Radical Nursing

IMG_1286 2
Seattle Women’s March. Photo credit: Josephine Ensign/2017.

(Note: parts of this Yale School of Nursing 2017 commencement speech were adapted from the chapter “Soul Story” included in my forthcoming book Soul Stories: Voices from the Margins.)

Good afternoon. Thank you Dean Kurth, and all the faculty, staff, students, and the friends and family members of today’s graduates, for this opportunity to speak to you about a topic I am passionate about: nursing. But not traditional nursing—not the Lady with the Lamp during the Crimean War—and not the white uniform-clad nurse angel of Hallmark moments. About that nurse angel, to paraphrase Virginia Woolf and her similarly stifling angel of the house: whenever you feel the shadow of her wings or the radiance of her halo, take up the inkpot or whatever modern equivalent is nearby and fling it at her. Because nurses are flesh and blood people. Nurses are not supernatural beings. We, as nurses, are human beings. Today, I want to talk to you about the real life transforming and transformational nursing of which you are all a part. I want to talk to you about radical nursing. And about the radical self-care it takes to be a radical nurse.

Radical. Not necessarily in the political use of the word. Instead, I mean radical, in the OED definition “of or relating to a root or roots—fundamental to or inherent in the natural processes of life, vital.” It is derived from the Latin radicalis, which referred to “the moisture or humour once thought to be present in all living organisms as a necessary condition of their vitality.”

What feeds and waters your soul? What draws you to the work that you do?

The question of what draws us to the work that we do as nurses is an essential one. It is a radical one. It is a question which demands from us the act of digging deep through the layers of our being, down into the root system. It demands from us the time and space necessary to examine and then continue to re-examine our answers as we move through life. It demands the use of the arts and humanities in order to explore fully. The tools necessary to do this digging are not included in your nursing science toolkit. They are included in your arts in nursing and creative writing awards program led by Dr. Linda Honan. They are included through the meditation, yoga, and other self-care opportunities you have had here at the Yale School of Nursing. They are included in the creative pursuits you brought with you into nursing and that hopefully you have continued to nurture.

Because if we don’t attend to the work of that question—of what draws us to the work that we do— it often becomes an Achilles’ heel, tripping us up, making us lame. If we are not careful, the root of our passion for our work can become the biggest source of professional burnout.

I know this from personal experience. I have burned out—flamed out—rather spectacularly at least once in my career as a nurse. I now know my own particular set of warning signals for when I am beginning to get crispy, and I have worked out an action plan consisting of a short list of self-care that for me includes creative writing, and “real” books (not textbooks), and libraries, and more time in nature and with my family and friends.

I’ll tell you a condensed version of my cautionary tale about my first and worst experience with burnout. I wasn’t able to really think about this episode of my life until more recently as I began to write about it—creatively and reflectively.

A few years ago, I was in New York for a week to attend the narrative medicine workshop at Columbia University. I was there to learn ways to incorporate the stories of health, healing, and the human condition into my work. After the workshop was over, I spent a Sunday walking the length of Manhattan in flip-flops, which was a very silly thing to do since I ended up with a badly infected blister on the bottom of one foot.

But as I walked through Manhattan, I pondered questions that had been flashing through my head like an existential version of the NASDAQ sign in Times Square. Why am I attracted to the suffering of others? Why have I spent the past thirty years working as a nurse with homeless and marginalized people? Would I be happier—and able to afford a better pair of shoes—if I was drawn to work as a shoe buyer for Saks Fifth Avenue? The latter question occurred to me as I hobbled past the wrought-iron festooned display windows of Saks’ flagship store.

In one of our last narrative medicine workshop sessions we were asked to, “write about the last real thing that happened to you.” My last real thing had occurred the week before, during my work in Seattle. I teach health policy to nursing students at the University of Washington. Together with colleagues in the Schools of Medicine and Dentistry I help train and precept groups of medical, nursing, and dental students in the provision of basic foot and dental care for homeless people. The week before my New York trip, we had done one of these Teeth and Toes clinics at Seattle’s largest homeless shelter.

