Gaurdia Banister, PhD, RN, NEA-BC, FAAN: Why We Need More Diversity in Nursing

Q: Dr. Gaurdia Banister grew up in a family of caregivers in Casper, Wyoming. Taking care of people may just be in her blood. However, iit wasn’t until a college aptitude test suggesting nursing that she truly began to see a career as a nurse ahead.

She has always been a lover of learning, which led to a Masters and then a PhD in Nursing from the University of Texas at Austin, and then the Robert Wood Johnson Nurse Executive Fellows Program for Nurse Leaders. For the past 11 years Gaurdia has served as the Executive Director of the Institute for Patient Care at Mass General and Director of the Yvonne L. Munn Center of Nursing Research for the past two years. She is a champion for diversity, as has been recognized for her efforts to bring more people of color into the field. As a nursing leader, Gaurdia has worked hard to not only promote diversity within the workforce but also increase the retention and advancement of these nurses. So, welcome Gaurdia.

A: Thank you. It’s nice to be here.

Q: I know you found your way into nursing through an aptitude test, but I’m curious to hear how did you end up in a leadership position within nursing?

A: When I was in nursing school and I actually just, I fell in love with psychiatric nursing, that’s my background, psych mental health nursing, and I had such a wonderful experience and I just felt so passionate about it when I got out of nursing school, I knew that that was going to be my focus of my career.

So I wound up working in an acute care locked psychiatric unit in Colorado, and it was amazing. Everyone was incredibly generous and kind and they just really wanted you to do your very best, but one of the things that I noticed is that everybody was going to school, including the nurses. And so at that point I decided I wanted to go back to nursing school and when I entered my Master’s program in addition to focusing on my clinical specialty my minor was nursing administration. And so I think that that helped launch me into the direction of wanting to be in leadership. And then certainly after getting my doctoral degree as well it just seemed to kind of flow from there in terms of some of my opportunities and just how things progressed in my career.

Q: I’m curious to ask, I think we have a lot of stigma or stereotypes around what a pscyh ward might be like, but what was it like to be the caregiver in that setting?

A: I think it was very important as a nurse and as a provider of care, you have to have first of all empathy and compassion, and also recognize that mental illness is a medical problem. It is an illness that requires intervention. And I think that most people believe that, particularly with psychiatric and also substance use disorders, that somehow the person brought that on themselves in some way. And they really didn’t. It can be certainly biochemically, physiologically based, and requires not only medication, but in many instances individual therapy, group therapy, family therapy, depending on what the situation is.

So, I think taking the approach that it truly is a medical matter, a medical illness, I think it helped me and I feel like that is another thing that I try to advocate for in terms of helping people understand that when you think about hypertension or you think about a cardiac problem or if someone is having an issue with their kidneys, we don’t say anything about how that is a problem or we’re going to end treatment or we’re not going to pay for it. I think we should approach mental illness, psychiatric disorder, substance use disorders in much the same way.

Q: What you’re talking about then I think about you have movies like One Flew Over the Cuckoo’s Nest, and we don’t have movies about hypertension in the same way. So, there is this difference in the field in a way.

A: Well, I think it’s just very distorted. And I think because like One Flew Over the Cuckoo’s Nest was such a popular movie, that’s what people think about when they think about what psychiatric illness or mental illness looks like and how they’re treated, and it’s not that way, it really isn’t.

Q: What is it like? What would be the day to day?

A: So, and of course now I’m dating myself, because this was about 30 years ago when I was like providing direct care, but when you walk into a clinical unit for the most part the patients are if they can, they’re wearing street clothes, and much of the day is filled with different kinds of activities that are going to really help them around how they can get back to the functioning that they want and need to take care of their families, to go back to work. In addition, there may be medication management and also they may have some fairly significant other medical problems that are being treated as well.

So, I think one of the things that nursing does in particular is that we look at patients from a very holistic and comprehensive approach, so we’re going to look at the biopsychosocial, we’re going to look at the spiritual, and what we really want is to get our patients back to their optimal level of functioning.

