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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stigma

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

Unknown transmission

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

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

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

Lack of education

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

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

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

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

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

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

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

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

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

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

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

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

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

Explain the primary role of a Sexual Assault Nurse Examiner. 

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

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

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

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

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

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

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

What is the training like?

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

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

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

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

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

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

What are the similarities between SANE nursing and SRH care?

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

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

What is the most rewarding part of your job? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What do you love most about being a midwife?

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

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

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

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

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

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

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

Has being pregnant shifted the way you approach midwifery?

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

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

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

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

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

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

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

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

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

It’s definitely exhausting though.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are there any last things you want to share?

Well there are so many resources....

Read:

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

Watch: All My Babies (film featuring Mary Cooley)

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

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

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

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

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

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

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

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

How has your work changed during the pandemic? 

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

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

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

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

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

What does equity in abortion care mean to you?

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

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

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

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

By La Rainne Pasion

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

Podcasts

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

News outlets and websites

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

By La Rainne Pasion

Debbie Bamberger is a WHNP-BC with over 30 years of experience and a member of NSRH's Board of Directors. This February, we talked to Debbie about her love of SRH provision and how she uses her creativity for self-care:

What is your role in sexual and reproductive health?

I am a Women's Health Nurse Practitioner by training, but these days I prefer to refer to myself as a Sexual and Reproductive Health Nurse Practitioner, since I take care of people of all genders. I graduated from UCSF in 1994 and have been providing SRH services since then and even before. I am aspiration-abortion trained and provide in-clinic abortion services at Planned Parenthood in Oakland. I've also done extensive training of clinicians in providing IUDs and implants, and I helped work on the new law in California that will mandate that all public universities provide medication abortion in their student health centers by 2023. 

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

I love providing this type of care to people. Taking care of people's sexual and reproductive health needs incorporates justice in many forms--reproductive justice, of course, but also racial justice, social justice and more. Providing abortion care is also an intimate and powerful moment in which to meet my patients where they are on their journeys. 

I recently completed my Doctor of Nursing Practice degree, and I hope to find a way to bring restorative justice practices to the SRH workforce.

You’re also an artist. What inspires your art?

I started art journaling five years ago, having no prior art practice, and I found it completely transformative. Art journaling is journaling through art, in a book. I use it to process, spew, express, forgive and connect. 

How do you see art-making as a form of pleasure? Or as a form of self-care?

I art journal for pleasure and for self-care. I love making a page that looks beautiful, but the process of making it is extraordinarily cathartic.

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

By Lina Buffington, PhD, NSRH Executive Director

Each month we will highlight and explore one of our values; it is apropos that we should start in February with a focus on pleasure, and not because of Valentine's Day. As most folks know, February, which also happens to be the darkest, coldest, shortest month of the year, is also the month officially designated as "Black History Month". Throughout this month, corporations, organizations, and the media will often spotlight civil rights leaders and activists as well as exemplars in the arts, sports, education, and industry by hosting festivals, exhibitions, and television specials. Black authors are highlighted in bookstores and libraries while companies like Amazon might highlight Black entrepreneurs on their platform. Though the history and achievements of Black people are inextricable from the history, wealth, and culture of the US, this month provides a small window of opportunity to shine a light on what has remained a gaping absence. 
But what does all of this have to do with pleasure? What does Black History Month have to do with pleasure when so often the focus of this month is on struggle--the struggle for freedom, for humanity, for civil rights, for justice, for equity? I do not believe that Black History Month is the only month for folks to finally finish that copy of The Autobiography of Malcolm X, or watch the film Roots, or make a trip down to their local museum of African American arts/history/etc. I believe that the history of ALL peoples of this Nation are worthy of continuous study. I believe that Black History Month is a time for celebration, and at the heart of celebration there is pleasure. While I do not wait until a government designated time to celebrate my ancestors, I see this month as a time of collective celebration, of collective remembrance. It is through this act of re-member-ing that we keep those we have lost alive and present.

