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.
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.
With dozens and dozens of nursing specialties, some nurses take varied paths to end up in the specialty that is the best fit. Many try different health care situations or medical training before deciding that one area of nursing is the career where they will make the impact they want and will satisfy their professional goals.
Jose M. Maria, MS, FNP, RN, CEN, director of emergency services at Brookdale Hospital and Medical Center in Brooklyn, New York, says he came to emergency nursing after gaining training and experience as an EMT and paramedic. “Emergency medicine was the next logical choice in starting my nursing career,” he says. “I haven’t looked back since.”
Maria, a native of the Dominican Republic, says his specific EMS experience really gave him a solid foundation to know what he wanted and provided him with the essential capability for any emergency nurse. “It allowed me to develop the skills to adapt to any situation while keeping a cool head,” he says.
But emergency nurses also benefit from having more than a cool head and a great skill set, says Maria. The flexibility to move from one situation to another one that is entirely different is essential for a successful emergency nurse. And then there’s the part where you work your tail off. An emergency nurse who doesn’t complain about the task (or 20 tasks) at hand and does what’s needed will have a much easier time working in such a fast-paced environment.
And when it’s time to transition a patient to inpatient nurses, challenges remain. In fact, Maria says that transition point is one of the most challenging aspects of emergency nursing. “This is a common challenge at every organization I have been a part of,” he says.
Preparation and planning, as with any part of the emergency nurse’s job, can help. And finding out how other nurses work also helps inform your own practice. “I try to stay current in practice and use resources like ENA CONNECT and to speak with colleagues across the states,” says Maria. “Like many professions, preparation is key for success in the emergency department.”
But with those skills and responsibilities, emergency department nurses encounter a lot of critical and crisis situations to adapt to. For Maria, those situations reveal why he does what he does. “The most satisfying and most important part of my job is to save lives,” he says. “It’s a powerful and overwhelming feeling to have brought someone back from death and see them walking out of the hospital.”
Anyone considering emergency nursing as a career path can follow Maria’s advice to rotate through other specialties before deciding on the ED. Each area offers you a new set of experiences and training that will be useful in the emergency department.
“Because we see a wide range of complaints, we can actually help our patients,” he says. “Working in psychiatry for example, helps you build conflict resolutions skills, improve communication techniques, and builds patience needed in the acute psychiatric emergency. Working in the ICU, with their attention to detail, improves your documentation. Working on a medicine floor helps in time management skills. Working a surgical unit, improves your teaching techniques with patients.”
And while the emergency department is intense and fast, emergency nurses do find a way to offer each other the kind of support and camaraderie that is distinct. Their humor might even be considered dark, says Maria.
“People have a hard time understanding that even in the darkest of times, humor helps us deal with our internal anxiety about the cases we work,” he says.
Having a strong mentor and academic advisor can make a huge difference in the lives of undergraduate and graduate nursing students. Being that mentor is what motivates Ronald Hickman, PhD, RN, ACNP-BC, FNAP, FAAN, associate professor of nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, OH.
Hickman has been honored with two esteemed awards for student mentorship at Case Western Reserve University: the John S. Diekhoff Award for Excellence in Graduate Mentoring, which is presented to four full-time faculty members who make exemplary contributions to the education and development of graduate students; and the J. Bruce Jackson Award for Excellence in Undergraduate Mentoring, which celebrates faculty and staff who have guided a student in their academic and career paths; fostered the student’s long-term personal development; challenged the student to reflect, explore, and grow as an individual; and supported and/or facilitated the student’s goals and life choices.
“Mentoring has been a cornerstone approach to making a difference in the lives of undergraduate and graduate nursing students,” says Hickman. “The receipt of two of the university’s top honors for mentoring undergraduate and graduate students is a testament to my commitment to making sure that I pay it forward.”
Hickman says the mentorship he received across his undergraduate and graduate studies has been invaluable. “My mentors shared their lived experiences and lessons learned to help me avoid pitfalls and inspire me toward a career in academe. These honors highlight my commitment to mentoring and acknowledge the impact of effective mentorship on the lives of emerging leaders in nursing practice and research.”
However, nursing was not Hickman’s original career plan. “As an undergraduate student, I majored in biological sciences with the intention to attend medical school after graduation.”
He was not admitted to medical school, but upon reflection about potential career paths he decided to pursue nursing because it aligned with his personal philosophy of health. “Although nursing was not my first choice for a career, it was the right choice for me,” he says.
Hickman acknowledges that pursing a nursing career can be challenging for minorities.
“Many minority nurses are the first in their families to attend college and are standouts in their communities,” he says. “When entering the nursing profession, the academic preparation is challenging and, in most instances, the diversity of nursing faculty is often not representative. This can create situations where minority nurses do not wish to speak up and seek help when needed. Whether you are pursuing a nursing degree or transitioning to a new role in nursing, do not suffer in silence. Asking for assistance often facilitates your success and delivery of safe nursing care.”
Another key to success that Hickman recommends for minority nursing students is to find a strong mentor and strongly consider pursing a doctoral degree in nursing.
Hickman is truly paying it forward. “As a nurse educator, I am inspired daily by helping students develop as competent nurse clinicians and scientists,” he says. “Helping others achieve their goals is an invaluable and enduring experience for most educators. The opportunity to inspire and challenge future nurse leaders is a priceless reward.”
Hickman sees himself in a senior leadership position in a school or college of nursing in the future. “My aspiration to secure a senior leadership position aligns with my commitment to help an organization and its’ faculty achieve their goals and impact the health of Americans.”
