Are You Mentoring Someone?

Are You Mentoring Someone?

One of my greatest pleasures in life is being a mentor to the next generation of nurses (not all of them, obviously!). I’ve learned over the years that the mentor/mentee relationship should be taken seriously. Mentoring relationships have often grown organically in my career. Though they are informal in nature, they provide a touchstone, an outlet, and a path for success to the mentee.

One thing you have heard in this career is that nurses eat their young. I’m not convinced that this is unique to the profession. Look around you and you’ll see someone in need of a helping hand in their life, and I’ll bet you have something to offer.

Here are 10 ways you can make the most out of your mentoring relationship.

1. Start by taking inventory of yourself.

What are your strengths and weaknesses as a nurse? With experience can come bad habits, corner cutting, and sloppiness. You don’t want to pass those on as wisdom. Conversely, I’ve gained deeper insight into the process of nursing, how to work within a system to promote change, how to put patient safety and outcome at the top of my priority list. These are the things I want to share.

2. Model the behavior you want to see.

I hate to say it but anyone can talk the talk. Oddly enough, I found that hand washing is a great silent instructional tool to model the correct behavior. There are plenty of nurses modeling bad behavior, but it only takes one person to do the right thing for it to catch on.

3. Be quick with praise.

The new nurse often works in a vacuum of praise. They are just expected to always be correct. I point out the correct behavior when I see it. That moment of reinforcement will last a lifetime. I’ll bet you can think of a time when someone praised you.

4. Don’t let a bad habit take root. 

Gentle correction like, “You are doing great. I can see why you did it that way, but let me show you the right way… and here’s why.” The trick is to give constructive criticism in a way that works to change behavior without humiliating the receiver. One humiliation can sour a relationship. I never give correction in front of other people. I just don’t do it. Gentle correction in private is the way to go.

5. Be willing to learn.

Medicine requires a lifelong commitment to learning—and not just doing CE’s to renew your license every few years. Every day I find some new facet of my practice where I don’t know something. How does this medicine work? What is the natural course of this disease? What is the meaning of this lab value? Modeling to my mentee that I’m a learner encourages him/her to be a learner as well.

6. Be comfortable enough to share your mistakes.

We’ve all made them. I let my bad experience be a learning tool for my mentees.

7. Show the wonder of medicine.

Enthusiasm, excitement…these things can die if not frequently watered and fed. We have so much pressure on us as nurses that we can forget to see that caring for another human is a wonderful experience. The human body is an awesome machine for carrying around our mind. Even in great states of stress or disability, it can surprise us with its tenacity. It can also surprise us with its fragility.

8. Invest time in your mentee.

Time is all we have on this good earth. It’s my most valuable gift and when it comes to mentoring, I give it freely. Someday, one of these young nurses is going to be caring for me, and I want the compassion that I have for my patients and my craft to be reflected in the next generation of nurses.

9. Have fun.

If you aren’t laughing, you aren’t alive. Caring for the sick and injured at the bedside is tough cookies. Having a ready joke, seeing humor in difficulty, smiling…these are valuable coping tools that I use daily.

10. Finally, be compassionate.

It’s our most valuable asset. Having compassion for our fellow humans sharing this journey of life helps give us meaning. Compassion leads to love, and kindness, a desire to understand the plight of others, to intercede in tough circumstances, to be a good servant to mankind. That’s what we should want to pass on to the next nurse.

Don’t let a mentoring opportunity pass you by. You’ll find, like I did, that being a mentor is fun, rewarding, and a two-way street. I get 10 times as much as I give.

Understanding Patient Sexual Orientation, Gender Identity, and Expression (SOGIE)

Understanding Patient Sexual Orientation, Gender Identity, and Expression (SOGIE)

How often should a man get breast and cervical cancer screenings? Should a woman get screened for prostate cancer? The answer to these questions and more depends on knowing if your patient is transgender.

The Williams Institute estimated the transgender population in the United States to be 1.4 million in 2016. A recent study in Minnesota of 9th and 11th graders found nearly 3% of students identify as transgender or gender non-conforming. When it comes to health care, are we ready to meet these patients’ needs? Several cases where a transgender or gender expansive person was not properly identified or their provider simply was not aware of issues regarding transgender individuals have been in the news lately.

