Advancing diversity

FigureThe chief nurse fellowship program offered through my employer, Central and North West London (CNWL) Trust, is a nursing leadership and management program that provides healthcare services as part of the United Kingdom's National Health Service (NHS). The program was developed to support the career progression of Black and ethnic minority nursing leaders to executive- and board-level nursing functions that foster clinical excellence and quality within CNWL. It incorporates group and individual coaching along with a bespoke developmental framework created between the nursing directors and the chief nurse fellows. My bespoke program includes: attendance and responsibility within division, executive, and nonexecutive board levels for ensuring nursing quality and safety across the whole CNWL Trust; a personally chosen project about digital competence in nursing practice; and understanding and modeling accountability for service-level decision-making in psychiatric nursing practice, which is my area of specialization. As I reflect on this program as a person of color, I recognize that I chose this particular fellowship because I wanted the opportunity to show both myself and others nationally and internationally that there are, and can be more, nurse leaders who are Black and that these nurses can provide and implement strategic vision for nursing at a senior level. As an RN for 18 years, I'm very conscious of the racial disparity within division- and board-level nursing employers, which is common throughout the world. I encourage you to take a look at who's on your organization's board and who's responsible for your nursing practice and patient safety. I write as a nurse from England, but research shows that internationally nursing board members who make decisions regarding vision, finance, patient safety, staff well-being, and more don't reflect “on the ground” ethnicities. I'm not suggesting this is done maliciously; however, a fundamental part of nursing is to be aware of any unconscious biases we may bring into our leadership and management responsibilities. You may be making hiring decisions based on who you're used to seeing in those positions. The group and individual coaching element of the fellowship program has enabled me to focus on my personal experiences of my culture from a young age and how this has impacted my leadership and managerial processes in my current role. Everyone who has worked with me is aware that I adopt the role of a “rescuer”; I've had this role since I was young, which partly influenced my decision to enter the nursing profession. Once I became an RN, trying to “rescue” staffing issues and service resource issues along with providing patient care left me feeling frustrated with nursing practice. The chief nurse fellowship has shown me how to move from a place of rescue to a place of empowerment: empowering myself and others to provide the best nursing care possible within the resources given to services and celebrating the day-to-day achievements of working within healthcare. My confidence has also increased, enabling me to approach national healthcare arenas with my particular focus on digital and nursing practice. I've enrolled in a professional doctorate program as a next step toward nurse consultant/specialist-based roles that can be embedded within nursing clinical care and nursing service management. I've had nurses of varying ethnicities say to me: “You shouldn't have to do that to progress,” “I didn't have to do that; I worked hard,” “It's a checkbox exercise for employers,” and other phrases that you may have heard yourself when considering pursuing an academic or development program to advance your career. These nurses' viewpoints aren't wrong, and I understand where they're coming from if they've experienced difficulties related to institutionalized racism or internal conflict between the color of their skin and other people or systems. However, I figure the more experience I can get, the more I can share at my future senior or academic interviews about how I turned my development program into measurable outcomes and successful actions with my clinical experience. Also, any phrases like these in conversations with nursing staff provide an opportunity to network and show them the positives of the program and possibly help them to understand where those thoughts originated based on their experiences. I do realize that ultimately, because it's a bespoke program with rigorous interviewing processes, chances are that those applying really do want to be in the program. Internationally, there are likely to be similar leadership programs where you're based. (See Tables 1 and 2.) It's not about the title because a chief nurse may have a different title in your country. However, this type of nurse is highly likely to have responsibility and accountability above and beyond only clinical care. It's also likely that this level of employment will have a statutory (legal) role at the board level for managing regulation around nursing practice; be responsible and accountable for all nursing practices and specialties, as well as service roles, at a board or executive functioning level; and within a leadership hierarchy, have directors of nursing reporting to them. There could be a level of government influence as part of the role for nursing practices and safe care. Table 1: - Nursing leadership and fellowship programs across the globe Here are a few of the many organizations throughout the world that offer fellowship or development opportunities for nurse leaders: American Organization for Nursing Leadership Education Programs www.aonl.org/education/overview Australian College of Nursing: Emerging Nurse Leader Program www.acn.edu.au/leadership/emerging-nurse-leader-program Canadian Academy of Nursing Fellowship Program www.cna-aiic.ca/en/academy/fellowship-program Florence Nightingale Foundation Leadership Programmes https://florence-nightingale-foundation.org.uk/academy/leadership-development/leadership-programmes National Academy of Medicine: American Academy of Nursing Fellowship https://nam.edu/programs/health-policy-educational-programs-and-fellowships/american-academy-of-nursing-fellowship University of San Francisco Health Department of Nursing: International Fellowship Programs https://nursing.ucsfmedicalcenter.org/international-fellowship-programs Table 2: - US-based programs focused on advancing diversity Although many leadership and fellowship programs include a diversity component, the programs listed below are specifically focused on minorities and advancing diversity in healthcare. American Nurses Association: Minority Fellowship Program www.nursingworld.org/practice-policy/workforce/minority-fellowship-program Rutgers School of Nursing: Minority Nurse Leadership Institute https://nursing.rutgers.edu/ce/course-catalog/mnli Substance Abuse and Mental Health Services Administration: Minority Fellowship Program www.samhsa.gov/minority-fellowship-program University of Massachusetts Boston, Manning College of Nursing and Health Sciences: Clinical Leadership Collaborative for Diversity in Nursing www.umb.edu/academics/cnhs/partnerships/clinical_leadership_collaborative Vanderbilt School of Nursing: Academy for Diverse Emerging Nurse Leaders https://nursing.vanderbilt.edu/academy/emerging/index.php At time of writing, I'm in my final few months of the fellowship, which has broadened my experience of responsibility and accountability at more senior levels in the organization. I'd encourage any nurse of color to take on the challenge and apply for these types of senior leadership programs. We need to see each other here.

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