Politics Challenging Opportunities to Improve Nation’s Sexual Health

I had the privilege of attending the NSRH’s 6th annual activist conference, this year called “Nurses at the Forefront for Change.”  I was a little worried about attending. I did not know anyone there and my background is strictly in adult, acute care.  I have always joked that I knew nothing about birthing babies, or any part of that process. I was wrong and it was an amazing experience.  As a human being and a nurse educator, the conference cemented how important sexual health education and rights are.

Many healthcare professionals are concerned with policy challenges impacting public health. The conference did not waste time going into why right now is such an important time to be an activist.  The current administration’s supposed plan to block title X funding will have detrimental effects across the country, particularly for vulnerable populations in the Southeast. The southeastern states boast higher rates of unplanned pregnancy and some of the worse maternal mortality outcomes in the nation.  Many STDs are on the rise. Women are going to die because of this administration’s policies.

Centers, such as Emory’s Center for Reproductive Heath Research, in the Southeast have research, translation, and education aims to try and navigate through the public funding reproductive rights landscape.  As many know, Title X is not “abortion funding”. The Hyde Amendment prohibits federally funded abortions. Title X funds go to comprehensive care and family planning. An estimated 1/3 of low income women have received birth control from a Title X-funded center.  The biggest concern is what the administration will do with Title X funds. One potential is that they will be sent to predatory crisis pregnancy centers. Crisis pregnancy centers present the false impression that they can give women medical care. Most have policies against contraception outside of natural family planning.  They are not well regulated and I heard anecdotal stories at my table of these centers telling women that were 6 weeks pregnant the gender of their unplanned pregnancy in an attempt to get them not to abort.

Throughout what could be described as doom and gloom stories about what happens next, there was hope.  Many brave women demonstrated the research they were currently working on involving education and promoting reproductive health.  Several researchers were working on abortion stigma reducing-programs with varying degrees of success. One speaker gave a particularly inspiring talk on translating harm reduction strategies into the reproductive health world.  Self managed abortion may be a more autonomous, affordable option for some women. The conference managed a tone of inclusivity and had several individual sessions promoting this.

The overall message of the conference was how nurses need to act as activists and advocates for our patients.  Our patients are not just those we care for in the clinical setting, but also in our communities. We have 3.5 million RNs in the US.  We have power. While we have been socialized to not make trouble, we are also the ones who fix problems. In order to fix this problem, we can’t be the demure angels in white.  We must “cause trouble and make people uncomfortable”. This can be accomplished by advocating for a better scope of practice laws. States that give AP nurses more scope are associated with better health outcomes.  Adding sexual and reproductive health education and rights to curriculums is needed across the spectrum from maternal to geriatric care. We need to serve on committees, join professional organizations, run for office, and make our powerful voices heard.  

Abortion access is a public health issue.  We must have a wider lens and look at this as the long term situation it is.  We are playing chess not checkers. We are ethically obligated to our patients and communities and must be at the forefront of change.  

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Amanda Chapman Howard, MSN, RN is a nursing instructor, ICU nurse, and currently a PhD student planning on researching the beliefs and barriers of rural Americans after suffering a stroke.   She is passionate about social justice, human rights, and healthcare access for all.  

 

Nursing School and Social Justice: A Case for Inclusion

What do nurses need to know about social justice? Is there a place for it in nursing school curriculum? Do nurses who understand intersectionality and health equity make better patient advocates? In this Radical Nurses discussion, University of Wisconsin School of Nursing Diversity Director, Dr. Mel Freitag, shares how she worked with a supportive Dean, engaged students, and a committed School of Nursing, to integrate social justice into the very fabric of the institution via incremental changes in curriculum development, faculty hiring, student admissions, and grievance reporting.

Five years ago when Dr. Freitag interviewed for the position of Diversity Director at the University of Wisconsin School of Nursing, she asked if they were only seeking applicants with nursing and healthcare backgrounds. With a PhD in Literacy Studies and a minor in Rhetoric and Composition at the University of Wisconsin’s Department of Curriculum and Instruction, she was not a typical nursing school hire. Dr. Freitag’s expertise in curriculum and instruction, as well as her background in safe spaces, LGBTQ identity politics, social justice education, and health equity provided the interdisciplinary breadth and scope for which the hiring committee were searching.

A background in research and writing on topics like, “Queering Educational Landscapes,” and teaching in gender studies and sociology, while vital for the position of Director of Diversity, initially took a backseat to learning the language of healthcare. Dr Freitag explained, “It was a shift for me because the first year felt like an ethnography. While I knew and understood intersectionality, diversity, white privilege, and social justice, it didn’t show up in the nursing and healthcare literature. I had a recognition we were starting from the ground up.”

There was little outside of nursing cultural competency textbooks about how nursing frames diversity, intersectionality, and inclusion. Understanding how to care for diverse population groups is a core focus in nursing. However, a lack of education about political and historical attempts to limit health equity and access impinge on nursing students’ ability to understand and act on issues of social justice that impact individual and population level health (Boutain, 2016).

