While maternal outcomes have improved over the years, a considerable number of women in the United States die from or continue to experience a number of pregnancy-related complications. According to the National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], each year approximately 700 women die of pregnancy related causes while 50,000 women experience severe pregnancy complications. Women living with chronic conditions such as hypertension, diabetes, heart disease, and obesity are at a higher risk for complications during pregnancy, childbirth, and the postpartum period. In particular, African American women are more likely to die from pregnancy-related complications when compared to their white counterparts. Notably, maternal mortality is higher in the United States than in any other developed nation.
Severe maternal mortality is due to severe pregnancy complications. According to the NCCDPHP, these rates have doubled from 2000–2010 and have affected more than 50,000 women in the United States. Some contributing factors include: maternal age, persisting chronic conditions, complications during delivery, and pre-pregnancy obesity. Researchers note that approximately half of pregnancy-related deaths are preventable and point to implications for reducing maternal mortality.
Efforts to reverse these disturbing statistics will require a multifaceted and comprehensive approach. Interventions must include a focus on better data collection, quality improvement measures, provider and patient education, earlier identification and intervention targeting high-risk women, proactive preconception health approaches, and improved obstetrical and maternal care services. Many hospitals and health systems across the country are addressing the mortality death rates and have designed programs, which include some of the aforementioned strategies.
The rise in maternal morbidity and mortality has stimulated discussion and action among nongovernmental and governmental agencies, advocacy, and professional groups and the United States Congress. Groups such as the American College of Obstetricians and Gynecologists, Black Women’s Health Imperative, and the Alliance for Innovation on Maternal Health (AIM), to name a few, are speaking out for legislative action. The table below provides a brief snapshot of legislative proposals introduced at the federal level during 2018, the second half of the 115th Congressional Session. These and other initiatives are a critical first step to reversing the poor maternal health outcomes for women.
Nurses are encouraged to stay abreast of this issue by identifying the state of maternal health in their respective communities. Nurses wishing to improve maternal outcomes can do so by helping to identify high-risk populations and working with their respective institutions to develop educational programs, outreach initiatives, and quality standards for maternal care. As health care providers, nurses are well-suited to work with multidisciplinary teams to disseminate best practices as well as advocate for sound public policies focused on alleviating poor maternal outcomes.
Additionally, nurses can look to professional/specialty organizations to identify what organizations are doing to address maternal mortality. For example, the Association of Women’s Health, Obstetric and Neonatal Nurses, one of nursing’s leading organizations devoted to women’s health and newborns, has a number of resources on this issue and advocates for work that expands the work of state-based Maternal Mortality Review Committees. Maternal Mortality Review Committees are critical to collecting, reviewing, and monitoring data on pregnancy-related deaths.
Maternal Health: Proposed Legislation
||Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMA’s Act)
||Rep. Robin Kelly (D-IL)
||· Establishes an expert federal review committee to help enforce national obstetric emergency protocol
· Establishes best practices between providers and hospital systems
· Improves access to culturally competent care training and workforce practices
· Standardizes data collection to collect uniform data
· Expands Medicaid coverage to cover the full postpartum period
||Ending Maternal Mortality Act of 2018
||Rep. Raja Krishnamoorth (D-IL)
||Amends the Public Health Service Act to require Department of Health and Human Services to publish every two years a national plan to reduce maternal deaths occurring during or within 12 months of pregnancy
|H.R. 5457 / S. 2637
||Quality Care for Moms and Babies Act
||Rep. Eliot Engel (R-NY) / Sen. Debbie Stabenow (D-MI)
||Amends Title XI of the Social Security Act to improve the quality, health outcomes, and value of maternity care by developing maternity care quality measures and supporting maternity care quality collaboratives
|H. Resolution. 818 / S. Resolution. 459
||Black Maternal Health Week
||Rep. Alma Adams (D-NC) / Sen. Kamala Harris
||Creates awareness about the maternal health care crisis in the black community and the urgency to reduce maternal and morbidity among black women
Experts agree that mentoring is vital to your professional and personal development as a nurse. Good mentoring can lead to getting into—and through—nursing school, getting a great job, and getting into graduate school. However, as a minority nursing student or nurse, you may have little experience being a mentee and have many questions. Questions like: How do you approach a person you would like to have as a mentor? Do you only need one mentor? How do you know if you have a good mentor? Some minority nursing students and nurses have had mentors of the same culture or ethnicity as you and you may feel uncomfortable asking a nurse, instructor, or professor from an ethnicity or culture different from yours to be your mentor. The following tips may help you find a mentor and set the foundation for a rewarding mentee-mentor experience.
How do I know if I need a mentor?