Q: So you said this isn’t your day to day anymore.

A: Correct.

Q: So, what is your day to day now?

A: So, my day to day as the executive director of the Institute for Patient Care, it’s like this amazing wonderful opportunity, because I oversee clinical and professional development, we also have a patient and family learning center, we have a center for innovation and care delivery, we also have a nursing research center. And then we have other programs, including we credential over 800 advanced practice nurses and physician assistants that practice at Mass General. We also have collaborative governance, which is a structure to ensure that our front line clinicians, that their voices are heard and that they really contribute into how we deliver care.

The way that I describe my position is that we provide the infrastructure to advance and support exemplary professional practice, so that our patients receive excellent patient care.

Q: And when you think about the hospital as sort of a habitat or an ecosystem what do you see as the role of nurses within that?

A: So, I love that idea of ecosystem, because I feel like it’s an ecosystem is alive and evolving and changing in terms of what kinds of opportunities and challenges that they face. So I can say from a nursing perspective, we are embedded in every aspect of that ecosystem at Massachusetts General Hospital, from having senior leaders as nurses, including obviously we have our chief nursing officer and senior vice president, to our front line clinicians, our staff nurse clinicians who are taking care of patients, and then everywhere in-between.

So, we’re also involved in, as I said before, education, innovation, research, advocacy, finance. Nursing is everywhere. And we’re part of that entire inter-professional team that ensures that or we try our best to deliver excellent patient care.

Q: How do you interact with patients, with doctors, with the other clinicians?

A: So, I think we interact in a variety of ways. First of all, care is delivered as a team and one of the things that I love about Mass General is that it’s very consensus driven, so there are any numbers of committees, as an example, that nurses are a part of, along with other disciplines, whether the physicians, PTs, OTs, finance, and we oftentimes sit down together, depending on the focus of the committee, to make decisions about what is best for the hospital and what is best for patients and families.

There are a lot of committees that involve our clinical staff, as I said earlier, in terms of making sure that how they perceive care and deliver care, what are the challenges and what are some of the barriers, and how can we take those things away so that they feel like they have the time, and also the expertise and lifelong learning to do what they do best.

Q: You said you have been practicing for over 30 years. How have you seen the field change?

A: I think a lot has changed. First of all, I think that first of all the kinds of patients that we’re taking care of now, care is very, very complicated.

And patients come in with a lot of challenges that need to be addressed, as an example. So, I think that we’re just seeing patients that really require the expertise of the entire team to get them back to their optimal functioning.

I also think that there is a better appreciation, particularly from a nursing perspective, of the expertise and the knowledge that nurses bring in terms of how we fit into the care team. I think as you were talking about movies like One Flew Over the Cuckoo’s Nest, I think there’s all kinds of other images of nursing or of nurses that are not necessarily as positive as they could be because nurses have their talent and expertise in terms of just the rigor of our education, the care that we deliver to our patients, how we interact with the entire team, the fact that we’re with patients every day, seven days a week, 365 days a year, we are really doing that surveillance function, and we notice those imperceptible differences that are going on with patients that alert us that maybe some kind of intervention is needed.

Q: And what about technology? I’m curious how that has impacted the work that you do.

A: Well, I think that there is a lot of technology, and I think the technology is, one of the big things that I see is that we’re putting technology in the hands of our patients. So, before much of what was happening was done to our patients, and now they are partners with us in regard to technology. So, when I think about, for instance, the Apple Watch, it’s now going to be able to do an electrocardiogram. Now it’s in the hands of patients, and I think that that is really, really important.

I also think that technology has allowed people who may not have lived 30 years ago or 40 years, now have the ability to not only live but have a wonderful quality of life.

Q: When you think back over your career what do you think has kept you in the field for so long?

