April 13, 2022

Episode 67: How do we teach nurses to be anti-racist?

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Description

We’re back for season 5 of The Handoff with a very special guest, Dr. Sheldon D. Fields. Dr. Fields is the inaugural Associate Dean for Equity and Inclusion at Penn State University, where he is also a research professor in the College of Nursing

Dr. Fields was the first-ever male Registered Nurse selected for the Robert Wood Johnson Foundation Health Policy Fellowship, in which he served as a policy adviser to Senator Barbara Mikulski on the Senate HELP committee during the passage of the Affordable Care Act. Dr. Fields is a fellow of the American Academy of Nursing, the American Association of Nurse Practitioners, and the National Academies of Practice. 

After more than 30 years in the healthcare industry, Dr. Fields has said that it is his personal mission to do everything he can to help nursing move forward with a plan to diversify the profession. Today he and I talk about what that plan looks like, what nurse educators need to do to help combat racism in the field, how we can recruit more diverse students into nursing and how we can teach nurses and nursing students to be anti-racist.

Links to recommended reading: 

Podcast

Transcript

Dan:

Hey everyone, welcome back The Handoff, a podcast about all things healthcare, innovation, and nursing. Today, we're kicking off this season with Dr. Sheldon Fields. Excited to have you Dr. Fields. Thanks for joining us.

Sheldon:

Thank you for having me. I'm excited.

Dan:

You've had an amazing career really focused on multiple things, but diversity has been sort of a theme throughout all of your roles and all of your research. What is driving you towards the idea that we need to diversify our workforce, and what are some ways that nursing is sort of failing in that point right now?

Sheldon:

Yeah. Well, thank you for the question. I've been a nurse for 31 years. A lot of people don't realize that when they meet me, because they assume lots of other things. And therein lies sort of the crux of part of the issue. As a male, as someone who identifies as a male, who is both African-American and Latino descent, in nursing, there are not many people that look like me. So, diversity, the idea of equity and inclusion has always been a part of my nursing journey, whether I was teaching, whether I was being a researcher, my entrepreneurial work, my work within advocacy and health policy.

Sheldon:

Here's the bottom line. There is no other more important healthcare profession than nursing. We are the largest segment of the healthcare workforce, and we are the most trusted. That means that within almost every healthcare interaction, there is someone who is performing some type of a nursing function. If nursing truly does touch almost everyone within the system, we need to do better than having a profession that is 90% women and 80% white, because the community, the environment, the population, the country that we live in does not reflect such a small and narrow gender and/or racial ideal.

Sheldon:

We are a much more diverse country. The literature tells us a lot that we get better healthcare outcomes when people understand and respond to the ethnic and racial nuances, as well as the other characteristics involved in how people show up to actually partake of their healthcare. So, the more diverse we can be, the better healthcare outcomes we're going to get, and it's actually going to even be cheaper to run that type of a healthcare system than the one that we're currently running.

Dan:

Yeah. I think you bring up some great points there. I think we don't have a diverse nursing workforce, and even on the innovation side, which is my passion around change, leading change in healthcare, diversity allows for better innovation. There's literature on bringing different ideas from different backgrounds, different lived experiences that can really catalyze the change we want to see in healthcare, and that alone is needed across sort of our broken healthcare system. Even in my experience through nursing school, I remember reading the books, and everything was the nurse, she will, she will.

Dan:

There was never even representation for the male gender in there. Where do we start with this? It seems like it is a systemic problem. I know the American Nurse Association and Ernest Grant has the end racism campaign. Where do we start with really bringing diversity, equity, inclusion back into our profession?

Sheldon:

Yeah. Well, I'll comment on what you just said, because I remember that as well going through nursing school, particularly my community health book, that referred to the nurse as she, she, she. I actually took that to one of my professors. I was like, how do we change this? Because I didn't know how, I was a student. We actually wrote the authors and the company that published the book just to let them know. And they actually did change it, but let's even go one step now, because now we went from it being she to now being She/he, which is still not inclusive of how people identify themselves along gender lines.

Sheldon:

Now we need to expand it even further because that binary of she and he is also not how everybody identifies. People identify as non-binary all the time now. So, we need to go to they, them, and other ways of allowing people to express themselves. Because within the most caring and most helping profession, people need to be able to show up exactly as who they are, and not be denigrated, and not be made to feel that there's not a place and a space for them. That is what nursing truly should be doing.

