Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Our guest today is Dr. Shiloh Williams. Dr. Williams is an assistant professor at San Diego State University School of Nursing, co-founder of SDSU's Empathy RX Lab, and faculty research fellow with SDSU's Virtual Immersive Teaching and Learning Research Center. She recently began a fellowship with the National Rural Health Association, where she will have an impact on health policy initiatives at the national level, and she's here today to talk about her journey and how other nurses can get involved with policy. Thank you so much for joining us, Shiloh. We're so happy to have you here today.

Thank you. Thank you so much. I'm really excited to be here and just uh honored to be able to talk a little bit about my journey and then really demonstrate to nurses, you know, how you can take that first step, how to use your voice beyond the bedside, and really highlight that advocacy role in the nursing profession.

That's amazing. We're so excited to learn more and grateful to hear more about your journey here today. And I want to talk about your work beyond the bedside, right? Because you've worked as a nurse, you worked as a nurse administrator, an educator, and a researcher. And, you know, with all that expertise, I do I am curious to hear what first sparked your interest specifically in health policy.

Yeah. So, you know, one of the first things I did was um, you know, having worked in all those different roles, you get exposed to the community, particularly as I was the director of education uh for my hospital. We did a lot in community-based education and really trying to get out there. And, you know, I saw a lot of issues and I saw a lot of challenges in the population. And, you know, as a as a nurse, especially a nurse who works in a rural setting, you learn how to put band-aids on things, right? You don't solve anything really, but you figure out how to put a band-aid on. And I was tired of putting band-aid on after band-aid after band-aid. And so, you know, I kind of started thinking about, you know, what what's going on? Why do we keep having to put band-aids? And um, you know, a great term that we learn in community health is we swim upstream. And so I started swimming upstream on some of these issues, trying to figure out what was that root cause. And so um, you know, as I learned more about these issues, learned more about the challenges, I began to realize that, hey, you know what? I need to get to the decision makers. So this is happening outside of my realm as a bedside nurse or even as a hospital administrator. This is happening in the community, this is happening at higher levels than where I'm at. So, how do I get to those decision makers? And so that really started me on this idea of what is health policy? Um, and so I spent, this is a complete no-no, don't do this, but I've spent about a year looking at health policy from the outside. And I was trying to better understand it. What is it? How does it work? You know, how does this happen? And, you know, as through my explorations and my reading of textbooks and materials and and you know, articles, um, I began to realize that I was no better off after a year. I didn't understand it. And so I thought, okay, well, this isn't a good strategy. I remember a conversation I had with one of my colleagues, and I said, you know, how does health policy happen? And he was like, Well, it happens behind closed doors, and it happens, you know, in kind of tit for tat. If you do this for me, I'll support you on that. And it was like, okay, well, I'm not behind those doors, I'm not in these conversations. How do I do this? And so I thankfully took one little step out. And I I joined the at the time I was a member of uh ACNL, the Associated of California Nurse Leaders, and I took a step out and became a member of their health policy committee. And my first couple of meetings, I can tell you I was overwhelmed. It was a new language, just like in any new, you know, setting, any new role you take on, there's a new language. And the the committee has been so wonderful to get me up to speed, to get me caught up, answered my questions. And I went from just, you know, a question here or there that I would ask to actually giving my perspective, giving advice, um, to leading things. You know, I uh recently was able to help uh write the association's position statements on some of the most pressing policy issues right now. And so yeah, it was just one step out and um really started opening up this door uh to figuring out how to make change at, you know, that systems level.

