Many nurses often decide to work in the profession due to their struggles in life, but few are willing to make a difference in their work based on their hardships.
Dr. Sharrica Miller, PhD, RN, has used her voice to speak up against injustice against Black nurses. She’s an assistant professor at Cal State Fullerton, where she serves as chair of Diversity, Equity, Inclusion, and Student Engagement. Miller also owns her consulting firm and works with organizations to implement diversity initiatives.
Miller took the time to answer our questions about her nursing experience and how her beginnings as a foster child inspired her DEI work.
Can you give a brief introduction about yourself?
My life’s journey has been unique and full of challenges. After spending 12 tumultuous years in foster care and emancipating from my last placement in Compton, California, I went to Howard University, where I obtained my Bachelor of Science in Nursing. Let me tell you, it was a struggle! I lacked the academic and social skills to thrive and was lost and overwhelmed when I arrived.
After graduating, I worked bedside for over a decade in various specialties, including pediatrics, critical care, and home health. During that time, I obtained my master’s degree in nursing and most recently graduated from UCLA with my PhD in 2017.
What made you decide to become involved in nursing? Did your upbringing influence your decision to become a nurse?
I needed to make money in foster care to pay for school expenses, so I became a certified nursing assistant at 16. I was still unsure about my future until a family tragedy changed the course of my life. My father was involved in a drive-by shooting my senior year, just a few weeks before I was set to leave for Howard. I’ll never forget the compassionate care the nurses provided to my dad and my family, and from that moment on, I knew that would be my path moving forward.
How does your experience in healthcare influence your roles as a DEI consultant and assistant professor at CSU advocating for inclusive nursing environments?
My first job was in Long Beach in a pediatric rehab center, and I worked with many adolescents who were gang-violent victims. I had the opportunity to work at UCLA as a new grad, but I wanted to be in my community caring for patients who looked like me.
What makes nursing special is that we look holistically at the person in front of us and consider all the circumstances that led them to our care. Thus, having firsthand experience working with diverse patient populations has made me a more experienced DEI strategist and consultant because I learned early on always to remember the person behind the patient.
How have you been able to give back to the foster community? How do you feel when you know you’ve helped them achieve their future goals despite barriers?
Sitting in foster homes as a child, I made big plans about what to do when I grew up and have tried to live up to those goals. My work in the child welfare system has centered on transitional-age foster youth. These young adults between 18 and 26 are emancipating from foster care.
The transition to adulthood is difficult for anyone, but foster youth especially need more skills and resources to navigate the world successfully. I give back to the community by facilitating workshops for child welfare professionals to teach them how to better engage with this population and also by serving as a mentor. It’s a full circle moment when I see my youth succeed. I hope the little girl who made all those plans is proud of me.
What do you value most about your work for diverse nurses?
I value the look on Black nurses’ faces when they finally feel seen. These nurses are on the frontline dealing with discrimination and retaliatory behavior in the workplace, and now they finally see someone calling it out.
What advice would you give younger adults struggling in nursing school or the workplace due to past trauma or microaggressions they’ve experienced?
I would tell them you are the most important person in your life’s journey. You have to affirm, support, and believe in yourself. We tend to go through life looking outward for the answers, but overcoming trauma means getting to know ourselves and building ourselves up.
Dealing with microaggressions requires a different skill set rooted in emotional intelligence. Sadly, many Black professionals, particularly Black women, have to decide if they will stay low or fight for what they believe in. Both have potentially adverse consequences; one hurts our souls, while the other hurts our careers.
My best advice is practical. Build your expertise in various areas and develop multiple income streams to handle a particular employment situation. If you find yourself stuck in a toxic workplace environment, be ready to pivot to the next opportunity.
To learn more about Miller’s work, read her book on the life lessons she learned in foster care or follow her on Instagram at DocMillerSpeaks.
A utilitarian ethical approach views to balance the greatest good over harm to everyone involved while considering the benefits and consequences (Velasquez et al., 2021). Migration occurs when a new circumstance or opportunity is better than the existing situation. The looming shortages in the nursing workforce globally make migration inevitable. It is essential to weigh the benefits and consequences of nurses’ migration.
Nurses can migrate and work in other countries if the country’s visa and employer requirements are met. Frances Hughes, RN, BA, MA, DNURS, FAAN says that nurses in lower-income countries migrate to higher-income countries seeking better career and financial opportunities (Hughes, 2022). Stakeholders directly impacted by the migration process include individual nurses and their families, recruitment agencies, and supplying and accepting countries.