Sheldon:

We go forward now, post the whole issues of George Floyd and the realization, the reckoning, if you will, that we had with racism in this country. A lot of times people say, "Well, Dr. Fields, what does that have to do with nursing?" Everything has to do with nursing. Because nursing was on the front lines. And nursing has always been on the front lines. We saw it with the pandemic. We saw it with the protest. We were there, because we are the backbone, we're the glue within our healthcare system. So, you ask me, where do we start? We start with nursing students and their education.

Sheldon:

And here's why. I'm a long-term nursing educator. And nobody's born a racist. By the time you show up into nursing school, you are a product of your environment. So, you show up with certain ideas and isms about people and beliefs, and even religion. It's all about what you don't know and what you've been made to assume about people. We have to do a better job in nursing school, teaching people how to truly be equitable, accepting of diversity, and truly how to be in inclusive, but actually, also we have to teach them how to anti-racist. We can do that in nursing school, but we're going to have to make some tweaks to our curriculum and start teaching future generations a little differently.

Dan:

Well, you mentioned one of the hardest things I've found in my career to change, which is nursing curriculum with the amount of committees and things that it has to go through. With the newest essentials coming out and some pushes to really change the way we educate nurses to create a faster, more prepared nursing cohort to inner practice, where do we start? Where can nurse educators start adding content and discussion and deep dives into these issues within their curriculum?

Sheldon:

So, the curriculum changes are going to be pushed by the new essentials, but by two other documents as well. One of which you mentioned, the American Nursing Association's Commission on Racism, which the final reporters due out soon, and the 2020, 2030 report on the future of nursing, which centers the whole issue of health equity. If we are ever to achieve a level of health equity, we are going to have to become more innovative about how to be anti-racist. How do we do that in curriculum? We start with nursing history, then we put a more diverse and full expression of nursing history within the nursing curriculum.

Sheldon:

What do I mean by that? If you talk to nursing students currently, yeah, they might know about Florence Nightingale or Clara Barton, but there are so many other nurses of color that get erased from nursing history. Very few people learn about the first professionally trained nurse, which was Mary Mahoney. Right alongside fighting in the Crimea was Mary Seacole, alongside Florence Nightingale. And you just don't get that at history. Once you realized that nursing started out with some very diverse people, then you don't get a sense that it was only white women that really promulgated the profession.

Sheldon:

Because honestly, it's simply not true. You start there. The other thing is we got to teach active anti-racism skills. You can unlearn your bad habits, and there is a cadre of exercises and things that can be put into curriculum and more diverse clinical simulations that really centers the issues related to the social determinants of health, any number of the social determinants of health. That's one way of infusing it as well. Those two things really focus, I believe, at the undergraduate level.

Sheldon:

By the time we get to the graduate level, we need to be teaching our DNP students, those future advanced practice nurses, all of those projects they work on, they all need the center on finding ways to innovatively meet the needs and solve the problems related to the social determinants of health. All those PhD students in nursing need to be focusing on using anti-racism healthcare frameworks to look at their research. Therein lies, at all levels, a couple of places where we can start, and we can do that right now.

Dan:

Yeah. I think it comes down to the ability also, to build those relationships across different lines as well. That's just leadership. That is the essence of how we lead. I think we get stuck in these task things and the history that we're told. Like you said, across the curriculum, there's opportunities for us to build relationships and understanding across groups, which eventually helps us fix the broken system. As you think about recruiting more diverse students into nursing, I think the number's still around 12, to maybe upwards of 20% in some cases of people who identify as male entering the profession. People of color as well are not as apt to choose nursing as a profession. Where do we start in recruiting a more diverse pool into nursing school at the undergrad level?

Sheldon:

Where we start recruiting, honestly, we need to go way back and we need to start in elementary school. That's where you start building a pipeline. Because honestly, by the time kids get to high school, it's too late. And you think about it, even in movies and TV, you have these little scenes where they go, they ask the kids, "Well, what do you want to be when you grow up?" The kid's like, "I want to be a fireman. I want to be a truck driver. I want to be Superman." No little kid steps up and go, "I'm going to be a nurse."

Dan:

That's 100% true.

Sheldon:

You don't hear that. So, being that, that is the case, let's take our sort of mission and cause, if you will, right to the elementary school, and start teaching, at a very early age, what a nurse is and what a nurse does. My really great colleague, Dr. Martha Dawson, who is currently the president of the National Black Nurses Association, she has developed something called the Mini Nurse Academy, and through NBNA, that is exactly what we are starting to do. There is a whole curriculum through this Mini Nurse Academy that focuses on our chapters, which we have in 34 states to partner with elementary schools to go in and start teaching these young kids at a very early age exactly what nursing is and what nursing does.

