We Belong is a strategic initiative created by UCSF Benioff Children’s Hospital (BCH), in the San Francisco Bay Area, to improve diversity in its nursing workforce. Increasing ethnic and racial diversity in the workforce improves racial concordance for patients in the communities the hospital serves.
The idea for the program came from Brandie Hollinger Quao, BCH PICU Unit Director. Areon Williams, BCH Oakland 4 Medical Nurse Manager, was a founding member of the initiative and now co-leads the effort with Brandie. They spoke with AACN’s Strategic Advocacy and Policy Advisor Sarah Delgado about the initiative and its connection to nurse staffing.
Sarah Delgado:
Can you share how We Belong is a new approach to nurse recruitment and retention?
Brandie Hollinger Quao:
This work was really organic from its inception, and we wanted to address something that we were seeing at the bedside in direct correlation with the patient’s experience.
What's new and innovative about it is that it employs a triple-aim approach:
Aim 1 is focused on how we standardize our interview and hiring practices in the organization. That means making sure that there's not a lot of variability across the institution in who we decide to interview and hire across the system.
Aim 2 is focused on increasing retention of our Black, indigenous and People of Color (BIPOC) nurses, and understanding exactly what makes nurses stay, and what makes them leave. Once you have that data, it is important to further stratify that information by race and ethnicity. While there may be certain things that work for nursing as a whole, you really need to customize and better understand what those different pathways might be for nurses of color in an organization.
Aim 3 is focused specifically on improving diversity recruitment practices, and how we actively go into our community and recruit, and understand where nurses are that want to work in our organization. And then, how do we provide them with opportunities that may be outside what we're currently offering in terms of shadowing, internships and fellowships?
So I think it's innovative, and we think that it works because it doesn't look at just retention or just recruitment or just hiring; it looks at the whole nursing engagement package.
Areon Williams:
Also, at this time and where the world is, diversity, equity and inclusivity has not always been a topic in the workplace. Now that this is something that is on people's radars and is a national patient safety goal, I think that this is a priority. It is a way to really make sure that the patient population is being served in the best way possible. And so, our initiative is really in line with all of the things that are currently happening in the world.
Sarah:
How does We Belong change the experience for nurses who are newly employed at UCSF?
Brandie:
One thing that we have changed is that we require a diversity statement at the very beginning of the application process. So for our new nurse residency programs, the applicant submits a diversity statement as part of their application process.
As a new employee, when you fill out your application to work at UCSF, we want you to know from the very beginning, this organization is committed to DEI. It's not just part of our pride values; it's actually embedded in our application process.
The second part is about retention specifically, so we use Gallup as our employee satisfaction engagement. Last year, we were actually able to ask a series of questions that we weren't able to ask before, specifically around retention. So I think it asked something along the lines of, if you're wanting to stay at the organization for the next year, what are the reasons for that? And it lists eight to 10 different responses, and people can check the boxes that they feel the most drawn to in terms of why they're staying. Of course, there's always the other box where they can qualitatively put in a more personal response that’s not already listed. I think for reasons why you want to leave, the same thing, same answers, and you can kind of stratify your reasons for that, and then, also put in the write-in if needed.
So we've been working with Gallup; specifically, we have a point person there that's working with the We Belong initiative directly. They're able to stratify the responses to those retention questions by race and ethnicity. That way, we can actually look and see that our white nurses have decided to stay because of A, B or C reason; our Black nurses have decided to stay because of A, B or C reason. Let's figure out what similarities can be found throughout, and then, on the flip side of that, what are the differences, and what are the things that certain nurses are seeing that they need more of or less of to be able to stay? This helps us better target our interventions after having a full understanding of the data.
If there's something that we're seeing in the data that needs more unpacking, we consider doing more listening sessions and having some race affinity-based discussions with nurses to better understand their needs. For example, this is how you answered the survey, but we know there's more here; there's more that we need to unpack. So we're actually able to really target our interventions based on data, and it'll help us focus when we start to have more conversations and more discussions.
Areon:
I just think that for a newly employed nurse, knowing that your organization thinks that this is important, especially if you're a BIPOC nurse, can help you find reassurance and a sense of belonging. No matter what your ethnicity or what you identify with, if there is a diverse workforce, you will feel like you belong.
Sarah:
Can you talk about the impact of We Belong on patients and families, too?
Areon:
Here in Oakland, for example, we have a large Hispanic population. As a patient or family member, just imagine not being able to ask for diapers or a bottle, and every time you want something, you have to go and get an interpreter. Having a nurse who speaks Spanish and can talk with the family is critical. For families to be heard and understood in their native language, and really be able to understand the whole plan of care, that has an impact that you can't even measure.
Sarah:
I know you've been working to expand We Belong across both BCH hospitals. Any lessons learned from that experience of growing the program?
Areon:
We just finished a work group with the UCSF Adult Team, and they're going to be adopting the We Belong hiring toolkit. What we found is that this is really powerful; this is something that we want to see in all areas of UCSF Health. The toolkit is standardizing the way that you hire people in all aspects. Also, knowing that the executive leadership backing is there really pushed it to the next level. I think it will help us get to that place where our toolkit will be something that is used system-wide.
Brandie:
I think you also need the executive leadership backing not only when you're trying to expand, but while you're doing the initial planning work. When we first started We Belong at the children's hospital only, I think some people may have thought that what we were presenting was just kind of a nice suggestion and not really the mandated way to move forward. Having executive sponsorship was integral to a successful launch of this initiative and the subsequent work.
Sarah:
So, if a nursing director approached you saying they want to implement a similar process, is there other advice that you would give?
Areon
I think the first thing that you have to do is look at your staff demographics, and then look at your patient demographics. Is there an issue, is there a gap? Then you have to go to that executive team, and you have to present this information. Let them see where the gaps are, and let them see that this is something that is valuable.
Even if it wasn't something that was important to them before, it needs to be something that's important to them now, and how they can support that and facilitate getting a program like this up and running. How can you get the end result of having a diverse workforce that reflects the community that you serve?
Sarah:
What are the next steps that you all see for this program?
Brandie:
We want to ensure there is more protected time for leaders to be able to do this work. I think it's agreed upon, and everyone says yes, but then, what resources go along with that to have people be able to have bandwidth to lift this work up and really amplify what we're trying to do. With those changes, there would come faster turnaround time to intervention.
Areon:
We also want to continue to work on our Aim 2, which is retention, and Aim 3, which is recruitment. Our next thought is, how can we now go into our communities and facilitate high school students becoming nurses, that pipeline of people from the community into our hospital system?
At the end of the day, the ultimate goal of all of this is to make sure that everybody comes to work and feels like, OK, I could do it another day because I have friends here, people like me, I feel like I belong.
Share Your Story
Do you have a successful staffing solution that works in your unit or facility? We want to hear from you. Submit your solution.