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What We Need to Remember this National Hispanic Nurses Day

 

What We Need to Remember this National Hispanic Nurses Day

Author: Melina Lopez*

There’s no better time to think about what being a bisexual Mexican and Puerto Rican nurse means to me than when Bisexuality Awareness Week, Latinx Heritage Month and National Hispanic Nurses day happen at the same time. It’s hard, though, because I can never reflect on these identities as mutually exclusive. It’s even harder when I think about how within the greater scope in which these identities exist (i.e. bisexuality in the LGBTQ community, heritage in the Latinx community, and nurses in the healthcare field), each of these identities have long, deeply rooted histories of erasure and subjugation. 

For bisexuality, it’s the tendency to question the legitimacy of the sexual orientation and consider it less valid than being gay or lesbian. For heritage, it’s the phenotypical hierarchies of power that values lighter-skinned over darker-skinned Latinx people in sociopolitical contexts. For nurses, specifically Latinx nurses, it’s the use of gender as a rationalization to subject nurses to the male-dominated field that is medicine. 

I don’t have the privilege, or rather the ability, to separate these histories from one another since separating these realities would mean erasing their marginalized truth. In thinking about these identities, I’d like to specifically hone in on the role of U.S. imperialism in the history of professional nursing in Puerto Rico.

Puerto Rico, formerly a colony of Spain, became and still remains a colony of the U.S. under American Protestant missionaries seeking to bring salvation and civilization to Puerto Rico in the early 20th century by introducing hospitals and nursing schools to the island. These nursing schools adopted racist admission policies that excluded Afro-Puerto Rican women by arguing that allowing women of color into the nursing program was not in the best interest of the hospital, nor to the women. White nursing advocates for these ‘whites-only’ admission policies reveal an interesting acknowledgment, compliance, and continuation of women of color’s marginalization in nursing because they claim that Afro-Puerto Rican admission into these schools would not only undo all of the work to advance white women’s political power as nurses, their admission would be unfair to them because they would still be considered socially and professionally inferior to white nurses based on the island’s classification of race, which is a fluid hierarchy based on phenotypical registers of Blackness where money and education have the power to essentially ‘whiten’ Puerto Ricans and grant them higher social status. 

These imperial and local ideologies of race, in conjunction with the belief that Afro-Puerto Rican’s presence in nursing would weaken the white nurses’ political power in health, suggest that gender and social class superseded race when it came to the professionalization of Puerto Rican nursing. It’s important that we acknowledge these intersections this National Hispanic Nurses Day to show that while yes, Latinx nurses have made incredible strides in the advancement of nursing and deserve to be celebrated, we cannot deny how the execution of Nightingale nursing was done at the expense of Latinx, specifically Afro-Latinx, women. 


So, as we celebrate Bisexuality awareness week, Latinx heritage month, and National Hispanic Nurses Day, I urge you to pay special attention to the role American nurses have played in establishing the state of nursing in Latin America. I also caution us from celebrating the myth of homogenized, universal “Latinidad” this Latinx heritage month. Rather, let us all look at the US role as facilitators of these countries’ socialization into American norms and practices through the nursing field. 

Ellen Walsh, “’ Called to Nurse’: Nursing Race, and Americanization in Early 20th Century Puerto Rico, Nursing History Review 26 (2018): 138-171. 

 

 

* Melina Lopez is an inaugural NSRH Karen Edlund Fellow, providing insights to the NSRH Community for Bisexual Awareness Week (September 16-23) and Latinx Heritage Month (September 15- October 15)

Get To Know Our Fellows Series: Leslie Chase

This week NSRH’s student engagement coordinator, Rosie Laine, spoke with Leslie about what brought her to nursing and SRH specifically, and about our monthly value (Power) 

Stay tuned to learn about the amazing work Leslie is doing to support sex and bodyworkers through her Nurse Leader Project in Karen Edlund Fellowship 

NSRH: Tell us a little bit about your SRH journey? What led you to study nursing and how did you become interested in the intersection of nursing and SRH?


Leslie Chase: I always knew that I wanted to be in the medical field from a really young age. I think what really led me to sexual and reproductive health is I graduated college the month after the 2016 election, with my first undergraduate degree. I had always been comfortable talking about sex and answering my friends’ questions, giving them someone to talk to about topics t they were embarrassed about, or they felt a lot of unease about. Right after the 2016 election, I became really motivated to work in something that made a difference. I ended up applying to Planned Parenthood, and I knew that’s exactly where I wanted to be. I’ve been working with Planned Parenthood since I graduated with my undergraduate degree, and it’s done nothing but bolster my interest in SRH. There are so many avenues within it, and you can see really concretely where you’re making a difference in people’s lives. It just felt like a very natural progression of things. 


NSRH: You mentioned that you were interested in nursing, or the medical field, from a pretty young age. What led you to think about this health education degree as something to supplement? 


Leslie Chase: I think really it’s my work with Planned Parenthood. I think often people think of nurses as individual contributors. What I really liked about my exposure to Planned Parenthood is that because of my work on the administrative side, I got to see how organizations like that enact change on a high level, and the impact that you can have to change an entire health landscape with the community. I really liked that idea. I liked my master’s program in health education because it helps you learn how to take your knowledge of being an individual contributor, to assessing the needs of an entire population, or community, or region. I learned how to build projects and programs that have a high impact and impact a lot of people. I liked that perspective of service. 

NSRH: To play on the NSRH Value of the Month - Power - if you had a superpower, what would it be and why?

Leslie Chase: I think teleportation. I love to travel, and I love the experience without all the cost, waiting around, and the carbon emissions. So I think teleportation.


Endurance + Consistency

If you read all 8 of our Trusted Community series, way to go sticking it out with us as we laid out our plans to launch NSRH membership next week! As Lina mentioned in her Still Weaving blog, the team has been working the long-game to build programs, education and a membership program that can bring our nursing community together. 

There are so many clichés about good things come to those who wait or the rainbows come after the storms… we would like to express our gratitude for your patience with us as we worked through the global pandemic, the uprising, and team transitions to bring us to where we are today. Starting next week (it’s really here!), nursing students, nurse professionals, SRH advocates and allies, and retired nurses all have a home with the Nurses for Sexual & Reproductive Health! We’ve prepared content for our Online Institute for members to tap into immediately. The NSRH Social Hub is buzzing with opportunities for more members to gain access to our safe, trusted community social space. And we will constantly be planning more and more to deliver to our members, we want to care for you. 

We call on you to tell your friends, family and community as we open the doors for members to apply. Joining our network will allow them to  start or continue their journey with us on the consistent path of change, learning, and development. Want to make sure you or someone you know can get enrolled, feel free to send us a message and we can follow up with an invite to membership!

Contribution + Action

Performative activism or action is the fast path to losing trust in a person or organization. NSRH shows up in ways that create impact, not performance. Ways that can make the difference for a nurse on their path to delivering the inclusive SRH care they desire to learn and share. Our goal has always been, and will continue to be, providing you with the knowledge, skills, and support to take direct action and make meaningful, lasting contributions to your community.

Becoming an NSRH member will give you the resources necessary to initiate and maintain meaningful change in your clinic and community. We offer online education that can fulfill CE needs, and resources to build your advocacy skills. When you look back at our origins, you’ll discover that our focus has always been to offer resources to students to advocate for changes in curriculum and policy. NSRH started with passionate, young nursing students with a fire for change, and the next generation of nurses & SRH advocates that will continue that legacy of action . We transitioned our membership program from student chapters exclusively to offering community to nurses (students and professionals) and allies that can share the same space. That shared community offers opportunities to contribute and participate in a variety of ways!

Are you interested in action and contribution for the SRH community? We are SO CLOSE to being able to invite you to apply for membership with NSRH. Stay tuned, we will be opening applications and we can’t wait to welcome you to our action-oriented community!

Clear + Direct

Think about a glass of water that you are given at a restaurant. What makes you know that water is safe for you to drink? Is it because you know exactly what tap it came from, or that you’ve eaten there before or know the staff? Maybe. I bet it could also be that it is served in a clear glass and the clarity of the water helps you trust that you are drinking a glass of safe water.

