Curse of a Nurse: Social Justice Nursing in the World

The curse of a nurse is an educated mind often formed by religious and social backgrounds combined with work experiences which enable us to see things from a little different perspective. Principles of religion, education, and nursing practice illuminate what is wrong in our society.

We are both blessed and cursed with what we see and experience. The day of an average nurse is full. It is full of cultural perspectives, love and hate, grief and joy, violence and compassion, and fear and bravery. Nurses see people when they are vulnerable and willing to share truths, but they also see them when in the delirium of medication or pain they reveal what they would normally never give a voice. The nurse in the clinic or at the bedside sees the end result of failed policy, bigotry, and poverty. The nurse also sees those with privilege, success, and wealth and realizes the results of disparities.

Nurses experience all we see and what we see fills our lives with wonder and a search for the truth. There are days that we are bone tired with aching feet. The best we can do is ramble on about what we have seen to supportive family and friends. There are times when the mind is too tired to resist and in those times the truth is most apparent. There are also angry and frustrating times when we can identify with the worst instincts of humanity. It is a unique perspective and empathy that drives us to work for social justice. Out of our wonder, we find joy.

Many nurses are called to address social justice in the world and see it as part of what it means to be a nurse. It is tied to our spirituality. I write from my perspective as one who embraces the curse of a nurse and strives to pursue social justice in my small piece of the world. Love my perspectives or hate them, but know I have a thick skin and think we all grow through open and honest conversation even when it is difficult.

And so the [hu]manwho philosophizes and wonders is ultimately superior to one who submits to the despairing narrowness of indifference. For the former hopes?  – Joseph Pieper


Immigration Health: My Biggest Regret

Life has sometimes taken me on unexpected journeys. When I joined the U.S. Public Health Service (PHS) it was to work with the poor and the underserved. I had a vision of working with those that were homeless or with Indian Health Service. Fate had a different plan. The care of immigrants and children in cages reminds me that rather than making progress in the care of immigrants we have actually gotten worse.

In 1997 I accepted a job as a Health Services Administrator for an Immigration detention facility. It was a joint facility of the U.S. Marshalls service and Immigration.  From the interview on it was an adventure and a moral challenge. During the interview, one person kept asking me questions that were nonsensical to me. After what seemed like an hour, probably 30 minutes, I couldn’t take it and replied, “what the hell does that even mean?” I was sure I was done at that point, but the Immigration Officer in Charge (OIC) of the Facility stood up, pointed at me, and said, “she’s the one.” Seventeen days later I was selling our house and traveling to New York.

When I arrived I was wearing a Service Dress Blue and the OIC took one look at me, handed me a hard hat, and sent me to get jeans and boots. It was the first clue that this was going to be a challenge. The clinic wasn’t finished and it smelled of skunk. Before the building was finished a skunk got in the clinic and the workmen killed it in the bathroom. Every time it rained it smelled which foreshadowed the entire three years I worked for Immigration. It was the omen of the skunk.

It wasn’t just Immigration that was difficult. Unlike the Federal Bureau of Prisons, Immigration was disorganized and the immigrant advocacy organizations were any better. As the health services administrator, I tried to reach out to them to coordinate care for those that were released to the community, and especially those taking medications for a positive tuberculosis skin test. I’m pretty sure they thought I was the devil. It didn’t matter that I was trying to do the best I could for the person being released, they didn’t want anything to with me. I suppose they thought it would be better if there was no healthcare personnel in the facility. I never gave up trying, but I never succeeded either. When I left we were a Joint Commission accredited clinic, had a fully implemented telemedicine system in 1998, and had a fully staffed clinic with a physician, nurse practitioners, medical records, assistants, dental care, and a pharmacy. The clinic was well equipped and well staffed. Our only problem was getting patients we requested in a timely fashion.

After the successful accreditations, I was excited to accept a job in DC where I quickly became the Chief of Field Operations with oversight of all the clinics nationwide. There were only 12 Immigration detention facilities at the time, but it was an opportunity to make a difference in the lives of those seeking the promise of the USA.

Within a short time of arriving in DC we deployed to Guatemala for a mass migration of Chinese. They had boarded a death trap masquerading as a ship bound for the U.S., but when they ran into trouble the ship was pulled to port in Guatemala by the Coast Guard. With a small team of physicians, nurse practitioners, and RNs we carried all of our supplies with us including a portable x-ray machine. Excluding the x-ray maching, we were only allowed to bring 75 pounds each into the country so most of our luggage was medications and equipment.

