Ampy de la Paz, MSN, RN, a 40-year nursing veteran who works as a quality management analyst at Bayshore Medical Center in Pasadena, Texas, uses an incident from her own career to demonstrate to newly arrived nurses from the Philippines how to negotiate in the American workplace.
[ads:career]
The incident occurred when she was offered a promotion a number of years ago [by a previous employer] and met with her superior to discuss her new salary. The first lesson de la Paz imparts to her colleagues is that she didn’t walk into the meeting blindly. She prepared for it by deciding how much of a raise she deserved on a percentage basis and how much various percentages meant in actual dollars.
Then, when the initial offer came, she knew the dollar amount was a smaller percentage increase than she deserved, and she told her superior the amount he was offering wasn’t enough. A few weeks passed before the superior returned to say he had spoken with someone in human resources who claimed that a survey of people at other hospitals employed in the same position had found that the amount de la Paz had been offered was average for the position.
Her response was: “I’m not average.”
She had lots of management experience, she told him, as well as a master’s degree, so she couldn’t accept the salary the organization was offering. Several more weeks passed before the superior met with her again. This time, he made what de la Paz considered an acceptable offer and she took the job.
Although negotiating is more often associated with legal, business or union issues, advancing your nursing career requires negotiation skills, too. Many people find negotiating difficult and some experts believe minority nurses are at a particular disadvantage when it comes to lobbying for promotions, raises or support for their projects and ideas. For example, they may come from cultures where disagreeing with superiors is considered disrespectful, or where being humble and part of a group is valued over self-promotion.
“The majority of [Filipino women] are very shy, so they [are] not as assertive as [they need] to be,” says de la Paz, the former executive director of the Philippine Nurses Association of America (PNAA). “They’re taught to avoid arguments and not rock the boat.”
Filipino nurses often get passed over for promotions because of this, she continues. “Sometimes you have to encourage them and tell them, ‘Why don’t you apply for it? You’re qualified to do that.’ They want to be asked [rather than ask for it themselves]. They would not go out of their way to ask for [a promotion], but if it’s offered to them they would take it.”
Know Your Value
In negotiating for a promotion or a pay increase, de la Paz says it’s important to know your worth, become comfortable with the person you’re negotiating with and demonstrate your value to the organization by promoting yourself whenever you get the chance.
For Ruth W. Brinkley, RN, CHE, president and CEO of Memorial Health Care System in Chattanooga, Tenn., negotiating in the workplace means “having the confidence to position yourself in a way that helps you best put forth your unique qualifications, skills and abilities, so that those skills and abilities become apparent to the organization.”
That may mean obtaining skills and knowledge you currently lack. “However,” Brinkley maintains, “I believe that in many cases people [already] have the abilities and skills they need, but don’t know how to position themselves and package themselves correctly. Once you know what skills you have and you’re confident in what you have, then you’re better able to negotiate from a position of strength and sell yourself to your organization.”
When a position that you want becomes available, she continues, “the first thing you’ve got to do is be able to package your unique set of skills that [are a good fit for that job]. It’s not always apparent. Many times we don’t recognize the skills we have.”
Years ago, Brinkley left a job as a chief nurse at an academic medical center to become a consultant for a professional services firm. “It took me a while to understand how to repackage my skills from an operational framework to a consultative framework,” she says. “I began to recognize that I did have the skills to be an effective consultant. What I needed to do was use the skills I had in a different way.”
Know Your Organization
Gwendylon Johnson, RNC, MA, a staff nurse at Howard University Hospital in Washington, D.C., and past president of the District of Columbia Nurses Association, says one of the most important things a nurse can do is to understand his or her organization as much as possible. This means not only knowing the direct care aspects of your working environment but the business aspects as well. Selling your idea, or yourself, will be easier if it fits in with the organization’s mission, she says.
Tips for Successful Negotiations• Do your research. Understand your objectives and what the other side wants.
• Decide what is negotiable. Draw up a list of what you are and are not willing to compromise on.
