Paving the way: Advocating for yourself

CDI Journal - Volume 15, Issue 1

by Carolyn Riel
There are times in life where most people need advocacy, be it with a career opportunity, clashes with friends and family, or obstacles in their personal life. Generally, people can draw on others’ help in achieving those goals, but there might also come times when people are left to go it alone. In particular, people who belong to minority groups often find they have to advocate for themselves more often than others.

“I’m not one to say there haven’t been changes from when I started to now. I would say a lot of changes have been made,” says Chinedum Mogbo, MBBS, MSHIM, RHIA, CDIP, CCDS, CCS, CDI manager with Tenet Healthcare in Dallas, Texas. “People are beginning to speak up and advocate for themselves or have other people such as coworkers or organizations like ACDIS see their struggles and advocate for them.”

Though Mogbo says she has seen improvement since her start in CDI, there is still much room for growth.

“I have seen many times where people have moved to the next level of their career because they had other people speak to their abilities beyond their face value and say, ‘This person can do this,’ eliminating the common pitfall of judging a book by its cover. And when you don’t have someone to speak up for you and attest to your abilities, self-advocating becomes inevitable and very necessary,” she says. “Often, being able to be a self-advocate starts with taking a lower pay and position to really show your skills and earn those stripes. That’s when you’ll be able to advocate for yourself and truly prove your worth, and also be in a position to advocate for other people as well.”

“I was in a leadership position and knew I would be leaving in about a year, so I started to really think about who I would want to take my position when I left,” adds Angelica Naylor, MBA, BSN, RN, CCDS, CDI consultant and manager with CorroHealth, based in Plano, Texas.

As she prepared to leave, Naylor mentored a CDI specialist who had recently transferred to the department internally and showed great interest in the program. “She came to me interested in CDI, asking what we do, if she might be a good fit, and if she could shadow,” Naylor says. “She joined the team, I trained her as I educated and trained everyone new to the team, and she became a top performer within six months.”

When it came time for Naylor to leave the position, this CDI specialist was her top pick for her replacement. The specialist was a top performer in the department, determined to succeed, and put in effort outside of her expected role responsibilities. “She joined ACDIS, went to the national conference on her own accord, regularly listened to the ACDIS Podcast,” Naylor says. “She was truly getting as much education as she could absorb.”

However, once Naylor left, her mentee was left without someone to advocate for her. “I was the only one. I didn’t do it because of her race or gender, I did it because of her merits, her competency, and her determination to excel,” says Naylor. “But her CDI peers opposed her and expressed to leadership all of the reasons that this CDI specialist shouldn’t be hired for the management role.”

None of these reasons were based on merit or performance, and instead consisted of microaggressions and biases. According to Naylor, some of the reasons the other staff members cited stacked up to personality differences, the CDI specialist’s short tenure in CDI, her reluctance to always eat lunch with the group, and other such minutiae.

“She had no advocacy to speak to her knowledge, skills, self-motivation, and abilities, and because of that, she wasn’t offered the management position,” Naylor says.

In these situations, it can be difficult to know whom you can trust for advocacy. While self-advocacy may be the best option, there are some ways an individual can identify others who will support them.

Identify outside advocates
When you’re met with a situation similar to those outlined by Mogbo and Naylor, start by looking for people who will support you but may not be in your own department—in other words, those who have an outside view of your strengths and merits. 

“In CDI, I feel the best group of people you can depend on to advocate for you are your providers,” says Naylor. “Other advocates outside of providers are hospital leaders, such as nursing unit supervisors and managers, quality and dietary department leaders you have met and collaborated with, and your peers, especially those you have educated and precepted.”

Forming professional, long-lasting relationships with providers means that they will gladly come to your support when you need it. If you’re looking for an advocate, Naylor suggests seeing if a provider will write a letter of recommendation for you and allow you to use them as a reference.

“Even if people in your office or department don’t want to see you in a position, if your reputation in that hospital is good with providers and they say good things about you, that will go a long way. Providers have connections with hospital admin,” Naylor says.

Networking broadly within your organization can also help you identify potential advocates, Mogbo says.

“Don’t work in a silo. Yes, you’re in CDI, but you should also extend to other departments because you don’t know who can speak on your behalf,” she says.

In one instance, Mogbo found that the quality director recommended her for a project based on the merits she had seen Mogbo exhibit before, even though they had different backgrounds and working styles.

Self-advocate
When you can’t find someone to advocate on your behalf, the next step is to advocate for yourself. Doing so, however, is not always easy. You may be afraid of retaliation, being viewed as abrasive, or being dismissed and devalued.

“If you have to advocate for yourself, just document, document, document and keep every single thing,” says Naylor. “Every award you’ve received, keep it. Every metrics report that shows your work, keep it. Every email you receive that speaks highly of you, whether from a physician or coworkers or in the CDI community, keep everything.”

When you’re in a situation where you have to prove yourself worthy, come to the table “fully prepared with all receipts and evidence as though you are walking into a courtroom to prove your case,” Naylor says. You may have to show why you’re the right person for the job and present the supporting documentation to validate your knowledge, skills, and worth.

