Sisters by Choice: United by Voice


Contributors: Jeneile Luebke, Jacqueline Callari-Robinson,
Elizabeth Rice; Ashley Ruiz, Kaylen Moore

           As nurse scholars, allies and advocates, our hearts are broken as we collectively share the horror of yet another woman lost to gender-based violence and express empathy for the family and friends of Gabby Petito.  There are no words to describe the loss of a brilliant loving woman, and all too often, this is our reality and the emotional distress we experience in our work as healers.  As practicing forensic nurses, scholars, and advocates we see and anticipate this trauma far too often, and it is our working reality. As antiracist and social justice activists, we are committed to sharing stories that all lives lost should be met with the same outrage and immediate response, quick compassion, justice.  As Indigenous women and allies, we are using our collective voices to highlight the systemic racism, oppression, and injustice that exists in response to survivors of gender-based violence among Indigenous women by police and mainstream media.

“Sisters by Choice, United by Voice”
Pictured from left to right:  Lori Rice, Jaqui Callari-Robinson, Elizabeth Rice, CJ Figgins-Hunter, Jeneile Luebke, Lucy Mkandawire-Vahlmu, photographed at the Lac Courte Oreilles Women’s Emergency Shelter.  This photo represents the sisterhood of community and academic partners coming together to address the crisis of gender based violence among ethnic minority women. 

           Anyone can be a victim of sexual abuse or intimate partner violence, but some communities are at greater risk after a sexual assault, and the response to their victimization is not heard or felt with the same compassion.  Indigenous women are disproportionately impacted by gender-based violence including intimate partner violence and sexual assault (McKinley; Luebke, 2021).  The US National Intimate Partner and Sexual Violence Survey (NISVS) revealed that 84.7 percent of Indigenous women experienced gender-based violence during their lifetime, and 56.1 percent of Indigenous women and 25.5 percent of men have experienced sexual assault in their lifetime (Rosay, 2016). Indigenous women in the United States also have some of the highest rates of homicide perpetrated against them compared to other racially defined groups; homicide is the third-leading cause of death among Indigenous girls ages 1-19 and the sixth-leading cause of death for Indigenous women ages 20-44 (CDC, 2020). 

           The unjust crisis of gender-based violence against Indigenous women began with the earliest colonial contact.  Violence against Indigenous women became a means of colonial conquest by European settlers through the social construction of Indigenous women as subhuman, exotic, and sexually promiscuous, leading to the idea that Indigenous women were (and still are) deserving of sexual violation (Casselman, 2016; Deer, 2015; Luebke, 2021).  Sadly, this violence continues into the present time.  For example, Native American women and children make up to 40% or more of sex trafficking victims in some states, even though they represent only 1-2% of the general population (Native Hope, 2021). 

           Indigenous women also experience systemic injustice and prejudice through erasure and invisibility, fueled by a lack of media coverage when they have gone missing or murdered.  Racialized and stereotypes are still pervasive in contemporary representations of Indigenous women in all aspects of society. When media reports occur about Indigenous women who are missing or murdered, the reports often sensationalize and normalize the violence in tribal communities.  Playing on centuries of historical and intergenerational violence, the media coverage of our MMIW is often infused with undertones of stereotypes and assumptions of our communities with references to drugs, alcohol, sex work, and victim-blaming, and shaming after experiences with gender-based violence (Native Hope, 2021).

           Conversely, when an affluent, white woman goes missing, it often comprises nationwide manhunts, alerts, an outpouring of prayers and support from the public, and round-the-clock news coverage.  Currently, the world has recently witnessed the disappearance and recovery of the body of Gabby Petito.  The police and FBI response was swift and immediate after Gabby’s family reported her missing on September 11, ten days after her 23-year-old boyfriend, Brian Laundrie, returned home from a months-long cross-country trip in the van without her.  After her reported disappearance, a media obsession and sensation began with frequent updates in national and international news outlets.  A google search on September 22, 2021, yielded 2,910,000,000 hits for “Gabby Petito.”  Sommers (2016) discusses this very issue of race and gender disparities in the media by highlighting the “white missing white woman syndrome”.  Time and time again, we see round the clock news coverage when a white affluent woman goes missing, while Indigenous and other women of color are not seen as deserving of such valuable media coverage.  It is critical to note that widespread media coverage of a missing woman can make the difference between life or death. Widespread media coverage often aids in the timely discovery of a missing woman, subsequently saving her life, as well as perpetrator being caught or not. 