Yeah, that's amazing, Shiloh. And I do want to I want to touch upon a few points that you mentioned too, because the first I would say is that when you started this journey of health policy, what you mentioned what really resonates, and that is the fact that there are a lot of band-aids, right, that we experience in the in the bedside or in our different nursing positions. There's a lot of problems that we try to solve, and as natural problem solvers, we want them to be resolved, right? It's something that we feel passionately about. So nurses actually have this very natural ability to want to find out more and to solve problems and to make some meaningful change. And that leads to the second point that um stands out to me is that health policy is a very complex field. It's a very complex arena to be in, especially for nurses who may not always have that in their training, in their residency or on-the-job experience. And so I think that it's very important to emphasize that as you ventured it into this um journey yourself, how complex it was and how it took you, even with the years um worth of um time to invest, it still was very complicated. And I want to I want to dive into that a little bit more with the next question because for nurses who are interested in this, I I'm curious if there were any early experiences or any mentors that really encouraged you to think beyond, you know, this bedside care and more into this advocacy or policy involvement.

Yeah, so I had, you know, apart from kind of my experiences just working out in the community and and figuring out that we had lots of issues, lots of challenges. I'm from a rural, predominantly rural community, um, worked in their healthcare system for a number of years. Um, and so you know, I often describe my community when I'm presenting at conferences and things as, you know, if we're supposed to be low, we're high. And if we're supposed to be high, we're low. And you can kind of, you know, extrapolate that over to any health data point you want to, that's where we sit. So lots of challenges, lots of concerns. But one of the key individuals that I got to work with early on in kind of my uh early years of my healthcare administration role was actually my chief executive officer of the hospital, Dr. Adolf Edward. And what was really neat that he taught me was the probably one of the most fundamental uh things to understand in health policy is that the individuals who are often making the decisions aren't healthcare professionals. They are, you know, local elected officials, they are uh government agencies, they are uh people who sit outside of the healthcare system who do have a genuine interest in the healthcare system and how healthcare is delivered and outcomes and things for the community, but they don't have that unique understanding that individuals working inside of these organizations do. And so he helped me to really understand that if you are not at the table, if you as that healthcare professional with that perspective are not sitting at the table, these decisions are still gonna be made, but they're gonna be made uh not without your perspective, without your experience. And I think we saw a lot of that happening, you know, even just recently during the pandemic. You know, decisions were made where I can tell you I was inside of the healthcare system during the pandemic, and I, you know, we get our newest guidance that morning, and it was like, what in the world is this? You know, and it was simply because individuals didn't understand the full scope of what was going on, or you know, they just they they don't live, they've not walked the walk, they've not, you know, been in those experiences. And so decisions get made. And so Dr. Edward was really, really instrumental in helping me connect. You've got to be in the community, you've got to be in these conversations in order to give that perspective. Because at the end of that, you're gonna get better policy decisions, you're gonna get regulations, laws, guidelines, whatever the product of that policy is, you're gonna get better products. And so um, that was really, really instrumental in just helping me to understand that connection between what's going on in the community is absolutely going to impact what's happening at that bedside.

Yes, absolutely. And I I really love that you had the mentorship and the the knowledge from from your CEO to share that information. Because even if it might seem like common sense, right, to have health policy decisions be made with health care experts, that's not always the case, right? Um, and I would say that based on what you shared, you know, I think a lot of people could be really intimidated by the process of communicating with their, you know, with their representatives and with the people who are in their Congress. Uh and I think what is really important is that with our expertise and what we uh what we live through and what we um and what we can know about the healthcare industry, we're really able to be in the position to connect those dots, right, for our representatives and to share our voices in that way so that those health policy decisions can be made.