My county hospital is rolling out changes to our HIMS to try to capture this complete information on all of our patients, including transgender and gender expansive patients. These questions are called SOGIE, which stands for Sexual Orientation, Gender Identity, and Expression, and we ask them at intake:

  • What is the sex listed on your original birth certificate?
  • What is your gender identity?
  • What is your sexual orientation?
SOGIE

Source: Benny O’Hara, Office of LGBTQ Affairs, County of Santa Clara

Our initial goal is to capture 10% of our patient population with rolling increases as we move forward. In the hopes of meeting all of our patients’ needs we will ask these questions just one time over the patient’s lifetime. However, the patient can initiate changes at any time in the future.

Our LGBTQ patients can have health issues that are occult if we don’t have correct data. A female-to-male, or FTM, person with residual breast cancer did not know he needed breast cancer screenings. By the time it was diagnosed, the cancer was advanced. Another patient, male to female, or MTF, did not discover her prostate cancer until it metastasized to her bones.

What are the barriers to care for transgender patients? The first is the patient’s comfort with disclosing information about their sex assigned at birth and current gender identity. For a variety of reasons, transgender and gender expansive patients might not trust their caregiver or the health care system in general. A person who has transitioned has spent a great amount of personal capitol to live the life they need to live. It’s not a lifestyle change. It is the core of a person’s being.

A 16-year-old patient who has made the transition from female to male tells me, “I’m not transgender. I’m a boy.” He does not identify as transgender. Practitioners find this a common outlook in their transgender patients. Some transgender individuals may feel that they have always known their gender, and that it was society and other persons who incorrectly assigned or perpetuated a gender identity on their behalf – one that did not ring true for them.  Sharing of this information with a caregiver who is not familiar with the patient might not happen if the patient is not trusting or believes the information is not germane to the situation. For a primary care provider not in the know, this creates problems with preventative care with serious consequences. The SOGIE questions start a conversation that might not otherwise have occurred.

Another barrier is on our side of the street. Are we comfortable asking a patient if they are gay and/or transgender? While rolling out our new SOGIE questions, we find push back in unlikely places. Care providers and nurses at our in-service had these objections:

“My patients will be insulted.”

“Patients of some cultures will be offended if I ask that.”

“Some patients will not understand the difference between sexual orientation and gender identity.”

“This will take too much time.”

For some, a supposed patient objection is a mirror of their own feelings. “I would be offended if someone asked me if I’m gay.” For others, cultural taboos of their own might get in the way. Are we projecting our issues onto our patients? Personally, I’m excited to see my patients’ reactions to the questions and I look forward to educating them on the meaning of the terms. It’s a valuable tool to identify health care needs and an opportunity to destigmatize a subject that might seem uncomfortable.

You can’t tell if a patient is gay, straight, or anything else just by looking. The original birth certificate does not indicate the patient’s current sexual orientation. Often, a transgender person will legally change their birth certificate to reflect their correct gender identity. We just don’t know by looking at a person or their documents what gender identity or sexual orientation they are. Health issues can’t be addressed if we don’t know.

Annette Smith, a nurse at Santa Clara Valley Medical Center in San Jose with 35 years of experience, has insight into changes in practice like the new SOGIE questions: “At the beginning, there is a lot of push-back. ‘The sky is falling! The sky is falling!’ But after a while, the process becomes normalized and it’s not a big deal. We end up wondering what all the fuss was about!”

East Meets West in the Bathroom

East Meets West in the Bathroom

A patient needed assistance in the bathroom.  An elderly, obese, female with Lupus affecting her legs and hips needed help transferring from her electric wheelchair and some assistance with hygiene and buttoning her pants. It’s something I’ve done a million times and I didn’t think twice about it. What happened later made me think about the differences in cultures between India and the United States and how to approach these differences when they come up with someone in the workplace.