           In contrast, the disappearance of young Indigenous women such as Katelyn Kelly, an enrolled member of the Menominee Nation in Wisconsin, received minimal media coverage limited to local media sources.  Katlyn was missing for nine months before her remains were finally recovered, and her family could grieve their loss, in comparison to the eight days that it took authorities to locate the body of Gabby Petito (Bezucha, 2021).  It was because of grassroots efforts from the Native community who performed endless searches, held vigils and gatherings to raise awareness about her disappearance.  Katelyn and her family did not receive a national response, teams of forensic experts, and endless outpouring of support from around the country, even though they were deserving of it.  In solidarity and collaboration with the Native community, we as recipients of a US Department of Justice FAST Grant, Tracking Our Truth, funded a billboard in hopes of gaining attention to finding this beautiful young soul while she was still missing. 

“Sacred Site”.  This is considered a sacred site on the Lac Courte Oreilles reservation by tribal members.  Our team was privileged and honored to be taken there by a tribal member to offer tobacco.

            Many missing and murdered Indigenous women today remain unnamed and their disappearances unheard of or unknown.  It is unknown how many Indigenous women, men, and children are currently missing or have been murdered in the US.  Collecting and tracking accurate data has yet to be prioritized by our local, state, and federal authorities.  There are thousands of reports of missing Indigenous women and girls every year, and few of them make it to the Department of Justice missing person database (NAMUS).  For example, in 2016, there were 5,712 reports of missing Indigenous women and girls nationally, and only 116 of those were logged into the NAMUS database (Urban Indian Health Institute, 2018).  In Wyoming, the state that Gabby Petito went missing from, there are at least 710 Indigenous people, mostly women and girls, reported missing between 2011 and 2020 (Wyoming MMIW Task Force, 2021).  A google search for “MMIW,” also on September 22, 2021, yields 679,000 hits.  The lack of media coverage of our MMIW relatives sends a clear message to women that they are not “worthy victims” deserving of media attention and valuable law enforcement resources, leading to further systemic oppression and violence against our people.

            Highlighting the pervasiveness of racial disparities and inequities that exist surrounding the phenomenon of missing and murdered Indigenous women has implications for practicing nurses and allies.  As with any survivor, it is crucial to recognize that the complex layers of current and historical trauma and resultant health disparities when working with Indigenous communities.  Given the colonial history of intergenerational and historical trauma experienced by Indigenous women, the first step that for nurses delivering services to address gender-based violence is to have a clear understanding of the traumatic effects of colonization and the impacts of violence, as well as developing confidence in the types of culturally safe and trauma informed care that will be effective (National Indigenous Women’s Resource Center, 2021).  Trauma informed care and practice embraces a recovery focused, strengths-based approach, with an understanding and response to the neurobiological impacts of trauma.  Trauma informed care emphasizes the psychological, physical, and emotional safety of survivors while consistently providing opportunities for the personal control and empowerment of survivors (National Indigenous Women’s Resource Center, 2021; Klingspohn, 2018). This ensures that we as nurses actively resist the perpetuation of trauma and oppression of our patients, while simultaneously building trust with survivors and their communities. 