While that is a superfluous example, having clarity into situations and systems allows for us to build trust more quickly compared to viewing obstructed information or feeling like we don’t see the whole picture. NSRH is committed to creating a community built upon a foundation of trust. Transparency and clarity in our actions fosters our shared understanding that uplifts nurses and promotes SRH education and connectivity. We understand that it can be hard to build trust when just starting in the SRH field or if you are entering a community new to you. That is why we will be sharing our Trust Levels system in detail with members to help grow trust in NSRH and trust within our community of disruptive nurses. Check out the Trust Level system overview.

NSRH offers clarity around our vision and values to help nurses understand quickly if this is the right space for them. We strive to remove ambiguity from our work to bring all our members together to share in NSRH’s goals for supporting nurses today and the future of nurses passionate about SRH. Trust and Integrity are two of our core values, and through clarity we are able to embrace those values openly.

We invite you to ask questions, make suggestions, and challenge us. We can ignite the revolution in SRH when we know clearly where we stand. Members play a key role in shaping the future we demand. This is your association, and we are here to support and serve you. Get ready to participate and engage with your fellow nursing community through the membership network of NSRH!

Still Weaving

Some months ago I wrote an article Weaving Community where I likened building community to weaving. I employed this lovely metaphor of community as an "intricate tapestry". Here is what I did not say, weaving is REALLY hard and can be terribly frustrating. Threads get tangled and break and you make a LOT of mistakes that cause unwanted gaps and holes and imperfections in the final project. You start out with this lovely plan where you decide on the pattern and the length and width of the cloth. You have this wonderful vision in your head of how things are going to go and then you sit down at that loom and it all goes to h***. You find that you have to keep deciding which errors to fix and which ones you will pretend were a part of the original plan. Well, that too is a LOT like building community. You start out with all of these wonderful plans and intentions and then life happens.

 

 

This is a pic of my latest project which has been an absolute nightmare. Notice all the little knots? Those are where I had to keep going in after I had supposedly finished threading the loom to fix broken threads.

 

 

 

There has certainly been a whole lot of "life" happening lately. As a nation we continue to navigate a pandemic, made more severe by "leaders" who place their political aspirations above public health. We continue to wrestle with the myriad impacts of white supremacy and hetero-normativity as it manifests in our economy, socio-political institutions, culture, and ultimately, our bodies. We continue to struggle against restrictive laws and policies that seek to control our ability to reproduce if, when, and under the conditions that we choose. NSRH, like many non-profit organizations, has also had to overcome a number of challenges. A lot of the things that we thought would happen (programs that we would launch, events that we would hold…) needed to be put on hold in order to attend to… "life". Believe me when I say there were times when I just wanted to crawl under the covers and hide from all the "life" going on. But then I would see some article about what nurses and other medical professionals were going through out in the field and I knew that, if you all could do it, if you could continue to show up even when our policies and institutions failed to keep you safe; I could certainly keep showing up for you. You are what kept us going. The good news is that we have come out on the other side stronger, more focused, and better organized. We want to be the best that we can be so that we can better serve you.

This has been a tough year and a very busy and fruitful year for us, and finally, yes finally! we are gearing up to launch our Membership Program to the larger community THIS month! I know I said that it was supposed to happen in March, but… "life" happened. In November 2020 we were able to successfully launch our pilot Membership Program and recruited 68 amazing Founding Members, which has allowed us to test various elements of our Membership Program in preparation for the full launch. In addition to this pilot launch we also:

  1. Received accreditation through the California Board of Nursing to provide continuing education (CE) credits/ contact hours for our content. YAAAAAH! This was an incredibly heavy lift for us and the process took about half a year.
  2. Completed a series of beautiful interactive SRH Education modules, which are available to our Members. Check out this sample course from our SRH & Nursing module.
  3. Created our own private and secure social Network, NSRH Social Hub, which is only accessible to our Members (think early Face book sans the Zuckerburg shenanigans).
  4. Continued to grow our Team in order to better serve our community. We went from 4 staff at the beginning of the year, to 3, to 2, to 4, to 5, and now 6! (Plus 3 amazing Assistants).
  5. Implemented a monthly Members Only Newsletter
  6. Launched our Karen Edlund Future Nurse Leaders Fellowship

While things did not work out quite as we had originally planned, we have managed to produce something beautiful. Is it imperfect?... Yes. Are there holes and flaws?... Most definitely yes, however, we are still weaving!

This is a pic of my last and largest project thus far. It turned out nice but it was a nightmare to make and I literally changed up the pattern midway through because I figured out that I did not like the initial pattern that I designed, which is why the one pattern transitions to a different pattern. 

Connection + Community

Those of you who have attended our activist conference have felt the power of the NSRH network. For more than five years now, NSRH has brought together nurses and midwives from across the country to hear from one another, expand their knowledge base, and build community. The activist conference is a cornerstone of NSRH’s commitment to building a strong and trusted community, and it continues (although interrupted by COVID-19) to provide an invaluable opportunity for nurses in SRH to reconnect and forge new connections.

These connections persist beyond the walls of our conference. Members of NSRH are able to attend our in-person events, and they will receive 24/7 access to an online community of students and professionals. Despite working, studying, and living in cities across the country, our nurses and midwives connect, whether virtually or in-person, with one another. This is because we share a common commitment of ensuring just, dignified, and comprehensive SRH care for all. Joining NSRH means joining a network of clinicians, researchers, students, and advocates who are as passionate as you are about fighting for change in our healthcare system. As a member, you will gain access to not only our catalog of educational, advocacy, and professional development resources, but a community of allies ready to stand alongside you as you navigate your journey through the SRH field.

At NSRH, our community has been a central part of our history, and it is core to our mission. Whether it be through our campus chapters, the NSRH rotations, or our activist conference, we have and will continue to unite disruptive nurses from different cities, different sectors, and at different points in their professional careers for a common goal. Our community is as strong as it is unique; because we support all nursing professionals and nursing students, connections are developed and knowledge is passed between nurses and midwives of varying backgrounds, credentials, and sectors. Joining NSRH is an opportunity to unite and mobilize, and we can’t wait to connect with you! To learn more about our membership program and the options available to all types of SRH students and professionals, reach out to Nikki at [email protected] to see where you fit.

NSRH Education Web

In the past year, we have all had to learn and re-learn techniques to heal, hold, and care for ourselves and the people around us. Some of us have looked back to learn how our communities have traditionally held each other, some have looked forward to imagine different possibilities for care. At NSRH we have done a little bit (a lot!) of both. We were reaffirmed that there are ways in which nurses have always been foundational to the care of their communities; and, we see that there are other ways of knowing and caring that need to arise. In planning our educational offerings, we have kept all of this in mind. Part of this process has involved learning from the natural world and its ability to regenerate and survive.

Consider the structures of a spider web: Spiders are able to adjust the consistency of their web based on function and need. The edges are sticky to trap food, the center is smooth to allow for mobility. Incorporating our values in our education program creates trust and allows for a center that encourages curiosity and discovery. From the nurse just beginning their journey into sexual and reproductive health (SRH), to the ‘SRH experts,’ we all need trust as a foundation to allow for comfort, mistakes and growth. Our web encourages all of us to lean into the sticky discomfort of unknowing, learning and cultivating a practice that celebrates sexual and reproductive care. Whether someone is using our online education platform to learn about comprehensive pregnancy options counseling for the first time, or a seasoned SRH vet is revisiting a topic after noticing moments where their theoretical knowledge hasn’t matched their practice, our education web holds all of that.

Spider webs are formed from single threads connected to function as a whole. We know that the education needs of the nursing community are vast. In order to transform healthcare to robustly celebrate SRH, we need to engage and support different learning styles and diverse education needs. From our Karen Edlund Nurse Leader Fellowship, developing the leadership capacity of nursing students from underrepresented communities, to online learning with CE’s that can be done on shift, to the Training in Abortion Care Fellowship for registered nurses to gain experience in abortion care, to in-person education sessions with partners in this work, each component of NSRH’s education functions as a thread strengthening the collective web of nurses in SRH.