After the job was completed and the patient gone, the episode came up in conversation between the patient’s doctor, who is from India, and myself. While she didn’t exactly dress me down, she was very firm that clinic nurses were not supposed to help patients in the bathroom. She gave me several reasons:

“The patient takes care of herself at home. Why do you need to do it here?”

“If the patient has a caregiver at home, where is the caregiver now?”

“What if you get injured, who is going to take care of you?”

“If you help her in the bathroom this time, she will expect help every time she comes.”

I thought about this conversation for a long time. Without a doubt, I was correct to help the patient. This I know. It’s required by the nursing oath, and it’s required by my own moral code. Why did this doctor see things so differently?

Indian society is rigidly stratified by religious and socioeconomic class. At the bottom are the untouchables who work with waste. This stratification was formalized during British rule with some 60,000 different classifications. With this in mind, I realized that my doctor was actually trying to protect me from performing work outside my caste, which would be degrading to me. From my point of view, all people are created equally. As a nurse, when someone asks for help, I don’t have to decide if that person is worthy of my help or if performing a task is outside of what is permitted by my caste. I just do it.

From the doctor’s point of view, I was performing a task outside of what is permitted by my caste and performing it for a person who is of lower status than myself. I was breaking social norms, degrading myself, and degrading the clinic and other nurses whom she expected would not perform such duties. After doing some thinking, I can now appreciate her point of view, but it is not my point of view. The tricky part is how to address it in the future in a culturally sensitive manner. I don’t want to insult my doctor. She is in a position of power over me. I don’t want to break my nursing oath or my personal moral code to always offer assistance when someone asks. In this case, I’ve decided to simply not bring it up again. I will continue to perform my nursing duties as I always have without mentioning it. I will respect my doctor’s culture by simply avoiding the subject in the future. In a perfect world where I’m king, I would explain to the doctor my point of view and expect her to change her point of view to suit my own. However, the world is not perfect, and I’m not king. So respect, cultural sensitivity, and work relationships will win out over my personal feelings.

Reassessing Male Behavior in the Workplace

Reassessing Male Behavior in the Workplace

I’m orienting as a charge nurse at a clinic. A middle-aged gay man (well, late middle age), surrounded by young women. Something odd happened that I want to share. My clinical partner, a charge nurse with 35 years of experience, pulled me into a room. “I’m going to tell you something awkward. Some of the nurses have said they feel uncomfortable when you touch them on the shoulder.”

You could have knocked me over with a feather. I honestly didn’t remember ever touching anyone and said as much. However, later that same day I actually caught myself just as I was about to touch a coworker on the shoulder and say, “Thanks for helping me with that patient.”  So I had touched someone….without their permission, without thinking about it.  I really had to rethink my behavior toward the opposite sex in the current climate.

Women are finding their power. Things that might have slipped by in the past are no longer going to get a pass. Frankly, I think it was a long (centuries) time coming. I hope it continues. I know it will. I’m excited to live in a time where women’s rights and female empowerment is in ascendancy.

I guess I just thought that being gay somehow made me immune from charges of sexual harassment (from women at least). This is just not the case. Harassment is in the eye of the beholder. If someone is uncomfortable with something, he or she has a right to their feelings, even if, from the other side, he/she/we may feel that nothing was done wrong (or at least intended). It’s hard to grasp, but important. Harassment is whatever someone says it is.

I admit, my feelings were hurt. I did not intend to make a coworker uncomfortable. My being gay or straight has no bearing on the issue of someone else’s feelings. I won’t argue that I didn’t mean to. I won’t say that I’m a hugger, or come from an affectionate family. Whatever my reasons for touching someone without their permission are not pertinent. All I can do is identify the behavior that caused the problem and fix it going forward.

Some might argue that the pendulum of women’s rights has swung too far. Anyone can say they feel harassed about anything. Any innocent touch, a pat on the back, is harassment and it’s just too crazy. That’s not the way to look at it. The #MeToo movement did not happen in a vacuum. It takes place in the context of an entire human history of women being treated as property and all that entails. There was a time when gay-bashing was, if not a national past-time, at least a frequent diversion, and I’ve been the victim of it several times. Gay rights didn’t happen in a vacuum, either. The broken body of Mathew Sheppard brings to mind exactly why we are fighting. Now, women are fighting.