Benefits and Consequences
There are several benefits to migration. Nurses who migrate to higher-income countries are happy with the host countries’ social, financial, and health-related advantages (Hendriks, 2018). One of the greatest benefits of migration is the diversity foreign nurses bring to the workforce. Recruiting foreign nurses also improves the workforce shortage in the host country. A diverse workforce elevates the quality of patient care by ensuring the provision of culturally competent care to a diverse patient population (American Association Colleges of Nursing, 2023). The benefits are not only limited to the host or higher-income countries. The remittance from immigrant nurses financially benefits the supplying countries (Shaffer et al., 2022), families, and individual recruitment agencies.
From a utilitarian view, other consequences of migration are the potential depletion of the workforce in supplying countries due to mass migration and the demand for additional resources by host countries to train foreign nurses to meet the needs of a diverse patient population. It is also important to remember that adapting to a new country and environment could be challenging for individual nurses.
Takeaways: Finding Solutions
The migrating nurses bring cultural diversity, unique knowledge, and skills to the nursing workforce in the host countries (Hughes, 2022). It is unethical to prevent migration considering the overall benefits to the individual, host, and supplying countries. However, a utilitarian cannot ignore the other consequences.
Migrating from one country to another comes with challenges, which vary for individuals from different countries. It is essential to identify the unique needs of foreign nurses and distribute resources in a manner that is easily accessible to avoid waste of resources. Most often, it is not the availability of the resources that is challenging but the need for knowledge in accessing them and finding the best resource that works for each individual—having a common website that provides information on the boarding process, eligibility exam centers, financial support, mentoring, and other essential resources during migration.
Regulated and ethical recruitment practices can be implemented to prevent nursing workforce depletion in supplying countries. From a utilitarian view, it is recommended to ensure transparency on the benefits and consequences of each nurse migration experience for all stakeholders. The availability of information on benefits and consequences will allow better planning and implementation of policies, programs, and resources that support migrant nurses and migration.
References
American Association of Colleges of Nursing. “Enhancing Diversity in the Nursing Workforce.” AACN. April 2023. https://www.aacnnursing.org/news-data/fact-sheets/enhancing-diversity-in-the-nursing-workforce.
Hendriks, Martijn. “Does Migration Increase Happiness? It Depends.” Migration Policy Institute. June 21, 2018. https://www.migrationpolicy.org/article/does-migration-increase-happiness-it-depends.
Hughes, Frances. “Nursing Shortage and Migration: The Benefits and Responsibilities.” CGFNS International. 2022. https://www.cgfns.org/nursing-shortage-and-migration-the-benefits-and-responsibilities/.
Shaffer, Franklin A., Mukul Bakhshi, Kaley Cook, and Thomas D. Álvarez. “International Nurse Recruitment Beyond the COVID-19 Pandemic: Considerations for the Nursing Workforce Leader.” Nurse Leader 20, no. 2 (February 2022): 161–67. https://doi.org/https://doi.org/10.1016/j.mnl.2021.12.001.
Velasquez, Manuel, Dennis Moberg, Michael J. Meyer, Thomas Shanks, Margaret R. McLean, David DeCosse, Claire Andre, Kirk O. Hanson, Irina Raicu, and Jonathan Kwan. “A Framework for Ethical Decision Making.” Santa Clara University. November 8, 2021.
The Diversity, Equity, and Inclusion Leadership Network (DEILN) named Frontier Nursing University Chief Diversity and Inclusion Officer Dr. Paula Alexander-Delpech, Ph.D., PMHNP-BC, APRN, as the network’s Chair-Elect.
DEILN is a convening body to unite expertise, experience, and guidance for academic nursing in Leading Across Differences. This network collectively explores innovative approaches to enhancing diversity, equity, and inclusion in academic nursing and the nursing workforce.
DEILN supports the efforts of the American Association of Colleges of Nursing (AACN) and its more than 865 nursing schools and academic nursing at the local, regional, and national levels to advance diversity and inclusion.
These efforts include, but are not limited to:
Sharing evidence-based promising practices
Engaging with the membership
Providing consultative services
Convening networking forums
“I am honored to have been chosen as the Chair-Elect of DEILN,” says Dr. Alexander-Delpech. “This presents a wonderful collaborative opportunity for all members of DEILN and the institutions we represent to share our knowledge and experience to improve the effectiveness of our collective DEI efforts across the country.”
The goal of DEILN is to align its efforts with the strategic diversity goals and objectives of AACN and the larger nursing community. Membership in DEILN is open to all faculty, deans, and staff interested in advancing diversity, equity, and inclusion goals.