Finally, one of the most magnificent elements of spider webs is their incorporation of beauty. Research has shown that the design of some spider webs are not just for function, but for beauty as well. This is a clear reminder that pleasure, beauty and differences are critical in shaping the whole structure. Prioritizing complexities as a means to pleasure is foundational to NSRH, including our education program. We know that not every community or every nurse has the same needs or vision. Rather making space for and celebrating our different shapes and structures is what makes our web capable and beautiful.

Cultivating Comprehensive Care

We caught up with NSRH founding member Alli Mitchell, RN, IBCLC, PHN, SNM, to discuss identity and the role of intersectionality in comprehensive SRH care. Alli (she/her) is a registered nurse, lactation consultant, and student midwife based in San Leandro, California.

What are the intersections of your identity?
I am a biracial, Black & Latinx cis-gendered woman. I am a registered nurse, a lactation consultant, and student midwife. I am the daughter of an immigrant and 1st generation Bay Area native on my mother's side. I definitely feel that the intersections of my identity allow me to foster deeper connections with my patients.

How does intersectionality impact your work in clinical practice?
Intersectionality helps me to relate to my patients. I am fortunate to be able to serve my home community here in the Bay Area, which is made up of large numbers of Black and Latinx people. I know that when I am supporting patients, they feel safe, seen, and cared for because we come from the same background and share similar life experiences.

On a day-to-day basis in the clinic, how can nurses and midwives better honor and respect their patients’ multiple intersecting identities?
I feel the best way that nurses and midwives can honor and respect their patient’s intersecting identities is by listening and holding space for them. Allowing them the chance to share their concerns and goals surrounding their care.

How can we use identity intersections to provide more comprehensive care?
Comprehensive care should be driven by an individual’s need and identity intersections. As providers, we should be tailoring care based on our patient’s individual needs and experiences.

Do you have any resources about this topic that you would recommend nurses look into?
I recommend the following resources: Black Mamas Matter Alliance, The Black Maternal Health Caucus, Expecting Justice, PostPartum Justice, and SisterSong.

 

Engagement + Commitment

Commitment to the mission has always been at the heart of what we do, driving us forward and navigating our changing landscape. Our mission reads, “NSRH provides students, nurses and midwives with education and resources to become skilled care providers and social change agents in sexual and reproductive health and justice.” We were founded by disruptive nursing student advocates who aimed to improve care and provide inclusive, full spectrum healthcare, and that is still at the core of what we do.

We invite you to celebrate, collaborate and commit to patience, learning and growth through NSRH membership. To share our collective growth edges, so we can all strive to bring better care to those in our clinics and community. We know that breaking into a new space (like membership or SRH) can seem difficult, but we are here to support you and make it easy and rewarding for you. We have a powerful network to build resource sharing and collective learning. We have downloadable advocacy tools for promoting change. We have online education to enhance nursing skills and we have CE credits for many of our courses. Plus, we are here to create and develop new resource ideas that YOU bring to us. As a membership group, NSRH’s community will aid in driving future content that engages and resonates with nurses passionate about providing robust, inclusive care.

We commit to listen as we are here to support nurses across their careers, from students to professionals to emeritus or retired. Unsure if membership is the right fit for you? Give us a call at 651-207-7293 or send us an email, get to know NSRH, we’d love the opportunity to care for you.

Competent + Capable

Nursing Students for Choice started in 2006 with a group of passionate nursing students who stood up for inclusive, full-spectrum sexual and reproductive healthcare. For well over a decade, nursing students have held the torch and marched toward changing their communities and curriculums to include comprehensive sexual and reproductive healthcare. Students are capable of so much and the competency earned and shared with chapter members created a foundation for nurses to come together to learn. Check out the full history and evolution of NSRH here.

It is because of our competent student leadership that we have been able to sustain and grow over time and we are excited to launch the full membership program to bring our nursing students and nursing professionals & educators together in community for support, continued education and connection. As individuals, we are capable of impacting change in our immediate circles. When we bring together the brain trust of experience and education, the community will have shared competency to influence change on a grander scale.

NSRH stays relevant by evolving our organization to expand impact and bring more knowledge around the needs and opportunities when providing SRH care. We are humbled by the wisdom of our sage nursing professionals and refreshed by the energy from our student nurses. Interested in sharing ways that NSRH can support and serve you with membership, send us a message at [email protected], we’d love to hear from you!

Constitution + Character

When you come across a great path in the wilderness that leads to a hidden spot with a lake or a view, do you ever think about the people who walked that path before you? The trail-makers who knew or felt that going a specific direction would lead to a better spot. Someone with unique knowledge knew to take those first steps toward their goal even though the beauty of their journey was still obstructed. They showed up time and time again to stomp down the path for others to follow.

At NSRH, we encourage trail-makers. By providing support and resources, we encourage them to take the challenging path with confidence to stop situations or institutions that are harming, marginalizing, or ignoring our community’s needs. Disrupting the status quo alone is isolating and can leave us feeling overwhelmed, and that is why the community of nurses at NSRH continue to demonstrate the constitutional changes that need to be made in healthcare. Our nurses come together to learn from each other and build the characteristics essential to delivering comprehensive care in the moments where the path is not clear.

In times of uncertainty, NSRH will stay true and take on the difficult tasks that will impact and improve the lives of nursing professionals and the communities they serve. NSRH does the hard work that needs to be done for nurses fighting for comprehensive sexual and reproductive health, reproductive justice and rights. It is through our dedication and character that we build the ongoing trust of our community, we are here for you.

If your constitution pushes you to get involved with like minded people, NSRH membership is the community for you! Get connected with us on social media by following us at @NursesforSRH on Twitter, Instagram, LinkedIn & Facebook and stay tuned for our membership program launch coming soon.

Tenderness + Benevolence

Have you noticed how some leaders seem to have organic followings that people are magnetically drawn to? Identify a few of the great leaders in your life, what made them special to you? Most memorable leaders share a common trait, they lead with compassionate care for the community that embraces them. By focusing on the needs of others, leaders are able to grow the talent in their communities.

We are more likely to trust and engage with leaders and communities that prioritize the greater good. Groups that have rigid structures don’t account for the tenderness needed in human relationships or the beauty in being benevolent. At NSRH, we put the needs of passionate, disruptive nurses to the front of our vision. We prioritize caring with compassion for our members, celebrating your victories and holding space for the challenges faced in daily life as a nurse.

We all have spaces in our life where we can bring our authentic selves and thrive. Third Space Theory is a sociocultural term to designate communal space, as distinct from the home (first space) or work (second space). NSRH aims to be the third space for our members to grow and realize their potential as compassionate, inclusive nurses. We strive to be a third space that fosters compassion with accountability, to provide education that develops inclusivity, and a safe space to have crucial conversations about what is going on at hospitals and clinics that can impact patient care or outcomes. It is when we gather in a collective third space that we can bring our lived experience and our learned experiences together to grow in a safe community together.

Features of the Trusted Community of NSRH are built on the foundations of compassion, benevolence, and tenderness. We move forward with our hearts and ears open. If this sounds like a community you want to be a part of or know other nurses interested in connecting, get in touch with us at [email protected] and join NSRH membership when we launch this summer!

Here is an example of an artistic representation of Third Space.

Pandemic Nursing: Forty Years of Advocacy

To honor and elevate the history and relevance of providing care with love to populations that have been stigmatized or marginalized, we invited a guest author, Kristopher J. Jackson, to share his voice on the COVID-19 and AIDS crisis. 

Kristopher J. Jackson, MSN, ACNPC-AG, CCRN
PhD Candidate, University of New Mexico College of Nursing, Albuquerque, NM
Acute Care Nurse Practitioner, UCSF Medical Center, San Francisco, CA

“Across the United States, wards of patients admitted to the hospital with an unusual pneumonia became more commonplace. Little was known about these patients’ condition, their projected illness course, or how to treat them.”