What I’m saying is that I understand that women have a right to be seen and heard, respected, and not touched in the workplace. They have a right to pick and choose how they will be interacted with and what is appropriate. They fought for that right and continue to do so.

I’m glad that someone thought enough about me to point out something I could improve upon in my work life. I’ll keep an open mind, and my hands to myself in the future.

Standing Up for the Right to Be Ourselves

Standing Up for the Right to Be Ourselves

How do gay, lesbian, bisexual and transgender (GLBT) nurses handle the issue of their sexuality in the nursing workplace? Are they “out” at work? Do they encounter discrimination from patients and co-workers, and if so, how do they deal with it? Is their sexuality an asset, a liability or a non-issue when it comes to being a nurse?

As a gay man who is also a nurse, I am very interested in exploring these issues. I recently spent some time searching Internet nursing forums and came across a very enlightening thread. I’d like to share some of the posts with you.

The discussion began with a gay nurse asking other gay nurses for advice on how they deal with questions from patients about their home life, such as “Are you married?” The conversation quickly turned to more general comments on the broader issues of acceptance of gays in the workplace and being “out” versus “in the closet” at work.

From a nursing assistant and Army medic: “There is NOTHING wrong with keeping your personal life (whatever that may be) COMPLETELY apart from your work life. That’s what professionals do.”

A nurse in Texas responds: “That’s not the real world, professional or not. Keeping my personal life completely apart from my work life is what I attempted to do many times over, but. . .it only leads to more questions, more probing and just as much if not more gossip and stories about you. Not that gossip in the workplace should rule how you react to it, but in my experience it just ends up making things worse when you act vague and mysterious about your personal life.

“For me, it has always been a struggle between [how to deal with] the ‘if you’re gay I don’t want to know about it’ straight co-workers and the ‘inquiring minds want to know’ types,” the post continues. “For the latter types, fine. Here’s my oh-so-interesting gay life. Pretty ordinary and not much different from yours. For the former types, I’ve always found it interesting that the same nurses who fall into the ‘keep your private life to yourself’ category tend to be the same ones who constantly talk about their [spouses] and children at the nurses’ station all day.

“Can all of you [nurses] out there who insist that your private lives are completely separate from your professional lives honestly say that you never make any mention of a spouse or love interest to your co-workers, whether voluntarily or [in response to] questions from your peers? [Or that you] only discuss professional work-related issues with them?”

Another poster argues, “When I am at work, I am a nurse. I leave my personal life where it belongs— at home, not work! I would never engage in discussions about my personal life at work, because I am there solely to ensure that my patients receive the best quality care.”

A critical care nurse in Texas comments at some length: “I disagree that you can work in such close environs and not share some personal information with your co-workers. Establishing professional relationships requires some personal disclosure. [People] don’t live in compartments— professional here, personal there. If you withhold all [information about] personal relationships, you will have a problem with being considered aloof or cold—and that would affect your professional relationships.

“It has been my experience that most nurses’ stations are literal Peyton Places of personal information. I couldn’t see how you could hide who you are for long. The effort to do so would seem to me to just cause too much dang stress—. “Will some people be comfortable with [your sexuality] and others uncomfortable? Of course. You have to read each individual and [then decide to give or not give] details of your life based on [how accepting you think that person would be]. That’s not the same as saying that you should remain ‘in the closet’ to co-workers who would have a problem [with your being gay], but you can certainly de-emphasize your conversation [about that aspect of your life when you’re working with them]. The bottom line is: as co-workers we have to work together, which means some give and take on lots of issues, including this one.

“I would think that [in this day and age] most of your co-workers would have come to terms with this issue anyway. It is my experience that there is either a higher percentage of gays in nursing [than in other professions] or at the least, a higher percentage of gay nurses who are willing to be ‘out’ about it. As such, most of your co-workers should have had ample opportunity to ‘get [used to] it.’