Historically, in the 1990s and early 2000s, diversity officers were tasked with supporting the student body specifically, addressing ad hoc matters of discrimination between students and university administration and faculty. Drawing upon the works of Damon Williams, namely, “The Chief Diversity Officer” and “Strategic Diversity Leadership,” Dr. Freitag sought to move beyond episodic interventions and promote transformational change at the institutional level. Dr. Freitag explained, “People assumed that we [Diversity Directors] were looking to support a diverse student population only. I had to push back on that. My position was not seen as a broad brush paradigm shift. I was often asked “Who has the issue? What’s the name of the person?,” on a seemingly ad hoc and personal basis.”

Dr. Freitag participated in curriculum reform with an emphasis on concept-based learning. Dr. Freitag explains, “In nursing, it tends to be very specific: this is a gerontology class, this is a mental health class. Concept-based learning cuts across particular topics studied in nursing. We went from mindset of lecture-based, one person teaching one subject, to team-based, active learning.” According to Walters Kluwer Education Blog, “Concept-based learning strategies allow nursing faculty to add or remove content as new information becomes available.” It is a more flexible and nimble approach to the rapidly changing healthcare field, where new innovations and insights are a constant.

Social justice, health equity, and culturally congruent care were integrated into the new curriculum, from discussions on the nursing process to disease processes. Dr. Freitag explains, “Nursing concepts, like advocacy and communication provide opportunities for the discussion of diversity and inclusion. We aren’t going to have just an LGBTQ day, we will be inclusive in each class. It was a shift in thinking.”

This shift required strong leadership from the Dean of the School of Nursing and the faculty. Some of the faulty said they didn’t feel comfortable facilitating conversations with students on how healthcare access, poverty, and race plays a part in patient care. Empowering all staff with the tools to teach on these issues required in-house discussions between and among faculty on social justice issues. Dr. Freitag explains, “The first step is to explicitly state this [social justice] in the curriculum and syllabi, and then to get staff comfortable with the discussions.”

These discussions caused some controversy as some faculty pushed back against the idea that examining the culture of nursing, which largely has its roots in heteronormative, white, christian, female leadership, should and can be critiqued. Also, there was a common refrain that because nurses “treat everyone the same,” diversity and inclusion did not need to be emphasized. Instead, the school sought to transform this idea of “color blindness” to honor differences. At its root, “social justice is about equity, not equality or sameness” (Boutain, 2016, p. 52). It was imperative to dive into health equity to understand why there are differences in health outcomes in the first place. Dr. Freitag explained, “This has required a lot of stretching and growing among the faculty, and has also mobilized the students to speak up. Many of them have the language to discuss these issues.”

The School of Nursing also started a microaggressions student panel. This resulted in faculty critically reflecting on their practice, while creating opportunities for “up teaching and a cross power dynamic” between students and faculty, according to Dr. Freitag. Indeed, this is an unusual paradigm shift in nursing, where it is traditionally perceived as risky to speak up or out against what is being taught. Students also have the opportunity to submit comments via a climate survey. It is available for students anytime; academic affairs receives these surveys and is required to respond. “This is in real time and empowers students. Students are now no longer just emailing me about concerns related to inclusion and diversity, it is built into the structure of the School of Nursing,” says Dr. Freitag.

Dr. Freitag teaches two courses at the School of Nursing, one on Culturally Congruent Practice, the other on Social Justice in Local and Global Settings. The Social Justice course fulfills the University of Wisconsin’s ethnic studies elective. It is open to non-nursing majors and covers the historical roots of nursing and health outcomes of ethnic minorities. Many of the students who take these classes are from minority groups, students of color, LGBTQ students, and students interested in community and public health. Dr. Freitag hopes these classes will at some point become required saying, “I want to teach students who don’t want to take this class because social justice is essential for nurses.”

Diversity, equity and inclusion are also now part of the interview questions for potential, new faculty. Dr. Freitag explains, “Every faculty member is now building credibility in this area.” While the admissions process is also diversifying. The School of Nursing is also looking for cultural competency and social justice engagement in every potential nursing student. The university continues to critically reflect on how to recruit and retain a diverse student body, citing the early entry PhD program, recruitment efforts in high schools, and a newly won grant to recruit Native American students, as particularly impactful.

Since beginning this process, Dr. Freitag says, “We have seen a huge shift in students vocalizing, taking classes on social justice, and a building a critical mass. Students have become the eyes and ears for seeing gaps.” Dr. Freitag says, “Nursing is looking more at itself, where they are more aware of their own ‘isms’ and privilege. Social justice is part of the field of nursing, but it isn’t leveraged enough. I see this as the time to have the tough conversations and do anti-racist work, including talking about how students’ privilege impacts their nursing practice.”

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References

Boutain, D. (2016). Social Justice in Nursing: A Review of the Literature. In M. Chesnay & B.A. Anderson (Eds.). Caring for the Vulnerable (4th ed.). Burlington, MA: Jones and Bartlett.

