Episode 291: Build a Sense of Belonging for Nurses and Patients

a sense of belonging is what tis us to those who share in our spaces that work with us belonging is fueled by a social connection which is one of our basic

human needs when you feel safe supported and valued you bring your full ethenic self to work and you're fully engaged to work collabora to deliver the best

patient care and quite frankly you be the best teammate ever you're listening to the oncology nursing podcast where ons voices taught cancer a

resource from the oncology nursing Society through conversations with subject matter experts we examine the important issues in oncology Nursing From new treatments to patient- centered

research to advancements in clinical practice join us as we hear from nurses in all facets of oncology care from bench to bedside and everywhere in

between welcome to the oncology nurs ing podcast hello and welcome to the oncology nursing podcast I'm your host Jamie wymer manager of oncology nursing practice at on and today we're talking

with Kisa Boyd director of inclusion diversity and equity in the Department of Nursing and patient care services at the Dana Farber Cancer Institute in Boston Massachusetts about how nurses

can contribute to a community of belonging for peers and patients as a reminder you can earn free ncpd contact hours after listening to this episode and completing the evaluation we've

linked in the episode notes thanks so much for joining us today Kisa oh hi Jamie I'm happy to be here I want to share with our audience that I use the she her pronounce series and I identify

as an African-American black cisgender woman I also want to share that I say ID inclusion the 1 Equity I put the I

inclusion in front of the D diversity I work at an organization that believes you cannot have diversity and Equity without inclusion so you will hear me say I instead of De and I throughout

podcast wonderful well so to start off today Kisa can you help Define what belonging means in the health care space and how is that different from some of those other Dei related terms like

inclusion and the others that you've just mentioned the difference between belonging and inclusion I think is a great question to start the podcast

because it go to the heart of what we are trying to achieve in the ID space we is the collective we all the folks working to build a better world through

the ID lens so you know let's bring it in close not just a better world but let's start with our better workplace in our situation A Better Health Care Facility for nurses and our patients are truly Thrive so when you come to work

when they come into our health C for care that they can arrive authentically and Thrive and be well so inclusion to Define inclusion inclusion refers to a

set of practices that an organization or healthc Care Facility will Implement to ensure employees feel safe inclusion are the behaviors and action and social

norms it's how we do things that ensure people feel welcome so inclusion focuses on engagement and is achieved when every team member feels welcome respected

supported and valued Bel long is how you feel as result of the inclusion effects is a subjective feelings of inclusion when you feel safe supported valued and

loved friend ships are created a sense of connection to people you share spaces with and a respect you can bring your full authentic self to work and be fully

engaged to work collectively to deliver the best patient care so for better understanding Jamie how belonging is tied into diversity inclusion and Equity

let's put in a context of a party so let's say diversity is being invited to that party Equity is receiving the invitations of the party in the way that

is right for you inclusion is being asked to dance when you get to that party and a sense of belonging is dancing like nobody's watching that's

wonderful I love that example that analogy it really helps to bring it to life and you know make sense I really appreciate how you created that

distinction between inclusivity and inclusion is the things that we can do but belonging is what happens if we're doing that right so belonging is the feeling that you have because all the

work you're doing to support the i d and e creates that sense of belonging so I really love how you've set that definition up to create that clarity thank you tamy so why is a strong sense

of belonging specifically important certainly for all members of the healthcare team but for nurses specifically a strong sense of belonging is important for nurses because it will

help create and sustain a healthy work environment that Fosters excellence and patient care and optimal outcomes for us as staff as nurses our patients and

other members of The healthc Care team and here's the reason why a sense of belonging is what tis us are those who share in our spaces that work with us

belonging is fueled by a social connection which is one of our basic human needs it's a basic human need that individuals must satisfy to maintain

their identity their physical well-being and mental health when you feel safe supported and valued you bring your full authentic self to work and you're fully

engaged to work elaborately to deliver the best patient care and quite frankly you be the best teammate Ever So Jamie the definition of sense of belonging

tells us we are not meant to go through life alone humans have historically needed to rely on each other for survival we are wired for that

connection and I also believe another benefit resulting connect with each other with our peers is building a trusting relationships building relationships at

work is how we build resilience to our everyday work environment resilience allows us to overcome those stressful situations and to adapt positively resulting in good well-being and mental