• Plan your strategy. Put it in writing, decide on your overall approach and be clear about the type of deal you want.
• Choose the right time and place for negotiating. Don’t negotiate in stressful locations or when you are under pressure to complete the deal.
• Outline your requirements. Outline your terms and conditions and try to get the other side to reveal their starting point for discussions.
• Ask questions and listen closely to answers. This will help you understand what the other party hopes to achieve and may get them to reveal what they’re willing to compromise on. • Don’t reveal your negotiating position and avoid making unnecessary concessions. When making concessions, look for the other side to do the same, and avoid looking too eager to make a deal.
• Be aware of negotiating tactics, such as false deadlines. Don’t be forced into making rushed decisions or unnecessary concessions.
Source: Microsoft Small Business Center, www.bcentral.com
“You have to make sure to bring to the table something that will expand the mission of the organization in a positive sense,” Johnson explains, “because [that way] you’re more likely to be able to get them to accept what you’re trying to do.”
Johnson, a past member of the American Nurses Association board of directors, says knowing the organization you work for means knowing its culture and how that culture defines value. This will help when it comes time to promote an idea, seek a higher-level position or negotiate for a pay raise. Determine what qualities the organization values and then seek to obtain those qualities.
Keep in mind, she says, that successful nurses don’t limit themselves to activities at the bedside. They bring other skills to the table, such as leadership abilities, organizational skills or knowledge of the community.
“[Hospitals] are now asking direct care nurses for ideas about how to market the organization,” Johnson points out. “If you are the nurse who comes up with the best idea, then you are probably the one who is going to be asked to advance or promote that idea. Also, [it’s important to have] a business sense of what the organization’s needs are and [how those] needs are in line with the mission statement of the organization.”
Gloria Ceballos, MS, RN, CNAA, BC, former chief nursing officer at Kettering Medical Center in Ohio, recommends volunteering to serve on a hospital committee that advances the organization’s mission.
“Volunteer for maybe some ad hoc work that the committee has to do,” she says. “This will expose you to other people, their ways of thinking and other professions outside of nursing. Not only that, the leaders [of your organization will] focus on people who want to advance. Those are the first people that leaders think of.”
Participating in committees and other volunteer activities helps increase your visibility within the organization and sets you apart as someone who is interested in more than just collecting a paycheck. “No leader is going to give advancement to somebody who’s just doing their work, coming in and going home,” explains Ceballos, who now works as a fill-in nurse while pursuing her doctorate. “You have to demonstrate that you bring value to the organization and that’s when the salary increases come.”
For example, Hispanic nurses should remember that their knowledge of the Spanish language and Hispanic culture can often be an asset, she says. “If [they work for a facility that serves] a lot of Hispanic patients, they add great value in communicating culture and differences in care that Hispanic patients would need.”
Ceballos recommends serving on diversity committees or volunteering to translate brochures into Spanish.
Prioritize and Practice
Johnson, who has worked as a union activist for the District of Columbia Nurses Association, advises nurses not to rush into things when preparing to negotiate with their employers.
“Take your time and fully develop what you see as a priority interest for you and the organization, because you have to set priorities,” she says. Build a strategic plan if necessary for how you can achieve your goals and how you can best sell yourself.
“Do not feel embarrassed about taking ownership of a new idea and doing something with it,” Johnson continues. “There are times when you have to step up and say, ‘Yes, this is my idea.’ But you also have to take ownership of the challenges and problems as well as the successes. Use every opportunity as a learning experience you can build on for future use, both from an individual growth perspective and an organizational growth perspective.”
Like other important nursing skills, negotiation skills can be learned. Johnson points out that many hospitals offer professional development programs that focus on cultural diversity and how different cultures address issues such as conflict resolution and assertiveness. She also advises minority nurses who have difficulty in asserting themselves to role-play.
“If you have difficulty doing it in a mixed-culture group,” she says, “one of the things I suggest is practicing in some type of group where you can feel comfortable–where you can say ‘this is what we have to learn how to do’ and practice it.”