All of us need a mentor. A mentor is an experienced person that advises you as you work to accomplish a goal or guides you through your education or career. As a nurse, there are many benefits to having a mentor. One benefit of having a nurse mentor is having someone who is impartial and can listen to you and give you direction. When your mentor shares their knowledge and experiences with you, you gain knowledge and insight. Thus, you can make choices, decide to gather more information, or even seek the advice of another mentor. Another benefit of having a mentor is often they will extend their network to you to help you. Many nurse mentors are willing to introduce you to other nurses that may be of assistance to you. For example, your mentor is a cardiology nurse and you are interested in going back to school to become an Adult-Gerontology Nurse Practitioner (AGNP). If your mentor knows one, they may often put you in touch with the AGNP because they cannot answer the types of questions you have about becoming one.
Many nursing students and nurses have more than one nurse mentor. You can have an all-round mentor, an education mentor, and one that is career specific, one that is research specific, and one that is a mentor in your practice specialty. You can have as many mentors as you need. It is better to find a mentor early in your nursing education or soon after you graduate because mentors are excellent recommendation writers for jobs or school because your mentor has listened to you talk about your aspirations and goals and can write about what they know about you.
The person I would like as my mentor is of an ethnicity or culture different from mine. Can that work?
Absolutely! In nursing, it can be very hard to find a mentor that is of your ethnicity or culture. It is perfectly fine to ask what has been their experience mentoring a person from a background different from theirs, what they learned, and what the challenges were. Keep in mind that you are deciding if this nurse will be a good mentor for you so ask what you need to know so you can make an informed decision.
How do I approach someone I would like to have as a mentor?
Before you approach your prospective mentor, think about or write down why you would like to have them as your mentor. It does not have to be elaborate. It could be that you aspire to be like them and you want to get their advice. It could be that you are interested in the type of nursing practice or research they do, and you want to shadow or work with them. Whatever your reason is, make sure you can concretely express it. Your potential mentor wants to know how they can help you. Remember, mentors are agreeing to share their time with you and they do not want to waste your time either.
Next, you should contact them by sending an email or calling them. When you contact them, you should let them know what you want and why. After an email response or call, you should ask to meet with them to begin the mentor-mentee relationship. This meeting can be over the phone if meeting face-to-face is not possible. This meeting is important for the two of you to get to know each other.
They have agreed to be my mentor! How do I prepare for our first meeting?
There are three goals for your first meeting. One is to have your mentor get to know you; the second is for you to get to know your mentor; and the third is to define your mentee-mentor relationship. In some cases, where a deadline or project is involved, a timeline may be necessary—and that is your fourth goal. There is no way for you to know everything about your mentor and for them to know you in one meeting. The important topics should include: where you are from, why you chose nursing, your goals and aspirations, and why you believe your mentor can help you. You should ask those same questions and add a question about why they choose their nursing career path, and their current goals and aspirations. Having this conversation is an excellent way for you and your mentor to connect and begin to build the foundation of a good mentee-mentor relationship.
Defining the mentee-mentor relationship should be the focal point of the first meeting because it establishes the foundation of your interactions. It defines what you want from the relationship and leads to the discussion on how to make your mentee-mentor relationship work for you both. There are three areas to cover in defining the relationship; the first is deciding whether the mentee-mentor relationship is formal or informal. An informal relationship does not require much work. Usually a verbal agreement to stay in touch with some regularity and the person agreeing to be your mentor is enough for an informal mentee-mentor relationship. A formal mentorship is usually in writing because it usually entails a project or deadline. Mentee-mentor relationships can go from being informal to formal and from formal to informal. Communication between the two of you is essential to navigating that part of the relationship.
Second, you need to decide how often you are going to meet. In informal relationships, this could be as needed or once a month. In a formal relationship, the frequency of meetings is often defined by what the project or deadline is.
Third, you must decide what type of meetings you are going to have and how long will they be. Again, in an informal relationship that may not be necessary as you will not be meeting frequently, and you can set the length of the meeting as it fits you and your mentor’s schedule. In the case of a formal relationship where regular meetings are necessary, the length of the meetings are important so that the appropriate amount of time can be set aside. In a formal mentoring relationship, an agenda or key discussion items are sent to your mentor in advance of the meeting. The agenda helps keeps you both on target.
In the case of most formal relationships, a documented timeline (i.e., a beginning and end) of the relationship or project is established. In establishing a timeline, you incorporate meeting dates, dates when you will send something to your mentor, and the timeframe when you should expect their feedback. When you do this step early in the relationship, it tends to keep everyone on task and on target. Of course, things happen, but it is important that each of you honor your formal agreement and renegotiate timelines as needed.
What do I do if my mentor is not a good fit for me?