Vanderbilt University School of Nursing Associate Dean for Equity, Diversity, and Inclusion Rolanda Johnson, PhD’98, received the Vanderbilt University Joseph A. Johnson Jr. Distinguished Leadership Professor Award at the university’s Spring Faculty Assembly.
The award recognizes a faculty member who has proactively nurtured an academic environment where everyone feels valued and where diversity is celebrated. It is named for Joseph A. Johnson Jr., the first African American to earn a Vanderbilt bachelor’s degree and the first to earn a doctoral degree.
In recognizing Rolanda Johnson with the award, Vanderbilt University Chancellor Daniel Diermeier says, “Rolanda’s experiences in nursing — as a clinician, educator, researcher, and administrator — inspired her to make a difference in the lives of those who experience health disparities and inequities and are often overlooked. Her passion is educating nurses to better meet the healthcare needs of all populations and delivering high-quality, culturally sensitive care to all patients. Among her efforts at the School of Nursing was advocating for holistic admissions, contributing to more diverse enrollment.”
Johnson has positively impacted equity, diversity, and inclusion on regional, national, and international levels. She serves as membership chair for the Tuskegee University National Nursing Alumni Association, was the inaugural chair of the American Association of Colleges of Nursing’s DEI Leadership Network (DEILN), mentors for the AACN Diversity Leadership Institute, and a member of the American Nurses Association National Commission to Address Racism in Nursing Education Work Group. She co-founded Nashville’s chapter of the National Black Nurses Association. Johnson also served on the U.S. Pharmacopeia Health Equity Advisory Group.
At Vanderbilt School of Nursing, Johnson helps faculty create inclusive curricula and classrooms, offers guidance to student affinity groups, and is exceptionally skilled at recruitment, retention, and inclusion. Her research and scholarship focus on increasing EDI in nursing education and assisting vulnerable populations.
“Most recently, Dr. Johnson co-developed and co-directed the inaugural Vanderbilt Academy for Diverse Emerging Nurse Leaders, a one-week immersive for nurses who have been in leadership roles for less than five years,” says Pamela R. Jeffries, PhD, FAAN, ANEF, FSSH, dean of Vanderbilt School of Nursing. “This was an amazing week for 18 fellows from academia and healthcare systems all over the country. Many described the program as ’life-changing.’ The academy is well poised to be sustainable and in the long-term, will help to mitigate the diversity disparities evident in nursing leadership.”
Senior Associate Dean for Academics Mavis Schorn, PhD, FACNM, FNAP, FAAN, nominated Johnson for the leadership award. “She has advanced equity, diversity, and inclusivity by developing a strategic plan focusing on both recruitment of diverse individuals while also creating a welcoming environment where everyone feels like they belong,” Schorn wrote. “She led the efforts to create a diversity statement for the school and later led efforts to update it to include antiracism language. She has worked with all the admission committees to ensure the admission process is holistic.”
Johnson will carry the Joseph A. Johnson, Jr. Distinguished Leadership Professor title for one year.
“This award was a wonderful surprise,” she says. “I am humbled to receive this honor. While I am the honoree, the VUSN family deserves accolades for ‘WE’ have accomplished much and will continue to be leaders in diversity, equity, and inclusion in nursing and healthcare.”
Crystal Beckford is an accomplished healthcare executive with extensive experience in health systems in Maryland and Florida. She has a proven track record in hospital, health plan, long-term care, and health insurance leadership.
In her current role as chief nursing officer (CNO) and vice president of patient care services at Luminis Health Doctors Community Medical Center (LHDCMC), Beckford collaborates with the clinical team, medical staff, and executive team to develop nursing and clinical strategies that promote quality and operational excellence in clinical operations.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Crystal Beckford, Chief Nursing Officer and Vice President of Patient Care for Luminis Health Doctors Community Medical Center.
Talk about your role in nursing.
As the CNO and Vice President of Patient Care for Luminis Health Doctors Community Medical Center, I provide leadership to our nursing and patient care support team members. I provide coaching, direction, support, and leadership to grow current and future leaders. To be an effective CNO, one of my main objectives is to ensure clear and concise communication with team members to remain focused on our goals and outcomes. Most important, I always remind our teams why we’re here—to provide high-quality, safe patient care.
How long have you worked in the nursing field?
I have worked in the nursing field for 32 years. I started my career as a licensed practice nurse for two years and then earned my BSN, RN. To expand my knowledge in health care, I received my master’s in healthcare administration.
Why did you become a nurse?
Since I was about seven years old, I knew I wanted to be a nurse. There were many influential people in my life growing up, and three of them were nurses, whom I admired for their character and work ethic.
What are the most important attributes of today’s nursing leaders?
Flexibility, balance, resilience, humor, humility, passion, and understanding.