“There may be situations where you see a less qualified person moving up and you have to ask yourself, ‘What does this person have that I don’t?’ and you find that you actually are more qualified, and this happens more often if you’re a minority group such as a person of color, a woman, et cetera,” Mogbo says. “You need to make a case for yourself and keep every acknowledgment. It’s unfortunate, but that’s the way you fight for yourself.”

While self-advocacy can be intimidating at first and take time to develop, some cultures make it even more difficult. Selling oneself and practicing self-advocacy tend to be accepted in the United States, but people coming from elsewhere in the world may not have been raised to do this. (For more insight into the challenges of joining the CDI ranks as a foreign-trained physician, read the article on p. 12.)

“I come from a culture where we don’t necessarily blow our own trumpets, so to speak. I’m not one to ever say, ‘I’m so amazing and have done all of this.’ I like to let my work speak for itself,” Mogbo says. “I usually don’t sell myself enough, and I find in the American culture you really have to sell yourself and toot your own horn without being cocky, but you have to be able to do that.”

Mogbo had to learn quickly that if she did not advocate for herself, people would be promoted above her that might not necessarily be qualified to do so.

“A lot of us foreign-trained physicians don’t grasp this American mindset quickly and won’t boast about themselves,” she says. “That’s one thing I’ll say: As foreigners coming here, you have to sell yourself and save emails and awards so you can say, ‘I did all of this and I have a record of everything I’ve done.’ ”

Build your skills
In order to have those achievements to show and prove your worth, you’ll need to begin by building up your skill sets, Mogbo says. “You have to be a lifelong learner,” she says. “It’s so important to always be improving on your skills. No one will do that for you.”

If improving your skills requires going to school, Mogbo says to find a way to go and work at the same time. Look at people in the positions ahead of you that you want to advance into, and see what they are doing and what it takes to be in that position.

“If it requires a master’s degree, then get one. It’s hard, but you can do it,” Mogbo says. “There are people out there who are doing it. They don’t have two heads or more hours in the day and they’re doing it, so if you want it enough, you can too.”

Remember to not feel entitled and keep in mind that your goals require work, Mogbo says. “You can’t just sit down and wait for things to happen to you,” she says. “You have to say, ‘What next?’ and do it.”

While earning another degree represents one end of the difficulty spectrum, there may be other ways you can expand your skill set more easily and with less expense. For example, learning how to use a particular computer program or analyze data in Excel® can be accomplished with little to no outside help or cost.

“America makes it so easy; Google is your best friend,” Mogbo says. “There are a lot of resources out there, whether you’re researching what skills you need to further your career or if you’re actually looking for those educational tools.”

Regardless of your next career step and the degree to which you need to self-advocate, strong communication skills will take you far and may be a good skill set to start cultivating. Ask yourself what you need to do—maybe it’s learning to read people better, or learning to be a better team player—and then work to improve in those areas.

“By putting in that work, you’re putting yourself out there. Even if you can’t vocally say it face to face, people will see that you’re putting in the effort,” Mogbo says. “Maybe try writing an article. I hate writing, but I’d take a stab at it and encourage people to look within ACDIS for committees and local chapters that you can work in as well.”

Take the next step
If you’ve been working hard and still haven’t made career progress at your organization, found outside advocacy, or been able to advocate for yourself, it may be time to consider career growth options outside your current organization.

“If you’re passed up for someone beneath you, I’d say look outside for opportunities. It’s heartbreaking, but if that organization or culture is doing that, do you really want to work there?” Mogbo says.

Sometimes in organizational culture, certain people are ordained for positions regardless of whether they are qualified. If you are running into this struggle even with your skills up to par, it might be time to move on. “Organizations need to give people qualified positions, not just based on how long they’ve worked there,” Mogbo says.

Even if it seems fruitless at the time, Mogbo says it’s always better to speak up than to not. “I think people will stay quiet and not want to be heard or seen so they can just stay in their lane,” she says. “You’ll never grow that way.”

In cases where others see you as a threat or hold you back because of your self-advocacy, Mogbo says you should continue advocating anyway because you never know who is watching.

“I have experiences where my work wasn’t being showcased as mine, and I had to take the risk and advocate for myself and say, ‘I did this work,’ ” she says. “I got the attention of people above me and it helped me.”

On the other side of the coin, taking this risk may cause you to be passed up for opportunities because you are “too much.” But that doesn’t mean playing it safe is the right call.

“It’s still always worth advocating for yourself, even if you might face backlash,” says Naylor. “I have the mindset where if you lose anything because you advocated for yourself, that may not be the best place for you, in hindsight. Explore where you are welcomed and valued.”

While there are risks to speaking up, if you don’t advocate for yourself then you won’t be considered for a position at all.

“There’s no black or white,” says Mogbo. “There are both sides, but there’s more risks with not advocating for yourself.”

“If nothing else, you open the door, reset the tone, and create the space for the next person who follows you,” says Naylor. “If I lose everything because I’m advocating for the CDI profession, CDI staff, or myself and challenging policies, I’d rather do that because whoever is following me will not have to battle those issues because I’ve already paved the way. I want people to feel empowered and know the value they possess, especially in CDI. CDI is, and should be, a profession where people say, ‘The world is your oyster.’ ”

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CDI Management, Education