University School of Nursing recently hosted the first National
Nursing LGBTQ Health Summit, drawing deans and other leaders from top
nursing schools, representatives of nursing organizations including the
American Academy of Nursing and American Association of Colleges of Nursing,
and the National Institutes of health. The summit was conceived by the Nursing
LGBTQ Summit Advisory Board with a focus on advancing nursing’s progress in
addressing LGBTQ health issues.
The Summit was the first step toward creating a national health action
plan to raise awareness of and improve LGBTQ health. Participants were tasked
with mapping out an action plan, and discussing and brainstorming strategies
for bringing attention to LGBTQ health within the nursing profession and around
nursing education, research, and practice.
Keynote speaker Perry N. Halkitis, PhD, dean of Rutgers University’s School of Public Health, tells newswise.com, “One in five LGBTQ people do not seek health care because they fear discrimination… Moreover, the interaction between discrimination and other minority stressors—race and ethnicity, poverty, geography, lack of insurance—further drives LGBTQ health disparities.”
Participants identified a need to reduce disparities and improve
the health of people who are LGBTQ, which will require support from nursing
leadership to increase LGBTQ-specific content in nursing curricula and in
faculty development programs, policy development, and nursing research.
Lorraine Frazier, PhD, Dean, Columbia University School of Nursing tells newswise.com, “We’re here because we share a commitment to health equity, diversity, and the needs of the LGBTQ community and to looking at how we can advance education, clinical programs, research, and policy.”
Nurse leaders ended the summit with a call to action for the
nursing community to prioritize LGBTQ health through innovations in education,
research, and practice and to advance LGBTQ health policy. Following the
summit, attendees will devise a national LGBTQ health action plan focused on
the dynamic intersections among nursing education, research, and practice, as
well as a forum allowing participants to network and plan future
To learn more about the first national LGBTQ health summit
hosted by Columbia Nursing, visit here.
One of the nurses honored was
Louella Jackson Walker, part of the Licensed Practical Nurse program class of
1958. The program was a partnership between UVA Hospital and Burley High School,
an African American segregated school, to help fill a nursing shortage.
Walker tells cbs19news.com, “We took our jobs very seriously and they had a shortage of nurses and this was one way to fill that gap.”
Being an African American nurse at the time was not
easy, but Walker says she learned to show kindness to her patients, no matter their
behavior toward her. However, despite making history and helping to keep the
hospital and its patients afloat, she was unappreciated. She reports that she
is not sure where UVA would be today if she and other “hidden nurses” hadn’t served
as some of the first African American nurses at the newly desegregated
Honoring these hidden nurses came about after Walker
and another former classmate found old photos from the program at a yard sale.
They gave the photos to the UVA School of Nursing, which decided it was time to
make things right. Susan Kools, Associate Dean for Diversity and Inclusion at
the UVA School of Nursing, reports that the hidden nurses received a formal
apology from the dean for being excluded from their community, and were inducted
into the alumni association.
Albemarle-Charlottesville NAACP President, Janette
Boyd Martin, said she wanted to recognize the nurses because the black
community needs to celebrate leaders like them. She helped recognize the nurses
at the freedom fund banquet. Sixteen nurses from the LPN program were present at
Martin says, “People need to know about them and what they’ve done. Especially for our children, so they can see role models.”
To learn more about the UVA hidden nurses who were
recognized at the 2019 Albemarle-Charlottesville NAACP’s Annual Freedom Fund
Banquet, visit here.
In early 2016, Mt. Sinai Hospital* approached the Visiting Nurse Service of New York (VNSNY) to propose that VNSNY offer home care services to post-operative transgender patients. This was the genesis of VNSNY’s Gender Affirmation Program (known as GAP), which to date has provided home care to over 400 transgender patients. *a strategic partner of VNSNY
DailyNurse recently interviewed Shannon Whittington, RN MSN PCC C-LGBT Health, the Clinical Director of GAP at VNSNY. We asked her about the nature of gender affirmation treatment, the home nursing care that VNSNY provides, and the outstanding LGBT-friendly services that VNSNY offers to patients across the Tri-State New York area.
What is gender affirmation surgery (GAS)?
A surgical procedure that creates or removes body
parts that align with the patients’ gender expression. E.g. vaginoplasty,
phalloplasty, metoidioplasty, facial feminization, breast
Is this the same thing as “sex-change surgery?”
SW: It is the same thing but we don’t use the terms “sex-change
Gender Affirmation or Gender Confirming surgeries are the correct terms now. Understanding that this is a linguistically fluid language, words and meanings are always changing and we need to be mindful of correct terminology.
What are the components of the VNSNY Gender Affirmation Program?