Do not worry. Sometimes, the mentee-mentor match up does not work out as planned due to timing, different approaches, communication, and personality, among other things. Being an expert nurse, professor, or nurse researcher may not always mean that they will be a good mentor for you. If after your initial meeting or even after multiple meetings you find that you and your mentor are not a good fit, then the professional way to handle it is to end it. In the case of informal relationships, it is easier since there is no agreement for regular contact. However, it is best to thank your mentor for their time when you end the mentee-mentor relationship. In the case of a formal mentee-mentor relationship, a call, email, or letter is the most professional method to end it. Again, if you have spent time with your mentor, you should thank them for their time and what you state after that should be very professional, honest, and give at least one reason you no longer want to have a mentee-mentor relationship with that person. Keep in mind that if this is a person working in your career field that you do not want to “burn bridges,” so a scathing email or letter is not professional. When in doubt about what you have written, ask another trusted mentor or colleague.
How do I know I have found a good mentor?
Inc.com give us seven key qualities of an effective or good mentor. The seven key qualities are:
- Ability and willingness to communicate what they know. A good mentor is able to make complex concepts and issues easy (or easier) to understand. A good mentor is open to sharing all the “secrets” of success with you in an effort to help you succeed. You just have to be open to listening and learning.
- Preparedness. As a mentee, you should have an agenda or at least tell your mentor what you would like to discuss before you meet so that your mentor can be prepared. A prepared mentor has given thought to your questions or topic and is ready to have an efficient and directed conversation with you.
- Approachability, availability, and the ability to listen. As part of the first meeting, you as the mentee have set up dates and times with your mentor and your mentor should keep those commitments and be ready to listen.
- Honesty with diplomacy. A good mentor is going to be honest about whatever you are discussing. Being honest with you should be done in a professional and tactful manner, especially if your mentor is giving you feedback or critique.
- Inquisitiveness. Your mentor may know a lot, but that does not mean they know everything. A good mentor is willing to learn new things about you and new topics. In essence, a good mentor is a lifelong learner.
- Objectivity and fairness. A good mentor is looking forward to helping you succeed and that is it. There are no favors involved. Most often, your mentor may give you networking suggestions or offer to give you the name of a person who may be able to give additional support or a “foot in the door.” However, an expectation of a job or anything else because of the mentee-mentor relationship is not part of a mentee-mentor relationship. In the case where you and your mentor are working on a project, publication, or other work related items, the way your mentor will be acknowledged should be finalized before the project begins. For example, if you are a nursing student working on a research project you should know if you would be listed on a conference abstract or publication. If you are leading the project, you should ask your mentor how they would like to be recognized on the project.
- Compassion and genuineness. Essentially, your mentor should be a good person. Being honest, fair, and objective does not equal mean and cold. A good mentor listens when you are having difficulties and is happy when you succeed. A mentee-mentor relationship is not a friendship; you may not be Facebook friends or follow each other on Instagram. However, a good mentee-mentorship relationship comes awful close to a good friendship and over time, who knows?
Taking the first step to establish a mentee-mentor relationship is usually on the mentee. Like any relationship, a good mentee-mentor relationship takes planning and having clear expectations and goals for the relationship. For minority nursing students and nurses, finding the right mentor and having a productive mentee-mentor relationship can be a daunting task when you have not had previous mentee experience and there are very few minority nurses to select as mentors. However, understanding how to establish the mentee-mentor relationship may make it less daunting and even more fruitful to enhancing your nursing career.
Last issue’s health policy column highlighted nursing’s increased engagement in the public policy arena. To continue this conversation, this column highlights a registered nurse running for Congress to help champion access to affordable health care. Yes, Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois is running for Congress to represent the 14th Congressional District of Illinois.
Her Journey to Pursuing an Elected Position
Underwood is steadfast and fiercely committed to helping shape policies and programs focused on ensuring that everyone has access to affordable health care. She is a registered nurse who received her BSN from the University of Michigan and her MSN/MPH from Johns Hopkins University. Her nursing experiences include service as a health policy advisor, research fellow, senior director, and research nurse at the National Institutes of Health Clinical Center. Her passion for public policy was heightened while serving as a health policy advisor in the Office of the Secretary at the Health and Human Services in Washington, DC initially under the leadership of Secretary Kathleen Sebelius followed by the leadership of Secretary Sylvia Burwell. In this capacity, Underwood worked on private insurance reform, summary of insurance benefits, health care quality in the Medicare program, the Agency for Health care Research and Quality, and preventive services (free screenings, immunizations, and contraceptive coverage) for four and a half years from 2010-2014.
Lauren Underwood, MSN/MPH, RN
Democratic Candidate for Congress, 14th Congressional District of Illinois
Tell us about working for the Obama administration.
Got a call the week that Mr. [Thomas Eric] Duncan was in the hospital in Dallas with Ebola asking if I would be willing to join the President’s team to help with disaster response, so I transferred over to ASPR, the Assistant Secretary for Preparedness and Response, at HHS. We worked on emerging infectious diseases (e.g., Ebola, Zika Virus, Middle East Respiratory Syndrome virus, or MERS), we also did national disasters (e.g., wildfires, hurricanes, floods) and then bioterror (small pox, anthrax) and worked with drug companies to develop vaccines, treatments, and diagnostics. I stayed in the administration until the very end, the last day. And so, when the election happened in 2016 we were working on the water crisis in Flint. I was surprised, and I thought that Hillary Clinton’s team was going to win and that we were going to hand off our work on health reform and on Flint to people who cared and wanted to continue the process. And then we got the Trump team who made it very clear they wanted to do away with health care coverage. And that’s not why I went into nursing or why I did this work. So, I knew I could stay in government and help them do that. I wanted to continue the work and so I came back home to Illinois because Illinois is a state that expanded Medicaid. I got a job working for a Medicaid managed care company in Chicago as the Senior Director for Strategy and Regulatory Affairs for a company called Next Level Health.
Are you still there?
I left my job about six weeks ago. The primary campaign was about eight months. I worked full time six and a half months; you know you have to do that. I am a young person, not someone of particular means or whatever, so it was necessary. And then it was like “Lauren, you could really win if you put your time and energy into the campaign.” And so that was an easy choice to transfer to full time.
So, you are now devoting full time to the campaign?
This reflects your journey. Describe in a few words what really made you run for an elected position.
I am going to tell you a story. Last spring when I returned home, I went to congressman Randy Hultgren’s one and only public event. It was a moderated event hosted by the League of Women Voters. And during that evening, he made a promise and said that he was only going to support a version of Obamacare repeal that allowed people with preexisting conditions to keep their coverage. That’s important to me as a nurse. I also know how critical it is for people with chronic illness to have access to medications and procedures that they need. Obviously, I worked to implement the Affordable Care Act so I read the law and I know that it works. I know that we can fix what does not work. We do not have to throw the whole thing away. Like so many Americans, I have a preexisting condition myself. I have a heart condition, SVT (supraventricular tachycardia), and it is well controlled. As you know, it is a preexisting condition, so I would not be able to get coverage under these repeal scenarios. And so, when the congressman made that promise I believed him.
And then a week to ten days later he went and voted for the American Health Care Act, which is a version of repeal that did the opposite. It made it cost prohibitive for people like me to get coverage. And so, I was upset not at the vote itself, but because he did not have the integrity to be honest the one time he stood before our community. That’s not what a representative is supposed to do. A representative is supposed to be transparent, accessible, and honest. And we deserve better. I said, “you know what, it’s on! I’m running” and launched my campaign in August and just won the primary on March 20th. I was in a field of seven—the only woman running against six men—and I won 57% of the vote.
Were you the only African American?
I know you are concerned about overall access to care and have a deep commitment to utilizing your expertise and experience while working in the Obama administration.
I believe that health care is the number one issue in this election across the country and in our district, and we need a solution to make health care more affordable for American families. It is not enough for families to rake together money for their premiums and have an insurance card in their pockets and cannot afford the coverage.
I believe that a lot of the conversation in the last several years has been political in nature and undoing President Obama’s legacy and not on at all focused on trying to lower costs and make health care accessible for American families. That’s my objective! I want to work on drug prices. I want to work on this opioid drug crisis so that loved ones can get the treatment that they so desperately need. And so, I believe there is a lot of value in having a nurse at the negotiation tables when we are making these decisions and passing policies that will transform our health care system. I am excited about the opportunity to be a leading voice on Capitol Hill on these important issues.
What do you think are the most pressing issues impacting nursing and health care?
Affordability. Any program that is starved of resources will fail. The ACA has been intentionally sabotaged and as a result, we see extraordinary high premiums that are unaffordable for most families. That is not how the program was designed to work and so I think there are technical fixes we can do to make the program more affordable. We can do things like negotiate drug prices, it can be done, we need to take a strong position on this opioid drug addiction crisis. We need to implement reforms like how we pay for rehab and how we award funds to municipalities in order to create a pathway for lasting change. And then there are opportunities to expand coverage so we will have fewer uninsured Americans. What we are seeing now in order to resuscitate it takes 2-3 doses of Narcan because the drugs are so strong. Municipalities who have received Narcan grants are running out of Narcan. A Narcan only solution is not a solution. Law enforcement only solution is not a solution. Addiction is an illness and we need to treat it as such. We need to send people to treatment so they can have a shot at recovery. We could have an evidence-based policy solution. We know treatment can be effective.