There are lots of health tips that men and women can both benefit from. Getting enough sleep and exercise and eating a well-balanced diet are some good all-around health tips everyone can use. But the genders have some pretty diverse health challenges. For example, did you know men die, on average, five years sooner than women?
Whether you are a man looking into your own health concerns or a woman with men in her life, Men’s Health Week (June 12 to 18) is celebrating its 23rd anniversary this year and comes right in the middle of Men’s Health Month. If you’re a nurse and a man, use this opportunity to talk to your male patients about the specific health problems men face and what to do to help prevent them or cope with them.
How can men make sure they are doing the best they can for their own health? Here are some pointers from the Centers for Disease Control and Prevention and MensHealthMonth.org.
One of the best ways to stay healthy is to get regular screenings for diseases and conditions that can be detected and therefore treated, early. Get an annual checkup so you can stay on top of your blood sugar levels, your weight, your cholesterol, and your blood pressure. Get a colonoscopy if you’re past age 50— earlier if you have a family history of colon cancer or if you have certain conditions that could increase your risk. Be sure a prostate screening is part of your annual exam and examine your testicles at least every month to notice any changes or lumps and bumps. Check your skin regularly for new moles or those that seem to have changed size, shape, or color. If you notice any unusual changes on your body, bring it to the attention of your physician.
Play Hard, But Play Safe
Whatever your interest—biking, running, flying, rock climbing—make sure you practice basic safety rules. Use proper protective gear and equipment. If you’re swimming, go with someone. If you’re hiking or camping, let people know where you’ll be. Bring along extra provisions and proper weather gear. Basic safety considerations can go a long way toward keeping you healthy.
Men tend to let their social relationships slide when life gets busy. With work and family obligations, it’s tough to carve out time with friends. But social connections and solid friendships can help ward off many health problems including depression, heart disease, and even dementia.
Make Healthy Choices
All the basic health tips hold true because they work. Eat a diet rich in fruits, vegetables, and plant proteins. Ease up on meats, cheeses, butter, fried foods, and treats like full-fat ice cream. Get daily or near-daily exercise. Get enough sleep. Keep your vaccines up to date. Use protection during sex. Don’t smoke anything, ever. Drink alcohol in moderation. Wear sunscreen. Protect your heart health (and keep inflammation down) by keeping your stress under control. Find help for your stress if you can’t manage it on your own.
Wear Blue to Start the Conversation
The Friday before Father’s Day is traditionally a Wear Blue Day, when anyone concerned about men’s health can wear blue clothing or blue ribbon pins to show support of Men’s Health Month. You can also give a shout out on social media with #MensHealthMonth or #ShowUsYourBlue.
Spread the word about men’s health during the month of June. You never know what kind of lasting impact a few words of wisdom might have,
The American Association of Critical-Care Nurses held its annual National Teaching Institute and Critical Care Exposition this week in Houston, TX. During the four-day event, 25 acute and critical care nurses were presented with the Circle of Excellence Award, recognizing their efforts to achieve optimal patient outcomes.
Jose Sala, night nurse manager, surgical and liver ICU at Houston Methodist Hospital, was among this year’s honorees.
“I feel so honored and privileged to be a recipient of this prestigious award,” says Sala. “I consider it one of my most rewarding accomplishments. I dedicate it to my family, my former professors, and preceptors, and most importantly, the patients whom I’ve cared for at the bedside during the past nine years. They have been my best teachers.”
Sala earned his BSN in 2012 from the University of Texas Health Science Center at the Houston School of Nursing and feel in love with critical care nursing during his capstone preceptorship in a general medical/surgical trauma ICU in South Texas.
“I was awed and impressed by how knowledgeable my preceptor was about pharmacology, pathophysiology, and patient management,” says Sala. “I saw how she was such an integral part of the critical care team, and how she had finesse, confidence, and a strong rapport with the surgeons and intensivists and all the other professionals in the unit. That two-month period played a seminal role in my journey in critical care.”
In his current role as the night nurse manager in the surgical and liver ICU, Sala has had the opportunity to work on initiatives that have improved not only patient care, but the overall work environment for his team. These initiatives led to his Circle of Excellence award.
He is most proud of his work to develop “flash rounds” in his unit – an initiative that directly impacts patient outcomes.
“Together with Dr. Atiya Dhala, one of our intensivists, and with the support of my director, Michele Ramirez, I implemented what we called “flash rounds” in our unit that focused on the ABCDEF bundle,” explains Sala. “This bundle aims to prevent the unintended consequences of critical illness, including delirium, prolonged ventilation, and excessive muscular deterioration. Every morning, at 8 a.m., each and every bedside staff nurse presented their patient to the team – the intensivists, nurse practitioners, residents, physical therapists, and respiratory therapists – as they rounded on the whole unit. Strictly focusing on these components and separate from teaching rounds, the flash rounds set the tone for the day for the team. This was not only met with much enthusiasm and support by most of our staff, but it also helped increase the mobilization rate, decreased our self-extubations, and reduced our ventilator days.”
Sala has also worked hard to improve his unit’s work environment.
“One of our key challenges in our unit was the rocky transition of our new graduate nurses (GNs) into clinical practice,” he says. “I mentored a group of GNs whose project for their nurse residency program was to create a buddy program that paired upcoming GNs with a buddy (who is a different person from their preceptor). This allowed them to integrate more easily into the culture and fellowship in the unit.”
Sala offers this advice to aspiring critical care nurses: “Work hard and study hard, and don’t lose sight of your goals. When you do rotations in nursing school, or work in any unit, find key mentors who can either directly guide you in the process of becoming a critical care nurse, or introduce you to people who can. Be inquisitive, read widely, and always ask questions.”