As recipients of the United States, FAST Grant, Tracking Our Truth, we value the opportunity given to us by our community partners Lac Courte Oreilles Tribe (LCO), Gerald Ignace Indian Health Care Center (GIHC). We commit to advocating for all individuals and working side-by-side to create access to Advocacy driven Medical Forensic programming that is survivor-led and Native community-centered. Through this grant, we have learned to listen attentively and value the insights shared with us. All programing and outreach are contingent on consensus, as is this blog and all information and actions related to this project. We commit to showing humility, leading from behind, ensuring that our activities are antiracist, and listening for feedback. In a previous Nursology blog we omitted one of our valuable partners and were accountable for our actions with a commitment never to repeat the act of exclusion. As we continue to work on this project, we will amplify the voices of the community, listen with respect, and continue to nurture this sacred opportunity to build and value relationships to offer access to advocacy-driven medical forensic care. Last week former District Attorney of Ashland County and Wisconsin Representative Sean Duffy was complicit in perpetuating racist stereotypes and oppression on National television.  He was quoted saying, “They burned villages, raped women, seized children, and took land,” referring to the American Indian communities in Wisconsin. He also stated that “the conditions from Native Americans have everything to do with government dependency, cycles of poverty and alcoholism, and family breakdowns”, with zero evidence or factual basis for his claims (Native News Online, 2021). Upon hearing this news, we immediately acted, sharing this news and video with our National FAST Grant partners and the Social Justice Committee of the International Association of Forensic Nurses. We commit to advocating for American Indian Communities, using our privilege as nurses.

References

Bezucha, D. (24 September 2021).  A Special Feature in Wisconsin’s 2020 Domestic Abuse        Homicide Report Points to Need for More Accurate MMIW Data.  Wisconsin Public     Radio.  Retrieved from: https://www.wpr.org/were-forgotten-new-report-draws-long-       overdue-attention-missing-and-murdered-indigenous-women-girls.

Casselman, A. L. (2016). Injustice in Indian country: Jurisdiction, American law, and sexual violence against native women. New York: Peter Lang.

Center for Disease Control (2020). Multiple Cause of Death 1999-2018 on CDC WONDER         Online Database.  Retrieved from: https://wonder.cdc.gov/controller/datarequest/D77

Deer, S. (2015). The beginning and end of rape: Confronting sexual violence in native America. Minneapolis: University of Minnesota Press.

Luebke, J., Hawkins, M; Lucchesi, A., Weitzel, J., Deal, E., Ruiz, A., Dressel, A. & Mkandawire-Valhmu, L (2021).  The Utility of Using a Postcolonial and Indigenous Feminist Framework in Research and Practice about Intimate Partner Violence against American Indian Women.  Journal of Transcultural Nursing. 32(6) 639-646.  https://doi.org/10.1177/1043659621992602

Klingspohn, D. M. (2018). The importance of culture in addressing domestic violence for First Nation’s women. Frontiers in Psychology, 9(JUN). https://doi.org/10.3389/fpsyg.2018.00872

McKinley, C. E., & Knipp, H. (2021). “You Can Get Away with Anything Here… No Justice at All”- Sexual Violence Against U.S. Indigenous Females and Its Consequences. Gender Issues, (0123456789). https://doi.org/10.1007/s12147-021-09291-6

National Indigenous Women’s Resource Center (3 May 2021).  An Overview of Shelter and Advocacy Program Development in Indian Country:  From the Roots Up.  Retrieved from: https://www.niwrc.org/sites/default/files/images/resource/From_the_Roots_Up.pdf

Native Hope (5 January 2021).  January is Human Trafficking Month.  Native Hope blog. Retrieved from:  https://blog.nativehope.org/january-is-human-trafficking-awareness-month

Native News Online (17 October 2021).  Fox News attacks Native Americans after Vice

President Harris calls on Americans to reckon with its shameful past.  Retrieved from:

https://nativenewsonline.net/opinion/fox-news-attacks-native-americans-after-vice-president-harris-calls-on-americans-to-reckon-with-its-shameful-past

Rosay A. (2016). Violence against American Indian and Alaska Native women and men. National Institute of Justice Journal. 2016, 277:1-            https://nij.gov/journals/277/pages/violence-against-american-indians-alaska-         natives.aspx.