The shelter is in the downtown core of Seattle, at the bottom of the original Skid Road, which earned its name from the frontier town’s cedar logs, public inebriates, and Gold Rush prostitutes that all rolled downhill together into the mudflats and salt waters of Puget Sound. Entering the building, I was hit by the smell of a horse stable, something hay-sweet mixed with urine. The smell took me back to my work at the Cimmerian warehouse of the Richmond Street Center in Virginia, where I began my work with homeless people in the 1980s, and where I rolled down my own version of Skid Road and was homeless for six months.

Later that evening, as I inspected various scars or open wounds on the homeless clients’ feet, my mantra to them became, “What happened here?” Some people had simple replies, such as, “I was in a bad car accident a year ago.” Others were more complex. One patient was a woman dressed in a stained orange t-shirt, her short red hair flying away from florid, puffy cheeks. She stared at the ceiling while mumbling to herself, as if in prayer, her hands held in front of her neck, fluttering. I had the impression she was trying to catch hold of her exposed and scattered soul. Her only reply, while still looking at the ceiling and twitching her hands even faster, was, “I get nervous with too many questions.”

What happened here? is a question I asked myself about my own spiral into homelessness. At age twenty-five I was a respectable Southern preacher’s wife and a newly graduated nurse practitioner, running a health care for the homeless clinic in downtown Richmond. In a photograph of me from this time I’m kneeling on the floor of the clinic, my long straight hair falling in my face, and I’m washing the feet of a bearded Vietnam veteran homeless patient. I mostly worked alone in the clinic, tending to the health needs of thirty or more homeless patients each day for more than three years. I have no photo of myself towards the end of those years when I became a severely depressed divorcee without a job, living in my car and in abandoned sheds. There is no coherent story of this time, no map recording my journey, no facile answers to the question of what happened, only a mosaic of metaphors: rolling down Skid Road, falling into the rabbit hole, exposing my scattered soul, eating myself with rage—and flaming out. In retrospect, I see that my descent was partially caused by an extreme case of professional burn out, something nurses are especially prone to.

The term “professional burnout” comes from Graham Greene’s novel A Burnt-out Case, set in a Colonial British Congo leprosy clinic staffed by an atheist physician and Catholic nuns as nurses. The physician explains that a burnt-out case is a leprosy patient whose disease has burned itself out: the patient no longer has active leprosy but has the scars such that he or she is unable to re-enter normal life. In a conversation with the Father Superior of the village, the physician tells him of the issue of a leprophil: a person who is attracted to the suffering of lepers—who loves suffering and poverty and illness—a form of schadenfreude. He states that leprophil nurses “…would rather wash the feet with their hair like the woman in the gospel than clean them with something more antiseptic.” He likens leprophils to people who love and embrace poverty. The leprophil “makes for a bad nurse and ends by joining the patients.” The physician tells the priest that a patient can detect when someone loves their disease, their poverty, their suffering, instead of loving them as a person.

Why are people drawn to work with the lepers, outcasts, and homeless of the world? Is it, as the priest states in Greene’s novel, dangerous to ask what lies behind the desire to be of use, for we “might find some terrible things”?  This virtuous work or calling or vocation or zeal, whether religious or secular, can feed the Hungry Ghost ego. It can become one’s identity; it can become addictive and destructive. I know this because I became my work and through it I became homeless.

The lesson here is: please do not become your work. That goes for all of us, whether we are graduates or teachers or administrators. In order for all of us to work together to help make our world a better, healthier place for everyone—which itself is a radical idea—it requires radical nurses who practice radical self-care.

Nursing is the largest healthcare profession worldwide, yet continues to have the least direct influence on health policy. Within nursing we have people working in four categories: 1) direct service providers; 2) advocates who help make systems work better for people; 3) organizers who bring people together to change or create new systems; and my personal favorite, 4) rebels—people who speak truth to power and who agitate for radical change. The key is to recognize your own strengths, where you are most comfortable working at any given time in your career—but to also see the value in the range of roles played by different people. Because an effective social change movement and an effective, compassionate, and equitable healthcare system, require people—require nurses—working together in all of these roles.

The Yale School of Nursing may be small, but its graduates have an outsized positive impact on the healthcare system, here in the US as well as globally—and even in terms of planetary health. Graduates: you don’t have big nursing shoes to fill, you have your own shoes, your own important career paths to blaze.