When we arrived we were all shocked by the condition of the ship and that it held approximately 500 people. It was nasty and piled deep in garbage from the journey. I could not imagine what would drive a person to take such a risky journey on that ship? Their circumstances must have been unbearable.

We were on the ground within days of being asked to respond. I was going because I knew how to take and develop x-rays and had been working on mass migration plans with Immigration. My boss was going for the first few days and then would leave me to manage the team on the ground. What I didn’t know is that the equipment I needed to develop the x-rays wasn’t available. Instead, we traded our hats and boots to get a local man to mix the developer in a sink and develop the x-rays which we then hung on a lemon tree with clothespins to dry. They definitely did not teach me that in nursing school. We did x-rays for all 500 people on the ship.

We also did physical examins for all 500 people in what was less than ideal surroundings. To say what we had for a clinic was inadequate was an understatement. We had one room inside, but most of the care was provided outside and it was hot and humid. It didn’t take long before I was questioning Screen Shot 2019-04-09 at 9.46.59 PMthe morality of what we were doing. We could do cursory exams, but that was about it. We were able to bring one nurse that spoke the language, but the rest of us depended on interpreters. If the person was judged to be tortured or abused they could request asylum otherwise they would be put on a plane back to China where we didn’t know what would happen to them. Near the end of our time in Guatemala one young man became ill. When we took his shirt off he had what appeared to be cigarette burns all over. I do not remember the exact details which I’m sure I’m blocking, but when we pointed it out to the immigration officials they said there was nothing they could do. I do remember asking how it was missed in the physical, but I knew. Like too many providers, and with limited to no privacy they didn’t actually undress the patient.

By the time we recognized what had happened, it was too late as all the asylum claims were complete and the lawyers were gone. I reported it, but I took no for an answer when I was told there was nothing they could do. We failed the patient; a teenager. None of the medical staff knew what to else to do.

A few days later we were getting ready to board a bus to the airport with all of the immigrants. Young women were throwing themselves around our legs and begging us to help and we could do nothing. On the bus, from the coast to Guatemala City, a women saw the poverty of Guatemala and said, “These people should try to escape to China.” They had fled their country, but as bad as it was they thought it was far better than Guatemala. Is there any wonder that so many people come from that region seeking asylum?

Immigration has always detained people and they have never really shown the ability to handle the volume of people detained. However, there was a time when they were making efforts to improve the quality of healthcare, but at that time the healthcare personnel did not report to Immigration but were part of another organization. They seem to have struggled as they moved to for-profit facilities and began to contract out the healthcare.

I suspect the healthcare personnel in facilities with the children are doing their best to provide care. They are probably no better equipped than I was to address issues and are probably taking no for an answer when everything inside them is screaming to do something. They may even be questioning why they are there. Then they see the children and know someone needs to be there.

I have always believed God opens doors and so long as I walk through I will be where I’m supposed to be and all I need to do is trust and work hard. Maybe with immigration, I lost the trust and I certainly had lost my desire to pray. I had been told when I took the job that I needed to come in fully aware, but no warning was sufficient. There are patients I remember fondly and ones that made me wish I could have done more. There is only one I regret. A Chinese teenager with cigarette burns.


People Like Me and Racism

I went to the Ash Wednesday service at John XXIII which is the Catholic Center on campus. It was relatively full and it was interesting to look around and see people that I recognized, but whom I didn’t know shared my faith. Likewise, I heard a student say with some surprise, “Isn’t she the Associate Dean?” There is something that feels good about knowing there are people around you that share a cultural identity. It is suddenly a more familiar and safe environment. It is that familiarity and safety that I would hope we could make more available.

I’ve spent the majority of my adult life living in diverse cities and in diverse neighborhoods. Thirteen years in the DC metro area where I was happy to live on a street that boasted at least four languages, three years in Tucson, one year in San Antonio, and four years in St. Louis though while diverse was the 6th most segregated city in the country and once I got to my neighborhood you wouldn’t have known the city wasn’t 100% white and mostly Catholic.

When I came back to Tennessee my husband ask if I was sure. I’m Catholic and I have belonged to a Zen Center for years. Tennessee is the least Catholic state in the country and the nearest Zen Center is either in Nashville or Ashville. When I went looking for “community” I did it with greater intent than I did in St. Louis. I wanted a diverse community and a diverse church. I thought the university parish would be the most diverse and the most socially active, but I was wrong. I found that Holy Ghost was the most diverse parish in the city and relatively socially active so I ended up splitting my time between the two because I want to be part of the university community but also wanted diversity. I have found that I’m no longer that comfortable when everyone is like me and I never again want to live in a segregated community.