Sommers, Z. (2016).  Missing White Woman Syndrome: An Empirical Analysis of Race and       Gender Disparities in Online News Coverage of Missing Persons. Journal of Criminal            Law & Criminology, 106(2).  Retrieved from:              https://scholarlycommons.law.northwestern.edu/jclc/vol106/iss2/4

Urban Indian Health Institute (2018).  Missing and murdered Indigenous women and girls- A anapshot of data from 71 urban cities in the United States.  Retrieved from: https://www.uihi.org/wp-content/uploads/2018/11/Missing-and-Murdered-Indigenous-Women-and-Girls-Report.pdf

Wyoming MMIW taskforce (2021).  Missing and Murdered Indigenous People: Wyoming Statewide Report.  Retrieved from: https://www.niwrc.org/sites/default/files/images/resource/wy_mmip_report.pdf

About the contributors

Jeneile Luebke

Jeneile Luebke PhD, RN is an Anna Julia Cooper post-doctoral fellow at University of Wisconsin-Madison, School of Nursing.  She received her LPN/ADN degrees in Bemidji, MN, and her BS and MS in Nursing from UW-Madison, and her PhD in Nursing at UW-Milwaukee.  Jeneile is an Anna Julia Cooper Post-Doctoral Nurse Research Fellow at the University of Wisconsin-Madison, School of Nursing.  She’s Anishinaabe/ Métis (enrolled member of Bad River Band of Lake Superior Chippewa).  Her area of research and expertise include gender-based violence in the lives of Indigenous women, community health and utilization and application of postcolonial and Indigenous feminist frameworks. She is a key part of a team of multi-site researchers who are involved in several community engaged research and service grants that aim to better understand the lived experiences of gender-based violence, as well as advocating for survivor-led, trauma informed, and culturally safe interventions and options for survivors of gender-based violence.  Her other current work focuses on the impacts of gender-based violence on the health and wellbeing of Indigenous women and girls, particularly focusing upon the relationship between land violence and gender-based violence

Elizabeth Rice

Elizabeth Rice is an enrolled member of Lac Courte Oreilles Band of Lake Superior Chippewa and Director of the Lac Courte Oreilles Emergency Women’s Shelter.

Jacqueline Callari Robinson

Jacqueline Callari Robinson, BSN, RN, SANE-A/P, DF-IAFN is presently the Research Assistant for Tracking Our Truth, Department of Justice, FAST Grant, and a Ph.D. Student at The University of Wisconsin Milwaukee. Jacqueline’s clinical practice is a tele safe nurse for the United Concierge in Troy, New York, taking call to evaluate sexual assault patients. In 2020, Jacqueline edited the SANE A/P Preparation Manuscript, published by Springer Publishing Company. Her expertise is assessing and providing sexual abuse medical forensic care and training providers and systems to offer patient-centered compassionate care. Her present duties include oversight of the Advocacy Driven Medical Forensic Care to AI communities throughout Wisconsin, training nurses, program development, providing technical assistance, and Medical/Forensic program sustainability. Jacqueline also serves as Co-Chair of the IAFN Social Justice Committee, creates statewide protocols and procedures to develop survivor social systems response to sexual assault victims.  In 2011 she was awarded the Distinguished Fellow award from The International Association of Forensic Nurses. Jacqueline also provides case consultation and technical assistance; and develops training materials, resources, and publications.

Ashley Ruiz

Ashley Ruiz, BSN, RN is a doctoral nursing student and clinical instructor at the University of Wisconsin—Milwaukee. She is also a Sexual Assault Nurse Examiner (SANE) at Aurora Sinai in Milwaukee, Wisconsin, through which she has contributed to enhancing excellence in nursing care by addressing the healthcare needs of women who have experienced violence. She began her nursing trajectory (CNA and ADN) at Madison College in Madison, Wisconsin, after which she practiced at a local magnet hospital. She received her BS in Nursing from the University of Wisconsin—Milwaukee in 2015, while continuing a commitment to nursing practice through gaining experience within community health, long-term care, leadership, and in acute care settings. Through her experience in practice, Ashley began to identify gaps where healthcare providers failed to address the needs of patients who had experienced violence. Based on this experience, Ashley began to pursue a doctoral degree through the University of Wisconsin—Milwaukee. Her current work focuses on advancing feminist theory in nursing science for the purposes of providing a theoretical foundation for addressing the problem of violence against women, particularly for ethnically diverse populations.