What do you think is the most pressing issue affecting nursing today?
I think there are a few things. The high cost of our education. We have not really seen increases in funding. What we have seen are marginal increases or flat funding. I think that this is unacceptable, in particular in the context of what we are seeing in higher education more broadly. And not just at the federal level. In higher education, many states have reduced putting money into public education, shifting the responsibility to families and individuals and with that coupled with flat funding for nursing education we are seeing a generation of nursing students with significant debt. And that is going to be a barrier, I believe, to our profession being able to grow. Right now, we have an economic situation where we are not seeing the shortage that we saw ten years ago. But it’s very easy to get back to that point if the economics of going into nursing shifts when you graduate from a BSN program with $100,000 in debt and are limited in your initial salary. Loan repayment programs are not that plentiful as they used to be. The economics of it makes it tough. Because we are talking about middle class folks who are not able to take on that debt. And when it is becoming increasingly attractive to become an APRN, that is all debt to be able to get the master’s to become a nurse practitioner or a nurse midwife. We are going to need some serious advocacy and a plan to deal with the cost of our education.
What are your thoughts about safe staffing?
It is so interesting. Safe staffing has been a legislative priority for decades. We have not been able to pass these bills. I think the approach needs to be more balanced with safe staffing committees in these hospitals. Moving away from these ratios and having hospitals have safe staffing committees that would take into consideration the circumstances that facilities and the region when staffing levels. On these committees, nurses would serve so a legislative body is not dictating it. I think that this is an appropriate approach coupled with compelling Medicare participating facilities to set staffing levels and monitor outcomes.
When elected, what would you do to go about helping to ensure equitable access to health care?
That’s like the question! For me, equitable access to health care allows everyone to get health care. Health care is a human right. Human rights have been fundamental to my nursing practice. It is written in our Code of Ethics—this idea that everyone should have health care—and I think our policies should reflect that. For me, that includes fixing the Affordable Care Act to ensure affordable coverage; and making sure we have clinics, hospitals, and facilities in communities so that the burden is not on low-income people or people with transportation challenges or resource limitations so that people are able to get the care and services they need. We have so much innovation, technology, and so many improvements now in a way we are able to provide care whether it’s telemedicine or individualized health care. It is a shame if all of that innovation and all of those improvements are seen in resource communities. We need to be focused in these conversations about reform and transforming our system to ensure that it is serving everyone—rural, urban, low income, and elderly.
What advice would you give to aspiring policy advocates who may be considering a run for public office?
Your country needs you! There are too few nurses in policy positions. Seek a County Board position. The County Board supervises the local Department of Health. Run for state legislator, they address scope of practice issues. Run for Congress! There are many opportunities to serve and lead. Step forward!
One of the hottest topics amongst nurse educators today is finding strategies to promote safe learning in the classroom environment. According to the American Association of Colleges of Nursing (AACN), it is estimated that over 73% of “nontraditional” students are studying in undergraduate nursing programs. The term “nontraditional” refers to all students who meet the following criteria: over the age of 25, ethnic minority groups, speaks English as a second language, a male, has dependent children, has a general equivalency diploma (GED), required to take remedial courses, and students who commute to the college campus. Nurse educators have a responsibility to ensure that all of their nursing students are learning in a safe environment.
For instance, microaggression is something that nurse educators must address in order to promote a safe classroom environment. Microaggressions are subtle, verbal and nonverbal snubs, insults, putdowns, and condescending messages directed towards people of color, women, the LGBTQ population, people with disabilities, and any other marginalized group. These insults are often automatic and unconscious in nature, according to Derald Wing Sue, PhD, author of Microaggression in Everyday Life: Race, Gender, and Sexual Orientation. Microaggression can cause a person to question themselves regardless of whether the microaggression occurred or not because they were unsure if they were just being oversensitive to the offense or if the perpetrator really intended to harm them with what they said. Microaggressions are usually committed by “well-intentioned folks” who are unaware of the hidden message that is being transferred.
Types of Microaggression
Microaggressions are similar to carbon monoxide—“invisible, but potentially lethal”—continuous exposure to these types of interactions “can be a sort of death by a thousand cuts to the victim,” says Sue. He further outlines three themes in three microaggression categories. The three themes are: racial, gender, and sexual orientation. The themes appear to occur in three different forms of microaggression: microassaults, microinsults, and microinvalidations.
Microassaults. Also known as “old-fashioned racism,” microassaults are conscious verbal or nonverbal attacks meant to hurt, oppress, or discriminate against the marginalized groups. This can range from telling racial jokes, name-calling, or isolating a student base on their racial, sexual, or gender identity. For instance, a student may deliberately refer to an Asian classmate as an Oriental. (Hidden message: You are not a true American. You are a perpetual foreigner in your own country.) Another example of a microassault is a teacher asking an African American male student, “Are you a first-time generation college student?” (Hidden message: African American males usually do not go to college.) Microassaults leave the students feeling unwanted, uncomfortable, and invisible.