The program emphasizes home care following surgery from other providers. I train clinicians (nurses, social workers, physical
therapists, home health aides, speech and occupational therapists) in cultural
sensitivity as it particularly relates to transgender patients. The training is extensive and they are also
educated in how to teach the patients to care for their new or altered body
parts (i.e. penis, vagina, breast, face)
DN: How did you come to specialize in the treatment of Gender Affirmation surgery patients?
SW: Fortunately, I was chosen for this project by my
manager. I had no idea what I was saying
yes to but this has literally changed the trajectory of my career path. I discovered a passion that I did not know I
What sorts of clinical training do nurses in the program need to take care of
GAS post-surgery patients?
They need to know what to assess for and what is
normal and what is not. They learn about
vaginal dilation because the patients who undergo vaginoplasty must do this on
a regular basis. Patients come home with VACs, JP drains, foleys and supra
pubic catheters. Although the nurses are already familiar with these devices,
they need to teach the patients how to manage them. The clinicians are also
trained in social determinants of health for this cohort.
DN: What sorts of cultural issues do nurses need to learn about before tending to a GAS patient?
SW: We really need to understand that these patients, like all
of our patients, are patients first who happen to be transgender. We must
respect their chosen names, their pronouns and their gender expression. We
focus on getting them better and integrated back into society. It’s a beautiful
thing to witness and an honor to be associated in such a transitional journey.
DN: How does the Gender Affirmation Program reflect the larger VNSNY commitment to LGBT patients?
It reflects our commitment to this population on an
agency wide basis. What is great is that
we are now getting non-operative transgender patients who are seeking home care
services for reasons other than gender affirming surgeries. They feel safe here and seek care outside of
gender affirming surgeries.
We are initiating various ways to continue to be inclusive along
the binary spectrum by hiring gender non-confirming and non-binary individuals.
These individuals have a lot to offer and need to be the best expressions of
themselves in their work environment just like the heteronormative society we
all live in.
And can you tell us something about the SAGE training in your organization?
All divisions of the Visiting Nurse Service of New York have been awarded Platinum
certification (the highest level possible) from SAGE, the world’s largest and oldest organization dedicated to
improving the lives of LGBT older people.
than 80 percent or more of VNSNY’s clinical and other staff have received SAGE Care LGBT cultural competency
training, further establishing VNSNY as a
preferred health care provider for New York City’s LGBT residents.
SAGE training is designed to increase awareness among VNSNY clinical and
administrative staff of cultural issues and sensitivities around sexual
orientation and gender identification, so as to ensure a welcoming and
respectful health care environment for all individuals within the LGBTQ
Among other things, the training stresses the importance of approaching each patient in a non-judgmental fashion and never making assumptions about anyone’s sexual orientation or family structure. We want every patient to feel they can be totally open about who they are with every member of our GAP team who walks through their door.
Coming in March 2020!
Annals of LGBTQ Public and Population Health
The mission of Annals of LGBTQ Public and Population Health is to bring together state-of-the-art cross-disciplinary scholarship which seeks to enhance the health and well-being of sexual and gender minority (SGM) individuals at the population level with an eye to the intersectional identities that SGM people possess.
We are interested in papers that advance education, policies, laws, and approaches to enhance SGM care and SGM health.
INSIGHT Into Diversity magazine has just recognized Frontier Nursing University’s commitment and accomplishments for the second consecutive year. FNU has now added the 2019 Health Professions HEED (Higher Education Excellence in Diversity) award to their shelf alongside their award from 2018.
About the Health Professions HEED Award
“The Health Professions HEED Award process consists of a comprehensive and rigorous application that includes questions relating to the recruitment and retention of students and employees and best practices for both; continued leadership support for diversity; and other aspects of campus diversity and inclusion,” said Lenore Pearlstein, co-publisher of INSIGHT Into Diversity magazine. The magazine is the oldest and largest publication on this topic in higher education and is well-known for its annual Higher Education Excellence in Diversity (HEED) Awards.
Pearlstein adds, “As we continue to see a record number of Health Professions HEED Award applicants each year, nearly every school tells us they use the application itself as a tool to create new programs and to benchmark their accomplishments across campus. The process allows them to reflect on their successes and also determine where more work needs to be done. We also continue to raise the standards in selecting HEED institutions.”
Diversity Impact at Frontier Nursing University
FNU’s history of emphasizing and valuing inclusion was formally instituted nine years ago, when it instituted the Diversity Impact Program in 2010. Each summer, FNU holds the Diversity Impact Conference for nurse practitioner and nurse-midwifery students plus faculty and staff to foster collaborative discussions, address health disparities, and find proactive solutions to improve minority health among underrepresented and marginalized groups.
initiatives span all facets of the university, but one of the most telling and
important data points is the percentage of students of color enrolled at FNU.
In 2009, that number was 9 percent. In 2019, it has grown to 23 percent.