For those who have worked in the acute care setting during the last fifteen months, these statements certainly sound as though they were intended to describe the thousands of Americans hospitalized with severe COVID-19. However, the sequestration of patients afflicted with a poorly understood viral illness is not a novel practice. For those in clinical practice four decades ago, many may recall a different viral illness that created similar panic and confusion among healthcare professionals: the beginning of the AIDS epidemic. Undoubtedly, AIDS patients who presented with pneumocystis pneumonia in the 1980’s differed clinically from present-day COVID-19 patients today in a myriad of ways. Clinically speaking, the two diseases have almost nothing in common at all. Despite the overwhelming number of differences between AIDS and COVID-19 as clinical entities, there are some poignant similarities in the American public’s reaction to these two pandemics and they tend share a common theme: a fear of the unknown.

As both pandemics began to ravage communities in the United States, providers and public health officials found themselves having to answer challenging questions: How is the virus spread? How do nurses, providers, and hospital staff care for a patient with a potentially deadly disease? What protective equipment do providers need to take care of these patients? Who should take care of these patients? Meanwhile, the American public had many questions of its own: How do we protect ourselves? Where did this virus start? Who is to blame? Who should we ostracize? As both pandemics began to jeopardize the “American way of life,” fear and anxiety plagued a nation.

In the early 1980’s, more patients died from a disease initially referred to by scientists as “gay related immune deficiency” or “GRID” and – more colloquially – “gay cancer.” In 1982, one particularly reprehensible reporter and White House correspondent, Lester Kinsolving, once mockingly referred to the disease as the “gay plague” in a press conference with former President Ronald Regan’s acting press secretary, Larry Speakes. Despite the thousands of American deaths, Kinsolving’s remarks were met with jokes and laughter by members of the White House press corps. While reporters and government officials in Washington D.C. amused themselves with commentary about those suffering and dying from AIDS, these patients were being abandoned and spurned by their families and communities. Fearing what they did not understand, some physicians and nurses refused to see or care for patients living with the virus. Other members of the American public felt an HIV diagnosis was some sort of karmic punishment for the gay men and intravenous drug users that contracted the first cases of the disease. These are beliefs that, to this day, remain deeply embedded into the very fiber of some sects of American society.

Nearly forty years later, in December 2019, early reports emerged of a bizarre coronavirus-associated pneumonia in China. As the World Health Organization and international public health experts began to investigate this new virus in the weeks that followed, the American public prepared a response of its own. Videos of Asians or individuals of Asian descent consuming bats or “bat soup” plagued the internet. Much like the early years of the AIDS epidemic, the American “way of life” was in jeopardy and the American people needed to hold someone accountable. Former President Donald Trump would later come to refer to COVID-19 using a variety of derogatory, xenophobic, anti-Asian epithets including: “China virus,” “Wuhan virus,” “China plague,” and the “Kung-Flu.” As the leader of the free world ‘dialed-up’ his anti-Asian rhetoric to provide Americans a target for their rage, Asian-Americans faced more violence and more racism; hate crimes committed against Asian-Americans became more commonplace.

While decades apart, the early failures and relative inaction of the executive branch of the U.S. Federal Government during the beginning of both the HIV/AIDS and COVID-19 pandemics are well documented. The first cases of HIV surfaced in 1981 and the virus itself was isolated in 1983. Sadly, President Ronald Regan would not publicly utter the word “AIDS” until 1985. According to the Centers for Disease Control, more than 50,000 Americans would be diagnosed with HIV between 1981 and 1987 when President Regan formed the Watkin’s Commission to investigate the AIDS epidemic. More than 95% of Americans diagnosed with HIV as a result of President Regan’s flagrant disregard for the disease died during this same period.

In early 2020, as international public health experts warned of the severity and virulence of the novel coronavirus, the executive branch of the federal government failed to heed these warnings. However, perhaps more disturbing, is that former President Donald Trump offered the American people false assurance and abject lies. On April 7th, 2020, President Trump told the American people: "…so, you know, things are happening. It's a -- it's -- I haven't seen bad. I've not seen bad." The day before this announcement, the death toll of Americans who had succumbed to COVID-19 surpassed 10,000. By April 11th, more than 20,000 lives had been lost to COVID-19. The Federal Government also failed to issue a federal mask mandate or mandatory guidelines regarding social distancing, instead allowing individual states to choose how they would respond to this public health emergency. This leadership failure translated to a highly partisan response to a deadly virus, as well as unnecessary death and human suffering. To date, nearly 600,000 Americans have died as a result of COVID-19.

Despite the early failures of the U.S. Government to lead or act during either of these viral pandemics, everyday heroes worked to answer the desperate calls for help from patients, providers, and their communities. One of the first specialized AIDS wards in the country was opened at San Francisco General Hospital using an all-volunteer nursing staff. Shortly after the formation of Gay Men’s Health Crisis in New York City, the oldest AIDS organization in the United States, nurses offered volunteers trainings on basic caretaking skills. Over time, as HIV care transitioned to the outpatient setting and overburdened clinics, advanced practice nurses answered these calls for help and now play an integral role in the treatment and management of HIV in the United States today. Decades later, as COVID-19 wreaked havoc across New York City, more nurses answered pleas for volunteer assistance in the city’s overburdened hospitals than could be processed. During the last year, nurses across the United States stepped out of their outpatient clinics and lower acuity settings and into makeshift intensive care units to care for our country’s sickest and most vulnerable patients.

The AIDS and COVID-19 pandemics are merely two examples of public health emergencies where nurses have worked —proudly — on the front lines in their communities. While government leaders and policymakers may have been slow to respond to these crises, nurses were among the first to care and advocate for these vulnerable patients. Unfortunately, new threats to public health continue to emerge, almost daily, that further jeopardize the status of sexual and reproductive health care in America. Unlike AIDS or COVID-19, we as nurses know what these threats look like; we know how these threats will adversely affect the health and well-being of our patients. Taken together, these crises represent public health emergencies that require the same diligence and commitment to our patients that we have shown throughout history. The future of person-centered, quality sexual and reproductive health care in the United States rests on our shoulders.

Care During Crisis

The following is a summary of a conversation between Victoria Fletcher, MSN, ARNP, FACNM and Nikki Duffney, NSRH Director of Membership about the similarities from her history and lived experiences between the HIV/AIDS crisis and the COVID-19 pandemic. Edits have been made for length and clarity.

Victoria Fletcher, MSN, ARNP, FACNM is a certified nurse-midwife, NSRH founding member, and NSRH board member. She was contracted in 1990 to provide health education to healthcare professionals in the beginning of the HIV/AIDS crisis. Topics included etiology, transmission, prevention, treatment and caring for patients with HIV/AIDS. We sat down with her to discuss her experience working in healthcare during the HIV/AIDS crisis and COVID-19 pandemic, and what similarities and differences she has noticed between the two.

In the early days of the HIV/AIDS crisis and the COVID pandemic when little information was known, it invoked similar human reactions: stigma, shame, and fear. Health outcomes were driven by lack of evidenced based information, limited access to care, and health disparities. There are overlapping emotions that came to light as these two very different pathogens took hold of populations:

Stigma

Stigma toward the population that seemingly started it or had/has the highest incidence of infection was felt during both crises. HIV/AIDS saw initial stigma pointed at gay men and the LGBTQ populations, and Chinese people and government had the global finger pointing at them as the source or reason for the COVID-19 pandemic. Some even called COVID the “Chinese” virus, which can be directly tied to the increase in Asian-American Pacific Islander hate crimes.

Unknown transmission

At first, people didn’t know how HIV/AIDS or COVID-19 was transmitted and this ignorance led to fear, wide-ranging theories of transmission, and irrational ways to prevent transmission and to treat the diseases. Since there was early information about HIV/AIDS compromising immune function, the first AIDS patients who were hospitalized were cared for in protective isolation; staff and visitors had to gown and glove before entering their rooms to prevent a vulnerable person from contracting infections from staff or visitors. This changed as people received effective treatment for HIV/AIDS, hospitalizations were decreased and severe immune compromise avoided.

Having celebrities and athletes testing positive for HIV/AIDS gave the general population a different perspective on who could get the virus and how the virus could be transmitted. Magic Johnson, a pro-basketball player and considered a vision of health, revealed his status in 1991. Freddie Mercury died from AIDS related illnesses in 1992, the same year pro-tennis player Arthur Ashe’s status was revealed and traced to a blood transfusion. One year later Philadelphia, the first major Hollywood production on the topic of AIDS, was released.