Microinsults. A microinsult is an unconscious and unintentional discriminatory action against one’s identity. For instance, a teacher not asking a transgender student what pronoun to use when addressing the student (Hidden message: You are not acknowledging my identity.) Another example of microinsult is a teacher calling on an Asian student to come to the blackboard to work out a drug calculation problem. (Hidden message: All Asians are supposed to be good at math.) Or a student jokingly making the comment “that’s so gay.” (Hidden message: Being gay is associated with negative and undesirable characteristics.) A microinsult can also be nonverbal. For instance, when a white professor fails to call on the African American students in the classroom. (Hidden message: People of color contributions are unimportant.) Microinsults can have a far-fetching negative impact on a student, and they can affect a student’s motivation and commitment as well as mental health.
Microinvalidations. Microinvalidations are unconscious communications or environmental cues that faintly exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person’s identity. One example of microinvalidation is a student asking an Asian student, “Where are you from? You speak perfect English.” The Asian student replying, “I was born and raised in Florida.” (Hidden message: You are not American.) Or when a teacher continues to mispronounce the name of a student even after the student has repeatedly corrected the teacher. (Hidden message: I am not willing to learn how to pronounce a non-English based name.) Or a white science professor asking the male nursing students, “Why are you going into a nursing? It’s a female profession.” (Hidden message: Nursing is not “a real man’s job.”) Or the classic case of a white student telling her black roommate, “I don’t see color. There is only one race: the human race.” The color blindness offense is one of the most frequently delivered microinvalidations. Another example of microinvalidation is a student who unconsciously opens the door for a classmate who is in a wheelchair. (Hidden message: You are not able to independently take care of yourself.) The student should wait for the student in the wheelchair to ask for help if she or he needs it. Microinvalidation is one of the most harmful forms of microaggression because it leaves the victim feeling ashamed and asking themselves “Am I being oversensitive or paranoid?”
How to Address Microaggressions in the Classroom
Professors and students are the most common perpetrators of microaggressions in the nursing classroom environment. In the course of interaction, the professor or student may say something that offends a student intentionally or unintentionally. Since microaggressions are usually invisible to the perpetrator and may seem to have reasonable alternative explanations, the student may be left feeling uneasy and questioning themselves about what the implied message was.
Microaggression is processed in five different phases, Sue says. Phase one is the incident (verbal, nonverbal, or environmental). The perpetrator intentionally or unintentionally commits the offense. Phase two is the receiver’s perception of the offense. For instance, the receiver may ask themselves, “Was I just discriminated against?” or “Did she say what I think she said?” Phase three is the receiver’s immediate response to the offense. The receiver may respond by taking a defensive stand. Phase four is the receiver’s interpretation of the meaning of the offense. They may even ask themselves, “Should I say something?” or “If I say something it may make it worse.” Phase five is the consequence that may happen to the receiver of the offense. For instance, students may lose confidence in their ability to complete the course. Microaggressions can cause psychological consequences on the students over time, such as anxiety, depression, helplessness, and loss of drive, which can impede the student’s academic performance.
Therefore, the first step to addressing microaggression in the classroom environment is to acknowledge that it exists, says Jared Edwards, PhD, a psychology professor at Southwestern Oklahoma State University. Nurse educators need to get to know their students. You should be aware of their campus cultural environment and the specific challenges that your students from different backgrounds may face. Do not dismiss the classroom experience of microaggressions as “isolated” incidents. You should work with your students to create a safe classroom atmosphere by establishing solid ground rules and classroom expectations. You can incorporate open classroom discussions about microaggressions into your courses. For instance, have students conduct a group presentation on the impact of microaggressions in a classroom environment. This will promote teambuilding skills and communication and writing skills as well as help create awareness surrounding the common occurrences of microaggressions. Nurse educators need to be aware of what programs (e.g., student counseling center, disability services) are available on their campus so they can refer students who may need help dealing with the psychological consequences of microaggressions.
Nurse educators must be prepared to teach and advocate for culturally diverse students in a multicultural classroom setting. Additionally, they can show they value their students in many ways. For instance, taking the time to learn how to properly pronounce every student’s name can show the students that you value the student’s identity.
Nine years ago, I was so happy to have my first article published in Minority Nurse. The article was a discussion on whether or not it’s OK to be out at work as a gay person. Looking back at the changes I’ve seen over this time period, I decided to put together a few thoughts.