health I love that and I think something that oftentimes is conflated but maybe shouldn't be it's not the same thing as saying your co-workers your teammates your colleagues they don't have to be your best friends this is not the same

thing we're not saying that the people that you work with you have to be besties with there's other components to what creates those types of relationships but I really appreciate how you're emphasizing

why it's so important to feel as though you belong with your teammates because it does influence and underpin everything you do and then as a byproduct of that the care that you're

able to provide to your patients and so if you don't feel like you belong on your unit in your department you know on your team however you break that down then that impacts all the work that you

do and also psychologically impact how you feel about the work that you do and how you feel about yourself so it is really important but this is not saying that to be happy at your job you have to be best friends with everybody you work

with absolutely and I like how you said that too Jamie about the relationship and friends because know we all have different relationships with different points of our life for example like you were saying we have a relationship at

work and what are those relations at work it's different than what relationship we might have with our family or with other people in our lives but as you were saying saying what that relationship you have at work building

that relationship to get through the day as we know we work in a very stressful environments right especially after the pandemic and so having relations at work building that trust building that sense

of belonging will help us get through the day to get the work done so I love how you frame that Jamie as about the relationsship at work it's not just our besties but is really getting that job

done to be able to deliver the best effective and efficient patient and Family Care doing it together absolutely so what steps do you recommend to create that welcoming environment in nursing

especially as the field of nursing intentionally and wonderfully becomes more diverse I want to answer this question with a question I want to ask

our audience a reflective question and that question is how do you make an effort to welcome others in create a sense of belonging because in order to

create a a welcoming environment I believe we first have to think of our own experiences what Fosters or inhibits a sense of belonging for you because I

believe it begins with each of us as individuals to do some self-reflecting or some self-awareness because a self-reflection will allow us to

identify our own unconscious biases will allow us to check our assumptions will allow us to examine our role of power and privilege which will lead us to a

better understanding about the experiences of historically marginalized groups and when I say marginalized groups Jamie I'm referring to people of

color members of the lgbtq plus Community disabled these just some names some not an exhausted list but just what some of the historically modular groups

are and by the self-reflection and by examining ourselves it would help us see things differently through their lens because you know Jamie you know I believe we've all heard of The Golden Rule right you know the golden real

focuses on treating others as we like to be treated this rule was preached to me by my parents but now it's about the Platinum rule the Platinum rule emphasizes understanding and considering

others individual preferences and needs and how they want to be treated that's so important as I was listening to you respond I'm struck that this is a

conversation that applies also when we're thinking of just how our care teams have changed when it comes to welcoming in students or brand new nurses out of nursing school who are on

the first day in a unit that maybe typically didn't get new graduates before or we see an influx of travel nurses and so this idea of creating a space that is welcoming and belonging

can influence so much and it's important to keep in mind in every context of if you have someone who is on your team or in your space that is has not been there before or seems unfamiliar to the

environment just being mindful of how you're creating that welcoming environment for them all the things that you're bringing up today I think are applicable in those situations as well absolutely so in what ways do you think

healthcare workplaces effectively address both inclusion and a sense of belonging for its employees as I shared inclusion refers to a set of practices

that an organization or a health care facility will Implement to ensure that employees feel safe that they feel welcome that they F that belong and that

sense of belonging is how you feel from the results of inclusion so it's about changing the culture of a workplace to be more inclusive and there's a few ways

that an organization can do that and one way is maybe providing a Learning and Development opportunities in the idna space for example like this podcast that we're doing now it allows us to learn

about the sense of belonging and also our organizations to also promote and learning development opportunities in the space we need our organizations to foster a collaborative environment what