Actor Tom Hanks contracted COVID-19 while filming in Australia in March, 2020. A study found that public opinion surrounding the then-new coronavirus shifted after he was diagnosed, with some individuals taking the coronavirus more seriously as a result. Most participants wrote that the virus now seemed like more of a serious threat in their minds, and one said they felt “panicked” because Hanks “is rich and protected. He can get it. Anyone can get it.” (source: Huffington Post, 2/6/21)

Lack of education

There was a surprising lack of education and research available to professionals. Treatment options available in both the AIDS crisis and the pandemic were under-shared and left people uncertain about their options. Studies have shown that it can take up to 10 years for new medical guidelines and practice standards to reach doctors and nurses and become the standard of care. That timeline must be shortened, as we don’t have the luxury of time in situations like the AIDS crisis or COVID-19.

With COVID, there is a similar lack of information about transmission and treatments. There are Rx options like monoclonal antibodies for people who test positive that could lessen the virus’ impact and prevent hospitalization and death. Many healthcare providers and potential recipients don’t know about this option, and the treatment modality is not universally available throughout the US. Where is the standardized training related to COVID-19? What education and training needs to be mandated and required for all healthcare workers?

I wish I could believe that similar diseases are not on the horizon and it would be another lifetime before we encounter novel diseases such as the two discussed above. What is needed are rapid cycle strategies to identify new potentially devastating infectious diseases, mechanisms to crack the code on mode of transmission, identify prevention modalities and evidenced based treatment options. Also required is a clear, accurate communication plan for healthcare professionals and the general public especially the most vulnerable populations. We need to broaden our definition of emergency response to include protracted crises that last several months or even years. If we can accomplish this and reside in a state of perpetual readiness, then there is hope that we can learn from past experiences and improve response to the next pandemic or crisis.

This story is shared to capture the personal experience and feelings of a nursing professional that has offered support and care through these two unique and difficult periods. 

Do you have a story to tell? We welcome you to submit your story or blog idea to us so we can feature you in our newsletter or on our blog. Email us at [email protected] or message us on social media @NursesforSRH.

How to Network to Build Community

Networking, community, connection, synergy, contacts, friends, colleagues, comrades, buddies, or companions. We have so many names and ways to categorize connectivity with other people, yet the basics of how to make friends and build relationships can be challenging for many of us. Why do some people buzz in the middle of the room or have a large presence on social media? Is it because they are better in some way than others? I think not; they have often done the hard work at some point in creating their community intentionally, and I’d like to share a few ideas of how this can be done.

Networking plays an important role for nurses. From attaining that clinical rotation and building a network of nurses to support each other in getting jobs, to specific needs like having a doctor vouch for you when working on a complicated medical case if you are an APRN. Networking in nursing can even affect how people are able to get care. Not to mention, nurses need community! When you’ve worked three back-to-back 12 hour shifts, it’s important to have people in your corner who understand what you are going through.

Here are 3 ideas that may be helpful in your work or social space to expand your community intentionally. 

  1. Show up in the places that bring like minded people together.
    • This can feel overwhelming at first since you could be showing up to a room full of people you don’t know (yet!). Take this first step and ease into connecting with others by asking questions, sharing experiences, or offering to help.
  2. Start asking questions.
    • Learning the group norms by asking questions can help set us up for success when building relationships. By understanding how the community interacts with each other, we are more likely to connect with others quickly.
    • Once comfortable with asking group questions, start asking people relationship building questions. These questions don’t need to be too personal; start with more generic, accessible topics. Easy examples can be:
      • What brought you to this group?
      • What do you do with your time outside of this group?
      • Why do you like to participate with this group?
    • Remember that we are all experts at ourselves, so asking someone an open ended question about who they are can show you some of the important factors in their life. We can ask about family, pets, hobbies, or sports & recreation.
  3. Be direct and ask plainly for your needs.
    • If you are looking to build a dynamic relationship that involves exchange of information or mentor/mentee opportunities, go directly for it!
    • Be transparent about your goals and interests
    • Ask pointed questions that get you results, that could be “What is your biggest challenge outside of time or money?”

Lastly, meeting new people and tending to young relationships is FUN! It can feel a lot like dating, and there is potential for let down or disappointment; however, the connectivity with a community reaps such great rewards. It is worth the minor risk.

Wondering where you can build community with like minded people? Join the NSRH membership to gain access to a trusted community of nurses disrupting the status quo to serve patients with dignity and care. We are here to support you.

Supporting Survivors

Anna Brown (she/her) is an NSRH member and our new Training in Abortion Care (TAC) Program Director! Outside of NSRH, she is also a forensic nurse examiner. We chatted with her about the role of sexual assault and forensic nurse examiners, providing trauma-informed care, and how nurses can better support survivors of sexual assault. 

Note: Small edits have been made for length and clarity. 

 

Explain the primary role of a Sexual Assault Nurse Examiner. 

 

In my current role, I’m a forensic nurse examiner. That is an umbrella term, and sexual assault nurse examining is within that, but we do more broad exams for anyone who experiences violence. So that can be intimate partner violence, domestic violence, stabbings, sexual assault, or anything under this umbrella of violence. 

 

On the day to day, what does that type of care look like?

 

For me right now, our program is based within a hospital. So we are within an emergency department, but I have also worked in a free-standing clinic. Anytime someone comes to the emergency room with a complaint of something related to violence, our team is there full-time, 24-hours to provide that care. We work with the primary medical team, but our exam is completely independent. Our team has a lot of autonomy, which is great!

 

Why did you choose to go into that type of nursing care? 

When I was in college, I worked at a sexual assault survivor hotline providing emotional support and referrals. That was my introduction into survivor work. Knowing that I wanted to go to nursing school and already having exposure to what SANE nurses do really inspired me. A lot of times when you’re in nursing school you don’t get exposed to these types of careers, but I was lucky enough to have been exposed to them. I knew that this was work I could do and was really passionate about already. 

 

Did your nursing school have this curriculum or did you have to seek it out on your own?

 

No, not at all. Not even like, “Hey, this is a thing that exists,” much less any access to the curriculum. The hospital that I worked at after graduating nursing school was in partnership with our free-standing sexual assault clinic. If for any reason a patient’s care was a little bit too advanced to be seen at a free-standing clinic, this was the hospital we would go to. I already had the vague understanding of it, but it was definitely something I had to reach out for. I had to reach out to the organization, and I had to seek out the training while I was working full-time. It's a pretty expensive training, and these things are not paid.

 

What is the training like?

 

The training to be able to start working as a SANE nurse: you do a 40-hour didactic (in-class) training, and then you have a clinical requirement. That can look different by program, but everywhere I’ve been is really multifaceted. So you have to watch a certain number of exams, and you have to be supervised on a certain number of exams. But you also do things like shadow the police, shadow a district attorney, etc. All of the kinds of places that a person experiencing sexual assault might have to engage with, we have to shadow so we understand the process that a patient might be going through. 

 

How does providing care as a SANE nurse differ from other types of SRH care? 

 

I think one of the big things that I've noticed is the level of RN autonomy. A lot of nursing advancement will come from advanced degrees that give you more scope of practice. Whereas, I have found in SANE nursing, typically it is you and the patient. Your care and the type of care you provide is completely in your hands. That is something very unique, this level of autonomy in creating the patient experience and doing what you think and have been trained to do. Even while working in an emergency room that has all levels of education, the default is to come to us about anyone experiencing violence because they know we have such specific training that you just don’t get in education. Doctors and nurse practitioners will come to us because this education really isn’t anywhere unless you’ve sought it out. 

 

Then, with the actual care that is provided, there is more inter-organizational work. In a lot of SRH care that I’ve provided, it’s unique to that patient coming to whatever facility you’re in. You do the care and there's maybe some referrals, but the care is pretty limited to that experience. Whereas with forensic nursing and SANE nursing, I have found that the relationships you have with other organizations are so important. This patient is already in acute crisis, and referring them to someone who might not be supportive or who is going to ask them to recount the story but can’t follow-up with resources is doing more harm than good. So, not only am I going to be providing this one-one-one patient-nursing care, but I also need to make sure to build relationships outside of this organization. 

 

So you have to work with people outside of the hospital?