For this month each year we call their names as a collective: Harriet Tubman, Anna Julia Cooper, Sojourner Truth, Mary Edmonia Lewis, Zora Neal Hurston, Octavia Butler, Winnie Madikizela- Mandela, Nina Simone, Toni Morrison…we say their names and in that act of re-member-ing they live again. We share images of them and stories, we read their words, and look at their art, we listen to their music and watch their plays. Through these acts of re-member-ing, we introduce them to our children, carrying forward their work into the next generation, and the next. There is tremendous pleasure in the cultivation and nurturance of this connection to our ancestors. When I think about Harriet Tubman, who I think about a lot, I reflect on her words:

 

“Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world.”

In the face of some challenge, often one so much smaller than any of the challenges that Harriet faced, I think of her and marvel that this woman had the audacity to dream. She had the audacity to follow the stars when all around her was darkness. I marvel that some small seed of that magnificent human being lives in me and I draw from that. I call that up in myself and keep moving forward. Harriet Tubman is worthy of remembrance and of celebration, and if there are those who only hear her name or think of her in February, so be it. The contributions of Black people in this country are worthy of celebration. The fact that we made it through and over and continue to live is worthy of celebration, and so I happily claim this cold, dark, month for Harriet, and Malcolm, and Micheaux, and all of them. For me, there is tremendous pleasure in that.

By Lina Buffington, PhD, NSRH Executive Director

We find ourselves in a unique moment, simultaneously pregnant with hope and possibility and deep sadness and uncertainty. I have regularly found myself walking the line between grief and hope, anger and exhaustion. Like many, I breathed a sigh of relief on January 20, 2021 at 12:00pm. Not because I think that this changing of the guard represents some magical moment of healing and redemption for this nation, but because I no longer have to live with the very real danger of having a vocal white supremacist in office. I no longer have to lie awake at night knowing that “he” has the power to unleash nuclear holocaust upon the world. I now have hope that there will be a coordinated national effort to address the devastating impact of COVID-19 in this country. So, I sleep a little more soundly, I breathe a little bit more easily. All while knowing that we are far from out of the woods. I will never forget just how close we came to completely dismantling any semblance of Democracy in this country. I will not forget that 74,222,593 million cast their votes for white supremacy, or the ease with which an “angry” white mob overtook the Capitol as the result of collusion at the highest levels of government. We must not allow ourselves to forget that, as usual, it was the work of those most marginalized (particularly Black women) who kept the wolves at bay. We must acknowledge that communities most impacted by systemic racism and poverty cannot continue to carry the burden of democracy on their backs—Every back has limits. It is imperative that every one of us who claims to love justice, who claims to be a champion of freedom, take responsibility for the maintenance of this tenuous “Union”. We must not simply give lip service, turning “Black Lives Matter” into a slogan for t-shirts and window dressing. We must invest our resources in those communities that continue to do the work of protecting a dream of democracy that remains unrealized for so many of us. We must demand that calls for “unity” and “reconciliation” be mediated by a real and deep sense of justice and equity. We must continue to push our organizations to do better and be better when it comes to hiring and promoting BIPOC folks. Funders and investors must do better and be better when it comes to investing in organizations and businesses led by BIPOC folks doing the critical work. As Amanda Gorman so eloquently reminded us in her inauguration poem, this nation still has a “Hill to Climb”, but some of us have a much more steep and rocky terrain. Some climb on horseback, some in all-terrain vehicles, some with no shoes and empty bellies. If “we” are to make it over this hill it will require that those traveling with greater ease think more about how we might better facilitate another’s climb. How might we go back for those who have the hardest climb and carry them, rather than expecting them to carry us? These are the kinds of questions that we continue to wrestle with both as individuals and as an organization. We understand the critical role that nurses play in realizing the dream of comprehensive healthcare for ALL and so NSRH remains committed to doing the work of doing better and being better in our service to you.

In light of the recent election - everything that came before, and the many challenges that lie before us - we've decided to open our ears and hearts (and our blog) and provide space for our community of nurses and nursing students to share feelings and thoughts. Throughout the month of November, our blog will feature the stories, emotions, and perspectives of our community in this moment. We aim to lift up the critical perspectives and voices of nurses, nursing students, and midwives working to advance sexual and reproductive health for all.

If you would like to submit your story to be featured on our NSRH blog, complete this form. Anonymity is optional, we cannot guarantee that all submissions will be posted. If you have any questions, please email [email protected].