Yeah, I mean, I have a really great example of that. So, you know, um I attended uh at the same time I started working with the ACNL Health Policy Committee, uh, I took another step out, I got comfortable and took another step out and joined the National Rural Health Association. And so every they uh put on a health policy institute in Washington, D.C. And you spend about a day and a half in that institute going through briefings, learning kind of, you know, what the latest um uh proposals are, what's going on, who's supporting what, uh, and to prepare you so that the last part of that institute is going out and actually making visits on the hill. And that to me was so overwhelming because, you know, I can talk to a doctor, I can talk to a nurse, I can talk to my CEO, but to go and talk to an elected official was very much out of my comfort zone. You know, what what am I gonna say? You know, he's not a healthcare, he or she is not a healthcare professional. And so, you know, as a part of that experience, I thought, okay, take one more step. And I took that step out. And what was interesting was I went with my agenda. So when you meet with your elected officials, you know, you only have a few minutes. It's a very narrow window. You're often talking to their staff, which is just as important as talking to them. So, you know, sometimes I've heard comments from uh people who are like, you know, I didn't get to meet with the actual official. That's okay. Their staff is just as important. Their staff is just as critical. So use that time wisely, that limited time you're gonna get. And so I went, I had my agenda, I was ready to talk, I go through my spiel. And the staff member actually was like, Can I ask your opinion on another topic? Yeah, sure. And she said, What do you think of ambulance deserts? And and you know, what's going on around this? And it happened to be that there was a proposal on the table in DC at the time that had to do with some guidance and some regular regulations around ambulance deserts. That was not the topic that I was coming in there to talk about, but thankfully, being in a community that has ambulance deserts, I very quickly was able to share that story and to share that experience. And so again, it wasn't anything that I had prepared for. You know, my hours of notes and prep didn't prepare me for that moment. But to be quite honest, my career, my years of experience, my um, you know, living in this community gave me exactly what I needed. And so I was able to share the story that then could go forward. You know, the staff member shared that with the elected official, and the elected official take that and share that with others as they're garnering interest, as they're, you know, um going through that process of getting support for their proposals. So it became really important that all I was doing was sharing my experience. It had nothing to do with, you know, my agenda for that day.

Wow, thank you for sharing that. And I think it really speaks volumes to the impact that our that our lived-in experiences have when it comes to these discussions and conversations, even though they are, you know, pretty intimidating, right? Right. I mean, the building's big and it's like beautiful and we've never been in there before.

And lots of marble, lots of doors that you're walking past. Yeah, it's just it's very intimidating. But what's really neat, and and I'm sure, you know, my my colleagues that day saw it in me, it's always fun to watch someone who this is their first visit to go through that experience. And they go in, you know, kind of shy, a little bit timid, and by the end of the day, they are in charge and and super confident. So it's really a neat neat experience uh to be able to see that and to really see that empowerment that's happening uh just by visiting your elected official.

Yes, I agree. And what you shared is also very significant because I think just the act of sharing what's actually happening as nurses and in healthcare and sharing our specific stories is actually what ends up being one of the most impactful things that we can share with our elected officials and representatives. Um and and actually um surprisingly, sometimes these stories uh strike a chord with our elected officials in ways that we don't always expect, just kind of like with what you shared. Yeah. So um, so I think that that's a really important piece of this is when you have those conversations, sometimes the stories are the most important things, you know.

Absolutely.

Stories are incredibly empowered uh powerful to our legislators. And and really that's when we think about, you know, what they can grasp onto. The data is important, absolutely, but that story appeals to that emotional response. And that's what's gonna garner that support, that's what may push a bill over the edge. You know, if you can share a true story, um, share images of what people who are maybe going through these challenges or these issues in the community, what they look like, that appeals to that emotional response. And so, yeah, the story is just as important as the data.

Yes, I wholeheartedly agree. And and it sounds like with the with the story that you shared, it sounded like that was a really powerful moment, right? Because um, did you think that that was one moment where you realized that policy could really be a powerful tool for change, or was there another kind of moment where you experienced that?

No, I mean that was for me, that was in that moment, like I said, as I went into that conversation, prepared to talk about something completely different. And the staffer did, you know, listen to me. But when it got to that moment, it was very natural to be able just to share what I see in my community. Um, you know, and and in that case, the topic was about ambulance deserts. Well, I was able to share outcomes. I've been in that emergency room. My background is emergency room nursing, so I know how important time in that rig is, and and uh getting that ambulance to them and back to the facility or to the closest facility, how timely that is. And to be able to share that experience, I realized was very powerful. And that gave that staffer, you know, that story to be able to share as well, but to really highlight this is how policy changes, you know, changes things and makes change. So um that for me was really critical. And like I said, I walked out of there a totally different advocate, a totally different health policy, you know, newbie in a sense. I was no longer a newbie. I recognize the importance and the empowerment that comes with just sharing my experience and my perspective.

Yeah, that's wonderful. And, you know, there might be nurses or other healthcare professionals who are listening right now who are really interested in venturing more into the policy space and and, you know, just given what you've shared and and how how you've shared about your different roles and expertise, you know, being a nurse, an educator, administrator, and a researcher, how would you say that those different roles really prepared you to operate in this policy space and and what would you share with others who are interested in stepping into the space as well?

So each of my roles has been um, you know, a learning journey uh as I've gotten into that role and adapted it. And I'll give you an example. So um I mentioned earlier that I was an emergency room nurse. I had gotten to a point that I was burnt out a little bit, had some compassion fatigue, and I thought, you know, I've got to do something different. I'm not good for my patients right now. I need to do something different. And so I took, you know, nurses often say it jokingly, but I took a desk job, right? A non-patient care job. And my goal was to only do that for a short period of time, and then I knew I'd probably get back to the bedside at some point. Um, what was interesting was that desk job ended up being on the finance side of healthcare. And I ended up working directly for the CFO. And so that experience, and and I started out as kind of a frontline staff and then worked my way up to where I was leading that department. Um, that provided such an amazing experience because I got, again, that language, I got to learn the finance language and how healthcare is financed and how it works, and you know, all the way from the government regulation to the healthcare organization down to the patient and all the way back, you know, reimbursement. And that experience was actually probably one of the best ones I had in terms of preparing me to be able to go in and have conversations around policy and in particular financing of policies and how that actually happens or what happens. And so, you know, each one of my experiences, each one of those roles kind of shaped my journey in research. You know, one of the things I knew was data was gonna be a challenge for us in Imperial County. Oftentimes our data is wrapped up into the two very large counties next to us. So finding that level or even just that regional data is very challenging. And so I went after my PhD because I knew, okay, we've got to generate data, so I've got to be able to do some sort of research. And so, okay, I guess I'll go and get my PhD. And so that's what I did. And and you know, what came out of that was uh my expertise is in health literacy, and uh uh uh you know, just a short story. Um, you know, when I did started my doctoral um project, um I looked at the data for health literacy for Imperial County and I had to dig pretty deep to find it. And at the time the data told me only about 24% of individuals in Imperial County have low health literacy. And if you think about that from a population perspective, it's not earth-shattering, right? But I knew from how much I had worked with the community, cared for them, educated them, that wasn't necessarily what my experience was. And so that actually started my project. And I wanted to either prove or refute that that data point. Um, and what I found was actually it's much higher. 85% of the population actually has low health literacy. So when we think about our education approach, that's a problem. You know, that's something we really need to consider as we educate our patients, um, whether we're in the bedside or out in the community. And so that researcher piece became really important because so much of my research and my work actually is happening at that community level where we are generating the data that we need to look at the issues and challenges within the community, using the real data that's there, you know, using what is actually happening, figuring out those patterns and then digging down to find solutions. And oftentimes those solutions lead right back to the policy component, you know, what's happening at that federal, state, local level that is driving some of these issues and challenges. And on the flip side of that, what can we do at the federal, state, and local level to make change and using that policy approach? So uh for me, you know, all of my roles have kind of started wrapping up into the work that I do at the policy level. And I think that's so beautiful because, you know, I that's my passion. It's been my passion since I started into the nursing profession. And I just I get to do it every single day, which is a lot of fun.

Yes, I love that. And I was going to say too that um that it's beautiful to see this journey and see how it's evolved for you as you've gone through these different roles and how it's led you to provide all of it together to support the policy space. And I think it's one of those things where you know you look back on your journey and you re you realize that each step led you to where you are today. And I think that's a great example of that. So I love how that everything, every step seemed to make so much sense, right? And I think that happens with a lot of nurses too.

