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.”
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.
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.