A: I think nursing can be challenging, but I think what has kept me in nursing and so energized and excited is that there is so many different aspects of nursing. I have been able to do in my career, and when I say “I” I really feel like I have had the support of people that had confidence in me, mentors who developed me, colleagues who worked alongside me, so I mean I have not done anything by myself, but there have just been so many great and rich opportunities in nursing.

So, for instance, I have had an opportunity to teach as an example. I love mentoring and developing new nurses and also seasoned nurses. I have had the chance to do international work. I have been able to do research as a nurse. So, I’ve been able to do lots of things that I think as a nurse there is so many avenues and different opportunities to thrive and grow, that you could do something different every day.

Q: Yeah, absolutely. And when you interact with people outside of the hospital or outside of nursing do you find that there are misconceptions that people often have about nurses?

A: Well, I think those misconceptions are changing, primarily because I just think that when I think about how nurses are being portrayed I think in some instances it’s much more realistic in terms of what we are really doing as nurses, but sure I think that there are opportunities for education.

But what I find out is that if you’ve been hospitalized anywhere you know exactly what a nurse does, and then you are able to appreciate the critical and pivotal role that nursing played in your recovery.

Q: I’m also curious, what do you think is the most important skill to have as a nurse?

A: Oh my goodness. I think there’s a lot.

I would say certainly empathy and compassion, because you certainly are there because you want to care for others. I also think knowledge and expertise and talent for what you do, so whether you’re an oncology nurse, a cardiac nurse, a medicine nurse, a psychiatric nurse, having that knowledge and expertise is critical.

I think effective communication skills, because you’re communicating with patients, with families, with the inter-professional team that you’re working alongside. I think the ability to accept that mistakes happen and being able to learn from those mistakes, whatever they might be, because I think that none of us are perfect, and we don’t always do everything correctly. And so being able to learn from those mistakes, and then go forward. So I couldn’t just say one thing.

Q: That’s--

A: And I probably have forgotten a couple more, but…

Q: It’s a complicated world.

A: That’s right.

Q: As a person now in a leadership position, how do you encourage people to make mistakes and learn from them?

A: Well, I think what we try to do is first of all if you’re going to make mistakes try to make them in a safe environment. So for instance, there has been the proliferation of simulation, as an example, as an educational modality. So that way in a simulated experience, if mistakes happen you can learn from them and the only effect it’s really going to have is on the mannequin that you’re using. So I think being able to make mistakes safely in that kind of environment and I think education is perfectly positioned for that is the opportunity.

Obviously other kinds of mistakes happen, and I think what we all can do is when you’re uncertain about something and you’re just not sure, it’s always great to ask for help, and an organization like Mass General, there are plenty of people that surround you that are there to help you, want to help you, want to support you, and ask them questions whenever in doubt.

Q: Yeah, so there is that sense of collaboration, it sounds like.

A: And community.

Q: Thinking about the community and the atmosphere that we’re a part of, I know that you have done a lot of work to try broaden that community and bring different kinds of people into the fold. Could you talk a little bit about how you have done that?

A: So yes, I think you’re probably referencing some of the work that I’ve been doing in terms of advancing diversity. And I can say that when I think about the nursing profession overall, about 83% of the nurses across the country are Caucasian nurses and most of them are women. And so when I think about the changing demographics of our population, well first of all it’s almost 50% women and 50% men as an example, and we know that in the next probably 20 or 30 years, there are going to be many more minorities or people of color, I think it’s incredibly important to have clinicians that look and sound like the patient population that they’re taking care of. I have really been passionate about how can we develop clinicians that look differently from sort of the traditional nursing demographics.

And maybe part of that is coming from my own background, because I grew up in Casper, Wyoming, which was a very different experience for an African-American girl. So, for instance, in my high school class there were like 500 people that were graduating and there were three Black African-American girls, so that tells you a little bit about what life was like in Casper. I think from that it made me think about wanting to make sure that as we look at the nursing profession and I look at these incredible men and women of color what can we do to help them to become nurses.