“We are incredibly
proud to receive the prestigious HEED Award again this year,” said FNU
President Dr. Susan Stone. “To receive this award two years in a row is a
wonderful honor. Our graduates serve people of all races and cultures and are
increasingly coming from diverse backgrounds. It is imperative that our
students, faculty, and staff have cultural awareness and competency in order to
effectively advance our mission. The HEED Award confirms the value of our
efforts and validates our continued emphasis on diversity and inclusion within
the culture of FNU.”
INSIGHT Into Diversity Magazine
INSIGHT Into Diversity magazine is the oldest and largest diversity publication in higher education today and is well-known for its annual Higher Education Excellence in Diversity (HEED) Award. In addition to its online job board, INSIGHT Into Diversity presents timely, thought-provoking news and feature stories on matters of diversity and inclusion across higher education. Articles include interviews with innovators and experts, as well as profiles of best practices and exemplary programs. Current, archived, and digital issues of INSIGHT Into Diversity magazine are available online at insightintodiversity.com.
For further information on Frontier Nursing University and the Health Professions HEED Award, visit the FNU site.
NEW ORLEANS — Everyone has unintentional biases, but physician practices can mitigate them with a few simple steps, experts said here.
The speakers defined unintentional biases as “stereotypes or beliefs that affect our actions in a discriminatory manner.” Such bias may affect our actions in a way contrary to our intentions, two speakers said at the Medical Group Management Association annual meeting.
Unintentional biases — also known as unconscious biases — can work against a practice’s commitment to diversity in hiring and workplace inclusion, said Steve Marsh, founder of The Medicus Firm, a physician recruiting firm in Dallas. “Diversity and inclusion go hand in hand,” he said. “you can do a good job of diversity hiring, but if you don’t have an inclusive environment that’s welcoming to all the people you brought in, it’s worthless; in fact, it can backfire on you.”
Achieving these goals “isn’t real complicated, it’s just really hard
to do,” he added. “You can’t do a a crash diet on diversity hiring; you
can’t do a crash diet on inclusive culture. It’s a lifestyle, not an
188 Types of Bias
Pam Snyder, head of recruiting at Baystate Health, a healthcare system based in Springfield, Massachusetts, cited the launch of the video viewing site YouTube as an example of the perils of a non-diverse workforce. When YouTube’s mobile version launched, “there was a glitch in it — 25% of people were reporting it wasn’t working,” she said.
The reason? The mobile version was designed entirely by people who were right-handed and all turned their phones a certain way to see videos; left-handers turn their phones the opposite way, so the videos all appeared upside down. “Because they had that lack of diversity on their team, the product wasn’t launched accurately.”
A total of 188 types of unconscious bias have been identified, Snyder said. She listed four of the most common types:
Affinity bias: We tend to be more receptive to people who resemble our lives in some way. For example, Snyder was hiring a new recruiter on her team, but happened not to be there on the day one candidate came in for an interview. But during a follow-up phone call about the candidate, “I had at least three different staff people say, ‘You’re going to love her; she reminds me of your daughter.’ That was their affinity bias.”
Confirmation bias: We look for information that supports our beliefs and ignoring details to the contrary. Snyder, who is from Tennessee, explained that “when you hear someone with an accent like mine … you think they’re not well-educated. Confirmation bias is when you look for things when you’re talking to someone that confirms that.”
Halo effect: There’s something good about someone and because of the one good thing, we think everything about them is good. “In Tennessee, when we got a CV and it was from a Harvard grad, we’re like, ‘We’ve hit the jackpot,'” she said. “This halo effect was real; there were things we’d ignore about that candidate because of what was on their CV.”
Perception bias: This one is “really scary, worse than confirmation bias,” said Snyder. “You know it — you’ve met one person that had these physical and emotional attributes and you’ve formed your opinion and you can’t get away from that. That’s really the scariest when it comes to recruitment.”
Steps to Overcome Bias
To overcome unintentional bias, “the first thing we have to do is accept the fact that we have it,” said Snyder. “We can’t control the experiences we have had.” She suggested taking an “implicit association” test such as this one offered by Harvard. “You need to take an honest look at your unconscious.”
To mitigate bias and foster a diverse workplace, organizations are
moving toward competency and evidence-based recruitment, she continued.
Part of the competency-based evaluation for interviewees involves asking
behavioral event interviewing (BEI) questions involving something the
person experienced in the past. Such questions often begin with “Tell me
about a time when…”
“Tell Me About…”
For example, one practice wanted to know whether its candidates for a physician slot would be able to handle the workload, which involved seeing as many as 25 patients per day with only one medical assistant and a shared RN. So they might ask candidates the following about their previous job experience: “Tell me how many patients you saw in a day and what support you had.” If the candidate answers, “I saw 10 patients a day, and had two medical assistants and my own RN,” that might mean that the candidate isn’t a good match for the position, she said.
