Over the past few months, we have received countless emails, links, and social media posts about and in response to Black Lives Matter, structural racism, being a Black academic, and health care disparities for Black people. Our Black colleagues in academia and clinical practice have expressed their exhaustion, frustration, and hope.
As we continue to manage our workloads as well as new responsibilities and additional stressors related to the COVID-19 pandemic, we must set aside time for personal reflection and collective reflexivity. Time to reflect on our viewpoints and biases that were created from our conglomerate of life experiences, unique identities, cultural upbringing, and personal preferences. Time to reflect on how our viewpoints have influenced our daily interactions with colleagues, patients, and family members. With each shift and each day, our clinical practice is impacted by our personal biases, for better or for worse. We have struggles, and we have successes. Allocating time to self-reflect and engage in collective reflexivity with our colleagues on how our viewpoints and biases have negatively and positively impacted our patient care and each other is necessary for professional growth.
We teach nursing students the importance of self-reflection through endless self-reflection papers throughout their entire clinical experience. However, once we enter practice, what space do we allow ourselves and our colleagues to engage in self-reflection? When and how do we come to a place in which reflection and debriefing may be considered a weakness and not a strength?
As nurses, one of our strengths is in our numbers. We have an obligation to ourselves, our colleagues, and our patients to regularly and constantly self-reflect on how our viewpoints impact our critical thinking, clinical judgment, and practice, as well as our interactions with others. We also have an obligation to swiftly change our culture into one that promotes reflective practice and engages in collective reflexivity, which is fundamental to meaningful, holistic, and safe clinical practice.
As more in-depth conversations about race in the United States continue to unfold, we hope that those who have not engaged in such conversations will do so. As health care professionals, we must openly admit our personal biases and support each other in reframing to prevent interference in providing exceptional care to our patients as individuals and communities, including Black people and Black communities and people of color at large. To contribute to the conversation, we have provided strategies through the acronym REVOLUTION.
Strategies Through Revolution
R—Reflect regularly. Implement a structured time for self-reflection as an integral part of your daily routine, such as journaling or 60 seconds of mindfulness. As charge nurse or nurse manager, implement a structured time for collective reflexivity on a daily, weekly, or as needed basis.
E—Engage in learning more about your fellow Black psychiatric nurses and how Black cultures may impact their viewpoints and clinical practice. Engage in courageous conversations that may lead to awkward or difficult questions and respect the potentially awkward or difficult responses.
V—Voice your concern independently and collectively. If you witness prejudices, biases, microaggressions, or macroaggressions, speak up. If appropriate, speak up in the moment and name it. If not appropriate, such as with power dynamics, speak up after the moment.
O—Openly acknowledge that we all have biases, even you. The first step toward making change is acknowledging this truth. Then, we can confront our fears of being vulnerable, which can lead to personal growth and openness to learning from others.
L—Learn about Black cultures and how they may impact your patients' understanding of their illness and recovery journeys. You do not know what you do not know. And that is okay. The key is transparency. You are in partnership with your patients. Be willing to be vulnerable and acknowledge that you are not the expert of their lived experiences, but they are.
U—Understand how your viewpoints impact your clinical practice as well as your interactions with Black colleagues and patients. Through self-reflection and personal development beyond your workspace (e.g., reading, attending seminars and lectures), you become more self-aware of your viewpoints. Then, you will have the tools to modify your clinical practice to be more inclusive and one that promotes equity.
T—Trial and error will happen. Practice. Practice. Practice. You will not be perfect. You must constantly be vulnerable and that is how growth occurs. It is a journey for all of us. Collectively, we must accept missteps and stay focused on the ultimate goal of providing inclusive and equitable care to our patients.
I—Include your voice. Be more aware of your potential to impact your environment. Become actively engaged in creating or implementing strategies that promote a safe and inclusive environment. For example, you can write a letter to your unit's or organization's leadership, regularly ask how patients' culture impacts their well-being and the nursing care received, and collectively ensure that the voices of Black nurses are heard.
O—Own it. You are responsible for your actions and non-actions. You are responsible for how you demonstrate the value of respect in diversity, equity, and inclusion. Reflect on your day and identify whether you had opportunities, both big and small, to change the narrative. And did you? Why or why not? What would you like to do differently or the same with future opportunities?
N—Never give up. Change can happen and will happen. Remember that creating an equitable and inclusive health care system and society is a personal and collective journey. We must support each other, and not become complacent about progress and the necessity for change.
Our acronym, REVOLUTION, provides strategies for psychiatric nurses to acknowledge that Black Lives Matter in health care and academic contexts. Thus, moving closer to All Lives Matter. Bias, unconscious and conscious, is commonplace and persistent. Although you may not see yourself as being biased, self-reflection and collective reflexivity provide a space in which you can critically evaluate your viewpoints. Once you are aware of your biases, you can take actions to change our contexts and societies to be inclusive of and equitable to Black people and Black communities.
Karen Jennings Mathis, PhD, CNP, PMHNP-BC
Assistant Professor and PMH Track Coordinator
College of Nursing University of Rhode Island
Nursing Education Center
Providence, Rhode Island
Nadia Ali Muhammad Ali Charania, PhD, RN
Clinical Assistant Professor
University of Michigan School of Nursing
Ann Arbor, Michigan