Nursing Out of the Closet

Today at 12:01a.m., the government of my hometown of Seattle began to issue IMG_0672same-sex marriage licenses. Last month Washington Referendum 74 for marriage equality passed with 54% of the state vote (and 82% of the vote in Seattle). The Seattle couple given the honor of being the first same-sex couple in Washington State to receive a marriage license was Pete-e Petersen (age 85) and her partner of 35 years, Abbott Lightly (age 77). They are both retired nurses. Ms. (Captain) Petersen was a Korean War Air Force nurse who ran a M*A*S*H-type hospital and then went into public health nursing. She became California’s first nursing home ombudsman for the State Department of Health under then Governor Ronald Reagan.

In interviews with Petersen and Lightly, they talk about the prejudice, stigma, and threat of losing their nursing jobs if they didn’t ‘pass’ as being straight women. It wasn’t until they moved to Seattle after they both retired that they felt safe enough to come out of the closet and live openly as a lesbian couple. In a televised interview with the couple early this morning, they both said they didn’t think they’d live to see the day when they could get an official marriage license and get married.

I’ve been reflecting on nursing, and especially nursing education, in terms of LGBTQ issues. I remember my very closeted lesbian nursing instructors from the 1980’s, and the still closeted lesbian nursing professors I know. In nursing school I got absolutely no educational content on LGBTQ issues, except being told that gay men were vectors of HIV/AIDS. Most nursing education today is not much better, although hopefully we teach that HIV/AIDS comes from a virus and not from gay men.

I think back to a time in the 1990’s when I was running the women’s clinic at a Baltimore LGBTQ community clinic (the photo here is of me with friends, at the March on Washington for Lesbian, Gay and Bi Equal Rights and Liberation/April 1993). I was advised by colleagues to not publish a paper I’d written based on my experience providing health care at the clinic(co-authored with my wonderful Johns Hopkins professor/expert on women’s health, Elizabeth Fee). This wasn’t based on their concerns for patient confidentiality, but was based on their firm belief that publishing the paper would label me as deviant and could negatively impact my future career in academic nursing. Since I was a single mother, I needed a job, so I ditched the paper.

Carla Randall and Mickey Eliason, both present or former nurse educators, write about similar experiences in their recent article “Out Lesbians in Nursing: What Would Florence Say? (Journal of Lesbian Studies, 16:65-75, 2012). They point to the fact that historically nursing was dominated by “lesbians, nuns, and spinsters.” They contend that lesbians currently constitute the largest minority group within nursing. (I would add that is only likely for the older cohort of nurses. The largest ‘minority’ group for the younger cohort of nurses is men/ a healthy addition to our profession). Randall and Eliason state that none of the national or international nursing organizations include sexual orientation or gender identity in their nondiscrimination policies. Most other health professions organizations—including the American Medical Association—have issued statements specifically addressing non-discrimination for LGTBQ patients and health care professionals. They also point to results of a study they published in 2010 in Advances in Nursing Science where they reviewed all articles in the top 10 nursing journals between 2005-2009. They found that only 0.16% of the articles included LTGBTQ issues. Longtime nursing educator and activist Peggy Chinn has also published about her experiences of homophobia within nursing education. Her 2008 article “Lesbian Nurses: What’s the Big Deal?” was published in the journal Issues in Mental Health Nursing. Interesting choice.

Turning to the younger—and thankfully more open-minded/supportive of LGBTQ human rights—generation, I am inspired by the young nurse activists who are helping to bring positive change to nursing education and nursing practice. Some are my own students (one of whom contributed to my ‘resources’ list below). Two others are Fidelindo Lim and Nathan Levitt, who both work and teach in NYC. They co-authored a thoughtful “Viewpoint” essay in the American Journal of Nursing (Nov 2011) “Lesbian, gay, Bisexual, and Transgender Health: Is Nursing in the Closet?” In their essay they conclude:

“Homophobia, stigma, and discrimination lead to health disparities and reduced access to care. If we are to remain faithful to our profession’s mission and the public’s trust, we must take a proactive approach to addressing the health needs and safety of LGBT patients, some of whom are nurses themselves.”

There’s a wonderful interview clip of Nathan Levitt, a transgender male, talking about his own experience with health care when he sought breast surgery. His surgeon required him to first see a mental health therapist to “see what’s wrong with you.” When he got to the therapist’s office, she told him she’d just completed one of his cultural competency trainings on LGBTQ health, and that obviously he was the expert on this, not her (video-clip interview available on The American Nurse Project site.) Education and enlightenment can have a boomerang effect.

Additional recommended readings/resources: