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NURSE PROFILES

Raising Voices:
Med-Surg Nurses Making a Difference

Efforts toward stronger diversity and inclusion have not gone unnoticed

By Linda Childers
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M
ed-surg is the largest nursing specialty in the U.S., with the Academy of Medical-Surgical Nurses (AMSN) serving as the only organization dedicated to the specialty. Its more than 10,000 members (and 40,000 certificants in MSNCB) range from nurses who work in a hospital’s med-surg unit, to those in leadership roles working to impact patient safety and quality of care delivery.
Meet two members of the AMSN who are using their backgrounds and interests to advocate for system change and transform care.

Working To Increase Diversity in Nursing

As an openly gay man in the South, Justin Fontenot, DNP, RN, NEA-BC, assistant professor of Nursing at the University of Louisiana at Lafayette, and associate editor of the peer-reviewed journal, Teaching and Learning in Nursing, knows the importance of ensuring inclusivity in nursing. “Some hospitals are doing a good job creating inclusive spaces for staff and patients but haven’t addressed the lack of diversity in the nursing workforce,” he said. “Having a diverse staff reduces health disparities, while also improving patient outcomes in the LGBTQIA+ community and intentionally marginalized racial and ethnic groups.” Much of Fontenot’s research has centered on how nursing schools can better recruit underrepresented students. “The nursing workforce doesn’t currently reflect the diversity of our nation,” said Fontenot. “Nursing schools have varied selection processes, including the deidentification of gender identity, age, sex, and ethnicity. They also rely heavily on grade point average and academic performance to guide admission decisions.” To attract a more diverse student base, Fontenot recommends nursing schools look beyond traditional criteria and consider factors such as aptitude, characteristics, and real-world experiences — thereby adapting a radical approach to holistic admissions processes.
“Having a diverse staff reduces health disparities, while also improving patient outcomes in the LGBTQIA+ community and intentionally marginalized racial and ethnic groups.”
— Justin Fontenot, RN
“We also need to have an ethnically diverse faculty in order to attract students of different social and ethnic backgrounds, genders, and sexual orientations,” he said. A 22-year veteran of nursing, who previously worked in med-surg and home care, Fontenot is currently collaborating with the AMSN to develop an online certification program that covers diversity in the 21st century. “I served as a subject expert on the sexual orientation module, one of seven modules representing intentionally marginalized communities,” said Fontenot. “The modules cover everything from religion to cultural differences and discuss how nurses can acknowledge and appreciate these differences, while breaking down stereotypes and addressing any unconscious biases.” Fontenot has also conducted research on using the PREP framework to improve critical thinking for pre-licensure nursing students. He says that because standard clinical tasks take precedence during the clinical experience, it leaves little to no time for students to complete paperwork such as care plans or concept maps until after clinical experiences. The PREP model allows critical thinking to occur in the clinical setting. “Following traditional methods creates a challenge for both med-surg nurses and patients,” said Fontenot. “I believe if we looked at ways to close the theory/practice gap in the education environment, it could relieve the burden placed on institutions, while also preventing new nurse burnout and turnover.”

Ensuring All Staff Have a Voice

In her new role as Director of High Reliability and Clinical Safety at Ochsner Medical Center-West Bank in Gretna, Louisiana, Kenesha Bradley, MSN, APRN, ACNS-BC, is continuing the work she began two years ago as chair of her hospital’s psychological safety education committee. “Healthcare staff who feel psychologically safe are comfortable voicing their ideas and concerns, asking questions, and offering feedback without fear of being disciplined or humiliated,” said Bradley. A 13-year employee of Ochsner Health, Bradley began her career at the health system as a med-surg nurse. She went on to become an Adult Health Clinical Nurse Specialist for seven years leading an interdisciplinary team in education initiatives that include addressing diversity and inclusion issues, building trust, and confronting implicit bias. In March, she assumed her current role. According to Bradley, conversations about psychological safety began as part of a quality improvement project and continued after the hospital held viewings of the documentary, To Err is Human. The film sheds light on medical errors and those working behind the scenes to ensure patient safety.
“Healthcare staff who feel psychologically safe are comfortable voicing their ideas and concerns, asking questions, and offering feedback without fear of being disciplined or humiliated.”
— Kenesha Bradley, APRN
“Everyone — from housekeeping staff to executives — saw the documentary and shared their thoughts after,” said Bradley. “We discussed the hierarchy in organizations, where we all saw ourselves on the playing field, and how some employees didn’t feel they had a seat at the table.” Bradley says creating a culture of psychological safety allows all employees to feel comfortable speaking up, seeking clarification, and engaging in team conversations, without facing negative consequences. Psychological safety has been shown to create stronger diversity and inclusion in the workplace, lower employee turnover, and emphasize a culture of safety. Bradley said recent employee surveys show the concept is working. “We conducted a psychological safety survey among staff in 2019 and then again in 2020, during the COVID-19 pandemic,” Bradley says. “We found a statistically significant increase in awareness and use of the term psychological safety, especially among front line clinical staff.” Bradley says Ochsner is committed to continuing to emphasize psychological safety and to implement positive changes that ensure better outcomes for patients. For those wanting to learn more about psychological safety in nursing, Bradley created a webinar for the Academy of Medical-Surgical Nurses on Diversity and Inclusion’s Role in a Culture of Psychological Safety.
ABOUT THE AUTHOR
Linda Childers is a freelance writer.