And when I think about the academic challenges of becoming a nurse, and I’ve heard so many stories of people who have wanted to become nurses and either financially they couldn’t support it, family dynamics, you name it, all the other barriers that kind of got in the way. I feel like I want to be a champion to figure out how to eliminate those barriers and help them realize their dreams.

Q: So, how are you going about doing that?

A: So, I’ll tell you two stories, There was a program in Washington D.C. These were African-American young women who had their goal and their dream in life was to become a registered nurse, and these were high school students, but they had a lot of challenges. They had family members who weren’t necessarily supportive of them going to school, as I said the expense, and so we created this program called the Health Alliance where we put these wraparound services around these students to help them become registered nurses. So it included coaches, mentors, financial support, tutoring, all the things to help them to become successful.

And I can remember when we had our first graduate from nursing school and just how proud she was that she had become a registered nurse. And she was going to change the life not only for herself but for her family and for the rest of her family, because she became a role model. She became a spokesman. She became someone that was a success story. And so other people looked up to her and said, “Well, if she can do it I can do it too.” And that, there is nothing more powerful than that.

So, Mass General has a program which is called the Clinical Leadership Collaborative for Diversity in Nursing, or CLCDN. Jeanette Ives Erickson who was our former Chief Nursing Officer at Mass General and also the dean of UMass Boston, Grier Glazier, together along with the Partners Chief Nursing Officer Counsel decided that, they recognized that there were changing demographics and that they felt like it was really important to start recruiting nurses who were diverse in their backgrounds.

So, we got together and created this program and worked with UMass Boston, which is one of the most diverse nursing schools in the community. First of all, UMass Boston has amazing, amazing students, so we took juniors and seniors, who were like the cream of the crop in their programs, and many of these students had overcome any number of barriers. So, for instance financial challenges, they may have been refugees at some point, English as a second language. Literally every barrier you could imagine they had overcome it to the point that they were applied and accepted into nursing school.

We took these students, we provided them with tuition for their junior and senior year, we also assigned them mentors of color, so they had someone that looked and sounded like them, that had kind of overcome some of those barriers so that when they had barriers they had someone they could talk to. It was not only for their junior and senior year but their first year practicing as a nurse.

We helped them with their exam, test-taking and also just to make sure that if they needed any support they had that. We provided educational programs for them, so we had these great speakers that would come and talk about emotional intelligence or communication skills or how to deal with conflict or how to address feeling isolated. We really shepherded them through the system. And I can proudly say that probably about 80 or 85% of them were hired somewhere at Mass General or the Brigham or Spalding or Faulkner, and many of them continue to thrive to this day.

Q: That’s so exciting to see. It’s those sometimes just small changes to just support someone that can have such a big impact.

A: And I think we did a research study on some of them and we brought them back and we wanted to ask them a little bit about their experience, and there were a few things that they said. So, exactly to your point, they talked about the fact that someone invested in them. That someone saw their talent, someone saw their expertise, someone felt like they had something and were willing to invest in their future.

They also talked about wanting to give back. That was just such a clear theme, and I think that is part of the theme of my own life. I feel like I have been given so much and I’ve had so many privileges I want to be able to give back to others in some way, and they feel the exact same way as well.

They also are champions on their units. They are ambassadors when they are walking to a unit and maybe there aren’t a lot of people that look and sound like them, there is this opportunity to get to know someone that looks different from you and their culture may be different or their rituals might be different.

And then patients, they talk about the fact that patients who are on the unit enjoy seeing that kind of diversity and feel like oh there is someone who looks like me, there is someone if I’m having a problem, and not that all nurses have to look like the patients that they take care of, but I do think it’s important that that healthcare team reflects the patients that are being served.

Q: Yeah, so it’s not sort of an us and them, it’s a community of people.

A: Correct.

Q: The other thing I’m wondering as you’re talking about diversity and bringing different types of people in, as you said traditionally it’s been a very female heavy field, is there work being done to try to bring more men in to make it a little more diverse in terms of gender?