Sheldon:

Showing up at their health fairs, so that they really see nursing as a viable option for their profession. That's how you start. That's how you show up. And that is really what's necessary. We need to fund these types of programs so that people that look like me and Dr. Dawson and other people of color can show up, and those kids can see. Because a lot of times I step in front of a classroom and these kids are like, "You can't be a nurse." I'm like, "Why not?" Well, I've never met a male nurse or I've never met a black male nurse. Well, now you have. Now you can't say that anymore.

Dan:

Yeah. I love it. So, also representing being out there in the world. I was recently at Georgia Center for Nursing Excellence Workforce Conference, and we had a panel discussion I was moderating. We had HR leader from Delta Airlines and we had a leader from Georgia Power. Georgia Power, it was a similar, it was kind of a cool analogy or similar experience since they have trouble recruiting kids into the power industry. So, line workers and electricians and engineers and all those type of things. What they did is they got virtual reality goggles, and they basically went into elementary schools and said, "Hey, put these on and go climb the pole and see what you can do."

Dan:

And they found an amazing engagement of, I never knew I could do this. He told a story about a young girl who put on the goggles and climbed then said, "I could do this. I'm going to be a line worker when I grow up. This is amazing. I can't wait." I think we could deploy some of those strategies as well. How do we expose people beyond what's in the media? Which nursing is always ... The shows are all about physicians and all that kind of stuff, and nursing just not out there. So, how do we bring them into our world?

Sheldon:

Well, the whole point, even of the Mini Nurse Academy, it is about exposure. And it is about putting out positive images of what the profession really is. Not the negative ones. Hollywood sometimes can be incredibly not helpful with the image of nursing. Nurses have either been portrayed as being hyper sexy. Everybody wants to be like the sexy nurse for Halloween or something crazy like that, or nurse ratchet, the other extreme, or just the handmaiden to the physician, all of it, which is not true. Or the funny male nurse in all those movies that ... Was Adam Sandler playing those movies?

Dan:

Ben Stiller.

Sheldon:

Ben Stiller. Yeah, Ben Stiller. The whole joke was, oh, he's a nurse, and somehow that was funny. I think that was funny. So, we need to do more and it is how we show up. We are highly educated, degreed, licensed, certified professionals. That's really the narrative that we should be putting out there.

Dan:

Yeah. I agree. We'd have several guests on the show about that as well. And their lived experience of experiencing racism as they go to work and how it impacts their practice and ability to care for patients. At the end of the day, when behaviors impact personal lives as well as patient outcomes, it just can't be acceptable. So, in your opinion, how can health systems start addressing this behavior and holding people accountable to it?

Sheldon:

There are stories upon stories of nurses of color, of male nurses that encounter people within the healthcare system that say things like, "Well, I don't want a male nurse." Well, in some cases, that might be an appropriate request, but in a lot of times, it's based in ignorance, and it is not an appropriate request. Healthcare systems need to partner with all of their nurses and have very clear policies about when those types of gender specific requests will be honored. The other part is even when patients, or people would say things like, "Well, I don't want a black nurse." That is probably never appropriate.

Sheldon:

That is not things that we can tolerate and a system should be supporting. If I worked for a healthcare system that didn't support who I was showing up to work, I wouldn't work there. So, systems need to realize that when they stand on solid, well-founded policies, then they can be anti-racist. That is an anti-racist act. Giving in and making that worker feel as if they are somehow less than who they are as a qualified nursing professional is never the right thing to do. That's one right there. In terms of hiring, so I'm a nurse educator, I work at a big university.

Sheldon:

I talk to recruiters in hospital systems all the time because they want to recruit our students. I ask them very upfront, "So, what are you doing in your institution to promote an environment of diversity, equity, and inclusion, and now even justice?" I'm always very leery of a representative who can't answer that question. Because if you can't answer that question, that means you're doing nothing. In this day and time, doing nothing is no longer acceptable. You got to be doing something. You either have to have in place affinity support groups for people, whether you have a nursing LGBT group, or whether you have an interfaith nursing group.

Sheldon:

People can meet and talk and really find their support within your institution. Because again, everything that we know, what the little just says, that if you stand up a more equitable justice driven, diverse, and inclusive work environment, people will also stay and continue to work for you. And then you don't have that turnover. We don't have that cost associated with turnover within your systems. But you got to have a plan and it has to be a part of your strategic plan. If it's not a part of your strategic plan and you haven't really planned to succeed, then by default, you have planned to fail.