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Before working in abortion care, I had no idea nursing is what I would be called to do. Graduating in 2018 with a political science/public admin degree and gender & sexuality studies minor, my post grad journey landed me working as a patient advocate at an independent clinic. This is where I discovered my passion for providing dignified and patient centered care to people seeking abortions. 9 months in to this amazing job COVID hit, bringing with it an entire staff lay off. Now, Minnesota has only 1 clinic in the entire state that provides abortion care to the state limit. So here I am, almost a year into a pandemic and now starting nursing school. I am determined to work in later term abortion care as an RN- I know I was meant to do this.

- Sarah, MN

As a nursing student in such times, each day is truly a challenge. I’m currently on my 3rd round of mandatory quarantine this semester, and while it’s been hard (and often quite lonely), I have had the opportunity to sit with my goals and decide exactly where I want to take this career. When I decided to go into nursing, I thought I wanted to work in labor and delivery. I knew I loved women’s health and thought L&D was it for me. However, the last couple years have opened my eyes to my true calling: sex education. In wake of the #MeToo movement in 2017, combatting rape culture became a priority for me. I feel that advocating for and providing comprehensive sex education is the best way to use my position as a future nurse. With reproductive rights also at stake, my focus in politics has been on much more than just the presidency. I graduate this spring and cannot wait to get to work; continuing to learn and helping others to do the same in hopes of creating a better world with access to comprehensive sex education, reproductive health and justice for all.

- Samantha, NY

We talk a lot about trauma-informed care - so much so that it’s become a buzzword. We’re told to be trauma-informed when we speak with patients, in the way we care for them. We focus these efforts so much on our patients that we forget about our students. Students deserve trauma-informed education and educators. Our students should be lifted up, made to feel like they can accomplish this tough, tough work. We can empower without causing trauma. We can uplift without lowering standards. Not just in a pandemic. This is the way forward. We cannot traumatize our students and expect them to be at their best at the bedside or in the clinic. Students are people, too. We must humanize the people doing this work if we want our patients to have positive experiences and outcomes.

- RN, Student Nurse-Midwife

NSRH has been weaving a network of nurses, nursing students, midwives, and allies committed to high-quality, gender-appropriate, full-spectrum healthcare, since 2006. Starting early next year, this informal network will transition into a structured membership program. This organization has gone through many transitions during its young life. Many of you first came to know us as Nursing Students for Choice (NSFC), some of you became aware of us when we were Nursing Students for Sexual and Reproductive Health (NSSRH). Now we are Nurses for Sexual and Reproductive Health (NSRH). This latest iteration has represented the greatest leap for us. While our work with students remains the backbone of our work, we are excited to be able to expand our community to formally include nurses, midwives and other professionals.

To accomplish this expansion, we are implementing a membership model that provides entry points for a wide range of individuals: from nursing and midwifery students (who will always enjoy up to four years of free membership); to practicing nurses, LPNs, midwives, and doulas; to retired practitioners; to allies including doctors, activists, and educators. Our membership model is grounded in trusted community: you will always know that your fellow members are aligned with your commitment to quality, evidence-based SRH.

We have adopted the language of weaving to explain our work, because it best reflects the multilayered, intersectional, multi-dimensional nature of this community. The nursing sector is incredibly large, broad, and complex; as are the myriad obstacles that we face in our work for sexual and reproductive health and justice. This metaphor of weaving is also deeply personal for me. The funny thing is that the connection did not hit me until I was sitting at my loom maybe 300 threads into "sleying the reed", as weavers call it, a delicate process of threading each individual thread through a "shaft." How perfect is that! What better a representation of the work of building community? In weaving you have to attend to each and every individual thread in order to weave them together into a beautiful and intricate textile, which becomes more intricate the more threads, textures, and colors you add. Each and every thread is critical to the composition; there are no outliers.

"Sleying the reed" is just one element of "dressing the loom," preparing the loom for weaving. We have been "dressing the loom" over the past year, laying the foundation for this new membership program. We have a new strategic plan, new database, new learning management system, new staff, new website, etc. All elements necessary for crafting the beautiful, intricate tapestry of community that we will all weave together. 