Johnson says she has seen it work in minority nursing associations, such as the National Black Nurses Association (NBNA) and the PNAA. “I have experienced it firsthand with the NBNA and with Chi Eta Phi Sorority. Organizations like these have programs that focus on teaching nurses, regardless of their cultural background, to speak up and stand out as a positive influence in the workplace.”
Strength in Numbers
Having an advocate in the workplace who can lend support to your cause is also beneficial. “One of the things that helps is if you have a mentor,” Johnson says. “That person can also serve as a conduit for floating some of your ideas.” If you don’t have someone who can serve as an advocate, she adds, then finding a partner who has the ability to enhance your proposal is the next best thing. “That means knowing your colleagues and knowing the organization to be able to make that determination.”
Brinkley agrees that it’s helpful to have an advocate in the workplace who can tout your abilities. It’s also important, she says, to be willing to take on extra duties and responsibilities, especially unpleasant or difficult ones, in order to get noticed and increase your value. Plus, you should be willing to take risks and work outside your comfort zone.
If you don’t have certain skills, learn them and work with a mentor or a career coach, Brinkley advises. Talk with that person about ways to position yourself to improve your value at work. “I would encourage any minority nurse who’s having trouble with that, or who can’t find a mentor within their organization, to invest in a coach,” she emphasizes.
It’s important to remember, Brinkley adds, that because of the nursing shortage, nurses are in a good negotiating position at the moment. “Organizations don’t want to lose valued employees, they just don’t. So to the degree that you are able to constantly repackage and refine and continue to develop your skills, you make yourself that much more valuable to the organization.”
Improving your negotiating skills also means being willing to change employers if necessary. “If it isn’t going to happen for you in the organization that you’re in,” says Brinkley, “then you have to decide whether you’re willing to move on and [find] an organization that values you.”
Hispanics are the fastest-growing segment of the United States’ population—they currently comprise 16% and are expected to grow to 30% by the year 2050, according to the U.S. Census Bureau. However, Hispanic nurses make up only 3.6% of all registered nurses in this country, as reported by the 2008 National Sample Survey of Registered Nurses (NSSRN).
While other minority populations experience problematic underrepresentation in nursing, it is especially apparent in the Hispanic community, and the gap widens every day. In 2008, only 5.1% of all RNs spoke Spanish, according to the NSSRN. There are not enough Hispanic nurses to deal with the health care issues facing this growing population, and the language barriers and lack of cultural understanding created by the void lead to substandard health care for the entire community. In fact, a July 2006 article published by USA Today pointed out that the lack of English language proficiency in patients directly contributed to diminished health care for those individuals.
A 2008 workforce survey showed that Hispanics were 28 years old on average when obtaining their initial licensure compared to an average age of 25 for whites. The most common type of initial R.N. education among Hispanics was the associate degree in nursing (55.1%) followed by the bachelor’s (39.4%), and then a hospital diploma (5.5%). Why does the associate degree come out ahead? The reason may be financial. The A.S.N. provides earning power earlier than a four-year bachelor’s program in nursing. Hispanics were also more likely to pursue a bachelor’s degree after obtaining the initial R.N. (41%), but were less likely to pursue graduate degrees (11%) than white, non-Hispanic RNs (39% and 14.5%, respectively). Hispanic nurses comprise only 3.5% of all nurses in advanced practice fields.
The vast majority of Hispanic nurses (68.8%) work in hospitals and then in ambulatory care (6.9%). Hispanic nurses also hold only 10.9% of all nursing management jobs, possibly due to the low number of Hispanic nurses with graduate degrees. Finally, there are fewer Hispanic mentors in higher education and nursing leadership positions who can guide other Hispanics. Attracting and retaining nursing students from racial and ethnic minority groups can’t be accomplished without strong faculty role models. According to 2009 data from American Association of Colleges of Nursing member schools, only 11.6% of full-time nursing school faculties come from minority backgrounds, and only 5.1% are male.