Dan:

Yeah, I think that's a great quote. I think nurses across the country have realized that they have choices, and the idea that you go to a health system and work there for 30 years and retire with a pension is no longer the case. The next generation of nurses is standing up and saying, if my values don't align with this organization, I'm out, and I'm going to go do something else, travel, or I'm going to go find a health system that will. I think it's going to be essential for organizations to have to figure this out, or they're never going to get recruiting.

Sheldon:

Look, look, I hear you, Dan. I'm gen X, and there's lots of issues that I have with millennials, but one thing that I think that millennials have done really well is they have turned the work environment on its ear. They're like, "What is this 9:00 to 5:00, 40 hour work week crap that y'all are doing? I'm not doing that." So, they do have choices and they're expressing those choices. I am not mad at them for that.

Dan:

Yeah. No, it's actually really empowering and I'm right on the border with you there I'm like a zennial, so I have the optimism of the millennials and the pessimism of the gen X, and I straddle that every day.

Sheldon:

Yeah.

Dan:

But I think it's great. And we have to just rethink it. It helps us challenge some of those assumptions from the past. And one of your pieces is really on, how do you unlearn racism or how do you teach students to unlearn? Where do you start with that conversation. Those are tough topics. They make people extremely uncomfortable. That's a lot of stress on the whole group. So, how do you approach this in a way that engages people and gets over that stress and actually creates a productive conversation?

Sheldon:

There are lots of ways that you can instill a conversation about being anti-racist that isn't accusatory, but might be a little uncomfortable. However, from that discomfort, often growth occurs. It's really about making people feel heard and feel safe in a nonjudgmental environment. You're here to learn. That's why I say we need to start with nursing students and with schools, because students are there to do one thing, they're there to learn. Yeah, we can give them their nursing skills, but we also need to give them some other skills.

Sheldon:

We do that through effective communication by bringing up clinical scenarios in which we can really safely practice. Because there is something called cultural learning that we can do. Nobody knows everything about everything. I have a PhD for an Ivy League institution, Dan, and I don't know everything. So, I never make those types of assumptions. Once you approach it that way, and you give people the place and the space to ask questions that they might not have even ever thought they would ask, here's one thing that happened.

Sheldon:

During the height of the pandemic, with the racial reckoning, almost every single white colleague that I went to graduate school went mainly, called me at some point and started with a question that went something like, "You know, Sheldon, I know I need to do more, but I don't know what to do. What do I do?" We had those types of conversations. I don't mind having those types of conversations. Part of my professional life, Dan, I am the inaugural associate Dean for equity inclusion at Penn State University. In that role, I serve as a role model and a resource. I've had some pretty uncomfortable conversations with people, but everyone at the end is always better for it.

Dan:

Yeah. I think you're right. It is that discomfort that creates growth, and that's in whether you're working out or you're growing as a person, or you're learning new clinical skills, being uncomfortable triggers something in the brain. I've been in that same place. What can I do with my platforms to help change the conversation as well? There have been some uncomfortable conversation. We actually had some of these conversations on the podcast in some previous episodes as well, but I think it's being open to that.

Sheldon:

No, I actually had to say to a colleague recently, I was doing a workshop, and he was a white male. And he said, "Sometimes I don't feel like I have ... I should step back and I don't have a place and a space. I shouldn't talk as much because people of color need to talk more." And I said to him, I said, "No, no, no." I said, "Let me tell you something. You realizing that you have a certain amount of social capital, as a white male, and you understand what that privilege gives to you, and standing in your privilege and being able to support and be a good ally is exactly what is needed. So, I don't need you to not speak. I need you to speak, and I need you to also talk to people who look like you, because oftentimes they will hear something very different from you than they will ever hear from me."

Dan:

Yeah. I've experienced that as a white male nurse executive. I've been in the same boat, and there are times where I've been in meetings where I've felt I shouldn't, or couldn't speak up. I had a conversation with someone of about the exact topic you just mentioned, about leaning into that and using that opportunity to involve others and send a message to people who might listen to somebody differently and all those type of things. So, I think that's a key takeaway for our listeners to lean into this and be that ally.

Sheldon:

Absolutely.

Dan:

We talked about a lot of heavy stuff, which is great because it needs to be out there, but what makes you optimistic about the future of nursing?