A question to ask when you want to find out about the candidate’s teamwork abilities is, “Describe a time when you were part of a team that worked well together. What role did you play? How did you show respect for others on the team?” said Snyder. Candidates’ egos can really be revealed with this answer; if they answer the question by just talking about themselves, “it’s a big red flag for us.”
When developing questions for a competency-based evaluation, it’s important to get buy-in from the staffers working in the department being recruited for, and to ask all the candidates the same questions, she said. Having a diverse panel of interviewers is also critical. “If you’re looking at an interview panel of all white males, you failed.” Also, panelists should work in a variety of positions at the company: “if you’re hiring a surgeon, you need someone from the surgery department that’s a non-provider … When you have those different inputs, you get a stronger decision.”
Benefits of Diversity
In addition to unintentional biases, practice managers need to be on the lookout for intentional ones as well, according to Marsh. For instance, “over the last 2 or 3 years, I’ve seen one of the biggest intentional biases ever creep in: politics,” said Marsh. “Five times in the last 2 years — not in group settings, but in individual meetings — I’ve heard, ‘We can’t recruit a Republican’ or ‘We can’t recruit a Democrat.’ I’ve heard it on both sides of the aisle. People have some very strong polarizing biases in the environment we’re in right now, but it has nothing to do with competency. It has nothing to do whether they’re good for this role.”
Hiring a diverse workforce results in more creativity, according to Marsh. “You have all these ideas coming in that you never would have had if everybody looked and acted the same,” he said. “If we’re able to create an environment where everybody has a voice, you’re going to have meetings — and be thankful for them — where somebody says, ‘I don’t think that’s a good idea.’ If you have an inclusive environment and welcome additional ideas, many times you’ll avoid pretty bad circumstances.”
Once a diverse workforce is on board, the next step is to work on inclusion, defined as “a feeling of belonging, a feeling of being appreciated for unique characteristics, and the extent to which employees feel valued, respected, accepted, and encouraged to fully participate,” said Marsh. And you have to have a meaningful process for addressing bias-related concerns. “You can do everything right, with all the good intentions in the world, but if you’re scared to address the issues, it all goes for naught because everybody’s watching.”
A fundamental tenet of culturally competent care for patients is providing clinically and personally pertinent information to patients in a language that they understand. As the diversity of non-English language speakers increases in the United States, nurses may find a new area of priority in advocating for their patients to overcome language barriers.
Fortunately, the Office for Civil Rights within
the U.S. Department of Health & Human Services (HHS), serves to protect
non-English speaking or limited English-speaking patients. Nurses,
however, can do this on a smaller scale in their daily work.
In accordance with Title VI of the Civil Rights Act of 1964, and the guidelines for developing a language access plan by HHS, health care institutions that receive federal funding must provide language assistance services suitable to the communities that they serve. This is assessed and implemented based on a stepwise approach appropriate for the patient population, qualified language service personnel, and interpretation devices and technology. Furthermore, health care personnel will be trained sufficiently and regularly to maintain an understanding of both the logistics and necessity of utilizing these services. This is especially true for nurses, who often have initial and ongoing close contact with patients.
Patients who speak limited or no English may be unwilling to admit that they do not understand the nature of their health care visit or its intended outcome. This is a detriment to both the provider and patient as the provider may proceed with a treatment plan with the belief that the patient is cooperating. It is easy to see how this can create increased stress and fear for the patient when actions are taken on behalf of their health that they did not corroborate and may not agree with. Regardless of the reasons for the patient’s decision to withhold their lack of understanding, health care professionals can take responsibility for establishing mutual understanding and help prevent these occurrences.
Utilize Available Technology
Fortunately, technology provides many resources today that allow for effective interpretation between providers and patients. Most hospitals have a team of on-site personnel that are credentialed interpreters in languages appropriate for the patient population of that site. For those languages that are less common, there are many devices, including phones and tablets, that provide immediate 24-hour access to remote medical translators in virtually every language. Many of the written documents that patients are exposed to are now offered in languages other than English as well.
Find a (Qualified) Translator
With a full understanding of the services offered, patients may decide that they prefer a family member to translate. Although it is not ideal because family members may lack health literacy, it is the patient’s prerogative to make that choice. If the patient requests that a bilingual nurse translate, he or she can only do so if the nurse has been credentialed in accordance with their facility’s policies related to medical interpreting. This is especially true regarding important documentation such as informed consent and does not include casual conversations or explanations.
It’s not a lack of resources, but a lack of understanding, that prevents non- or limited English speakers from getting what they need in health care today. Despite all of the services offered, providers may still try to take shortcuts for the sake of efficiency. As patient advocates, nurses can be mindful of patients and ensure that understanding is complete by utilizing interpreter services and reminding providers of the services available.