Kaylen Moore

Kaylen Moore, BSN, CCRN, SANE-A, SANE-P.  Kaylen Moore is currently a PhD nursing student at the University of Wisconsin-Milwaukee. She earned her BSN from Marquette University in 2003. Kaylen began her career at Froedtert Hospital, a Level I trauma academic medical center, where she has held many leadership positions in Shared Governance and continues to be involved in nursing research. She has been a Forensic Nurse Examiner with Advocate Aurora Healthcare since 2013. She has contributed to forensic nursing practice and the trauma-informed care of sexual assault patients through her authorship of the chapters Medical Forensic Photography in the Sexual Assault Patient and Medical Forensic Documentation in the book IAFN Sexual Assault Nurse Examiner Certification: A Review for the SANE-A® and SANE-P® Exams. Her research interest includes gender-based violence among ethnic minority women with a current focus on Black women survivors of intimate partner violence.

#DetentionIsDeadly  #FreeThemAll #D4CCQuiltProject


Guest contributor: Jane Hopkins Walsh

Background

 Social justice movements have historically incorporated arts based visual components to amplify their messages by using images and visual art to literally making the invisible more visible. Examples of this include Judy Chicago’s Dinner Party  and the AIDS quilt

As an arts based medium, quilts are powerful semiotic vehicles for protest and memory, and actual representations of comfort and care. Throughout history, suffragettes, abolitionists, enslaved people, Vietnam war protesters, and HIV/AIDS and 911 survivors have used fiber art and the quilt medium to come together in communal spaces for the purpose of grieving, memorializing and honoring others, and for communicating political opinions about important issues of the day.

This week, health care providers from the group called Doctors for Camp Closure, (D4CC) are coordinating a nationwide 24-hour protest vigils outside detention centers to draw attention to the serious risks of infection from CoVid-19 in detention centers and prisons nationwide. In solidarity and collaboration with community groups around the nation, D4CC are incorporating many arts based events including poetry reading, music, story telling, reflective journaling, and the creation of a virtual and actual protest quilt called the #D4CCQuiltProject.

 Using the social media platform Instagram and the use of the project hashtags, the virtual  #D4CCQuiltProject project will “sew” together images from the nationwide protest, banner messages, and other images or words drawing attention to the risks of CoVId-19 infection for detained and incarcerated people. The #D4CCQuiltProject can also spotlight less obvious historical and structural issues of the Capitalocene that are driving refugees to immigrate around the globe including persistent white settler colonialism, neoliberalism, militarization, persistent extraction of living and non living resources around the world by the Global North, and climate related extremes- all factors driving im/migration globally and to the US, and contributing to conditions of extreme poverty, violence, and food and water insecurity throughout the world. Structural violence issues 

MIssion Statement:  The #DetentionIsDeadly  #FreeThemAll Quilt Project messages are intersectional social justice messages and may include these ideas among others :

  • Show healthcare worker support for the Free Them All movement to release people detained by ICE during COVID pandemic, draw media attention to the dangers of incarceration, and increase public support for decarceration
  • Prisons and detention centers are filled with impoverished Black and Indigenous People of Color, and Undocumented People, and they are increasingly the largest sites of COVID-19 infection
  • Social distancing in detention or prison to reduce the risk of COVID-19 is impossible.
  • As health care providers we oppose detention.
  • Many prisons and detention centers in the US are capitalist oppressive for-profit systems that filled with people who have been disadvantaged across generations by the very systems that now hold them prisoner.
  • Migration to the US is driven by intersectional issues for which we as US citizens are complicit including US colonialism, climate injustice, capitalist extractive industries, globalization and neoliberalism (think sugar, palm oil, hydroelectric power, coffee, lumber, beef, global agriculture to name a few).
  • Native American and Indigenous land rights issues in the US are erased within discussions of immigration. (One example among others is: May 2020 The Wampanoag Tribe in in Massachusetts are struggling to retain land rights).
  • LQBTQI issues get erased in the discussion of immigration and detention.