“As far as patients go, your relationship with them is far more temporary. I would think it would be, if not appropriate, then certainly more convenient to not bring it up and only disclose that information rarely, [especially if you are working with older patients]. The older generation is much more fixed in their [biases and stereotypes], and a few days’ exposure to a challenge of those stereotypes is not going to change them, [especially if] they are sick enough to be in the hospital or a family member who is stressed over their loved one being in the hospital.”

What an interesting and revealing conversation! These posts shed light on some important issues that are all too often overlooked in discussions about the need for more diversity in the nursing workforce. Above all, they show that while GLBT nurses face many of the same biases and barriers to acceptance as racial and ethnic minority nurses, we must also deal with a whole set of other challenges that are uniquely our own.

To Thine Own Self Be True

As a gay RN who is now in his 40s, I have seen the incidence of homophobia in the workplace decline quite a bit in recent years. Of course, that’s partly because I moved from Georgia to more liberal California to escape some of that. But all in all, it’s a more accepting workplace.

Like other groups who are perceived as “different” by the majority population, GLBT people have had a tough time as a minority in society. I remember when I was in my 20s and saw my first gay bashing. Then, when [21-year-old gay college student] Matthew Shepard was beaten to death [in Wyoming in 1998], it put homophobia in the national spotlight.

Since then, many states and organizations have taken action to protect GLBT people from various kinds of discrimination, including employment discrimination. While it’s still legal in 26 states to fire someone because of his or her sexuality, another 25 states have laws on the books protecting homosexuals from workplace discrimination. Some of the gay participants in the abovementioned Internet nursing forum say they rely on their hospital’s code of ethics to protect them from harassment in the workplace.

As for myself, I’m out at work. I have a partner of six years and I find (some) men attractive. That’s who I am. I have a sexuality and while it’s not really part of my work life, I am not going to hide it in fear. It is just as beautiful and worthy of respect as any other part of me or anyone else. We owe it to the next generation to leave this world in better shape than we found it. I do that, in part, by fighting homophobia and promoting tolerance. I perform my nursing care in a nonjudgmental fashion and I don’t expect to be judged if my sexuality is revealed in casual conversation.

Nursing is, by its nature, a very personal profession. We perform embarrassing and sometimes painful procedures on people, and so our patients sometimes want to know a little bit about us. Accepting who I am allows me to better accept other human beings for who they are. Some people are in a mindset that requires some personal growth before they can be accepting of gays— or blacks, or Indians or any other minority. It’s not for me to shelter them from my sexuality and stunt their growth nor to judge them. I owe it to the world to be a good person and a worthy nurse who, among many other things, is an unashamed homosexual. I don’t accept intolerance and I point it out when I see it.

Based on those Internet forum posts, it would appear that the main concerns on the minds of today’s GLBT nurses are about disclosure— whether to hide or downplay their sexuality at work or to stand up for their right to be accepted as who they are. That this is still an issue clearly shows how laws against equality for gay people—such as the recent Proposition 8 in California, which took away same-sex couples’ right to marry—can be passed in this modern age. If gays are afraid to stand up and be counted in the workplace, then people who are on the fence regarding GLBT rights will never know who we are and what great people we are. They will never know what positive role models we are as nurses and as minorities fighting for acceptance in society. And most importantly, they will never know about the unique qualities, knowledge and insights we bring to the nursing profession and to patient care.

We bring compassion and a special advocacy for the underdog. We have known discrimination and the fear that comes from being different. GLBT nurses turn this into an ability to strive harder to meet the needs of minority patients and the underserved. We know what it’s like to have to work twice as hard as other people to reach the same goals. We cherish the things it takes us more effort to achieve, such as marriage, children and equal rights under the law. We respect people for who they are as individuals, regardless of skin color, gender, age or affliction. That’s what GLBT nurses bring to the nursing workplace. Now it’s time for us to step up and be recognized for those contributions. I urge all GLBT nurses to bring one more very important thing to the work we do: the willingness to stand up and be proud of who we are.

Just Published!

The Minority Nurse Spring 2018 issue is now available.

Improving Patient Care Through Unique Clinical Solutions

How Nurses Can Make Better Financial Decisions

 How to Protect Yourself from Stressful Work Experiences

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