Southern Shrines of (Racist) Memory

DSC00528
Statue of Jefferson Davis, Monument Avenue, Richmond, Virginia. Photo credit: Josephine Ensign/2009

MY HOMETOWN OF RICHMOND, Virginia is a city anchored to its past by bronze and marble Confederate shrines of memory, by an undying devotion to the cult of the Lost Cause. I was born and raised in the furrowed, relic-strewn Civil War battlefields on the city’s tattered eastern edge. A captive of its public schools, I was taught official Virginia history from textbooks approved by the First Families of Virginia. But I came to understand the shadowed history of my state by caring for its homeless outcasts.

These lessons began while I was in nursing school. The modern hospital of MCV curled around the former White House of the Confederacy like a lover. My clinical rotations were nearby in the crumbling brick former colored-only hospital, which then housed indigent and homeless patients as well as prisoners. Most of these patients were black, so I called it the almost-colored-only hospital. The prisoners, shackled to their beds and accompanied by brown-clad armed guards, were from the State Penitentiary located across town. One of my patients was a death-row inmate. When I spoon-fed him his medications, I was simultaneously afraid for my own safety and ashamed of being an accomplice to murder. I knew I was nursing him back to health only to return him so he could be killed by the state. I wanted to talk to him, ask about his family, about his life in and outside of prison, but the stone-faced armed guard loomed over me. I knew from experience not to discuss my ambivalent feelings with my nursing instructor. She considered these to be inappropriate topics. I wanted to finish nursing school as fast as I could, so I kept silent. (From the chapter “Relics” in Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, pp. 57-58).

 

DSC00315
White House of the Confederacy (right) and Medical College of Virginia (now VCU) Hospital. Photo credit: Josephine Ensign/2009

These words—my own words— have come back to me this week as I followed the news of contested sites of memory, of whitewashed Civil War memorials literally being fought over once again in places like New Orleans and Charlottesville, Virginia—and perhaps soon in my hometown of Richmond, Virginia. In Charlottesville, white nationalists waved lit torches and chanted “You will not replace us” in front of a statue of General Robert E. Lee in a city park. (source: Associated Press, Washington Post, “Torch-wielding group protests Confederate statue removal” May 14, 2017). New Orleans has begun the removal of four Confederate monuments in the city, starting with the Battle of Liberty Place monument commemorating the Crescent City While League’s violent fight against desegregation of the city’s police force—in 1876 during Reconstruction. (source: Christopher Mele, New York Times, “New Orleans Begins Removing Confederate Monument, Under Police Guard” April 24, 2017).

Richmond, as the former Capital of the Confederacy, likely has the largest collection of statues to Confederate “war heroes” of any city. I took my driver’s test on the then still cobblestoned streets of Monument Avenue, a five-mile long stretch of tree-lined divided grand boulevard punctuated by traffic circles around five towering statues of civil war heroes. A sixth and very controversial statue was added in 1996 at the far western end of the avenue—of native Richmonder Arthur Ashe (1943-1993). Besides being an international tennis star, Ashe was also a civil rights and HIV/AIDS activist, and a champion of urban health equity work. His memorial statue on Monument Avenue portrays him standing, holding books in one hand (he was also an excellent student and UCLA college graduate) and a tennis racket in the other hand. In the statue, he faces west, away from the Confederate statues. When Ashe was growing up in segregated Richmond, he was barred from playing tennis in the city’s whites only parks—and, ironically, he also would have been barred from even walking down Monument Avenue, a whites only residential area.

Since Monument Avenue in Richmond is a designated national park and indeed, is the only national park to consist of city street, it is unlikely that any of the Confederate statues will be removed anytime soon. But perhaps it is time to rename the street Memorial Avenue. This idea comes from University of Richmond professor of philosophy Gary Shapiro in his NYT opinion page essay “The Meaning of Our Confederate ‘Monuments'” (May 15th, 2017). Shapiro points out that records of city planners of the Confederate “war hero” statues on what would become Monument Avenue, “show that they meant to legitimize and dignify the white supremacist regime that had taken hold in Virginia.” He quotes philosopher of art Arthur Danto who states, “We erect monuments so that we shall always remember, and build memorials so that we shall never forget.”