Freitag, M. (2013). A queer geography of a school: Landscapes of safe(r) spaces. Confero: Essays on Education, Philosophy, and Politics, 1(2), 123-161. http://www.confero.ep.liu.se/issues/2013/v1/i2/confero13v1i2.pdf

Rooddehghan, Z. ParsaYekta, Z. & Nasrabadi, AN. (2018) Nurses, the Oppressed Oppressors: A Qualitative Study. Global J Health Sciences, 7(5), 239-45. https://www.ncbi.nlm.nih.gov/pubmed/26156912#

Williams, D.A. (2013). Strategic Diversity Leadership: Activating Change and Transformation in Higher Education. Sterling, Virginia: Stylus.

Williams, D.A. (2013). The Chief Diversity Officer: Strategy Structure and Change Management. Sterling: Virginia: Stylus.

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This piece was written by Vanessa Shields-Haas based on a discussion with Dr. Mel Freitag. Vanessa is a radical nurse and activist for harm reduction, comprehensive sexual education, LGBTQ rights, and reproductive freedom in the deep South.

 

 

Context Matters: A Case for Safe Staffing as Massachusetts Goes to the Polls

In 1974, the feminist periodical Off Our Backs reported that in June of that year, “4,400 members of the California Nurses Association (CNA) closed down all but critical care units in 41 Bay Area hospitals.” Nurses on the picket line carried signs saying “Better staffing — one night nurse for 38 patients is unsafe,” and “Patients’ Rights — Nurses’ Rights.” Nurses didn’t get everything they were asking for out of that strike, but twenty five years and another major strike later,  California passed the nation’s first – and, to date, only – nurse-patient staffing ratios law.

Now, twenty years after the CNA secured safe staffing ratios for California patients, voters in Massachusetts are being asked to decide Question 1. This ballot measure, proposed by the Massachusetts Nurses Association (MNA), would set nurse-patient staffing ratios across hospitals, determined by type of unit and patient acuity. Continue reading “Context Matters: A Case for Safe Staffing as Massachusetts Goes to the Polls”

A Manifesto for Nurses

Last week, I unpacked some ideas about the exigency that nurses understand and embrace the inherently political nature of their work. One of the mantras of Women’s Liberation was “the personal is political,” an idea first presented by radical feminists Carol Hanisch, Shulamith Firestone, and Anne Koedt. This is a critical contribution of radical Second Wave feminism because it highlighted the importance of the division of labor and the work that has historically been written off as “personal” and thus unworthy of study. It’s just a small leap, given nursing’s conventionally-feminine identity, to “nursing is political,” but one I think is critical that we make. We devalue our own contributions and importance when we insist that nursing should be an apolitical endeavor. The face of healthcare is changing. The needs of our communities, our country, and our globe are changing. Nurses have to engage across as many domains as possible to ensure that we represent our professional needs and to advocate for the well-being of the future health of our world. To that end, we – Vanessa and I – have put together a proposal for working together as nurses. Continue reading “A Manifesto for Nurses”

Embracing the Politics of Nursing, Constructing Nurse Consciousness

Florence Nightingale is often hailed as the founding heroine of professional nursing. In many respects, perhaps she is. Her Notes on Nursing was a call to arms of sorts, the watershed that cantilevered the domestic work of women into a respectable profession (1860/2012). Nightingale violated cultural norm after cultural norm of her day in pursuit of building a profession that embodied the potential she saw in nursing. At the same time, her admonition to stay above the fray directed nurses to stay out of the woman suffrage cause (check out the concluding paragraphs of Notes!). There is a wide array of interpretations of Nightingale’s political position, but here, I would point out that even this controversy bestows nursing with a conflicted legacy of apoliticism, a hegemony that starts at the very beginning of our professional identity. Continue reading “Embracing the Politics of Nursing, Constructing Nurse Consciousness”

A call for an end to family separations at the border

As a Radical Nurse, I use my voice and passion for humanity to speak out against the inhumane treatment of individuals, and in this case, children. Today, as our collective attention continues to bounce from tragedy to tragedy, the atrocity of forcibly separating children from their families at the US-Mexican border continues. On September 12, 2018, New York Times reporter Caitlin Dickerson cited that the number of children separated is the highest number of detained children ever recorded.  Dickerson later reported on September 30th  that many of those children have been traumatically relocated in the middle of the night, without notice, to Tornillo, Texas where there are currently no accommodations for schools and they are forced to live in tents. Continue reading “A call for an end to family separations at the border”

Radical Nurses support survivors

 

For survivors of sexual assault, this past week brought a maelstrom of emotions: disbelief, frustration, fury, and shame, to name a few. Radical Nurses stand with survivors of sexual assault. We respect those who are unable to share their stories as well as those who have spoken. As nurses, we practice trauma-informed care and recognize that trauma, such as sexual assault, can impact healthcare throughout the lifespan.  Continue reading “Radical Nurses support survivors”

Nursing as a radical act

The reality of providing care often challenges our initial assumptions of what we thought nursing would be, while also illuminating the powerful impact outside influences, such as climate change, poverty, and violence, have on the people we serve. Ethical dilemmas are plentiful in nursing; for example, many of us struggle to navigate complex health systems where accountability is often to an employer, as opposed to the public who seek our care. Continue reading “Nursing as a radical act”

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