I mean by this is to celebrate and leverage diversities and what does that look like that can look like when you're onboarding new hires or like our people

are coming into our organization that are students how do we welcome them we can welcome them by sharing them asking questions about their culture asking questions about their story or sharing

our stories when you open up and share your stories they fall reciprocated it and they'll share their story so I think that's very important and what I mean by celebrating and leveraging diversities is a acknowledging the differences and

how you can acknowledge the differences like on one of the units I work on there's a big board that we share and that any celebration that culture that they may share in that month that they want to share with the rest of us like

whatever the holiday may be that we're not be aware of we post it and we talk about that just kind of celebrating and lovage and diversity really helps bring that sense of belonging for employees

thank you for that and I think you've provided some great examples and emphasized how it really is important that the messaging comes from the top down and that it is an organizational

wide initiative and effort and priority from the top down to really help to elevate and prioritize the work that is required to ensure that we are creating

that sense of belonging prioritizing diversity Equity inclusion what we know is that a lot of times what really happens the meaningful pieces happen at that unit level so individual to

individual or in that department because that's where you get to know people and really create that sense of belong so can you provide some examples and just speak a little bit more about how nurses can help to create that welcoming

and belonging environment on their own floor or their own unit I believe that there are many ways that we can build a sense of belonging on that floor that unit and really tailored to what that

floor and that unit needs but I think there's some basic key items or key ideas and building a sense of belonging and one of those is connecting with your team you know how do you connect with

your team you connect with with your team by asking questions and listening sharing stories embracing those random connections what I mean by that is the

random connections by like the offering for help as you're working on your team as you may see as we know we have we taking care of patients in various Health Care settings and it can get

challenging we get pretty busy and pretty stressful and so by offering to help about the random connections we talked about since of belonging and also since belonging is building that

relationship and that's one way you can build a relationship offering to help jumping in and by jumping in offering to help and maybe sharing and saying oh I know that's happened to me before

sometimes I forget to do that it shares your vulnerability which opens other body else to share their vulnerabilities it's really building that trust and relationship sharing stories asking questions like really connecting with

your team and you do that you have to talk and you have to listen so that's important also I believe an embrace rcing our purpose and values and

strengths our individuals and also as our peers by doing that is you're asking for their feedback you're asking them for their suggestion you're asking them for their ideas when you reach out to

them and you put them at the table you want to hear their voice you want to hear their opinion that's embracing sense of belonging because you're pulling them in s them at the table you

know and also too I think since a belonging is embracing everybody's differences our uniquenesses that we bring to the table that we bring to our

unit embracing that means to pause and reflect on the different cultures and practices to make it seem that they're free to talk about their culture and practice that they're free to be themselves and that's embracing

diversity and how you can do that once again is really truly actively listening acting questions and embracing those connections and really building that

trusting environment I love that and it really to me it's two messages that I feel it's when when those things happen when you feel like people are interested to learn about you or just know more

about you or be present and helpful if there's something that you need help with or guidance it sends the message that I'm not alone I'm not here all by myself people acknowledge that I'm here

too and most importantly somebody cares somebody cares about I'm here or how am I doing or you know what makes me unique or special or just my own person and I

think think those are two really important feelings that maybe we don't always articulate or identify that that's underpinning our sense of belonging but I think those are two

important byproducts of just trying to make those connections with your co-workers of just making sure that they know that they're not alone and that we are all in this together and anyone

who's worked as a nurse in any kind of Department inpatient outpatient you can't do it alone you can't it's so important to really be intentional about trying to create those relationships and

Foster them and cultivate them so that everyone's work feels a little bit lighter because they know that they don't have to shoulder the burden of any given situation or any given day by

themselves because they have their teammates to support them absolutely so we've talked a little bit about this earlier but what effect does a belonging environment have on patients and families and overall care and is there

anything additional that nurses should consider to Foster those feelings of belonging among their patients as well you know Jamie it's all good when you have a sense of belonging it's really

just fantastic because when you feel you are truly part of a care team you'll be working as your best self your authentic self you feel support and respected patient outcomes will be definitely be improved it has proved the fact that

that will happen science has told us that to share that with us Studies have shared with us us about that and Jamie you know I want to say as nurses we are able to connect because that is what our

profession is it's truly about focus on relationships right now we are taught how to connect with our patients to Foster feelings of belonging we do that every day what we need to do is do that with each other we know what it looks

like with our patients we need to do with each other and I like how you said Jamie that we're not in this alone and to feel that connectedness and it's very it's the small little things that do it

and I want to share a story with you as we're talking I remembered when I first started my organization I was one of the first black nurses hired and not feeling

a sense of belonging and it was one thing one act of kindness that opened it up for me and I remember this and it came back I said as we're talking today and it came back to me is I remember

walking into a room and it was a very important meeting with nurse leaders and I walked into the room and I was the only black face there it was a room was full of of white faces of all white women and there was not a cheer at the