Instructive and remarkably prescient here are words of Henry James, in his travelogue book The American Scene, in the chapter “Richmond” about his visit to Richmond in the late winter of 1905. A late snowstorm prevented him from traveling very far from the center of Richmond, but he describes his walk to the then newly developing Monument Avenue and the statue of Robert E. Lee (erected in 1890). James reflects on his visit to Richmond and writes:

“History, the history of everything, would be written ad usum Delphini—the Dauphin being in this case the budding Southern mind. This meant a general and a permanent quarantine; meant the eternal bowdlerization of books and journals; meant in fine all literature and all art on an expurgatory index. It meant, still further, an active and ardent propaganda; the reorganization of the school, the college, the university in the interest in the new criticism.” p. 374 Henry James, The American Scene (London: Chapman and Hall, Ltd).

My own then budding Southern mind, educated in the Virginia public schools of Battlefield Park (named for the Civil War Battle of Cold Harbor) Elementary School, Stonewall-Jackson Junior High School, Lee-Davis High School—and then VCU/MCV nursing school—was negatively affected by that still-lingering, ardent, white supremacist propaganda. Through my father I am related to Varina Davis, First Lady of the Confederacy. That legacy, and the work that I have done and continue to do to actively resist racism, is something I do not want to forget.

Just Say No to Nurse Angels

FullSizeRenderThe American Nurses Association has declared this National Nurses Week (May 6-12, 2017) theme as “Nursing: The Balance of Mind, Body, and Spirit” to accompany their designation of 2017 as “The Year of the Healthy Nurse.” To help nurses celebrate the week, a host of businesses are offering “freebies” to nurses, including 1,000 calorie cinnamon rolls. I have nothing against high-calorie baked goods, but to celebrate nurses I recommend books and inkpots. Books, as in real books by real nurses (my current favorites listed below). And inkpots? I explain that in the following excerpt from my upcoming commencement address to graduates of the Yale School of Nursing:

“Thank you for this opportunity to speak to you about a topic I am passionate about: nursing. But not traditional nursing—not the Lady with the Lamp during the Crimean War—and not the white uniform-clad nursing angel of Hallmark moments. About that nurse angel, to paraphrase Virginia Woolf and her similarly stifling angel of the house: whenever you feel the shadow of her wings or the radiance of her halo, take up the inkpot or whatever modern equivalent is nearby and fling it at her. Because nurses are flesh and blood people. Nurses are not supernatural beings. We, as nurses, are human beings. Today, I want to talk to you about the real life transforming and transformational nursing of which you are all a part. I want to talk to you about radical nursing. And about the radical self-care it takes to be a radical nurse.”

I have always bristled at the mention of nurses as angels and included this pet peeve of mine in a previous blog post from January 10, 2016: “Sick Nurses.” So I was delighted to run across a poem, “Killing the Nurse in the House,” by nurse and poet Cortney Davis. I had the pleasure of reviewing her forthcoming collection of poems, Taking Care of Time (Michigan State University Press), which won their Wheelbarrow Books Poetry Prize. This is the endorsement I wrote: “Searing and unsentimental, the poems of Cortney Davis serve as haunting and truth-telling companions. Whenever I am in need of inspiration or of reconnecting with compassion and with all it means to be human, I return to Davis’s ’stories tamed on the page.’ Although, as in her poem ‘The Snake Charmer,’ Davis knows her poems connect us with the wild, untamable places of our lives.” Taking Care of Time avoids the overly religious (to me) themes that have appeared in some of Davis’ recent writing. It will have a permanent place in my home library once it is published.

My current favorite “Real Books by Real Nurses” (and yes, I do include my own and yes, I do realize that this is not a very diverse group of authors and welcome suggestions of books I may not know about):

 

 

 

Going Public: Out of the Ivory Tower

IMG_4119Yesterday, I attended and was part of a timely all day workshop at the University of Washington Allen Library Research Commons, “Going Public: Sharing Research Beyond the Academy.” It was sponsored by the UW Libraries, College of the Environment, eScience Institute, and the Simpson Center for the Humanities/Public Scholarship program. Timely, of course, since science, climate change facts/efforts, the humanities (and arts), and even higher education in general are all under increasing attack in the United States.