The county hospital where I work is rolling out some new intake questions for our electronic health record system. The impetus is to better serve our LGBTQ patients. A transgender person with residual breast tissue did not know he could still get breast cancer. An MTF person developed prostate cancer. These patients slipped through the cracks because they lived their true self but had body parts susceptible to illness that the caregiver was not aware of. By next month, we hope to have 10% of our patients properly classified using our new Sexual Orientation and Gender Identity (SOGI) questions. As the program rolls out, we will capture more and more of our population so caregivers can better serve them.
As a gay man in my 50s, I have seen great changes in my lifetime on LGBTQ issues. There was a time when just being out was a danger. But we bring some unique perspectives to our job that shouldn’t be overlooked. We know what it’s like to be the underdog. We cherish family because we worked so hard to have our families recognized. Respect for minorities come easily to us because we have suffered discrimination. Fairness in treatment under the law was not free for us or other minorities so we always strive to protect our patients’ rights. We know that being gay does not give you AIDS, but we also know what those risk factors are and we are able to educate our patients on the facts without judgement.
Now that we are rolling out a campaign to identify our patients’ unique needs regarding sexual health, reproductive issues, and mental health, we are working to destigmatize these issues in our community. Just asking these questions can be a litmus test of our own feelings. When the program was being explained in an employee meeting, there was pushback. “Our patients will be insulted.” Or, “Our patients won’t understand the terms.”
It occurred to me that we might be projecting our own feelings and, in some cases ignorance, onto our patients. Of course, there are what seem like valid issues when trying to tease this information out of patients in the geriatric clinic. My feeling is that you just throw the questions out there and you get what you get. The elderly are just as much part of the world as the young (and in between).I can’t wait to get some real world experience in asking these questions:
- What is the sex on your original birth certificate?
- What is your gender identity?
- What is your sexual orientation?
Some explanation might be needed with some patients. Sexual identity is not your sexual orientation. Sexual identity cannot be inferred from your birth certificate. We are looking forward to the rollout but with a bit of trepidation because we are not used to asking such personal questions. But,if you want to better serve this population, you have to identify them. The FTM person who never got a breast cancer screening because his caregivers never informed him of the risk—that can be preventable with better understanding of our patients. More information is better than less.
I take away two points from the SOGI questions that excite me. The first is that caregivers are going to be more aware of the disparities in health care that can occur with our LGBTQ patients. We are charged with the care of all our patients, not just the ones that fit into neat boxes. Just being aware of the differences makes us stop to weigh implications that might have been missed in the past. The second is that by normalizing this conversation, both patients and caregivers can talk openly about a subject that was once taboo. It’s OK to be gay or lesbian, FTM, MTF, something in between, or nothing at all. We all have health care needs.
Annette Smith, a nurse and coworker with 35 years of experience, has insight into changes in practice like the new SOGI questions: “At the beginning, there is a lot of pushback. The sky is falling, the sky is falling. But after a while, the process becomes normalized and it’s not a big deal anymore. We end up wondering what all the fuss was about!”
There was a time when just talking about sexual orientation was not even considered. Now we are required to ask! This destigmatizes the whole subject. To revisit my first question: It should never be a question of whether it’s right or wrong to be out at work. It’s just a question of you being comfortable enough in your own skin to let other people know.
In May 2015, I joined the faculty at the University of Florida College of Nursing (UF CON) as an associate professor. Fourteen months later, I became a single adoptive mother to a newborn. My successful journey through single motherhood while balancing my academic responsibilities was due, in large part, to the overwhelming support I received from the entire body of the CON including the dean, department chair, faculty, staff, and students.
Working From Home
When I think about the reaction of my senior colleagues when I shared the news that I adopted a newborn, I am in awe. My department chair was elated, and after congratulating me, the first words she uttered were,“Miriam, you have my support. I am here to provide you with whatever resources you need to succeed at motherhood and your academic career. You can take maternity leave, work from home to direct your research, teach online, and teleconference as needed.” Before I could respond, my department chair excitedly went next door to inform the dean, who glowed with joy about my news, grabbed my hands, and stated emphatically, “You are taking maternity leave.” I was stunned.
I was surprised about the reactions I received from the administrators because I was not sure what to expect. I was a newly hired associate professor trying to build my research program following relocation from another institution. Because I was a relatively new hire, I was afraid they would express misgivings about my status as a single mother with no family support, which might affect my productivity as an employee; however, these fears were not realized. Although the administrators strongly encouraged me to take maternity leave, I opted to work primarily from home and hire a babysitter to assist me, who cared for my son when I travelled to campus to teach and to attend research team meetings. Incredibly, senior colleagues encouraged me to bring my son to our hour-long meetings and to classes after students requested it. As a result of their kind support, I brought my son to research team meetings, where my colleagues enjoyed meeting him, and to class, where my students happily posed for photos with my son and me.
