By Mel Freitag, PhD
I’ll never forget a comment made during one of my first years of teaching at the School of Nursing. One of the ways I framed all of my classes was that future nurses would be working with communities instead of for them. A critical way to teach this is by flipping the power and inviting the community in as experts of their own experiences, offering best practices and guidelines to the future nursing workforce.
One such group of community members were called “Mothers in the Neighborhood.” They identified as mothers and community leaders who volunteered for their local health center. Through their community-based model, these mothers and grandmothers would go door to door to let their neighbors, friends, and family know about what the health center provided. After the group had shared their experiences with the class, a nursing student shot up her hand. “As a future white nurse, how do we HELP you? What should we do?” One of the community leaders paused and then said, “When you come to my neighborhood, don’t assume you know how to help me and my people before you talk to us. Ask us what we need. We know what we need more than you do.”
My nursing students usually had a debrief group after each of our presenters to process and have a space to put their thoughts in the larger context and concepts of the course. During the debrief that day, I told them that if they took nothing else away from this class, it was the lesson that was shared by the community member: don’t assume, ask. Remember that you do not know what is best for people before you ask them what they need. Remember that you do not have all the answers, nor should you. Remember that it is okay not to know. You are there to serve — not fix or help or save them.
Remember that you do not know what is best for people before you ask them what they need. Remember that you do not have all the answers, nor should you. Remember that it is OK not to know. You are there to serve — not fix or help or save them.
Diversity, Equity, and inclusion are often discussed in lofty and abstract terms, with vague statements or plans or strategy. Yet the impact of service, especially within a profession like nursing, is much more palpable, human, and real. In her 1999 groundbreaking article titled Helping, Fixing or Serving?, Rachel Naomi Remen, MD, wrote on the distinction between the three, “Serving requires us to know that our humanity is more powerful than our expertise… our limitations serve; our wounds serve; even our darkness can serve. My pain is the source of my compassion; my woundedness is the key to my empathy.” Serving requires us to know our own shortcomings. Acknowledging our own experiences — good, bad, and ugly — makes us who we are, better practitioners, and more prepared to heal. It means knowing that patients are not the only ones who experience life — grief, loss, addiction, anxiety, depression. Nurses do, too.
Serving also means being aware of how “helpful” mindsets can be experienced as patronizing or even unwelcoming, especially because nurses are still predominantly white. One of my colleagues, a graduate student who identified as Black, shared that they were often asked, “Can I help you?” when they were walking through buildings on campus, and they noticed that their white colleagues were not asked the same question when in the elevators or walking through the halls. Even though the question here can seem benign (much like “where are you from?”), the impact of assuming that they do not belong in the building can be harmful and distrustful. It is up to all of us to cultivate a culture where everyone feels a sense of belonging, and sometimes that means examining our own behavior.
It behooves us then to socialize the next generation of nurses to intervene in unjust situations, to advocate, and to acknowledge our own blind spots. To name racism, sexism, and homophobia, and to do it when we are a bystander and recognize when someone has created harm. It will be messy, imperfect, and we are never done. We may get it wrong or say the wrong thing; it just means we have to get up and try again. In order to dismantle harmful “helpful” environments, we have to break the silences of oppressions within our own lived experiences. In order to have an authentic culture of health, everyone needs to be willing to make mistakes regardless of their status or degree or rank, admit them when they happen, apologize, and learn to do better. And then do it again and again.
Vulnerability, saying you don’t know, staying curious, keeping it real, learning from mistakes, accepting progress not perfection, that is really where both individual and collective healing begins.
To serve is to be vulnerable; not knowing every language, every custom, every ritual, every food. In order to heal, we need to also be healed; be open to the idea that we were wrong, that we don’t know, that we can’t save everyone. We are not immune to life. We are not saviors, but we can be healers. We are not exempt from realizing our own shortcomings. When we fix or help, we assume something is broken and we can mitigate it with our own expertise or knowledge – but it creates distance. Westernized views of medicine and health do not view the patient holistically; and nurses can be at the forefront of not only patient care, but health care provider self-care. Vulnerability, saying you don’t know, staying curious, keeping it real, learning from mistakes, accepting progress not perfection, that is really where both individual and collective healing begins.
The more we create spaces where we share these stories with our students, with future nurses, with our colleagues, the more we can truly serve those around us. To serve is to collaborate. Servant leadership is about empowering others, and we can only do that if we see ourselves as servants of our students, of our colleagues, and each other. If we want to truly build leaders for a better society and improve health outcomes, it has to start with us.
As the proverb goes, “Weak leaders expect service; strong ones give it.”