The opening keynote speaker was Scott Montgomery, a geoscientist and lecturer in the UW Jackson School of International Studies and author of numerous books, including The Chicago Guide to Communicating Science (University of Chicago, 2003). For his talk, titled “A Story in 25 Images,” he practiced what he preaches by using PPT for showing a series of images to accompany a story (with a traditional narrative arc) of his journey as a communicator of science. Most of his images were abstract geology sorts of themes, but the ones that included human images portrayed only white men in suits. Yes, I was wearing my critical feminist academic bonnet, and yes, there were many women and persons of color in the audience. One young female attendee pointed out in the Q&A session that women within the academy face significant barriers, not just to entering science fields, but also to have non-traditional, public-facing and public-engaging scholarly work—barriers faced by men as well but to a lesser degree. And this is not only a gendered, but also a “minoritized” (her term and one that I like) issue.

The middle part of the day’s workshop consisted of panel discussions and break-out sessions focused on various issues of working with the media in all its varied forms—from TV and newspapers to podcasts, blogging, and other types of social media. I moderated a lunchtime round table discussion on academic freedom and public scholarship, two overlapping topics close to my heart. I didn’t share this in the session, but I have had to fight to defend my academic freedom in terms of this blog over its now seven year history. And public scholarship, such as what I do in my work on health and homelessness? It would seem that it is not deemed “nursing science,” whatever that term even means. But hopefully that is a cohort effect that will change for the better.

I was part of the final panel, “Navigating the Path from Research to Public Policy,” along with Dr. Simone Alin from UW Oceanography and NOAA; Washington State Senator Rueven Carlyle; Sally Clark, former Seattle City Councilmember and current Director, Regional and Community Relations, External Affairs at UW; and Tim Thomas, with the Urban@UW Homeless Initiative. The moderator’s question to the three of us panelists who are researchers was, “Can you tell us a little about how you’ve been involved in informing policy-making through your research.” Indeed, I can and I did, including a mention of my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, which is research-informed and is written as a policy narrative—policy narrative being defined as ” a new genre of writing that explores health policy through the expression of personal experiences” by the editors of the Narrative Matters section of the health policy academic journal Health Affairs. Narrative Matters needs better inclusion from nurse writers, but that is another story for another day.

Homeless Feet Come Full Circle

IMG_6180
Josephine Ensign/ foot care at Cross-Over Clinic, Fall 1986, from Freedom House brochure.

“I did a lot of foot care at the clinic… Of course, it had its Biblical roots, but there was something about foot washing that most people found comforting and even pampering…I knew that having your feet cared for could somehow make you feel better all over…Almost all the homeless patients I saw had foot problems. They had to walk around town to get to different agencies, meal sites, and day-labor pools. They walked in the rain and the snow and the heat, usually in ill-fitting, secondhand shoes with dirty, holey socks, and carrying heavy backpacks.”~ from my book Catching Homelessness: A Nurses Story of Falling Through the Safety Net, pp 86-87.

In this excerpt, I was referring to homeless patients I cared for when I worked as a nurse practitioner at the CrossOver Clinic in my hometown of Richmond, Virginia in the mid to late 1980s—over thirty years ago. But I could be (and indeed, am now) writing about currently homeless people and foot care here in my adopted hometown of Seattle, Washington.

There is this brief part of a haibun (prose mixed with haiku) reflection I wrote after helping with a foot clinic at ROOTS Young Adult Shelter in the University District near where I work: “Tonight in the homeless shelter a 19-year-old man from Georgia says, ‘My momma always told me not to go barefoot and I didn’t listen. That’s why my feets so bad. And I have to walk everywhere on them now.’ He reaches down and gently rubs his brown gnarled feet soaking in a white plastic basin. His feet are darkly scarred and calloused: the feet of an old man.

walking barefoot/we find our way/though cruel paths scar”

(From Soul Stories: Voices from the Margins, in the haibun/chapter titled “Where the Homeless Go”).