As the U.S. population becomes more diverse, leaders in multicultural segments, including Hispanic communities, must encourage minorities—and minority nurses—to become leaders themselves, so when they continue to build upon their skills and advance their careers, they will help themselves and their communities. Health care for this underserved population should ultimately improve if it helps members of the Hispanic nursing community become leaders in health care, experts in the growing field of nursing informatics, and trained nurse educators.
Taking advantage of the online learning environment
Many factors promote successful career development and mobility among Hispanic nurses, and one of the most important is the opportunity for educational advancement. Online higher education programs in the field of nursing help students develop critical leadership skills that, in turn, lead to improvements in their overall community. The online format provides flexibility, providing students the opportunity to take courses while meeting their professional and personal obligations, contributing to multiple other benefits of studying nursing online.
Minority students at all educational levels can see graduates from these programs as role models and examples of how they, too, can achieve success. In cases where students may be struggling, it’s especially important when they can point to a nurse in a leadership position—someone who looks and sounds like they do—as an inspiration to keep going, whether it’s toward getting a Bachelor of Science in Nursing (B.S.N.), a Master of Science in Nursing (M.S.N.), getting a promotion, or taking on an important social change initiative to help a group in need.
Many of these minority students seek out mentors in school, possibly other minority nurses, and often go on to become mentors for the next generation of nurse leaders. For example, many of Walden University’s graduates work and teach in associate degree nursing programs, which have a large representation of Hispanic nursing students, and they help in retain these students through mentoring.
In some ways, online education “levels the playing field” for minority students, fostering increased participation and confidence that may lead to their greater success in the classroom and workplace. Many Hispanic students speak English as a second language and may write better than they speak. Since writing is integral to online learning, it adds a level of confidence that Hispanic students may not feel when sitting in a traditional, bricks-and-mortar classroom. There is no sitting in the back of the room or far from the action and dialogue up front. Consequently, minority students who may struggle in a traditional setting often thrive in online classes, which provide a unique venue for students to have a new voice, speak up, and become leaders in the classroom and beyond.
Increased participation in the online classroom has additional benefits for Hispanic and other minority nursing students. These students not only have the opportunity to hone their personal and professional skills and talents, but they can also develop relationships and network with other nurses across the country. A nurse working in the Cuban American community in South Florida may share best practices with a nurse working with the Mexican American population in Southern California. Or perhaps non-Hispanic nurses working with Hispanic patients may consult with their Latino classmates online for advice regarding how to provide the best care for these patients. Online higher education gives students a special way to connect so they can enhance their education and make a difference in the lives of many.
Making strides toward improving access
As a minority fellow of the American Nurses Association and a current board member of Ethnic Minority Programs for the organization, I work with my colleagues to develop proactive strategies to train, recruit, and retain more minority nurses, especially Hispanics. As Associate Dean of Walden University’s School of Nursing, I lead an experienced, dedicated, and talented team of faculty and staff focused on creating the next generation of leaders in the minority nursing community. Through programs like our Master of Science in Nursing and Bachelor of Science in Nursing Completion Programs, we can make great strides toward increasing the number of Hispanic nurses who serve as role models for the larger minority community.
Online Education in Nursing Informatics By Dr. Kathleen Hunter and Dr. Toni Hebda, Online Master of Science in Nursing Program Faculty, Chamberlain College of Nursing It’s hard to believe, but online education has been around for some time now. Many early online classes were largely text-based, inconsistent in quality, and less than dynamic. Today, the quality of instruction continues to improve, as schools integrate audio and video to meet different learning styles and provide robust student support structures and resources. With nursing informatics, it makes sense to use information technology to teach nurses about how that same technology can support them in a clinical, administration, or educational setting. Nurses must develop their informatics capabilities to understand how to use automated record systems to document care and to retrieve information on individuals as well as patient populations in order to track quality and identify potential problems. As patient advocates, nurses need to be involved in the design of this technology to ensure it promotes patient safety, is easy to use, and supports the caregiver. Increasingly, nurses will be involved in the delivery of care at sites heavily reliant on such technology, including home monitoring and virtual intensive care units. Many online education programs offer informatics, exploring core concepts of data, information, and knowledge in depth. Students gain experience in data management, health care information systems, and project management. The courses prepare nurses to combine their knowledge of information technology, health information exchange, and legal and regulatory issues with their clinical background. Nurses trained in informatics can:
Make the transition to a technology-rich health care delivery system smoother, more efficient, and safer for nurses and patients.