What does being a nursing leader mean to you, and what are you most proud of?
Inspiring and influencing others to achieve their greatest potential is truly an honor.
Tell us about your career path and how you ascended to that role.
My first year of nursing was in the medical surgical unit. While at Catholic University, the nuns told us we must complete at least one year of Med/Surg. I quickly learned it wasn’t for me. Critical care was my life’s calling. I was captivated by the equipment, the technology, and the nurses’ knowledge. I practiced in just about every space in critical care, including the intensive care unit, cardiac care unit, open heart surgery, emergency department, and respiratory care unit. I quickly developed strong acumen, knowledge, and skills in critical care. My colleagues saw my potential as a great leader and encouraged me to apply for a managerial role. Once I landed the position, I kept pushing myself to grow in leadership roles because of my passion for the business and the clinical side of healthcare.
I chose Luminis Health Doctors Community Medical Center to make a difference in my home community. Healthcare equity is a major passion and concern of mine. The hospital has embarked on a $300 million campaign to renovate and expand the nearly 50-year-old campus, including building a women’s health center for inpatient obstetrics services, labor and delivery, and postpartum care. Right now, eight out of ten women have to deliver their baby outside of Prince George’s County, and the area’s maternal mortality rate for Black women is 50 percent higher than the national average. As a nursing leader, my mission is to collectively address health inequities, improve health outcomes, and make meaningful changes within our organization and the community.
What is the most significant challenge facing nursing today?
The most significant challenge facing nursing today is getting more young people interested in this career. In my role at Luminis Health Doctors Community Medical Center, I’ve made it my mission to speak, teach, coach, and mentor at area nursing schools, historically black colleges and universities, community colleges, and high schools. We offer internship opportunities for students that may lead to future employment. Since approximately 70 percent of our employees (including myself) live within Prince George’s County, we are focused on growing and maintaining our own diverse workforce. One of the reasons I enjoy working here is I’ve felt welcomed the moment I walked through these doors. It has a small southern town feel in a larger community, even though we’re outside Washington, D.C.
As a nursing leader, how are you working to overcome this challenge?
See above. My greatest support is not my words but my actions. I fully support a work-life balance by encouraging my team to take paid time off and offering various types of shifts that fit any lifestyle.
What nursing leader inspires you the most and why?
My former CNO has been my mentor and a source of inspiration for more than 20 years. She is now a COO for a start-up corporation but remains inspirational by being herself. She is smart, wise, humble, and demonstrates humility. She has always been a wonderful person and leader.
What inspirational message would you like to share with the next generation of nurses?
Nothing worth doing is easy. Don’t make five minutes of a bad situation your narrative for the day or your entire career. Instead, focus on the positive and good experiences we have as healthcare workers.
Is there anything else you’d like to share with our readers?
Nursing will always give you more than what you bargained for. Regardless of my title, I am and always will be a nurse.
Robin Geiger, DNP, MSN, APRN, NP-C, FNP-BC, NEA-BC, is an accomplished, results-driven, board-certified nurse executive with over 20 years of hands-on clinical leadership experience. Dr. Geiger’s professional focus is on health equity and clinician advocacy, aiming to increase resilience for healthcare providers, improve quality care and create solid support systems through the ACT (Advocacy. Career. Tools) program for all clinicians within the Ingenovis Health brands.
With a long-standing history of assembling impactful and forward-thinking teams emphasizing improving healthcare quality and increasing patient safety, Dr. Geiger’s vast experience includes accreditation and developing policies to support foundational programs through assessment and data analysis.
She previously served as associate dean of academic affairs for the National University School of Health Professions and focused on strategic planning, clinical program development, and academic operations.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Dr. Robin Geiger, Senior Vice President of Clinician Advocacy of Ingenovis Health.
Talk about your role in nursing.
As senior vice president of clinician advocacy for Ingenovis Health, I’m pleased to lead our ACT program focused on clinician well-being, resilience, and support. I hold board certification as a nurse executive advanced (NEA-BC) and chair our Chief Nurse Advisory Board, an interdisciplinary advisory group focused on creating solutions for current frontline clinician challenges.
I support the nursing community as much as possible. I serve as an editor-in-chief for a medical publishing company, focusing on nurse practitioner certification and nursing ethics. I also remain current in clinical experience as a board-certified family nurse practitioner (FNP) and co-founder of an NP-owned concierge practice in North Florida.
How long have you worked in the nursing field?
I’m surprised to say that I have been working in this field for more than 23 years!
Why did you become a nurse?