 

Yes exactly. I’m very fortunate with the program that I’m in now; our nurse leader is amazing! They do so much to advocate for patients, and it’s been the first nursing job I’ve had where the whole system is tied together. They really focus on us being involved in advocacy and involved in state legislation to make this experience better for patients. I find that there is a disconnect a lot of times in nursing. We understand that laws impact what we can and can’t do and what our patients can and can’t receive, that’s obvious. But I’ve never been somewhere where it’s so connected to a specific piece of legislation that affects our patients and our jobs.

 

What are the similarities between SANE nursing and SRH care?

 

SANE nursing is SRH care. We are providing sexual and reproductive health care and because of that autonomy, we really have the opportunity to bring in the whole health. The patient came to us, and we are engaging because of a certain instance, but we can also broaden that topic to talk about sex, healing, mental health, and isues that were going on with sex beforehand. A lot of times for people, the SANE exam is the first time they are getting a pelvic exam, and that is a big piece to navigate. It involves explaining what I’m doing and how this exam is not the same as if they were to go to see a regular nurse practitioner or women’s health provider. Because there is so much acute trauma happening, it is really important to navigate consent very explicitly-on-going and all the time. On the flip side, working in other fields of SRH you experience patients who may or may not disclose that they are survivors of sexual assault, and that can change the type of care that is provided. 

 

Someone who experienced sexual assault may also have other SRH needs, so we need to make sure that the places we refer to are trauma-informed. I could never work in SANE nursing and not support things like abortion access because they are so directly linked. My support of abortion access comes from people who have experienced trauma and pushed on to survive and thrive. It is a piece of empowerment to be able to choose how their family and their lives look after power was taken away. They all bleed together. 

 

What is the most rewarding part of your job? 

 

A piece that most people don’t know is that these exams are so long (5 or 6 hours), so you’re with this person one-on-one for a very long time in a very acute situation. Noticing how the behavior has changed at the end of the exam is always something that is most rewarding for me. It encourages me to improve my practice and provide trauma-informed care. A lot of times in this job it is really, really hard to do exams like this with so much trauma happening and then [at the end] it’s like, “OK, bye.” Our clinic does follow-ups and phone calls on all of our patients, but it is hard to be so engaged with someone in such an honest way, then it’s done, and you go to another exam. Being able to see tangibly in the moment how the care you have provided has impacted this person and has the opportunity to impact that person is definitely the most rewarding. 

 

It’s Sexual Assault Awareness month. What would you want other nurses to know about people who may have experienced sexual assault? How can nurses be better at supporting them? 

 

I wish there was more conversation in nursing about what sexual assault really can be. A lot of times it gets watered down to just being a heterosexual rape, and it’s so much more than that. To be able to provide care for people who have experienced a spectrum of violence is something I don’t see talked enough about. Groping is sexual assault. Penetration with an object is sexual assault. Finger penetration is sexual assault. When we as nurses and healthcare professionals are leading the conversation just focusing on penile to vaginal rape, it really does a disservice to our patients who have experienced other forms of sexual assault.

 

If the healthcare profession is only portraying sexual assault as one thing, are people who experience other types of sexual assault going to come in for care? Are people who are engaging in other types of sex or who are LGBTQ going to come forward and feel supported in a healthcare system that has probably not validated them already? Probably not.

 

For example, in Georgia, the only thing that will qualify as a rape charge is penile to vaginal penetration, and that is common in a lot of other states. Part of that comes from the role that healthcare providers play in portraying what rape is, although that is not the only thing that impacts the laws, of course. So the reality is, in Georgia, if someone is choosing to report, it’s important for me to have conversations like, “This is what you define it as, and this is what the law is going to define it as.” I hate having to qualify and name their experience.

 

Do you have any resources for nurses who want to learn more about providing trauma-informed care to survivors?

 

In terms of sexual assault nursing specifically, look up the programs that already exist in the state (that’s if you’re fortunate to have more than one). Most places will have at least one sexual assault organization who is already doing this type of care, and that’s pretty much the only place for someone who wants to be trained in sexual assault nursing.

 

The Academy of Forensic Nursing is a professional organization that hosts weekly webinars and focuses on nurses at all levels. That’s been the place that I’ve gotten a lot of education, and it provides a community outside of potentially the other SANEs you’re working with. It can be a pretty isolating job because it’s typically just you and that patient. So it’s nice to have a community of other people who do such a specific type of work. 

 

For those thinking about learning how to provide trauma-informed care, Beautiful Cervix is a resource that shows pictures of cervices and talks about self-speculum exams. Also, consider following organizations committed to Reproductive Justice like SisterSong, Amplify, the Feminist Women’s Health Center, Access Reproductive Care - Southeast, and your local abortion fund. Honestly, healthcare is really lacking in trauma-informed care. Seeing how communities are talking about this and providing community-based care is how I developed awareness of trauma-informed care. Then I had to translate that and seek out specific healthcare resources for how to provide that.

 

We know that the past year has been hard on everyone, especially nurses. As we enter into May, which is Nurse Appreciation Week, we want to know: what do you do to practice self-care?

 

My program offers a non-religious chaplain, and they’re available 24/7 if we ever want to talk. That’s something that I personally don’t take advantage of, but it’s really nice to have someone who is there for you to unload on. Once I moved into this new forensic job, it was really important for me to make sure my program had mechanisms for encouraging self-care and support because this job is so difficult. It’s important to me to have someone in leadership reminding us that taking care of ourselves is important.

 

I personally take care of myself with a lot of quiet time. If an exam has been really hard or is affecting me in a type of way, I immediately write that down. I’m not necessarily doing a whole three-page journal session, but just writing down immediately how I’m feeling. This is what I have found has been the most hard about taking care of myself in this work -- people don’t necessarily want to hear about my exams and the trauma. And that is totally fair, I signed up to hear about and engage with people’s trauma, but the people in my life who would normally support me didn’t. I’ve had to learn that boundary, but that doesn’t mean that I don’t still have things that are going on that I need to get out and things that are affecting me from these exams. So I have found that right after the exam, jotting down what’s coming up for me is really helpful. If I want to revisit that later, great; if not, that’s fine. It's like a purge for me, and really identifying in that moment what is happening. 

 

I also don’t think self-care has to be something that you pay for. So like: do I want tea right now or do I want to just sit and read my book and have no stimulation. That is something I have found is really important because in these exams you are feeling someone’s crisis, and that energy is very palpable. It’s sensory overload, so when I come out of it I need sensory deprivation. I need quiet time, I need calm, I need no calendar events, no internet. It’s really time in my house, by myself.

 

Do you have a story to tell? We welcome you to submit your story or blog idea to us so we can feature you in our newsletter or on our blog. Email us at [email protected] or message us on social media @NursesforSRH.

 

Midwifing the Midwife

Lodz Joseph (she/her) is a certified nurse midwife (CNM) who works in Southwestern Georgia. We caught up with her to talk about her journey into midwifery, her experience being a midwife while pregnant during the COVID-19 pandemic, and her advice for nurses and midwives to be better patient advocates.

Note: small edits have been made for clarity and length.

 

To start, can you tell us about your journey into this field? What inspired you to become a midwife?

 

I was doing work overseas, and I was pretty much drawn to maternal and child health programming. Instead of designing big picture programs, I realized I just loved the one on one connection. So, I started getting exposed to experts in the field. Overseas, those experts weren’t necessarily the OBGYNS; they were highly educated midwives. So people who were trained at the doctorate level that could of course clinically manage, but then also design large-scale international programming. They were just amazing, and so I was like, “What are you guys doing?” I started hanging out with them and knew that midwifery was it.

 

And then I came back to the states, was a doula for a while, and then a breastfeeding consultant. Then I said, “Let me do the craziest thing I’ve ever done and become a midwife!”

 

What do you love most about being a midwife?

 

Patients. Hands down it’s the patients; it’s the people; it’s the stories. You walk into a room and you know that cliché: “if these walls could talk; these walls are sacred.” We joke. We also cry. I learn so much, and I hope that patients feel like they learn from me or that I advocate for them. I advocate hard. Sometimes post-call days aren’t enough to recover because you’re just so tired. So to me, it’s really just the patients and patient-centered care is what it’s all about. 