Help design information systems to optimize practitioner decision making.
Design, develop, and test tools for consumer health care, such as health-related websites, home care management systems, remote monitoring, wearable monitoring devices (smart technology), and telenursing (remote nursing via telephone, computer, and/or television).
Promote health literacy through the design and development of information tools that bring health information to diverse populations.
Teach patients using mobile technology (cell phones, notepads, etc).
For many M.S.N. and B.S.N. students, the training they receive in their online courses is put to work directly in their own communities. During their practicum or capstone course, M.S.N. students can choose projects that are inclusive of the needs of their workplace or neighborhoods. Often, these projects involve working with underserved populations to solve problems in community health care. B.S.N. students undertake similar projects in their community health practicum. They can all tap into their nationwide network of fellow students to come up with the best solutions for problems they encounter.
I especially recognize the importance of recruiting faculty members at the doctorate level from minority groups. Since there already is a shortage in the number of Hispanic nurses, you can only imagine how few in this population have earned their doctorates. Yet, they do exist, and when they teach, they make a difference.
One example is Patti Urso, Ph.D., A.P.R.N., C.N.E., Specialization Coordinator of Nursing Education, who currently teaches nursing education courses at Walden. Dr. Urso, a Cuban American originally from Miami, is a nurse practitioner who now lives in Hawaii and works with other underserved populations from Polynesian and Micronesian communities. In Hawaii, she engages with Hispanic patients through community churches and is involved in forming a new chapter for the National Hispanic Nurses Association. She hopes to inspire her students to reach out to underserved communities, and she mentors Hispanic students in the capstone course of the nursing education program.
One of the ways Dr. Urso works to connect with Hispanic nurses is through contact with alumni such as Lydia Lopez, one of the first graduates from Walden’s M.S.N. program in 2007. As a nurse and mentor, Ms. Lopez is committed to being a role model who recruits and retains minority nurses, keeping them interested in their course work and giving them the necessary tools and strategies to facilitate academic success. “True role models are those who possess the qualities that we would like to have and those who have affected us in a way that makes us want to be better people,” she says.
The nursing profession needs both men and women from all ethnicities to meet the needs of society. Minority nurses—especially Hispanics—with bachelor’s degrees and, eventually, master’s and doctoral degrees—who are prepared to educate and lead a new generation of minority nurses—will help improve this critical situation and provide essential health care for all.
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.
Aneesah Coates, BSN, RN, is an experienced psychiatric mental health nurse with nearly ten years of experience in acute care, long-term care, and home health care. She is the owner of aneesahcoates.com and is passionate about helping nurses, current and aspiring, learn more about the profession.
Coates works at a mental health crisis center as a senior professional evaluation nurse, preceptor to new nurses, Nursing Journal Club facilitator, and nursing department trainer for new staff. She’ll graduate with her doctorate in nursing practice as a psychiatric mental health nurse practitioner in December 2023.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Aneesah Coates, BSN, RN, and senior professional evaluation nurse.
Talk about your role in nursing.
I wear several hats in my current nursing role. I am a senior professional evaluation nurse at a local mental health crisis center. We’re part of the University of Pittsburgh Medical Center, specifically under the Western Psychiatric Hospital umbrella, a national leader in diagnosing, managing, and treating mental health and addictive disorders. And we are located in an urban community setting, so we get consumers with various needs and diagnoses.
My duties include triaging consumers coming into the center, conducting intake assessments, making referrals to the appropriate level of care, and working with local pharmacies to ensure that our consumers can access the medications they need. I also serve as a resource for other nurses and clinicians in the facility, providing mentorship and guidance to new staff members and helping with problem-solving when necessary.