Kendra and Ani1.jpg

And there is this description of a foot care clinic I helped with at Mary’s Place, a downtown Seattle women and children’s homeless drop-in center: “The most delightful—and tender—foot clinic patient we had that morning was the petite three-year-old daughter of a young North African immigrant mother. The child pushed around a pink plastic toy shopping cart from the shelter’s playroom, and she wore a dress, bright striped tights, black Mary Janes, and a huge pink feather boa around her neck. She came and sat on a metal folding chair while one of the students washed her mother’s feet. The little girl wanted her own feet to be given the same attention, so her mother removed her shoes and tights. Baby toes! So cute!… I wanted to scoop her up and protect her from the traumas, the abuses of the world. But, of course, I knew I couldn’t do that. It made me sad to watch her toes curl up in delight as she splashed her feet in the basin of soapy water.”

(From Soul Stories: Voices from the Margins, in a chapter titled “Walk in My Shoes.”

IMG_0678And finally there is this King5 TV news report on the University of Washington School of Nursing foot clinic I helped with a few days ago (“UW Nursing Students Host Tent City Welcome Party” by Heather Graf, January 13, 2017). Rusty, the homeless resident of nearby Tent City 3 (currently on the UW campus), told the nursing student working with him that he had never felt so pampered. Small things go a long way. They always have and always will.

Nursing Mile High Club Take 2

wierdflightattendants

Meliorism: The doctrine that the world, or society, may be improved and suffering alleviated through rightly directed human effort; a policy embodying this doctrine. (Source: OED) Meliorism, as in this statement by William James in his book (or really his collection of Gifford lectures given in Edinburgh) The Varieties of Religious Experience (1902): “The idea of a universal evolution lends itself to a doctrine of general meliorism and progress which fits the religious needs of the healthy-minded so well that it seems almost as if it might have been created for their use.” (p. 90) I recently re-read this book for an essay I am writing on science and religion, but it also has come in handy as I process the recent backsliding (yes, a religious term) in social justice progress in our country. Meliorism as a doctrine was, of course, dealt a serious blow with WWII and the Nazi atrocities as revealed during the Nuremberg Trials.

My own ‘belief’ in meliorism has been dealt a serious blow, but my resolve to work towards social justice is strengthened. And I look for evidence of progress wherever I can in order to bolster my resolve. Including in the somewhat dusty archives of this blog. “The Nursing Mile High Club” (originally published February 11, 2011) is one of my personal favorite blog posts to research and write. Re-reading it (and re-viewing the accompanying photo) makes me smile because it reminds me of how far nursing as a profession has come. Plus, it reminds me of how far my “real writing” career has come in the six years since I started this blog/website. Enjoy.

************

Nurses are a lot like flight attendants. Imagine the modern hospital as a large flying spaceship. The physicians are the pilots, or perhaps they would contend that the administrators are the pilots. The hospital patients are mostly all the passengers packed into economy class, with perhaps a few VIP hospital patients in first class patient suites. So, of course, the nurses are the flight attendants of this hospital spaceship. They keep passengers comfortable by bringing them coffee, tea or soft-drinks, they help passengers in and out of bathrooms, they answer call bells, they ensure safety by keeping bed guardrails up, and they help to avoid a mass stampede of panicked passengers/patients running for the exits.

In fact, the first flight attendants were nurses. From 1930 to 1945 Boeing  Air/United Airlines hired nurses to be flight attendants—called stewardesses then. Nurses were hired to calm passengers’ nerves in the early days of flying, and to attend to their comfort by bringing passengers food and drink, and tucking them in at night on long flights. Perhaps they gave sedatives to really nervous passengers. They wore the iconic white nurses’ uniforms, replete with the winged nursing caps left over from the nunnery roots of nursing.

But ramping up after WWII, stewardesses were mainly hired for their sex appeal, and soon became one of the most sexualized female lines of work—even more sexualized than nursing. Until the mid-1960s and the Civil Rights movement, flight attendants were all women. They were all pretty, thin, young, unmarried and un-pregnant women. They wore designer uniforms ranging from hot pants with patent leather go-go boots, to futuristic spaceship suits. Euphemistically known as “tarts with carts,” “trolley dollies,” and ‘flying mattresses,” stewardesses regularly endured pats to their derrieres as they worked the aisles, and it was common for frequent flyer businessmen to marry a stewardess. National Airlines had an infamous and financially successful “Fly Me” TV ad campaign in the early 1970s, with sultry female flight attendants declaring “I’m going to fly you like you’ve never been flown before.” The feminist NOW organization picketed their headquarters.