A: Oh absolutely. I work with some incredible male nurses. One is our Director of our Norman Knight Nursing Center for Clinical and Professional Development, one is the Director of our Blum Patient and Family Learning Center, incredible male nurses who are role models for not only Mass General, but for the country. So, I think that there is a lot of work underway. But I do see a lot more nurses, male nurses coming into the profession, and I think that there are opportunities for them to be mentored and developed by other nurses that are already at Mass General as an example.

So I know these two nurse leaders, in particular, Gino Chisari, and also, Brian French, and I do think that nursing is being perceived as one of these occupations in this very turbulent financial time that we’re in where you know that you’re going to be able to have a position. Where you know that you’re going to be able to take care of your family. You know that there is going to be ways that you can progress and develop and be promoted. So I feel like it’s becoming a much more attractive profession, and then the Gallup poll for the last 16 or 17 years, nursing and nurses is the most trusted profession in the country.

Q: Really?

A: Yes. Yes.

Q: I’m wondering if you can talk a little bit about challenges that you faced. I imagine it hasn’t necessarily been a smooth process to try to really enact change within a culture.

A: Well, I think I have faced, and again I would, the great news is that it wasn’t like I faced some of the challenges alone, but I think there are plenty of challenges of being a person of color, first of all, in an environment where you’re not the, you’re not the majority.

I think that one of the things that I grew up in a family where they faced challenges all the time. My parents were very committed to the community and civil rights during that time, and so they were always sort of out there facing challenges and essentially saying, “We can do it.”

So, my parents are from New Orleans and at that time the segregated South and a lot of discrimination, but my father had been in the military and he had just gotten out of the military. So he had a friend that was in Casper, Wyoming, of all places, at that time my father was an electrician, and asked my mother and father if they wanted to move to Casper.

Now, they had never been there before, ever, and at that time I was four months old. So they said yes and they decided to make that move. And I describe my parents as trailblazers, because they wanted to make a better life for their family. So, they get on a train in January, never been to Casper, Wyoming, before. They arrive in Casper.

My mother describes the story where she is looking out the window, and of course she has this baby, she looks out the window and there is nothing out there, nothing, cold, snowy, and she says to the attendant on the train, “This can’t possibly be Casper.” And the person says, “Yes, this is the last stop. This is it.” And there is nothing there.

So, they lived there for a little over 25 years or so. So they saw a lot and I think they instilled in us that even if things knock you down and even if there are challenges you brush yourself off, you stand up, you try to face it head on, and you just keep going.

When I face challenges, and as I said there have been, just being a woman of color, people kind of questioning sometimes your beliefs or who you are or your values, but you just brush yourself off and you just keep going.

Q: Do you think growing up in that setting where, as you said, you were one of three black women in your graduating class, did that spur you to do this diversity work later in life?

A: I think certainly that helped to shape my point of view. And I think as I said, seeing my parents who were also a part of the Civil Rights Movement. And then I think just having the lived experience of seeing people struggle who want something better for themselves and want something better for their families, and they feel like nursing can be the career to help them to get to where they want to go, because they care about people, they’re smart, they’re talented, they’re intelligent, I think that gives me-- I know I’m excited about trying to see them realize their dreams.

Q: You mentioned mentoring, and I am curious how do you approach those mentoring relationships?

A: So, I approach it in a couple of ways. That in regard to mentoring it is a relationship, so it’s not so much about what I think and not so much what the other person thinks, but it’s about how we come together to look at what does this mentoring relationship look like. So, there is a lot of time, I think, is just getting to know them, just getting to know the person and what their thoughts are, what are their aspirations, what are their challenges. And then we begin to talk about how can I help you, what can I do.

Sometimes I might introduce them to other people that they need to meet, expose them to opportunities that they might not be exposed to otherwise, think about educational opportunities that they might want to pursue. I want to make sure I mention this before I forget it, is that it really is a two-way relationship, because I find that I am enriched when I’m mentoring someone else, because we’re able to talk to one another, support each other. And I’ve learned so much from the people that I’ve mentored. And to watch them grow and fly and develop and do extraordinary things is really gratifying.