Sheldon:

There's a lot going on. Nursing has seemed to have waken up, and nursing has now realized that it has a responsibility, in that it was derelict in its responsibility to really use its collective power. I mean, we are 4 million plus strong in this country, Dan. What nursing wants in the healthcare system, nursing can get by banding together. I am also a health policy person. I was a Robert Johnson Health Policy fellow. I had a front row seat to the passage of the Affordable CARE Act. And what nursing wanted in that bill, nursing got, because nursing came together.

Sheldon:

That is actually what makes me optimistic. Now that we have this window of opportunity, if you will, and a lot of activity going on around what nursing can do, there's a lot of momentum and we need to use it. We have huge platforms. When nurses step to the forefront and start to speak, people listen, and that's a good thing. But with the power of the 2020, 2030 report on nursing, that gives us a really great, great framework for what we should be doing to achieve health equity in our system, with the very clear directives that will be coming out with the ANA's report on racism and nursing, a first of its kind ever.

Sheldon:

And with the hiring of a lot more diversity, equity, and inclusion professionals, particularly in the academic space, as well as in our healthcare systems, there have been more people put in places to now really do the work of DEI all throughout our system, and that's a good thing, because a lot of us are nurses because we have that background, and not only knowing the profession, but also being able to work with people because that's exactly what we do. There is so much going on. I get requests every day to speak or talk.

Sheldon:

We've been writing papers, really adding to the knowledge base of DEI within this space, and talking with people about how to do and create an anti-racist nursing agenda. And even like I said earlier, how to infuse it into the curriculum for the future. So, I'm excited. There's lots to do, and that's not a bad thing.

Dan:

No, that's not. I think one of the key pieces here is nurses need to come together in a united front. And sometimes it feels like our profession is fragmented in a million ways. So, our voice is not as powerful as it could be in some cases. I think the more we can unify around a defined message is going to be important for us to move forward.

Sheldon:

Like I said, we did it during the buildup for the ACA. We can do it now.

Dan:

Yep. I mean, I see it every day in the health systems. If you don't include nurses in the change efforts, and the innovation, and that kind of stuff, they will put that technology or that care model in the drawer and shut it and never see it again. You can vote without action as well. Nurses have the power in the health system and we need to use it more.

Sheldon:

Yeah. Ask any new intern the power of a nurse. They know.

Dan:

That's right. Yeah, July 1st is coming right around the corner.

Sheldon:

It is. It is.

Dan:

Well, Dr. Fields, it's been so great to chat with you. We like to end the show with that one thing that you want to hand off to our audience, that one nugget of information that you'd like them to take away from our conversation today. So, what would you like to hand off?

Sheldon:

At the end of the day, Dan, if you really want to be an effective nurse that is true to our ANA code of ethics, practice more humanism. If you realize that, with a heightened sense of empathy and humanism, if you place yourself in that space, then you can't do any harm. And if you commit to the lifelong learning that nurses must do, and understanding that we deal with people, sometimes at their most vulnerable moments in their life, and that it is a privilege to be present in those places and spaces, and you take your responsibility seriously, there is so much that we can do to move the needle, but have to start seeing each other in that humanism, because we're all, at the very end of the day, we're all just people with a lot more in common than differences.

Dan:

Yeah. I think that's a great way to sum it up. That goes for nurse in practice with patients, as well as nursery leaders, and health system leaders as well. We're people and we need to start treating each other a little bit more like humans. So, Dr. Fields, thanks for being on the show. Really appreciate it. If people want to learn more about your work and maybe get in touch with you, where's the best place to find you?

Sheldon:

I'm all over the place. If you Google me, everything comes up, half my life.

Dan:

I see that.

Sheldon:

I know. It's kind of scary to tell you the truth. My webpage at the university will come up, my page, and my work with the National Black Nurses Association comes up. I'm accessible. You can find my email address. It's very simple, which is sheldondei@psu.edu. I'm on LinkedIn using my real name. So, people can find me there. They can find me on my Instagram as well, which is @sheldonfields. So, I'm easy to find, Dan, very easy to find.

Dan:

I love it. We'll put some of those links in the show notes as well so it's easy for the listeners to find. And just want to thank you so much for taking the time to be on the show and look forward to the report that's coming out soon and all of your future work.

Sheldon:

Absolutely. Thank you again. My absolute pleasure, sir.

Dan:

Thank you so much for tuning into The Handoff. If you liked what you heard today, please consider leaving us a review and subscribing on Apple Podcasts, or wherever you listen to podcasts. And for more information about Trusted, please visit trustedhealth.com. This is Dan. See you next time.