More formally, I am trained as a preceptor to new nurses, so I help lead nursing orientation and provide ongoing support during the onboarding process. As the trainer for the nursing department, I give presentations to new staff from all disciplines, providing them with an overview of the nurse’s role within the team. My goal is to ensure everyone who works here understands our role as nurses and how we fit into the team’s overall approach to helping our consumers.
Lastly, I serve as the Journal Club facilitator for the nursing department. I started this initiative by creating a presentation to refresh us on defining key research terms and levels of evidence. Every month, I select a journal article relevant to our work, conduct an article critique, and provide the group with a summary of the main findings. I also provide them with a blank copy of our research critique form and encourage them to reply to the initial email to share their thoughts to foster discussion. Each of my roles has this common thread of support for consumers and staff alike and empowering everyone in the process.
How long have you worked in the nursing field?
This year marks a decade as a nurse for me.
Why did you become a nurse?
Becoming a nurse was a natural progression for me. Seeing my dad in the hospital greatly impacted me as a child, and I was continually inspired by the nurses who cared for him. Despite being in and out of the hospital, my dad was involved in my education and invested a lot in my early education. He nurtured my curiosity and encouraged me to keep learning. My mother’s hard work ethic was also an influence on me.
Between their encouragement and my growing interest in healthcare, nursing seemed the perfect fit. I was drawn to all aspects of the profession and wanted to make a difference with my work. That desire has only grown since then, and I’m continually driven to learn more and improve my practice.
What are the most important attributes of today’s nursing leaders?
A great attribute for today’s nursing leaders is being able to role model the behaviors and attitudes they’d like to see in their staff. Nursing leaders should be able to demonstrate qualities such as professionalism, accountability, and integrity. It’s also important that nursing leaders are problem-solvers and innovators, ready to take on challenges and come up with creative solutions for their teams. Nursing leaders should strive to be lifelong learners and stay current on best practices and evidence-based research to improve care.
Many attributes that contribute to successful nursing leadership can be learned and developed over time. So if an aspiring leader still needs to possess the desired qualities, they can acquire them through professional development opportunities such as certifications and continuing education. Mentorship and networking can also be great resources for learning and developing these skills.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nursing leader means taking an active role in helping shape healthcare’s future. It’s about understanding how my work can impact the lives of my patients, their families, and our community. It’s about being an advocate for all those I serve and working to ensure that everyone has equal access to healthcare. It’s also about empowering my colleagues, mentoring them, and encouraging them to reach their potential as healthcare professionals. And this can all be done no matter what level of nursing leadership you are in.
I take my leadership role very seriously. I am continuing my education to obtain my doctorate in nursing practice (DNP) to become a psychiatric mental health nurse practitioner (PMHNP). I plan to graduate this December and am excited about the opportunities this degree will bring. I am also excited about the work I have done to create aneesahcoates.com, a website devoted to helping students and new and seasoned nurses navigate the world of nursing by providing access to resources and insights on a variety of topics.
Tell us about your career path and how you ascended to that role.
My career path in healthcare began 20 years ago as a dietary aide in a hospital cafeteria. My nursing career started sometime after that when I decided to attend a local community college and obtain my associate’s degree in nursing science. From there, I went to the California University of Pennsylvania for my bachelor’s degree in nursing. And three years ago, I entered Robert Morris University’s BSN-DNP program to become a psychiatric mental health nurse practitioner. As a nurse, I have worked in an acute care setting caring for lung transplant patients. I have also worked in skilled nursing, home health care, long-term care, and psychiatric mental health care.
What is the most significant challenge facing nursing today?
The most significant challenge facing nursing today is the shortage of nurses (source). The nursing shortage results from multiple factors, including low enrollment in nursing programs, a lack of nursing school faculty, and a significant segment of the nursing workforce nearing retirement age. Not to mention how the pandemic has put an even more tremendous strain on the nursing profession. And the shortage is likely to have several downstream effects, including a strain on staffing ratios, leaving nurses overworked and stressed out, which can lead to nurse burnout. This can negatively impact patient outcomes and the quality of patient care. To address this, we need to focus on initiatives such as recruitment and retention programs and professional development opportunities that focus on building leadership skills. We should also continue to invest in incentives such as tuition reimbursement and scholarships to encourage more people to enter and stay in the profession.
