognition.
Collaborate with quality management teams to identify improvement areas and implement initiatives to enhance patient outcomes.
Oversee the recruitment and selection process for staff and agency staff.
Onboard new staff and agency staff.
Manage all agency staff recruitment, onboarding, and billing.
How long have you worked in the nursing field?
> 32 years
Why did you become a nurse?
I attended a Catholic high school where volunteering was a requirement to graduate. I volunteered at a local hospital because it was close to my school. Prior to volunteering, the field of nursing had not crossed my mind. However, observing the fantastic work of nurses during my volunteer service triggered that “ah ha” moment, where I realized that Nursing was the profession I wanted to pursue.
What are the most important attributes of today’s nursing leaders?
There are several important attributes of today’s nursing leaders. The one that is most important for me is adaptability and resilience. The healthcare industry is continuously evolving, and nursing leaders must be adaptable to embrace change and lead their teams through transitions. They should be resilient in the face of challenges, remaining calm and composed while leading others.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nurse leader involves inspiring and influencing others towards a common goal. I am most proud when I can create and sustain effective teams while fostering a positive work environment where staff feel supported and valued.
Tell us about your career path and how you ascended to that role.
My Career began as an Army nurse. After leaving active duty, I remained a federal employee working in a military hospital. My first job was as a manager of two 40-bed Med Surg Units. After several years in a managerial role, I transitioned to nursing supervisor. As a Nursing Supervisor, I had a keen sense of staffing and how it applied to budgeting and productivity. The role of the Director opened, and I was asked to step into the role based on my previous work and reputation.
What is the most significant challenge facing nursing today?
The biggest challenge in nursing today is our ability to change and adapt as healthcare changes. Since Covid, we have had to be creative with staffing to care for our patients. However, we must remember to care for our staff in the same frame.
As a nursing leader, how are you working to overcome this challenge?
By keeping the organization’s goals in sight, but always remaining humble and empathetic.
What nursing leader inspires you the most and why?
General Hazel Johnson-Brown was the first African-American woman to become a General in the United States Army and the first African-American Chief of the Army Nurse Corps. Her accomplishments and impact have had a profound effect. Her success demonstrated that black women could achieve the highest leadership positions with determination, perseverance, and skill.
What inspirational message would you like to share with the next generation of nurses?
Nursing can be challenging at times, and there may be moments when you feel discouraged. However, it’s essential to recognize that even the most challenging days present valuable personal and professional growth opportunities. Keep moving forward confidently, knowing that tomorrow will bring a fresh start.
For almost 40 years as the Director of Nursing for Throughput Operations at Montefiore Health System in New York, Elodia Mercier, RNC, MS, has been advancing patient care and creating and defining new roles for fellow nurses and other providers.
In June 2021, Montefiore was evaluating performance improvement initiatives to enhance patient experiences and alleviate flow challenges and decided to open a discharge lounge. The idea of a discharge lounge isn’t new, but being assisted by the clinician with whom patients just bonded is.
Mercier was chosen to open the discharge lounge and met the challenges of a crowded emergency department (Montefiore is amongst the busiest in the country) and limited beds for admissions. Under Mercier’s supervision, the lounge, intended to assist 10 patients daily, quickly increased to 30-40. Over 27 months, Montefiore’s Discharge Lounge received more than 678 patients per month. On average, patients stay for approximately 35 minutes. This time spent in the lounge has equated to more than 10,800-bed hours saved, the equivalent of 62 additional beds – a total game-changer, particularly for an urban hospital. Mercier showcased this success at the New York Organization for Nursing Leadership last September.
In addition to the discharge lounge, Mercier developed Montefiore’s SHHH (Silent Hospitals Help Healing) program and other vital initiatives. She is also an active participant in the College of Mount Saint Vincent’s mentorship program, which pairs successful alums/trustees and friends of the college with bright, dedicated students eager to gain skills and insight that will allow them to channel their passion and talents into successful, satisfying careers.
As a recipient of a National Association for the Advancement of Colored People (NAACP) award for her participation in community affairs in 2011, Mercier is an important nursing leader, and we’re proud to profile her as part of the Champions of Nursing Diversity Series 2024. The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Elodia Mercier, RNC, MS, Director of Nursing for Throughput Operations at Montefiore Health System in New York.
Talk about your role in nursing.
As a nurse of nearly 40 years at Montefiore Health System, I’m always focused on the people we serve regarding safety, getting well and their patient experience. My role as Director of Nursing for Throughput Operations combines these three aspects, specifically focusing on the discharge process and ensuring this takes place in a calm and comfortable environment.
Our Henry and Lucy Moses Hospital Discharge Lounge is the last impression patients have when leaving our hospital, and we want it to be a good one. I’m focused on this positive experience and memory for patients and their families, ensuring all needs are met and leaving them as fully satisfied customers.
How long have you worked in nursing?
July 23, 1984, to present. I started as a part-time nursing attendant at Montefiore while attending the College of Mount Saint Vincent from 1980-1984.
Why did you become a nurse?