 

How has the COVID-19 pandemic changed the way you work?

 

One, COVID has become part of my spiel. You know, in the clinic I have a whole thing about COVID. It’s part of anticipatory guidance. If you want to have a conversation about vaccines or if you want printouts, we can talk about it. So COVID is forever there; it’s just what phase of the pandemic we’re in.

 

Then, in the hospital, depending on when I get that call, sometimes I definitely wait on a COVID swab result, especially because I’m pregnant. And at this point in my pregnancy, it’s a lot easier to not wear an N-95. I still have gear and everything like that, but we are allowed to wear a different mask. So for me, if you’re COVID unknown, I have to wear everything, even if my hospital says I don’t have to. 

 

The thing that has changed for me is laboring with patients and what their support looks like. But obviously, if someone is nine centimeters, I'm not going to wait for a COVID result before going in. If there are people who come in and they’re having their baby in the waiting room, we respond.

And has the experience of being a midwife changed throughout the past year during the pandemic?

 

For me it has. Once I disclosed my pregnancy, my colleagues I noticed were more like, “Oh my God, be careful! You have to go in there.” And I'm like, “Well, yeah, I’m on call today. You know, it’s not like I don’t have to see COVID patients.” So I think that’s a thing that people don’t realize: you’re still pregnant, and you still got to work. I think that’s another layer of stress. All I've wanted to do is keep myself, my family, and my unborn child safe. So far, I think I’ve managed to do that. But, it takes a toll on you because you want to be there for patients, but I also have to think about myself right now. And that’s just something that I think is more difficult. 

 

Has being pregnant shifted the way you approach midwifery?

 

Absolutely. Absolutely, without a doubt, I think that birth is this special thing. But, it [being pregnant] only confirms that, for me, this is not all I want to do. I knew it, but it solidified it for me. For me as a midwife, birth is not the only thing that’s in my job description or toolbox. It’s so much more expansive. 

 

People connect to me totally differently. But, you know, there are also people who have losses who see their provider still pregnant. 

 

We’re in a high acuity clinic, and we definitely are allowed to take care of very high risk patients as long as we are co-managing with doctors (just because the midwives take first call). And so as a result, I had a patient whose BMI was 80, and they were like, “Well how didn’t you gain weight?” And I was like, “Well let’s not focus on that.” A lot of people want to turn to my experience. I’m like, “I promise I will answer the questions after the clinic,” and my joke is, “I have pregnancy brain. I want you to ask all your questions and not waste your time on me.” And I think that makes them smile a little, and we can continue the visit. I just say that to say, people are looking at me with a closer eye.

 

And then, I criticize midwifery care a lot more. I have a lot more critiques of it because I am, as my spouse reminds me, already a statistic in many ways. 

 

And I’m getting my care from a midwife, of course!

Our theme for the month of April is trust. Could you speak to the importance of trust in midwifery?

 

It’s everything. Our patients trust us. I think what people don’t realize is that right now, the national standard for obstetrics is maybe like a D (pretty much an F), and so midwives kind of get a C. We’re like, “Midwives are so much better.” But we’re just barely passing. But, I do think when you are in a setting where the protocols, the space, the staff, and the team is here for what is best for the patient, patients feel that and they trust you. Because that’s what it’s about.

 

Patients are interviewing us. It’s part of my spiel as well. I’m like, “Don’t forget, I work for you. It’s not the other way around. I’m not the boss just because I have some letters behind my name. You’re always interviewing me, you know? My job is a lot harder than your job.” I try to tell patients that. That’s the foundation of what we have.

 

And, when we do wrong by patients, the first thing you gotta say is “I’m sorry.” I have zero tolerance for providers who say “It’s this patient’s fault. They’re high risk, they’re overweight, they didn't come to prenatal care, or they were uncontrollable when I was trying to do their repair.” It’s like, those are all excuses. Because I can tell you, there is a different way to do it. There is a different way to model. And once you commit to that, almost unlearning what you learned in your clinical education, you’ll forever see it. You may get tired. You may get fatigued, but once you know right, you do right by the patient. 

 

It’s definitely exhausting though.

April 11-17th is also Black Maternal Health Week. With this in mind, what tips do you have for midwives and nurses to step up and challenge white supremacy?

 

First, you gotta acknowledge it. That’s the first thing. Don’t go to all the training sessions when you’re like, “I don’t believe it; I just need the certificates,” because that’s just BS. First acknowledge it.

 

Two, you have to do the work, but you have to understand that there are people that are tired. Like, I want this solved yesterday, but there are people that are like “Just go slow. Just go slow. It’s OK.” And what we have to understand is that the maternal mortality crisis happened on white midwives’ watch. And the thing that is so unsettling is that no one wants to take responsibility. And yet, BIPOC midwives are held to this higher standard of like “how are you going to solve this crisis because it’s your problem?” 

 

Three, talk to your patients. I mean really talk to them. As a nurse, patients should love you because you’re spending so much time, definitely in the hospital setting, with the patient.

 

It’s going to work patient to patient. I think people want us to dismantle this whole system, which I totally agree with, but if you can’t treat the person in front of you with that dignity and respect that you do your colleague, or you do patients who come from maybe the private practices, you’re not doing the work. To me, it doesn't have to be so performative. It’s these small, consistent steps, and then it’s building on that. It goes from individual, then group, then community, then systems. But you have to want it, and that comes with acknowledging it first. 

 

How can nurse midwives be braver in advocating for patient’s health and safety in the event of a birthing related complication?

 

Being vocal! Again my experience is primarily in the hospital in a high acuity setting, and I think it’s really important not to use that as an excuse. I want you to understand the practice that I am at: if patients miss appointments at other clinics, they get dismissed and they are sent to our clinic. If they are underinsured, have Medicaid, or have no insurance, they are sent to our clinic. Providers won’t take them in the area. We cover over thirty counties. We also have patients from Florida, Alabama, and Georgia who come to see us, so it is a lot of patients! And it is not an easy job. 

 

One of my friends just sent me this quote, and I want to share it with you right now.

“If you’re not the truth teller in the room, you can at least be back up for them. If you aren’t going to be the first domino, be the second.” - Luvvie Ajayi Jones

 

She was like, “You’ve always been the truth teller in class and in what we’re doing.” It can’t just fall on one person to be the most vocal. We all have to be vocal, because that’s how we advocate for patients. 

 

And I think for me it is also deep thinking. When I have time off, I get to replay things in my mind, that’s just my personality. I get to learn from that. There has to be room in this, what Dr. Stephanie Mitchell says, the “medical industrial complex.” As a midwife, I need room to grow. I need room to support my patients, to protect and advocate for my patients. I also can’t be penalized for every single thing. That is where so many Black midwives are. We are responsible for BIPOC people, and that responsibility is not put on white midwives. We’re responsible for ending systematic racism, which is not a realistic goal. And then we’re responsible for bringing our A-game clinically, but we are not OBGYNs. We can’t be doing it all. It is unfair. 

 

Recently, at the end of the day (that’s the time I tend to talk to new and student midwives, they can call me while I’m charting in clinic), there was a midwife who was like, “You know I really don’t like conflict in the workplace.” And I was like “Oh, I don’t have that luxury. I just don’t have that luxury.” She was venting about stuff that our colleagues are doing, but she didn't want to deal with the conflict. I was like “I actually don’t think I can help you,” because you have to go through conflict or uneasy conversations for growth to happen in your practice.

 

What are some ways that nurses and midwives can better listen to and honor the lived experiences of their patients, especially for Black people and people of color?

 

Oh, this one is easy, especially as a pregnant person now. Stop telling me everything is normal. There is a very big difference between reassurance and dismissing. Sometimes that dismissing can come off as condescension. 

 

My midwife reassures me and assures that I feel comfortable and vulnerable to ask the questions I'm embarrassed to ask, even as a midwife. That’s what our patients are coming to us with. I think that’s a big one. 

 

I’ve heard nurses say the most ill things of patients, like, “Can you believe she doesn’t know that?!” But then that same patient is blamed later. There’s just this dismissal, and it’s so nonchalant.