These initiatives can create a pathway for nurses to move up the ladder, which not only increases retention but also helps to foster an environment of strong leadership among nurses. I don’t want to minimize the challenge the nursing shortage presents. It’s a complex issue that requires innovative solutions and collaboration between multiple stakeholders.
As a nursing leader, how are you working to overcome this challenge?
I am working to overcome this challenge by engaging in various initiatives and activities to help recruit, retain, and mentor nurses. I am doing this through my website, which provides essential nursing resources to students and new nurses looking to enter the profession. My current professional role allows me to precept students and new nurses, allowing me to share my passion and excitement for the profession. I make it a point to express how nursing is a dynamic profession that can be whatever we make it. In the future, I plan to use the knowledge I have gained through my DNP program to contribute to initiatives and programs that will empower nurses through education and advocacy.
I am interested in health economics and policy, so we’ll see what opportunities open up.
What nursing leader inspires you the most and why?
Nurse Alice Benjamin inspires me. She does so much that you can’t help but be inspired by her. Nurse Alice has achieved so much in her career and is passionate about helping others do the same. She is a leader who uses her platform to promote health and wellness while advocating for nurses and patients. Nurse Alice is a force of positivity, and her passion for nursing is contagious. She’s an author, TV medical contributor, ambassador for the American Heart Association, Chief Nursing Officer at Nurse.org, and the list goes on. Her work goes beyond the traditional boundaries of nursing leadership, and she is an excellent example of how nurses can impact healthcare through direct patient care and advocacy.
What inspirational message would you like to share with the next generation of nurses?
My inspirational message to the next generation of nurses is this: the sky is truly the limit. You can make a real difference in healthcare and positively impact the lives of those who need it most. Believe in your professional abilities, stay true to your values, and don’t be afraid to push the boundaries of being a great nurse.
Is there anything else you’d like to share with our readers?
I want to remind readers that we all have the power to make a difference in the healthcare field and that each of us has unique skills and talents that we can use to help others. No matter what role you play in healthcare or how much experience you have, your contribution matters. So stay motivated, focus on the task at hand, and always remember why you decided to pursue a career in healthcare in the first place.
As the nation continues to grapple with the wide-ranging effects of racism, the nursing industry continues to take steps to address disparities, inequalities, and racism. Last summer, the Academy of Medical-Surgical Nurses (AMSN) ramped up the AMSN DEI Campaign, motivated by the killing of George Floyd.
Terri Hinkley, EdD, MBA, BSN, RN, and chief executive officer of the Academy of Medical-Surgical Nurses (AMSN) and Medical-Surgical Nursing Certification Board (MSNCB), says Floyd’s killing troubled her deeply, leading her to question if she had done everything she could to make the world as safe and inclusive as possible. Hinkley spoke with the presidents of AMSN and MSNCB and with her family and then wrote, My Reckoning, an op-ed expressing her commitment to actively working to combat racism.
While the program helps nurses learn about DEI, it’s also a way for them to build competence, says Hinkley, especially in areas they may not be familiar with or have a deeper understanding of. “We do not understand the norms, practices, and requirements of cultures we did not grow up with or in,” she says. “By focusing on building competency, we are striving to take away the ‘blame and shame’ that often surrounds these issues and discussions. Let us start with the basic principle that everyone wants to be respectful of others and build on that to help them understand and be able to take action to make that happen.”
75% of the nurses that completed the survey reported that they wished to have a better understanding of topics related to diversity, equity, and inclusion.
92% reported that it is important for their national professional association to take action regarding diversity, equity, and inclusion and lead efforts for its members.
46% reported experiencing harassment or discrimination because of issues of race, class, gender, age, religion, culture, sexuality, or ability.
63% witnessed harassment or discrimination.