I became a nurse because I like helping people. Also, when my great-grandmother was ill in this very hospital, I did not understand what was happening to her. This memory stayed with me, and in my mind, I knew I wanted to make a difference for patients and their families, helping them better understand what is happening in terms of care and being able to teach and help heal. Last but not least, I was the first in my extended family to attend and graduate college. This was important to me, coming from a Caribbean /Afro-American Hispanic background.
What are the essential attributes of today’s nursing leaders?
Being a transformational leader. This means keying into the emotional intelligence of the people you lead. It also means finding a way to help people best understand their roles and values and the importance these factors play in helping our patients. Each person learns and processes things differently. A good or transformational leader finds ways to help each person on the team understand how they process information and produce the best outcome. I believe in leading by example and rewarding staff, even if it’s a simple acknowledgment or a thank you birthday card sent to them at home outlining their contributions throughout the year as a nurse on the unit. I have always believed that happy staff leads to happy patients and great outcomes. A good leader listens and values their team.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nursing leader to me means supporting my teams by way of education, accountability, and pride. I am proud of a few things, so it is a challenge to name just one.
-I am proud of having the highest consecutive year-after-year Press Ganey scores on my units as a nurse manager.
-I am proud of having the highest 365 degree and staff satisfaction surveys.
-I am proud of the creation of the Silent Hospital Help Healing Program that I initiated at Montefiore for noise reduction.
-I am proud that I established the motto now commonly used around the campus, “Happy Monday” or “Happy Friday.” I intended to help nurses and anyone else focus on the good things in life and all the good things they may have accomplished and still hope to achieve.
Tell us about your career path and how you ascended to that role.
I started as a staff RN in 1984 in the Neurology unit of Montefiore and then moved to the Rehabilitation units for long-term care. I was then promoted to become a Patient Care Coordinator and then a Nurse Manager in the Department of Medicine. After consecutive years of consistently meeting high Press Ganey (patient. satisfaction scores), it led me to the next step of my career, which was being promoted to director of nursing.
Then, in 2021, Peter Semczuk, SVP and executive director of the Moses and Wakefield Campuses in the Bronx invited me to become the Director of Nursing for Throughput Operations and help open our discharge lounge. My focus now is on healing our patients and working with our nurses and other staff to focus on barriers that might hinder their safe discharge or could unnecessarily increase the length of stay in the hospital.
Data is the driving force of the discharge lounge. Our data helps empower our nurses to think of discharging from day one – from decanting the emergency department to getting patients home safely. Sample data include the average length of stay in terms of bed saved hours per unit and when patients are discharged to the lounge. Our data reflects how each unit contributes to the end goal. When the lounge opened, the intent was to assist 10 patients per day, but that number quickly increased to 30-40. Approximately one-third of adults leaving our Moses Campus and emergency department are cared for in the discharge lounge today. We’ve also saved approximately 11,000+ bed hours, equivalent to more than 62 additional beds – a game-changer for a busy, urban hospital. Currently, my colleagues and I use data to help specific units achieve target measures for throughput. Nursing is so diverse and has so many opportunities. I enjoy focusing on throughput as this position focuses on relationship-centered care.
What is the most significant challenge facing nursing today?
As a result of COVID, many new nurses missed out on opportunities to experience more clinical rotations when in school. When they arrive in the workforce, they depend on strong leaders and strong support to help guide them. Also, many senior nurses are leaving the workforce and preparing for retirement. This creates a more significant gap in mentoring and preceptorship by the senior nurses for the newer nurses. This is why it is imperative to have strong, supportive leadership.
As a nursing leader, how are you working to overcome this challenge?
Along with many of my colleagues and the outstanding nursing leaders at Montefiore, efforts are being made to help teach, engage, and provide more supportive and educational opportunities to meet the needs of both new and current staff. This month, for example, I conducted a Joint Commission mock survey prep for our radiology department. For many, it will be their first time participating in a Joint Commission survey, so I took the nurses on a walking tour of our radiology department instead of a formal class. We reviewed where some of the equipment, like the oxygen valves, were, and we reviewed the power of non-verbal communication, like body language. The message was that if a surveyor asks a question, then everyone should come to the support of one of our nurses. This sends a message of confidence.
What nursing leader inspires you the most and why?
Joanne Duffy, an adjunct professor at Indiana University because she focuses on the quality caring model and relationship-centered care. She believes in taking affirmative action to serve problems rather than identify and report them. I can very much relate to this.
Maureen Scanlan, our SVP and Chief Nurse Executive, is inspiring at Montefiore. Maureen exemplifies nursing theory and practice goals, has a calm demeanor, and is always gracious, supportive, and professional. As I have transitioned to various nursing roles, she has always been there to advise me and ensure I am kept abreast of all nursing-related topics within Montefiore.
What inspirational message would you like to share with the next generation of nurses?
Help, support, and never be afraid to try new things because success is derived from trying and learning – you never know unless you try.
Is there anything else you’d like to share with our readers?
I have loved being a nurse at Montefiore. I have worked hard here, and Montefiore has been excellent and supportive of me. If you want to see and experience a family, community, and well-organized hospital, visit – I will have a hot cup of coffee or tea waiting.