table for me I walked in and the room was filled and everybody was at the Table and there was no extra cheer for me to sit at this table so I was leaning up against the wall and I felt very

uncomfortable and out of place and then I didn't belong and a nurse got up and she went to this closet and she got a chair and she pulled the chair out and she put it right beside her and she

patted on the chair for me to sit down and I came and I sat down next to her and that act alone made me feel like you said Jamie that I wasn't alone that

somebody saw me somebody sees me and recognized me and that opened it up that okay it was a start that okay I do belong this organization and began began

with this nurse and so those one little small moments like that that will open it up and made me feel better and feel like I'm part of belonging of this environment so that something like

saying this is what can we do as one little small act that makes a difference because it made all the difference in the world for me it really opened it up that I started to see okay I can belong

here I can start working with this I love that that's a great example and you know when we connect the importance of seeing and prioritizing the

relationships we build with our team and our co-workers that it can't help but spill over into our patients and in oncology sometimes impatient but

definitely in the outpatient realm we have the benefit of seeing our patients over time building those relationships with repeated visits over Cycles over months and years and so we build those

same relationships with our patients as well and one thing I have experienced is that the patients can tell when the team has a feeling of belonging they can

sense if one nurse seems to be sort of on the outs and not part of the group that influences the patients and how they perceive their team and how their team acts and works together and so

again there's the benefits of prioritizing this work can't be overstated because I think the most important and direct benefit is to ourselves as nurses as professionals but it quickly spills over into the benefits

to our patients to their caregivers to their families because the work that we do in oncology really is finding people at their worst sometimes and so anything that we can do to help bolster our own

feelings about our work and our teammates and then having that directly impact the patients and the caregivers that we serve it certainly is is a worthy Endeavor right and I like what

you're saying too Jimmie that about caring if we cannot care for ourselves eles and our colleagues they working with how can we care for others right

it's so true that when we're caring for each other we can care for our patients and you're right patients can see when things are disjointed when there's not a

flow when there's not a cohesive team we're humans if we're insulted if we're hurt what I mean I'm sorry Jam is that we're animals right so if you're as animals if we're hurt or insulted we

tend to retrieve to go in we're not going to go out and so people see that when you go in and you're not really sharing and working as a team to deliver

this effective and efficient patient care not part of the whole team there's a gap there's a missing you're not able to add your expertise in the outcome of this patient's care and when you're

missing that you're missing completely give that care completely be yourself so what I'm trying to say is is that feeling that you belong feeling that you're respected and valued when you feel that way you feel your part of the

team and you're going to contribute to the outcomes for good patient care and also for staff safety so it's huge a sense of belonging and understanding that and putting it into action you know

we talk about words and definition but how do we make it more actionable how do you make sense a belonging actionable and one way that I shared with you is that offer of a cheer this little small

things of being aware of that you being aware what's around you and looking at what your colleague may need and getting that without asking I think the one thing that I'm always

struck with when we discuss topics like this is that I know for nurses that are in the thick of it and they're you know up to their eyeballs and documentation and patience and Joint Commission and

you know just like a million things and I know that these types of discussions can feel like just one more thing but this isn't fluff this isn't something nice to do if you've got the time or oh

it's just one of those things that the administration wants if it feels that way then you can acknowledge the way that it feels but I would challenge everyone to just also consider that

maybe it really is important and maybe it is while it feels like just a nice to do when you can if we could focus and prioritize this work it could

potentially create solutions for other larger problems that create more pressing issues in your day-to-day work so I would just challenge everyone to you can react everyone has is entitled

to their own reaction but this really is important it's not just a fluffy kind of on the top if you've got time for it really try investing in yourself and your teammates to create that great

sense of belonging at the place where you do your work I think we'll have enormous benefits that will spill over into all areas of your life including the care that you provide to patients absolutely well Kisa you know I've

really enjoyed our conversation today and as we approach the tail end of our episode I do like to ask a few quick fire questions to summarize some of the things we've talked about so to kick that off how can oncology nurses

evaluate their own implicit bias when it comes to belonging in inclusion so jam you know we all have unconscious bias you know if you have a brain you're bias

biases are just due from a lifetime exposure to cultural attitudes previous experiences social class gender race just a name a few but how we can look at