 

I think the biggest thing is just listening. You will know when your patients feel vulnerable. If patients don’t feel vulnerable with you, that may be a sign that you’re doing the minimum. And there’s a pot for every lid. So it’s not like I'm going to get some award like all my patients love me. But what my patients can say is that “she listens.” There is really something about listening to people and helping them solve their problems. And reassuring them. So I think that’s really our role, because pregnancy is freaking scary. Even if you have ten kids. My one patient said, “It’s my seventh time, but I still got questions.” If she has questions as a seven-time mom, I know I’m not crazy as a first time parent.

 

Are there any last things you want to share?

 

Well there are so many resources....

 

Read:

Killing the Black Body by Dorothy E. Roberts
Medical Aparthied by Harriet A. Washington

Watch: All My Babies (film featuring Mary Cooley)

 

Follow:
@the.birth.sanctuary
@thevaginachronicles
@anayahrose
@blkbfingweek
@bridgemidwifery

And once you do those things, you won’t automatically be “woke” or all of a sudden be an “ally.” But it will show you how some people enter the medical systems. I think that is something people can’t lose or take for granted. That’s the nuance of being a healthcare provider. Because nuance is what’s going to tell you the difference between health - all these things aren’t going to be black and white, all these diagnoses aren’t going to be black and white. We want to believe that racism is black and white and sometimes it is, but a lot of times it isn’t. 

 

Do you have a story to tell? We welcome you to submit your story or blog idea to us so we can feature you in our newsletter or on our blog. Email us at [email protected] or message us on social media @NursesforSRH.

 

From Patient to Abortion Equity Provider

Ashia George, RN is an abortion care nurse, labor and delivery nurse, board member at Abortion Care Network, and co-leader for the Michigan cluster of Reproductive Health Access project. This month we talked to Ashia about her journey into the SRH field, abortion equity, and the ways COVID-19 has impacted her work. 


Tell us about your decision to become an abortion provider: How did you end up in this role?


My journey to becoming an abortion provider started with my own abortion story. I was raised in a Catholic household, went to Catholic school, and at an early age was taught that abortion was a selfish and evil act. In high school, I transitioned from private to public school. At 17, I started working as a medical assistant for a family and internal medicine practice. At 19, I became pregnant with my first child and had a very difficult labor that ended in an emergency C-section. My son was born, and my life changed overnight. A year later, I became pregnant again. I immediately knew I didn’t want to be pregnant; I didn’t want to risk another C-section; I didn’t want to have another baby at that time. I realized everything I was taught about abortion was wrong. I knew having an abortion was the best decision for myself and my family. I made an appointment with an abortion provider near my home and had my first abortion on my 21st birthday. At my appointment, I remember feeling so thankful to have the service available to me, and when it was finished, I felt so relieved. After my birth and abortion experience, I knew I wanted to work in sexual and reproductive health. In 2013, I was hired as a clinical assistant at Scotsdale Women’s Center, an independent abortion clinic in Detroit. In 2014, I gave birth to my daughter, and the next year I had my 2nd abortion. At the clinic, I worked my way up to a leadership position and also became a Registered Nurse. Now I am a manager at Scotsdale Women’s Center, a staff nurse on Labor and Delivery, a board member of the Abortion Care Network, and co-leader for the Michigan cluster of the Reproductive Health Access project.

 

 

What is your day-to-day like in your job?


At the clinic, it is my job to ensure every patient is prepared for their medical or surgical abortion. I am also responsible for ensuring patient safety. I perform assessments, ultrasounds, lab testing, administer medications, and I counsel patients. I am knowledgeable and efficient in all clinic areas, and I am able to step in wherever needed. I help supervise and teach staff, and I also help create and update clinic policies and procedures. At a hospital in the same community, I work on labor and delivery. There I care for pregnant people during labor and birth, and I also provide newborn and postpartum care.


How has your work changed during the pandemic? 


Work during the pandemic in general has been different. It has been stressful, scary, enlightening, productive, and grounding all at the same time. In the beginning, resources were critically low, and there were so many unknowns; everyone was paranoid about getting sick. In worst cases, some states tried to block abortion access, and some clinics had to close. Social distancing has been a big change because we are so used to holding hands, sharing hugs and wiping tears. On a positive note, even with all the changes and fear, we were still able to provide exceptional abortion care to patients in the midst of a global pandemic. COVID-19 really showed me how resilient and dedicated abortion providers are. When faced with adversity, abortion providers are leaders and innovators who are capable of all things.


What are some things you’ve learned in your line of work?


During my career I’ve learned that everyone is on a different but important life path. Bodily autonomy and reproductive justice are essential for individuals and communities to heal, thrive, and be healthy. Spiritually, my career has affirmed my belief that birth and abortion are normal cycles of life. I believe there are diverse levels of consciousness, and life continues after physical death. Energy doesn’t die, it transforms. When we experience physical death, we transform into a higher level of consciousness, free of ego, pain, fear and despair.  


What do you love about being involved in this kind of work and activism?

  

What I love most about being involved in this work and activism is the validation it provides. I feel a strong sense of community service and social justice. Everyday at work I feel like I’m helping make a difference in someone’s life. Every patient I care for is special and important, and they all have their own story. It is an honor and privilege to care for people during some of their most sacred and vulnerable experiences.


What does equity in abortion care mean to you?


To me equity in abortion care means intentional, intersectional and accurate representation and support for pregnant people in need of abortion care. With special recognition and resources for underserved groups and communities.  


How do you take care of yourself/practice self-care?


Nurses are known for putting the needs of others before our own. There is no doubt self-care has been a challenge for me over the years, but I am getting better at making time and space for myself. I realize I am not able to help others well if I am physically or mentally breaking down. I find that staying hydrated, getting adequate rest and laughter helps me feel calmer and less stressed. I also enjoy being outdoors, meditating and breathing fresh air, it helps me relax. 


Do you have a story to tell? We welcome you to submit your story or blog idea to us so we can feature you in our newsletter or on our blog. Email us at [email protected] or message us on social media @NursesforSRH.

Black History Month Media List

By La Rainne Pasion

This month we're starting a media list of Black-led healthcare and reproductive justice podcasts or news outlets that we LOVE to listen to and learn from. Will you help us? Send us your favorites to [email protected] or tag us (@NursesforSRH) on social media, and we'll add them to this blog!

Podcasts

  • Coochie Business: “Podcast that discusses coochies in general, and Black Coochies in particular”
  • NATAL: “Podcast docuseries about having a baby while Black in the United States”
  • The Sex Agenda: “Created by Decolonising Contraception collective, an interdisciplinary collective of Black and people of colour, working across sexual and reproductive health (SRH); each episode gives a round up of sexual health news, social justice issues and focuses on the work of those addressing inequalities within our sector”
  • Therapy for Black Girls: “A weekly chat about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves”
  • Black Feminist Rants: “Conversations on Reproductive Justice and Activism is a podcast that centers the experiences of Black women and femmes navigating social justice spaces and the world”
  • Black Voices in Healthcare: “Over 200 Black healthcare workers from across the country signed up to participate in this project, which aired for ten weeks from June through September 2020, and highlighted stories of racism in the workplace, as well of stories of Black joy, Black love, and Black excellence”
  • Birth Justice NYC: “A space for dialogue and debate addressing one of New York City’s most pressing public health and racial justice issues: birth”

News outlets and websites

  • 21Ninety Wellness: “Part of Blavity's network, 21Ninety’s Wellness page provides health news for African-American millennial women”
  • Black Health Matters: “Provides information about health and well-being from a service-oriented perspective–with lots of upbeat, positive solutions and tips, including: Health, Beauty, Mind & Body, Nutrition & Fitness
  • MadameNoire Health: “Black women seek information on a wide variety of topics including African-American hair care, health issues, relationship advice and career trends - and MadameNoire provides all of that”
  • Black Voice News: “With a focus on advocacy, solutions-oriented and data-driven reporting, the Black Voice has addressed issues from disparities in health, education and wealth to police violence, social justice, and civil rights battles”
  • The Black OBGYN Project: “We are Black ObGyn doctors on our journey through residency while promoting anti-racism, equity & inclusion partnerships:”