Yes.

Well, that's just it. Is you know, I I always knew with my career I wanted to be open to opportunity. And really, there are times that I took opportunities not fully understanding why I was taking them like the desk job. I thought I'd I'll just escape for a short period of time and you know, then I'll come back. And it actually turned out, like I said, to be probably one of the best trainings I could have had. And so, you know, it's it's a puzzle and it you can't see the image until the end. And that's really what this journey has been. And just like you mentioned, that's often often the case for many uh professionals.

Yes, absolutely. And I love that um, you know, comparison to a puzzle piece, you know, when we're all going. Going in different parts of our own journey. We're putting different pieces of the puzzle until it makes a picture of who we are and what our passions are. And I think that in itself is very beautiful to think about. And uh I was really struck too by what you mentioned about your research and how you found this data point that was um something that you were really passionate about seeing if that was really accurate or seeing if there was um new data that could be, you know, in replacement. And wow, what a what an incredible finding to see that, you know, the vast majority of people in the community do have challenges with health literacy. Um and I I think that makes me um, you know, just going to my next question, it makes me wonder about uh, you know, a lot of people might not understand too what health policy is, right? And and I think just kind of going to that a little bit, when we say health policy, what what are we really talking about there? You know, what what kind of um decisions or systems really fall under this umbrella of health policy?

Absolutely. And that's that's the great question that I was trying to solve in that one year before I actually dove into it. Um, you know, at the core, health policy is about the decisions, the plans, the actions, things, you know, steps taken by governments, organizations to achieve specific health goals. And while that definition is accurate, as a clinician, as a nurse, uh, you know, it doesn't resonate with me. And so what I like to say health policy is is just the decisions around how healthcare is accessed, delivered, and funded. And if you get down to each of those buckets, you know, nurses, we are a part of every single one of those. We influence things like nursing staff ratios, you know, um, we influence how community clinics can operate. That's all health policy. And, you know, nurses have such an intricate role. Now, the challenge is as nurses, we're educated to care for people. You know, the the art and the science of nursing all come together. We were not trained to write policy. And so that's something I believe we need to change fundamentally about the nursing profession, in particular how we educate our future nurses, is they need to go in and understand, you know, that there's policy is a thing that will impact them and they need to be active. Um, and so again, like I said, the policy is so tangible to the work that we do, even at the bedside, you know, and I I hate, I use that word even at the bedside, um, because that's such a powerful role. But oftentimes those nurses don't feel engaged in that process. You know, they think others are taking care of that. Their CNO is working on that, or you know, community advocates are working on that. No, your job at the bedside, everyday caring for those individuals, is such an important part of policy conversation.

Yes, absolutely. And it kind of a nice mirror to what your journey was because, you know, where nurses can be really there to connect the dots for decision makers in health policy, nurses at the bedside, all of us as professionals can really be involved and connect the dots right from our own experiences to whoever is representing us as at, you know, in the communities where we are constituents. And, you know, I on that topic, is there anything else you want to mention about why it's so important for nurses to really be there to connect those dots and be engaged in policy?