that is like we talked about is that we to begin this change to talk about sense of belonging it begins with us individually of our own self aware awareness of our self-reflecting and we

can do that there are three implicit bio tests that are online one that just comes to mind is the harven Imp association test that's online because we have to acknowledge that we have

biases and what those biases are and once we know that we can work on that and kind of put a filter on before we jump to a conclusion it's like H where am I at with this where are my B where

are my assumptions in do that so I think that's very important because we have to address our implicit bias or unconscious bias in order to build relationships

correct because if we come to the table with our unconscious bias it can really derail our questions and perceptions of

people if we have these associations for example that a family is just composed of a man and a woman it's not always that way right now we know that sometimes a family is to men or same sex

transend so we kind of watch our perspectives we're coming to the table to ask the questions build a relation ships where are biases so it is important that we check those what are

some common misconceptions about Dei strategies including belonging we're all on this journey now right so I know in 2020 when we have the murder of George

Floyd and the many other unarmed black men and women combined with the pandemic showed us a lot about the social injustices justice and health care we

have to understand that this journey it's a journey it's one step at a time it's not going to change overnight and that we need to be in this together and we need to give

each other Grace and our self- Grace as we learn as as we grow because now as nurses and this what we're dealing with now is that it is our professional and

personal responsibility to address these injustices to look about racism and nursing it's part of our duty now it's a slow it's a journey we're in this

together I do believe that by ourselves we're a movement but together as large as our forces as large as our nurses and oncology we can be a

force and move together with this so the misconceptions is that one step at a time second H overnight is a journey and we are accountable to be accountable for

the changes in our iding journey I love that and it's progress not Perfection right there you go I love that right Jamie we won't get it right every time we'll still make mistakes we'll mess up

but you can acknowledge those you can apologize you can do better and you can learn so I love that what's something about this topic that's not often discussed but you wish people knew more

about being willing to be uncomfortable we have to learn to be uncomfortable with that and we don't talk enough about that because I believe that growth and comfort can never coexist because as

you're growing as we're changing it's uncomfortable and so to talk more about that to be it's okay to be uncomfortable and to learn to be comfortable with that because we can't grow without feeling

uncomfortable what additional training or education do oncology nurses need to contribute to Dei and belonging strategies that we've talked about today

on is I love what ons is doing what it's offering for us to learn in this ID space to be better stewards I think the training needs to begin with each of us

individually to perhaps go to our websites on the Internet or even at our organizations have like my organization has a website just for ID learning and education because that's important

begins with us now we talk about I think of the pillars of our ID Journey like the top pillar or the level is the organization and then you have a second

level is just the management like you have nurse directors and nurse leaders kind of that middle part that middle ground and then you have the lower level I think the most important level is us doing that cheers side bedside nursing

we're all responsible to all these levels but it has has to begin with us so the strategy is your awareness we talked about sense of belonging we talked about what can you do to welcome

new members on your floor offering a chair sharing a story introducing yourself using your pronouns things like that what can we do to make a difference

small difference small winds accumulate to large wins and it starts out small so I think that's important of our strategies takeing what we can do as individuals and what are some additional

resources maybe for patients other nurses or other providers on the healthcare team who want to learn more about Dei the web is wonderful Google quite a bit there's a lot of different search engines there's a lot of

information now out there about different resources to learn for us to be better do better all these sites and like I said our organizations have

different sites to go to so it varies where you can find this information from but basically I know if you want to if your intentional of doing go to a search engine and type it in and go from there

Kisa thank you again for your time your expertise it was been a great conversation and I'm so thankful that we were able to talk about this discussion today do you have any final comments for

our listeners yes Jamie you know I really hope this podcast will lead us in a direction where we're not just aware of the importance of this building a sense of belonging in our units or

organization but think of it ways to educate ourselves to empower ourselves to build connections healthy relationships with those we share

workspaces with because I really believe that the sense of belonging is the outcome of inclusivity diversity and Equity wonderful thank you again Kisa

thank you Jamie thank you for listening to the oncology nursing podcast tell us about your favorite part in this episode by leaving a review wherever you download

your podcast for more resources and information about oncology nursing visit us at .org or voice. s.org the ideas and

opinions shared in this episode represent those of the guest and not necessarily on