The racism, sexism, and homophobia was part of why I wanted to leave Tennessee in the early 1990s. The racist comments on the rock, the lack of acceptance of persons who are LGBTQ, and the recent blackface incident were shocking, but what I remembered. The difference between then and now is the response from the administration. In short order after each incident, the administration had responded with disapproval. That disapproval is being followed up with action. I am pleased that they are leading by example. They have held campus discussions and now are going to require cultural competency, inclusion, and bias training for all faculty, staff, and administrators beginning with the executive administration and it is to be developed and implemented immediately. While the administration and faculty didn’t paint the rock or record themselves wearing blackface they are saying change begins with me.

How has Tennessee changed since I left in 1991? People like me have looked at ourselves and said, where did these young people learn this behavior? And the answer may not be what I did, but what I didn’t do. I have had a fair amount of cultural competency and bias training and even included it in grants and program development, but I still notice my own bias. In St. Louis our program recognized a lack of diversity and in two years we went from 7% underrepresented minorities to 29% in our doctorate program. We didn’t change a single admission criterion, but we did recognize our own bias in the selection and ranking process. It was a painful two years for some of the faculty. They felt called out, but in reality, the change wouldn’t have happened if they didn’t recognize and own the bias and then act to implement change.

There will always be those that ask why they have to go to training when they aren’t racist, didn’t paint the rock, and have never taken part in offensive behavior. My answer is because our job isn’t just to teach or do research. It is to set the example of what it means to be a professional, a good citizen, and a person that can acknowledge their own bias and work to fix it. It is because they are young and they will identify with us. Whether we know it or not they see us.

Cultural competency training is needed and it needs to be ongoing at all universities. Many, if not most, nursing programs now have cultural competency and bias training is woven throughout the curriculum because we know the impact on health outcomes. The inclusion of cultural competency training for students beginning at orientation and global citizenship as part of our new curriculum will be beneficial for the community, the individual student, and for the patients for whom our students will provide care.

I don’t know what it feels like to always be in the minority or to have been the victim of racism. I’m all too familiar with sexism, but it frequently lacks the same level of hatred and hostility associated with racism, homophobia, and Islamaphobia though is likely equally harmful. The more people like me own our part in a culture that has allowed racism to exist the sooner all will feel welcome, safe, and respected.

I’m dedicated to a more diverse and welcoming campus. I’m also old enough to know that when we are silent about the evil that is racism, sexism, homophobia, or Islamaphobia we are complicit with that evil.


Labor Day

Labor Day honors the American labor movement which focused on a just society including social equality and good citizenship. We celebrate the contributions workers have made to the well-being of our country. Is there any better way to do that than to support the labor unions that helped create our prosperity? Among other things, we can thank unions for weekends, the end of child labor, and fairer and more equal wages.

I have never belonged to a union nor do I generally think they are necessary for professionals. However, there are times when we require assistance to use our skill for the benefit of others. For example, staffing minimums have a significant impact on the quality of care provided to patients. If nurses could negotiate evidence-based staffing ratios, they would. Progress has required the work of labor unions and professional organizations to push legislation making it a reality in sixteen states.

I am grateful for all labor unions have done in my life. My mother was a teamster, and my father was a member of the Atomic Trades Labor Council. I remember strikes and picket lines, but I also remember being firmly middle class, having good health insurance, and parents that worked 40 hour weeks. I support all those that belong to unions and look forward to a just society where they are no longer necessary for equality and a living wage.

If you hire a union worker, there is no doubt the works are paid a living wage. If you don’t then it is a good practice to ask what the workers are paid. If it isn’t a living wage keep looking.


Finding Clarke in All Places

When I went to Clarke University to teach nursing I felt I found my soul. I was able to let go and be the person I imagined I was born to be and not the one forged by 20 years of federal rules and regulations. As I taught nursing I learned how to be a better nurse. When I left the spiritual safety of a Catholic university I feared I would regress or in some way have my faith diminished by not being constantly in the presence of those dedicated to freedom, education, charity, and justice. What I didn’t know is that everywhere I go they are present.