Absolutely. So just as you mentioned, you know, nurses, not only do we have our lived experiences, but I think we carry the experiences of our patients. There have been so many, you know, patient stories or anecdotes that I've been able to tell to highlight important data points or to highlight important uh issues or challenges. So, you know, we often say that we become an advocate for the patient, and oftentimes we become a voice for the patient because the patient can't can't do that themselves or is not in a position to be able to do that. So, you know, in terms of how nurses can get involved, get out of your comfort zone, take that first step. Um, you know, I one of the probably most meaningful activities I have my nursing students do, I teach there at San Diego State, is to go out and and observe a some sort of a government or community meeting. And that is such a powerful impact because they come back to me and they're like, you know, the mayor, the mayor was making health policy decisions. He doesn't work in healthcare. And I'm like, yes, I know that's where that's happening. You know, that's where those decisions are being made. First step, go and attend one of those meetings, see what it's like, give your perspective if you're comfortable enough. You know, just like I did with the health policy committee, I started out as more an observer and a spectator. And then slowly, as my confidence built, as I got more comfortable with the lingo and the conversation, I was able to share. And that's nurses can do that. Um, one of the most powerful things I think I get to do is to interact with a lot of different community boards and organizations. And again, I'm not doing anything but sharing my own experiences, my own knowledge, you know, through years of service in the healthcare system to be able to help shape some of the decisions they're making. Um, one really great, you know, way to illustrate this and demonstrate that policy is everywhere is uh several years ago. So before I was a leader, before I was an administrator, um, I had worked with a youth sports organization. And one of the things that I was able to do, it was just a voluntary thing, was to reset their concussion protocol. At the time, concussions were a huge concern in youth sports, and particularly football, um, and to set their policy. They knew my background was emergency room nursing. So I set their policy and to help develop their protocols for safely bringing an athlete back after a suspected or you know actual concussion. That's health policy work. Even at that minor level, it was nothing formal, but that was health policy work. That ended up becoming a part of the association. So that was for a specific team, became a part of the association's policies and procedures. They built off of what I had initially created to create policies that met the needs of all. And that is health policy work. You don't have to be in an official capacity, you don't have to be a part of a health policy committee, though we would love you to be, you know, or be in a policy fellowship or, you know, in any official capacity. It's attending community events, giving voice, getting out there, sharing your experience, writing a letter if you're comfortable doing that to your, you know, Congress uh men or or women, um, you know, sharing data, any of those are activities that really put you in that health policy realm. And that was after my year of searching and trying to define, uh, that's what I learned, is you really just have to take the step because it's in all those little activities that you become engaged, you become informed, and um you're able to really uh attribute or I'm sorry, um contribute to the policy realm.

And that is so meaningful to share because I think when a lot of people think about health policy, they think of it from a much bigger picture lens, right? From the entire state or the entire country.

They have to run for office.

Right, right. Yeah, it's like oh, it's like the only way I can be in policies if I'm a mayor or if I'm like the president. And um, and I love that you mentioned about our local communities because a lot of things really start with the communities that we're in, the, you know, us being constituents of those communities, and even in, you know, the organizations that we work in, um, even in the different groups that we're part of, uh, town halls and the city and things like that.

Absolutely. And and, you know, it's it's sharing, whether it's with that elected official or their staff member or even just a member of their group, sharing your story and sharing your experience. And that's, you know, one small step. You are your own expert in your experience and your story. So share it. You know, don't be proud of it.

Yes, absolutely. And, you know, I feel like there's so much more we could talk about today, but I do want to wrap up our call today just with giving you um the floor to share any final comments or words of wisdom or advice to our listeners who might be interested in um getting involved with health policy.

Absolutely. It's been such a great conversation and so much fun. And I hope through this conversation, you know, if nothing else, I've just demystified. I spent the year doing that research to show take that step, you know, get involved, even at just that basic, what you feel might be a basic level. Um, but it's really been such a pleasure to be here. Um, to any of the nurses who are listening, your voice matters, your experience, your story matters, your patient's experience and story matters. And the policy world really needs that perspective. You know, we we want when we make decisions about future policy, particularly around healthcare, we want to ensure that it meets the needs of not only us currently, but future generations. And that only happens when we have more data, more information, more stories to be able to make decisions with. So I encourage you to get curious. I encourage you to get involved if you're not, and just trust that your background as a nurse equips you with the knowledge, the experience, and expertise needed to really be an advocate for change for your community and others.

Beautifully said. Thank you so much, Shiloh, for being with us here today and for sharing your wisdom and expertise. And we are so grateful for all of your advice today.

Thank you. It's been fun.

Our guest today was Dr. Shiloh Williams, assistant professor at San Diego State University School of Nursing. We'd love to hear your feedback. Email us at socialmedia at acnl.org and connect with us on LinkedIn and Facebook at ACNLNurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.