And I also suggest to people it’s not that you have one mentor, you might have many mentors, depending on what you’re trying to do, what you’re trying to focus on, and what your needs are, because one person may not meet the needs that you have.

So, I love it. I think it’s a foundation, frankly, of nursing and certainly other professions as well, but I think that is part of who we are and what we should be doing.

Q: I love that idea that you kind of need a posse of mentors.

A: Love that, posse, yes.

Q: You talked a little bit about the challenges of being a woman of color and being in a leadership position, do you feel like in the current political environment is that changing? Are you finding the environment feels different?

A: I’m very worried about the current political climate that we’re in. I don’t necessarily feel it at Mass General per say at this point, because I do feel like Mass General has tried to be a very welcoming and open environment. Not saying that it’s not perfect, not saying that there aren’t opportunities, but I do feel like there is some political will to understand that we are a very diverse community and we all think very differently, and how can we come together as a community.

With that being said, I am very concerned about the political environment where it feels very divisive to me, and that there aren’t opportunities, to me there are stereotypes of a lot of different individuals, and that is problematic, because I think that you have to get to know people.

So, I heard something recently, it was called like the dinner initiative. Most of us live in communities where people look and sound like we do. We go to church and people in the churches look and sound like we are. And we go to dinner with our friends. And so the recommendation was to find a few people who are different from you and have dinner with them and get to know them in a different way, and I think that begins to break down barriers and increase understanding that we are much more alike than different.

Q: Yeah, it kind of goes back to what you were talking about, being in the hospital and seeing people who are different from maybe you expect one sort of person and you see all kinds of different people fulfilling similar roles, filling different roles, but all part of the care system.

A: That’s right, and I think that people can learn from me and from the experiences that I’ve had. And I think I can learn from others that look different from me, and hear about their experiences. And then what I find out is even though we may look different, we may be a different age, we might be a different gender, we might come from a different part of the country, but we have a lot of things in common. We love our families. We want to succeed. We want to do a good job. We want to be great nurses, or we want to be a part of a team that is doing positive things.

And I think that we find that we have much, much, much more in common than we’re different. And then when there are differences how do we embrace them? That just because it’s different doesn’t mean it’s bad; it just means it’s different.

Q: Yeah. And I’m wondering too is there something you have accomplished you’re the most proud of in that realm?

A: It’s hard to narrow down just one thing, I am incredibly proud to be a nurse, first of all. I feel like I found my way, I found my passion, I found my love, and I have enjoyed being a nurse every single day. And I love being a Mass General nurse.

Other successes, I think I’ve had the privilege to work alongside of some of the smartest and brightest and intelligent nursing and other clinical colleagues.

And then to be able to in the role that I have really influence care and ensure, as I said, that our clinicians have what they need to practice expertly and exemplary, that makes me feel really good.

Q: Wonderful. Well, thank you so much, Gaurdia, for talking with me today about nursing and being a nursing leader. Before you go I have my final five questions.

Q: First question: What is the best advice you have ever gotten?

A: Be open to possibilities.

Q: The name of this podcast is Charged, so what does that word mean to you?

A: Excitement.

Q: How do you recharge?

A: I believe in having fun. Reading, exercising, being with friends, traveling, getting a lot of sleep.

Q: Perfect. When and where are you happiest?

A: I think I’m happiest wherever I am. I think my happiness comes from within, so wherever I am I feel happy.

Q: That’s beautiful. What rituals help you have a successful day?

A: I think thinking positively, that there can be a lot of negative things around you, so I think it’s that sort of cognitive reframing, thinking positive thoughts, that things are going to be successful, that things are going to go in a positive way.

Q: Great. Well, that concludes our conversation, so thank you so much, Gaurdia, for being here. It truly has been a pleasure.

A: Thank you for having me.