Today I went to the Catholic Worker House to help prepare food. It wasn’t the organized preparation we had in St. Louis for the St. Patrick’s meals, but rather the Zen method of taking whatever has been donated and turning it into a tasty and nutritious meal to take downtown to distribute in the park.

One of my tasks was to find the scissors and in the process found Sr. Mary Dennis. She quickly introduced herself and told me she was from Iowa. As soon as I said I had taught at Clarke she beamed and announced she was a Clarke graduate and a Presentation Sister from Dubuque. We talked about our love for the place and what it means to us and promised to talk more over coffee.

I came home to Knoxville, but Clarke and especially the Sisters that helped me with the transition to higher education continue to touch my life and faith. In every city I’ve lived in since I left Clarke I have run into a Clarke graduate and without exception, the one thing they have in common is their love for the place and the life-changing impact.

catholic-worker-logo-1I feel blessed that God sent a Clarkie to Knoxville to live in the Catholic Worker house, care for those that live there, and provide hope to those that are homeless in Knoxville.
Sr. Mary Dennis and the people of the Catholic Worker reminded me that it is my job to carry with me everything I learned from the BVMs. There will always be reminders along the way that we are a community of love and part of sharing that love is recognizing the dignity of every human being. It is the education we have and share with others that helps us develop our gifts and share them. I learned to be free. I will always be free.


A Path to Diversity

I spent most of my career taking diversity for granted. Having entered my career at St. Elizabeths Hospital in Washington, DC my first supervisor was an African American female. When I returned to St. Elizabeths as a new nurse practitioner my medical director and the supervisory physician was an African American male and in fact, most of my colleagues and those that helped me transition into practice were African American. When I left St. Elizabeths and moved to Tucson, AZ my supervisor was Indian American and my most of my colleagues were Mexican and Phillapino Americans. I had no idea at the time how the diversity I experienced in my early career formed and broadened my perspective. Nor did it ever occur to me that the people with whom I worked would be anything other than close friends.

It wasn’t until I was in my mid-career that first experienced being pressured to make a choice based on race. I was not asked to hire a less qualified person that was a minority. I was asked not to hire the more qualified person who happened to be an African American female. I was told, “When she fails, and she will because they all do I will hold you personally responsible.” I hired her anyway and she went on to be highly successful. I thought it was an isolated incident, but I never forgot it.

Diversity is a blessing

Diversity is in harmony with justice, grace, and peace. Diversity should be defended as it is representative of the dignity that belongs to each person. It is the uniqueness of each individual – ethnicity, religion, political views, nationality, sexual orientation, physical and mental abilities, age, vocation, and thought – added together that makes a strong and more perfect society. The source of diversity and thus the strength of the society doesn’t come from a state mandate but is the creation of God. If an organization lacks diversity, the diversity created by God, then we are going against the natural order and in so doing are weakening ourselves and our society.

I find myself disturbed by the lack of diversity in academia. Maybe it is the places I’ve been or the limited number of people with whom I’ve interacted, or maybe it is an issue in nursing departments. However, the more I read the literature the more I realize that perceptions are sometimes reality. A quick review of a post by Donna Nelson makes clear that there is a lack of diversity in academia and especially in the sciences. Thomas Pfau implies that while we in academia obsess about academic freedom we are a little less concerned about freedom of speech and certainly diversity of perspective.

What is diversity

Diversity refers to all the ways in which people differ and the effect of those differences on our thinking and behavior. This includes socioeconomic status, race, ethnicity, language, gender, religion, and age. A core element of diversity is inclusion, which calls for creating a climate where all individuals are actively engaged, feel safe, and are welcomed. – American Association of Colleges of Nursing

It is not necessary to commit to a substantive definition of diversity and make explicit the normative grounds on which such a definition rests. Diversity is about more than being of different races, ethnicities, or genders or quantifying this many of X and that many of Y. In fact, by adhering to such a definition and quantification one may be missing the attitude of respect that diversity helps to achieve. It may be sufficient to know which affinity group you identify as being important in defining diversity? How would the diversity help you to achieve a more perfect organization or society?