Currently, about 30% of all US flight attendants are male, and the median age is 44. These changing demographics, coupled with more enlightened cultural mores, successful unions, and post 9-11 increased seriousness of air travel, have all helped to raise the professional status of US flight attendants. In other countries, most notably Asian countries, almost all flight attendants continue to be young attractive females, although an enterprising new Thai airline is recruiting and hiring ‘kathoeys,’ otherwise known as ‘ladyboys,’ “third sex” male transgender people.

Flight attendants and nurses are both service-oriented professions with roots in traditional female roles. Flight attendants have a history of being much more overtly sexualized than do nurses. So how have flight attendants managed to come so much further than nursing in terms of gender parity—and in only eighty years? As I mentioned in a previous post “More than a few good men needed in nursing,” currently only 7% of the US nursing workforce is male. Although I was not able to find specific data on attrition rates by gender and profession, my sense is that male nurses have much higher rates of leaving the profession than do male flight attendants. So it’s not just a matter of recruiting, educating, and hiring more male nurses in the US, we also need to do a better job at retaining male nurses. Otherwise, perhaps they will all go join the friendly skies.

See also:  “Tracing flight attendants’ path from nurse to model to professional” blog post by Aubrey Cohen 1-28-11,  Seattle-PI‘s Aerospace News, about Seattle’s Museum of Flight’s display of flight attendants’ uniforms over the years (“Style in the Aisle”).

****

Note: 2016 statistics on gender parity for flight attendants is difficult to find, but most updated reliable sources seem to place male flight attendants at 25-30%. For nursing, the Robert Wood Johnson Foundation January 2016 policy brief “The Changing Face of Nursing: Creating a Workforce for an Increasingly Diverse Nation” states that the 2014 RN workforce was 10% men. So at least for nursing in the US gender parity—and work attire—is improving.

On Hope

img_0518
Detail from mural “Sonoran Desert:Yaqui Home” by Mario Martinez

Today was absolutely the hardest day to teach out of all of my decades of teaching. I have a class of about 150 nursing students for a course on community/public health nursing. They are a very diverse group in terms of race, ethnicity, religion, country of origin, sexual orientation, gender, and even age. Today’s topics were cultural humility and the social determinants of health equity. How appropriate. One of my students also pointed out to me how helpful it was that I had also assigned a training module on disaster preparedness, which included PTSD prevention. She found the content helpful in terms of facing the outcome of our national presidential election. This made me remember the highly effective CDC Zombie Apocalypse disaster preparedness public education videos and materials. There is a zombie-like mindset within our healthcare system, within academic nursing, and within our society that I find highly disturbing. It would be so much easier to just yield to zombie ways.

I take diversity seriously in my teaching and strive to promote a class climate of respect for all differences, including different political views. But the profession of nursing as a whole, and especially of community/public health nursing, is built on the value of social justice and health equity. And higher education at a public university is based on inclusion and social justice. To now have a president-elect whose political platform included openly racist, xenophobic, homophobic, and beyond-misogynistic-into-sexual-assault-on-women values, takes us—takes me as a teacher—into an entirely new and uncharted territory.

Today in class I tried to acknowledge this in a transparent and respectful way—and to emphasize our responsibility to do our part to make the world, to make our country and our community a better and healthier place. We had terrific trainers from the NW Network of Bi, Trans, Lesbian, and Gay survivors of abuse who helped us address some of these issues directly. And a group of nursing students are continuing a Knitting for Change community group, an idea my UW Study Abroad in New Zealand students brought back with them last year. My co-teacher for that program was the community empowerment “Neighbor Power” expert Jim Diers. And then after class today I received notification of this recent mention I made in a Seattle-area community event of the New Zealand concept of community cafes as places to help strengthen our communities. “Experts offer ideas to help Seattle area’s homeless youth” by Neal Morton (Seattle Times, November 9, 2016).

I choose to hold on to all of these examples of the goodness and compassion in the world. I choose hope and a renewed energy to work for a socially just society.