Was it Unprofessional to Bring a Baby to Work?
Despite the tremendous support I received to bring my son to the CON, at times, I felt that it was unprofessional. Realizing that I was projecting upon myself the negative stereotypes about motherhood and child-rearing, I asked myself several key questions: What is unprofessional about being a mother? What is unprofessional about role modeling to my son the importance of strong work ethics? What is unprofessional about exposing a baby to intellectuals who are positive role models? I surmised that exposing my son to an environment replete with kind, smart, and diligent professionals could only help him learn the behaviors he needs to become successful in life.
It has been nineteen months since I started my motherhood journey, and I am still breathless about the kindness and support I received and continue to receive from my colleagues. Knowing that I had the option of taking maternity leave as well as the full support of the administrators who were not concerned about my productivity was reassuring.
His Majesty, Kasi, Among Nurses
By Miriam O. Ezenwa, PhD, RN
Nurses, my Angels
They gather to do what they do best
Fix the ills around the world
Care for those needing their healing presence
Enters, His Majesty, Kasi, drawing attention
Heads turn left and back, eyes twinkle starry-like
Smiles everywhere, hearts blooming light
Love! Love in the air for His Majesty
Calm nurses, my Angels, research retreat in progress
Work in teams, way of the future
Stand strong, hands locked in place
Embrace people from far and wide
Including those who don’t look alike
We are stronger in the spirit of the rainbow
Need to rest from the trip to here
Nurse Karen holding tight, heart pumping peace
The future is smart for His Majesty, nurses’ wisdom grows in strength
His Majesty needs a diaper change
Nurse Jeanne-Marie and nurse mommy to the rescue
Now, where were we?
Back to fixing the world
How about fixing how we secure our existence?
Many ways of teaching, the more the merrier, the merrier the better
Sleepy-sleepy, growth in rapid measure
Uncle Yingwei got this one, his manly touch is much needed
Once! Twice! Hunger and starvation
Hurry Mommy! Tummy thunders, feels like no end in sight
Mommy doting, needs now met
Sorry for my interruptions, I am just a baby
To resume business, let’s take stock
Goals are important, set now, assess in time
We are nurses, born to fix ills, from birth to death
Yes, nurses fix ills all the time
His Majesty needs a break, nap is golden
Nurse Versie won the prize, His Majesty is a treasure
Mommy close by inspecting every touch
New mommy, but instincts never fail
Back to research retreat, His Majesty is listening
Teams assembled, lead authors identified. Here! Here!
Oh no! Nature calls again, can’t ignore
Nurse Cindi in charge this time
Mommy always in tow, my bag in hand
Back again to wrap up, day went well
We must tell our story, stir the soul
His Majesty must depart now
The throne at home beckons, Queen Mommy in charge
Car must be readied, His Majesty commands comfort
Uncle Yingwei again to help, he has been there from day one
Goodbye, nurses. His Majesty must retreat
Till we meet again, a year from now
Assess your outcomes, inform His Majesty
Did I say that nurses are great?
Lest I forget, nurses are magnificent
You are my tribe, away from home
His Majesty, Kasi, enjoyed your company
Spread the word, it takes a tribe
A tribe of nurses, best any time
It helped me focus on enjoying motherhood and have the peace of mind related to a secure livelihood. I remind myself of how blessed I am for the inherent flexibility of my academic position. This feeling of gratitude propels me to work harder so that I do not disappoint myself or the trust the administrators bestowed upon me, to find an appropriate work-life balance required for success in academia.
My Tribe Away From Home
When my son was six weeks old, the CON had a faculty research retreat, and although I did not have a babysitter, I did not want to miss the retreat. I talked to my department chair about this problem, and she suggested that I bring my son to the retreat. The entire faculty in attendance surprised me with their support. At that moment, I knew that I had found my tribe at the UF CON even though I was 6,000 miles away from my home country, Nigeria. I captured the interactions between my son and my newly found tribe in the poem, His Majesty, Kasi, Among Nurses.
Take Home Message
Current knowledge suggests that many mothers in academia struggle to succeed as they balance motherhood and academic responsibilities. These challenges could be quadrupled for single mothers in academia who are immigrants and who may not have family support. I experienced many challenges being a single adoptive mother, particularly on the days that my son was sick; however, I always had the help of my colleagues, who personally assisted me in caring for him. Their support enabled me to excel at motherhood and my faculty role, and I am immensely grateful for this support. Based on my positive experiences, I encourage other universities around the United States to emulate the actions of the UF CON administrators and support mothers in academia as they balance two important aspects of their lives: motherhood and an academic career.