Our shift to membership will support this important work. Here is a sampling of what our membership program will offer:

Community

• A trusted network of peers, experts and allies in SRH
• Networking opportunities
• Access to members-only directory
• Regional chapter support
• Connections with affinity groups aligned with your interests

Education

• Online courses through the NSRH Online Institute
• Ability to track your Continuing Education Hours (CEs)
• Members-only workshops
• Members-only Newsletter
• Discounts to NSRH Conference
• RN Clinical Training Program

Advocacy

• Updates on pending policy changes affecting SRH and opportunities to engage in advocacy
• Advocacy training
• Press training
• Invitations to participate in collective actions

Recognition
Opportunities to:

• Submit content to the newsletter
• Be spotlighted as a member
• Apply for fellowships
• Apply for Awards

Professional Development

• Access to the NSRH Job Board
• Ask an Expert
• Pop-ed Workshops

Pleasure

• Discount to NSRH Store
• Restorative Empowerment Circles
• Virtual book club
• Fun jams
• Free swag

There will be a number of major changes as we transition to the new membership model over the next several months:

• Beginning in November, our weekly newsletter will shift to bi-weekly for non-members. Members will receive an additional monthly members-only newsletter with specially curated content.
• In November we will launch programming for our Founding Members. Everyone who signed the Membership Pledge before September 16, 2020 will be considered for a Founding Membership. We were so excited to have received over 200 pledges!
• Chapter Support programming will continue with several enhancements.
• Nursing students will be able to apply for a free Nursing Student Membership in addition to their participation in their campus chapters. This means that students will now have access to NSRH benefits regardless of whether or not they have a chapter on their campus.

Full Launch March 2021!

We will continue to keep you posted as we prepare for this important and exciting transition. 

During these times it is more important than ever for nurses who care passionately about sexual and reproductive health to have a safe and trusted community. Whether it's negotiating power structures in your clinical setting, advocating for the diverse needs of your patients, or seeking comprehensive training in your course of study, we know that we do better when we work together, learn from one another, and share spaces of safety, healing and joy. The loom is dressed, let's get to weaving!

Lina Buffington, PhD

NSRH Executive Director

“The most disrespected person in America is the black woman. The most unprotected person in America is the black woman. The most neglected person in America is the black woman.”
- Malcom X

Yet again, we have seen the state fail to protect the lives and dignity of Black womxn and POC.

We stand with Dawn.
We will not stop saying your name, Breonna Taylor.

Last week, nurse Dawn Wooten’s testimony revealed what far too many are unwilling to acknowledge: Pervasive imbalances of power within healthcare leave many nurses and healthcare workers unprotected in their work serving and supporting vulnerable populations. From lack of PPE during the COVID crisis, to limitations on abortion provision for advanced practice clinicians, hierarchies within the healthcare field directly affect nurses’ ability to safely care for their patients--and themselves. Nurses should not have to be martyrs. Dawn Wooten should not have been forced to be a martyr.

Power: Nursing and social justice are inherently linked. Therefore, it is the role of nurses and other healthcare providers to challenge power structures and systems that inhibit the health and wellness of their communities. This includes transforming relationships of power inter-professionally and between providers and patients.

We must acknowledge the systemic oppression and criminalization of many of our patients. Immigration detention facilities are notorious for their blatant violations of human rights, and their abuse and mistreatment of detainees, including being neglectful of reproductive health care. ICE has no business dictating the reproductive lives of people and infringing upon the ability of immigrants in ways that impact their ability to reproduce, or not, or impact their ability to parent their children.

This brutality seeps far beyond the walls of state-run facilities, and into our homes and communities. The criminalization and murder of Breonna Taylor was a direct attack on her human right to live, to thrive, to become the nurse that she aspired to be. She deserved more. NSRH condemns the over-policing and undue criminalization of people of color - regardless of community or immigration status.

Safety: Criminalization and policing of women, people of color, and LGBTQ+ people in ways that interfere with and obstruct bodily autonomy, humanity, and life is inhumane and a threat to our communities. We support healthcare provision free from the obstruction of law enforcement.

