National Nurses United

RAD:1 10/17/07 9:56 PM Page 28 insurance without the leadership of its national labor movement. Since that convention, we have worked tirelessly with the unions of the AFL-CIO to achieve a unified, coordinated approach, and we have helped to move mountains. Today, 312 labor organizations in 44 states, including nine international unions and 22 state federations of labor, have endorsed HR 676, the national bill to create a single-payer system, based on an improved Medicare for all. In March, the AFL-CIO adopted a new healthcare policy—comprehensive, universal health coverage that builds on Medicare. And our leadership has met your directive and joined the family and house of labor by an affiliation with the AFL-CIO. Now we are a central participant in a national AFL-CIO campaign to make guaranteed healthcare for all a central focus of the 2008 election. And we are joined today by the second in command at the AFL-CIO, and a friend of all working people, AFL-CIO Secretary-Treasurer Richard Trumka, who will address you today. I fully expect that Rich will inspire you, and remind you of the great tests that face us, and the incredible opportunity we have to change the world. We don't have to live in a nation where 50 Americans die every day because they don't have health coverage, and one in six Americans with insurance lives in daily fear of bankruptcy or denial of care they have paid for. And we don't have to live in a nation where our president says the solution to our healthcare crisis is more tax breaks for the wealthy. It doesn't have to be this way. Against the enormous power of a unified healthcare industry, you won life-saving RN-to-patient ratios and then you won them again. In our fight with Arnold, we proved that an enraged movement of nurses, united with other Californians can beat down a Terminator. And we stand today united with an AFLCIO that stopped a president from privatizing Social Security and elected a new majority to Congress last fall. That's the power of everyone in this room. Together, we will win, because it is the fundamental core of who we are, and what you know you have in your heart and your soul. Thank you for your dedication, your passion, your relentless determination, your spirit, and your humanity. I Rose Ann DeMoro is executive director of CNA/NNOC. 28 REGISTERED NURSE NOT SEEING STRAIGHT (continued from page 19) lesbian nurses who feel comfortable being out at work—and nurses who are comfortable with their lesbian coworkers—are also more likely to be comfortable with and even welcoming of lesbian patients, said Chinn. When lesbians don't feel welcomed in OB/ GYN offices, they may choose to go elsewhere for their gay-friendly gynecological care. Some have their primary care nurse practitioner or doctor do their pelvic exam, said Napa-based general nurse practitioner Lauri Hoagland. "I have several lesbian patients in my general care practice for whom I do pap testing," she said. "They don't want to go to the gynecologist because they perceive it as a 'straight world.' At least in our [OB/GYN] department, there are a lot of pregnant women." In other words, it may appear to lesbian patients like the focus of the OB/GYN office is reproduction, not simply reproductive health. Hoagland knows how to talk to her lesbian patients about their STD risk: She mentions that STDs can be passed skin-to-skin and recommends her lesbian patients get tested. But she didn't learn any of that from her nursing training, she said. "I learned nothing in school about this," she said. "Most of what I learned is from friends who are gay. But I was in school in the 1980s. I'm hoping things are a little better now." Some nursing schools are improving. One example is the UCSF School of Nursing, which has integrated information on gay, lesbian, bisexual, and transgender health into all levels of the curriculum and has a committee that identifies places in the curriculum where they can add education about LGBT health needs, said Zina Mirsky, an RN and an associate dean at the school. And lesbian health groups, like the Washington, D.C.-based Mautner Project, UCSF's Lesbian Health and Research Center, and the Chicago-based Lesbian Community Cancer Project all provide training aimed at getting healthcare providers more comfortable with and knowledgable about treating their lesbian patients. (For more information about continuing education credit for cultural sensitivity training, see sidebar.) Training ranges from explaining to providers why it's important to use genderneutral terms when talking to patients about their partners to encouraging them to change their intake form to make it more gender neutral as well. Providers are also often encouraged to give patients a sign that W W W. C A L N U R S E S . O R G they're gay friendly, such as placing a rainbow sticker at the intake desk. "Nurses absolutely can change forms," said Dibble of the Lesbian Health and Research Center. "They just have to care enough to care for everyone." Beyond these basics, training gets more specific about bedside manner. It's important, said researcher Pearson-Field, for providers to pick up on signals that patients may feel apprehensive about their visit and take extra care while explaining things. "If you have a butch patient or a lesbian patient in general, recognize the cues, like fidgeting and tensing up during an examination, that they're uncomfortable and explain what's happening," she said. "These are things a provider should do generally. But also, recognize that a smaller speculum may be more appropriate for someone who has never been sexually active with men." Culturally-sensitive care doesn't mean you have to know everything about lesbian health, said April Nelson, who heads the Removing the Barriers continuing education program at the Mautner Project. In fact, being a great provider may simply mean "saying they don't know." In the years since Victoria Elliott learned she had HPV and started going to the gynecologist again, she said she's had plenty of experience educating her healthcare providers about how best to treat her. Oddly, that has often meant teaching providers not to offer to help her get pregnant. This seems to happen over and over when she goes to the gynecologist, she said. "I'm not sure why," she said, chuckling. "I think it's because they're so used to talking to their straight patients about how not to get pregnant." While some lesbians might eventually want to get pregnant, Elliott said she finds the obsessive attention some gynecologists lavish on the subject to be overwhelming. But she said she doesn't mind helping her providers become more comfortable. "I think the most awful experience is when it's clear the RN or NP or doctor is uncomfortable and they have no idea what to say but they aren't honest about it," she said. "If someone said to me, 'You said you're a lesbian and I don't know what to say to you,' I'd be happy to tell them: Don't tell me how to get pregnant, don't talk to me about birth control, and just do basic well-woman care." I Heather Boerner is a healthcare writer based in San Francisco. OCTOBER 2007

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