Amid the flashpoints of a pandemic and tragic incidents of social injustice, people were becoming more open to discussing sensitive issues such as racism and bias. As a Black woman sharing a hotel room with a white colleague on a business trip in 2017, Latonya Brumfield, MSN, RN, CCRN, had the first of many difficult but enlightening conversations about race, bias, diversity and equity. Over her decades-long journey as a critical care nurse, Brumfield has assembled a toolbox of methods and techniques for facilitating difficult discussions in a quest to make work environments healthier and to achieve health equity for patients.
Tell us about yourself and your work.
My name is Latonya Brumfield. I am from Baton Rouge, Louisiana. I've been a registered nurse for 21-plus years. Currently, I work part time in a PACU and I'm a nurse entrepreneur. I'm a life coach and career coach. I also spend a significant amount of time pursuing things that I think will change the world. In my job, I saw that not everybody had the same types of outcomes after their care, and it seemed that nobody else noticed it. So I started making my voice heard at that facility and started educating myself about health equity, diversity and inclusion. I wanted to explain to my leaders what was wrong and make suggestions for change.
What was the genesis for your NTI 2023 topic?
The first time I had a difficult conversation about race was at NTI 2017. In the hotel room that our employer paid for, it was me (an African-American female), a white Canadian-American and another African-American female. We had some deep discussions, and I could tell it was difficult for the white nurse. But it was difficult for me and the other Black nurse too.
By 2020, people I met wanted to talk about these issues, but they felt stifled. Some hospitals have policies against talking about certain topics just to limit the strife among staff. And I don't think it's beneficial.
If we're going to change the world, we need to talk. As nurses, that's part of our ethical mandate: to be the advocate, to drive forward a community, an environment, a culture in which our patients can really thrive, healthwise and otherwise.
My two colleagues and I are more comfortable having difficult conversations now. But it wasn't always that way. That conversation birthed the idea of providing different techniques that you can use to facilitate these discussions. We call them frameworks or tools. We presented them in our session, "Navigating Difficult Discussions About Racism, Bias, Diversity and Equity."
What are the tools for having difficult conversations?
When it comes to having difficult discussions about race, bias, equity (anything in that realm) you must have a toolkit to educate yourself on terminology that can have different meanings, context and nuances for different people. It also helps to have frameworks like BRAVE Breath and Body, Reflect, Ask, Validate and Educate.
B: Sometimes in a heated moment, someone says something that either offends us or that we're concerned has offended someone else. B stands for Breath and Body. Take that deep breath, let go of unproductive feelings. Calm down, prepare for productive dialogue.R: Then Reflect. Reflect on your own personal biases, and take a moment to think about what happened in the moment that drove the need to have the conversation.
A: Now, ask for more information from the person to ensure you're not making assumptions about any details.
V: Once you get that information, Validate it. Validate what you've heard to fully understand all the facts and details.
E: Finally, from that information, Educate the other person by sharing a personal experience. Sometimes education doesn't need to be facts, statistics and figures – although, depending on who you're talking to, that may be the perfect type of education for them. Some people need to see things through another lens. Sharing a personal experience humanizes the topic.
What are some other tools in the toolkit?
Another tool is cultural humility, being humble about your place in this world and your world perspective, your life experiences. Realizing that there's so much more out there than you've seen, and you cannot assume, think or purport to understand something concerning someone else. Once you accept that you don't know it all, you educate yourself, ask questions and get the information needed to drive the conversation and make sure it's productive.
Perspective taking is learning others' perspectives. First, look at your own internal biases to ensure that you're not asking questions in a biased manner. The way we ask questions can sometimes ensure we get the information that confirms our bias. Instead, ask open-ended questions that allow people to speak their mind or heart, from their point of view. And then, only then, should we offer our point of view, our life experience, our perspective. And we can do it in a balanced fashion because now we know where they're coming from, where they stand.
Ask people why they said this thing, why they did this thing, why they repeat this specific activity. It might bring up things we haven't considered. Perspective taking opens your eyes, reveals some of your own biases, but also creates a moment in which the person you're talking to becomes aware of their own unconscious bias. It defuses tension, creates a productive output and encourages that person to engage further with you on those topics.
How does mentorship fit?
My favorite tool in the toolkit is mentorship. It starts with empathy. We can't purport to have empathy and love for our patients if we can't have that same level of love and empathy for our colleagues. Understand that you don't know what that person has been through. You don't know everything they've seen in their life. Let's use all these tools together, and let's develop a consistent interpersonal communication and take the relationship to the next level.
Mentorship provides a venue for personal growth, for the mentee and the mentor. As you communicate with that person, you're learning about them, but you're also learning how to share information better. If you're trying to provide personal growth for that person, be aware that you may need some personal growth yourself.
How do these conversations help make care more equitable and just?
When it comes to healthcare disparities, these conversations are so important. We all have biases.
Outspoken co-workers make their opinions known. Sometimes they're extreme and it angers us. Those are the hardest people to talk to and we don't want to. But it's important that we do, because if their bias is that explicit, what's happening between them and their patients?
That's one way we can help fix disparities, by changing people. Have that difficult conversation that you don't want to have, because you're also doing it for the patients.
We also need to put ourselves in spaces like policy and research committees, and volunteer for research, so we can drive research, policy and practice in a direction that ensures we're addressing disparities.
In your view, how can AACN and our members advance their own EDI journeys?
If you want to improve diversity, equity in healthcare, our communities, our nation, our world, it starts at home. So as AACN and members, we need to focus on diversity in our organization, among our membership, in the way we present education, and in all our media and marketing. There's a lot more we can do. It starts at home, and for me, AACN is home.
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