Informed consent is the basic right of every patient and the responsibility of every provider. While we’d like to think that our society has evolved beyond our violent history of forced, coercive, and nonconsensual sterilization of Native, Black, Mexican, Puerto Rican, Japanese women, and people with disabilities; the atrocities inflicted at the Irwin County Detention Center has revealed that this is not the case. We condemn the inhumane actions of the Irwin County Detention Center, which violated the bodily autonomy of migrant women by removing their reproductive organs without informed consent.

Nurses are often recognized as being the most trusted healthcare providers in the nation. We see this “trust,” not as an emblem of honor to be taken for granted, but as a call to action.

Trust: Patients should be trusted to know what is best for their body and their family and are deserving of access to the services and care that support those choices.

Intersectionality: Oppression is systemic and intersected, and our approach to healthcare is rooted in affirming the various identities and experiences of patients and providers. We collectively challenge racism, ageism, classism, homophobia, xenophobia, white supremacy, misogyny, sexism, and all oppressive structures and systems.

In order to address these inequities we must begin to dismantle the silos between healthcare professionals. To support this work, NSRH is building relationships with physician organizations, like Medical Students for Choice and Reproductive Health Access Network, creating opportunities to foster interprofessional collaboration that centers patients as the agents of their own care.

Integrity: Our work is rooted in the trust of individuals, their communities, and the nurses and other healthcare providers who care for them. We honor and recognize the credibility and expertise of providers at all levels.

While we work to dismantle these harmful systems, we are also weaving a new future centered on collective healing, liberation, and pleasure. We believe that pleasure in its truest form is radical, especially in a society obsessed with the infliction of pain.

Pleasure: Pleasure is a form of care and a radical act in the fight for sexual and reproductive freedom and justice. We believe in centering consensual sex as a form of pleasure.

As we seek solid footing during these unsteady times we, at NSRH, are looking to our organizational values and thinking about how we can live those values in the work to achieve our vision for a world in which all people have access to just and dignified comprehensive healthcare. With the passing of Justice Ruth Bader Ginsburg, her legacy continues to show us that leading with honor requires that we advocate for our values and work towards a just society for everyone.

NSRH is honored to stand with Dawn Wooten, Breonna Taylor, and with all nurses (past, present, and future) who willingly and unwillingly become martyrs, placing their bodies and their lives on the frontlines in the name of justice.

In Community,

NSRH

Nursing Work Is Advocacy Work

By: Krystal Kilhart, NSRH Membership Intern

Nurses for Sexual and Reproductive Health is honored to participate in this year’s Black Maternal Health Week 2020 organized by the Black Mamas Matter Alliance. This year’s theme is “Centering Black Mamas: The Right to Live and Thrive.”

As nurses, providers and advocates for sexual and reproductive health, we work every day to address injustice within our healthcare system. According to the CDC, nearly 700 women die every year in the U.S. as a result of pregnancy or its complications. Black women are two to three times more likely to die from a pregnancy-related cause than white women. While we know that racism, poverty, and social inequity of all kinds puts many of our pregnant patients at risk before they ever see us, it is our job to interrupt and end cycles of violence that perpetuate these systems. It is our job to provide quality, compassionate care to all pregnant people, and believe them when they tell us what they are experiencing and need. It is our job to interrupt anti-Black racism when we see it operating in our healthcare systems, processes and protocols, even if it means questioning a colleague or supervisor. It is our job to educate ourselves and each other about reproductive justice, the history of reproductive coercion and other racial justice issues that affect our patients, as well as build consciousness about the conditions and cultures our patients are coming from. It is also our job to build opportunities for our fellow nurses of color, particularly Black nurses, to advance and thrive in healthcare. It is our job to listen to Black Mamas. 

We know that ending racism and addressing its impact on healthcare is a long game that will take all of us. We also know that our battle to provide care in the face of COVID-19 has just begun. We have a lot on our plates, and we are part of a collective grief that will take many years to heal from. This is the time to move into our power as nurses, to speak truth to power, and make sure we support Black Mamas in living and thriving. 

If you would like to learn more about Black Maternal Health Week 2020, we invite you to attend the #BMHW20 Webinar Series and online local events.