  • Race
  • Ethnicity
  • Gender
  • Sexual Orientation
  • Socioeconomic Status
  • Nationality
  • Political views
  • Generation
  • Genetic characteristics
  • Abilities (mental, physical, emotional)
  • Religion
  • Marital status
  • Work experience

It is not sufficient to tolerate others or the practices of others. Diversity is an attitude of respect that must include a  conscious effort to:

  • Understand and appreciate the interdependence of humanity, cultures, and the natural environment.
  • Practice mutual respect for qualities and experiences that are different from our own.
  • Understand that diversity includes not only ways of being but also ways of knowing;
  • Recognize that personal, cultural and institutionalized discrimination creates and sustains privileges for some while creating and sustaining disadvantages for others;
  • Build alliances across differences so that we can work together to eradicate all forms of discrimination. (QCC)

Reading these it is clear that if we practiced this level of respect and did make a conscious effort toward diversity we would be stronger as individuals, organizations, and as a society.

What is getting in the way of diversity

The easy answer is our fear of change, but that is too easy. I believe that the first and primary issue is that we have done a poor job of explaining the benefits and blessings of diversity. We have not made clear the positive impacts on thought, creativity, peace, and justice.

Question: Why did the universe or God put this person in my path? What am I to learn from them and what have I got to offer in return?

The second barrier is the bias in the way we view those that check different affinity groups from the majority. We all have biases, but not everyone lets bias adversely impact decisions. If I am willing to recognize and own my biases it is easier to break down barriers and not let them obstruct desirable and just action.

Question: What biases do I have and how are they impacting my interactions with others? Do my biases prevent me from treating another human being with full dignity and respect?

The third barrier is privilege. Those of us that grew up in the majority have trouble seeing ourselves as part of the problem. We view the world through a lens that has largely lacked discrimination. It is true that women face discrimination when competing with men, but white women are certainly advantaged over African American and Hispanic women. It is also true that some white males have been disadvantaged when competing for jobs as a result of a desire for diversity. However, it is the exception and not the rule. We could walk through every group in this same manner – older/younger, rich/poor, Christian/Muslim, and on and on. The result would be the same. Some groups are now and have historically been privileged and continue to benefit from those privileges which they did not earn, but were given.

Question: What privileges do I have?  How have those privileges made my life easier? Have my privileges resulted in someone else being made worse off?

The final barrier is lack of moral courage. How many of us have seen a more qualified person passed over for the less qualified? There is always a rationale that is offered and too many that are willing to accept the rationale as a reasonable explanation even when knowing that explanation violates our values.

We can and must remain connected to our fundamental values such as respect for human diversity and the need to create and sustain inclusive environments. Those of us who are associated with or work for organizations that have made their diversity and inclusion values public and even published them have an additional responsibility — to call on the leaders of those organizations to reaffirm those values. As Mahatma Gandhi said:

Your beliefs become your thoughts

Your thoughts become your words

Your words become your actions

Your actions become your habits

Your habits become your values

Your values become your destiny.

Five Actions for Diversity officers and Social Justice Advocates – Johnnetta Cole

Question: What are my values? Am I willing to show moral courage and call on my leaders to reaffirm the values of diversity?

Don’t be timid

It takes moral courage and effort to make diversity a priority. If one is to move an organization the first thing to do is acknowledge that people will be uncomfortable and accept that it is necessary for change. There will be no room to be timid.

For the Spirit God gave us does not make us timid, but gives us power, love and self-discipline. (Timothy 1:7)


Saint Louis Prays for Peace

If you are a nurse you probably remember the moment you felt the need to care for others. Nursing is more than a job for most of us. It is a vocation that we feel comes from God. Today at the prayer for peace in St. Louis one of the ministers suggested that the loss of public education and poverty results in much of the injustice that exists in our society. I could not help but wonder how many students we price out of nursing by the ever-rising tuition. How many students struggle and fail not because of inability, but because of financial barriers. And, how much inequality and injustice results from lack of access to education?

IMG_1964Standing in the shadows of where Dred Scott appealed to the justice system and found no justice, we joined together in prayer as one human family in solidarity for justice and peace. If we are to realize that prayer it requires that it result in good works and action from the whole community.

We can wonder if our prayers are heard or we can open our ears to hear. “Justice, justice you shall pursue (Deuteronomy  16:20). Are we able to recognize that many in our community are following their consciences to be civilly disobedient to an unjust law? Are we able to say what we can do to address injustice?

Whether we see justice as emanating from God or simply as fairness we should all be able to enter into a civil conversation about the issues and to do so we may need facilitators to help. I think today we meet many of those potential facilitators and they came in the form of Priests, Ministers, and Imams.

Whether the injustice your conscience calls you stand against is the use of force, escalating college tuition, health care for all, or the attack on the public school system you must stand and act. We are all called to pursue justice.

What does God want us to do? Only that we do justice.