DEI work is sometimes uncomfortable, as Hinkley noted, and that’s why it’s important to give nurses the tools to have discussions around difficult topics. “We genuinely believe that we, as nurses, start from a position of caring and compassion,” she says. “We believe that every nurse wants the best possible outcome for their patient, and for their teammates to be respected and supported as an integral part of the team.”
As nurses learn more and become more intentional with their DEI work, they can more effectively advocate for those around them—whether teammates or patients. “DEI isn’t a one and done initiative,” says Hinkley. “It is a journey that will only have its beginning in the first 18 to 24 months. This is a lifelong learning initiative, one that AMSN is embracing and committing to.”
Hinkley says AMSN is committed to making this process inclusive and developed several different activities intended to help nurses be able to identify their own biases, or those within their institutions, and develop solutions to combat them.
Members can participate in a six-module educational certificate program in which the first module (the first module is offered at no cost to members) will focus on why the program is important. The remaining modules will allow deep dives into the areas of greatest discrimination, such as race, sexual orientation and gender identity, disabilities, age, and culture and religion, says Hinkley.
As nurses begin to move through the process and gain a new understanding, Hinkley says stepping back for the big picture is essential. “AMSN wants to build a culture of inquiry, where our nurses can start to question why we do things the way we do, or why I believe the things I believe,” she says. “Is there a different perspective that might shape how I approach a situation, or patient, or problem? Am I intentional in my actions, or am I just doing what I was taught and the way it has always been done? It is all about opening conversations, with yourself and others.”
Gaining competence and new perspectives will transfer into better nursing practice, higher nursing standards, and patient care in very specific ways, she says, including
as individual employees who remain competitive and effective in a changing workforce
as employees of organizations who will be DEI ambassadors to their organizations after completing the certificate program
as members of the largest segment of the healthcare workforce who will increase DEI competence across the healthcare sector
as primary providers of patient care in the nation whocan address the inequities in patient care
Hinkley noted that even with a DEI focus, real-life experiences can be uncomfortable. “I would like to share an example I experienced recently,” she says. “Someone I know came out as non-binary, changed their name (I will call them Storm), and their pronouns. Another friend (I will call Alice) was so distressed she would not be able to remember Storm’s pronouns because we have spent a lifetime of only having binary choices: he/him or she/her. ‘They’ sounds odd and feels odd, and we have a lifetime of using ‘they’ for more than one person. That results in dissonance and is incredibly challenging from a cognitive perspective. Alice is doing her best to be supportive and respectful and was so worried that she was going to forget and say the wrong pronoun. I tried to help Alice understand that if it were an honest mistake, Storm would understand, and they would not be offended. I tried to stress that Storm understands that we are all doing our best to be supportive and, in turn, have new things to learn as a result.”
As Hinkley notes, overnight change isn’t expected, but there are things nurses can do to help themselves move forward. “I think it is important to understand that no one expects perfection, they just expect the same respect and value that everyone else is given. What helped me was practicing. I practice using inclusive pronouns at every opportunity. I also challenge myself not to use binary pronouns, but rather to collectively refer to individuals I do not know as ‘they’ until I learn their preferred pronouns. I am not always successful, and just the other day I said ‘he or she’ when referring to a nurse in an example to a point I was making. I was gently corrected to ‘they’ and the conversation continued. Life-long learning is a hallmark of the nursing profession, and we embrace that in every other area of our lives, so why not this one?”
As nurses’ DEI work grows stronger, Hinkley says it will have a pervasive effect on nurses’ work, patient care, and the workplace in general. “Having the opportunity to improve health for all individuals would be the best possible outcome of this initiative and would bring me personal and professional joy,” says Hinkley. “I also feel very strongly about doing my part to contribute to the work environment for all nurses. I am keenly interested in issues regarding the work environment, and the human cost of caring to nurses and healthcare providers. There are so many wonderful aspects to nursing and being in the caring profession, but we do not all have the same experience at work, and I am excited to be able to improve the work experience for all nurses.”