My interest in nursing peaked at an early age. I would hear stories about my grandmother, who was a nurse midwife; stories of how she helped others heal; and the need that would always exist for people to receive healthcare. I would stare at her nursing picture in which she wore a white dress and cap. She was my earliest influence in nursing, someone who looked like me and that I could relate to.
I started with an initial goal of becoming a certified nursing assistant (CNA). I wanted to handle the most humble and respectful connection of bedside care. I immediately loved it! Being there for some nursing home patients with little-to-no family and supporting them to accomplish daily tasks was important to me. I knew I could grow in nursing and pushed myself to do more.
What are the most important attributes of today’s nursing leaders?
Today’s key attributes for nurse leaders should incorporate an empathetic, resourceful, and advocacy approach. Considering the social climate when engaging new and existing nurses is important. External factors to keep in the forefront include mental health and bandwidth, which stem from work-life balance, something I like to refer to as a “work-life blend” when assigning and delivering care. Being supportive means including flexible options for staffing that align with a nurse’s history, respect for years of service, and include physical, social, and emotional support.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nurse leader means factoring in previous personal experiences of my own and those around me. An excellent example would be the formation of Ingenovis Health’s interdisciplinary Chief Nurse Advisory Board (CNAB). Solid decisions involve a multi-disciplinary approach to healthcare strategy and design. Multi-disciplinary teams provide a more global lens of how decisions impact all, from the social worker to the clinician and all the people that serve the patient.
I am proud to give back to the community by co-founding a concierge health clinic for the under-served population, creating MSN and DNP programs that consider the working nurse, and developing a clinician well-being program to encourage improved work-life blend and foster resilience – the ACT program.
Tell us about your career path and how you ascended to that role.
I’ve touched almost every area of nursing through lived experience, either as faculty, clinician, or leader. My life in nursing began first as an intensive care unit (ICU) nurse, followed by staffing various ICUs, ER, and OR at a level-one trauma hospital. I became a family nurse practitioner in multiple areas, including as an RN first assist in plastics, orthopedics, and general surgery. I have always mentored nurses along the way, and opportunities to serve as lead faculty, director, and associate dean in academia provided me ample opportunity to do so. I received my most impactful leadership training at the Veterans Health Administration. My career has included national leadership roles as VP of clinical care at a non-profit organization and later as Co-Owner/ CEO of a concierge clinic. My current role as senior vice president of clinician advocacy for Ingenovis Health allows me to combine my previous experience to support all clinicians – I enjoy what I do!
What is the most significant challenge facing nursing today?
Recognizing the importance of self-care is always challenging for nurses. I’m also guilty of this from time to time. Nurses are natural givers, and we often neglect the importance of reflecting on challenges, trauma, and the losses we experience. We provide our best care when we reflect on our experiences and learn from them. Covid was challenging, but we didn’t experience initial trauma and burnout with the pandemic. Nurses are strong – we have constantly been challenged. I’m glad we are now focusing on better health for the nurse, something we have needed for quite some time.
As a nursing leader, how are you working to overcome this challenge?
I’m working daily to be an example of incorporating self-care and eliminating stress. Ingenovis Health supports the ability to grow support and enhance the lives of frontline clinicians through the ACT program. I’m proud to lead this program, focused on providing a voice of advocacy, career pathing/ support, and tools to foster better mental and physical health. I think of the program as ongoing conditioning and strengthening to ensure our clinicians are prepared to lend their best selves to caring in various areas within healthcare.
What nursing leader inspires you the most and why?
Dr. Hollier is one of the many nursing leaders that inspires me. I found her certification guidelines and manuals amazingly insightful and well-written from a practical point of view. She inspires my entrepreneurial spirit to create better ways of accomplishing milestones and mentoring others to greatness.
What inspirational message would you like to share with the next generation of nurses?
We are all capable of more. You’ll receive a new challenge when you think you’re comfortable and have it figured out. Grow from each challenge by adding it to your toolbox. You’ll soon have a nice box of tools/ experiences to reach for and share with other nurses.
Allowing yourself to grow through mentorship will open ideas and create life-long connections you didn’t know you needed. Participate in shared governance and nursing associations to strengthen the profession and lend your voice and support.
Finally, consider that one day we will all become patients. You are influencing the future care for your family and yourself. Thinking this way is powerful; this forward-thinking always leads to positive and motivating actions.
Is there anything else you’d like to share with our readers?
There’s a personal quote I often use, “Everything revolves around the need to receive and deliver education.” This doesn’t apply to academia as it might seem but to life in general. Nurses are life-long learners. We don’t teach emotional and social learning in every education program, but to continue shaping this profession, we must learn how and when to share our stories to inspire others.