Project Vision   

  • A virtual quilt that “sews” together square virtual images that align with the purpose of the action. and/or 
  •  An actual quilt that has names, images etc on fabric and that can be actually sewn together and/or 
  • An intersectional art project that is open to the greater art community. 

Project Guide: How to Participate 

DIRECTIONS  

There are TWO WAYS TO PARTICIPATE IN THE QUILT PROJECT

VIrtual Quilt 

  • Take a square photo of any message or image that aligns with issues of social justice, examples above, open to interpretation; the only restriction is the photo/image must pass minimum standards for social media, ie) non vulgar non obscene etc
  • Can be poetry, single words or phrases, a photo of a flower, headline in news, anything, names of deceased persons to honor who have been impacted by structural violence, See some image examples below. 
  • You may superimpose a message on a photo you already have. You may superimpose the project hashtags, or a message on a picture of your Protest Banner.
  • A Square image is needed to “fit them together “
  • Upload to Instagram with 3 primary hashtags #DetentionIsDeadly  #FreeThemAll#D4CCQuiltProject
  • Secondary hashtags are fine too but you have to use these 3 so we can “find” the “images” on Instagram you can also Tag @doctorsforcampclosure 
  • Ultimately, the images can be placed on colored squares see below and “sewn” virtually into a virtual quilt. This will happen in the near future after we have a number of images.
  • The quilt will be shared on social media to amplify the messages

Actual Quilt

  • During the vigil, before or up to two- four weeks after vigil,  people can mail me 12 by 12 inch squares of actual fabric with messages hand written or sewn , and I will sew them together and make them onto a physical quilt. 
  • Any fabric is acceptable but dimensions should be 12 inches by 12 inches
  • This is a way to get the public, friends, kids,  and family members involved in this cause.
  • People can include the creation of a physical square as a way of reflecting during the 24 hour vigil. Think child art, spontaneous, no pressure to have any “art” or sewing skills. Just has to be about 12 by 12 fabric based no rules on type of fabric.
  • People can invite local community groups to participate in the creation of squares.
  • PM Jane Hopkins Walsh for address where to send fabric.
  •  Fabric must reach me by +- June 15th 2020. 
  • The actual quilt could be part of a larger traveling protest quilt that gets added on to in other future protests. 
  • Ultimately the actual and the virtual quilt could be part of larger intersections with the art community to amplify and intersect our messages. For example we could have sew-ins in protest in NYC or other places, intersecting with other protests, or the quilt could travel to other cities and immigrant groups to include diverse social movements and groups all over. This is fluid and open to discussion as it unfolds.

EXAMPLES OF IMAGES BELOW- PLEASE IF YOU SHARE THESE IMAGES  GIVE CREDIT  AS LISTED BELOW.

Credit these 4 tags for this image above please
@voxpopuliprintcollective @shimartnetwork #voxpopuliprintcollective
#shimartnetwork

Credit for this image: from Twitter user@denimfemme Lou Murrey

Credit for the quilt images are
Instagram @janewalsh357 #BorderQuiltProject

Credit for the two quilt images above are
Instagram @janewalsh357 #BorderQuiltProject

Credit for this image
@voxpopuliprintcollective @shimartnetwork #voxpopuliprintcollective
#shimartnetwork

 

About Jane Hopkins Walsh

Protest Opinions in this document are My own
Pronouns She / Her
Jane Hopkins Walsh MSN, PNPC
Pediatric Nurse Practitioner
Primary Care at Longwood
Boston Children’s Hospital
300 Longwood Ave
Boston, MA  02466
jane.hopkins-walsh@childrens.harvard.edu

Volunteer and Board Member
Cape CARES
Central American Relief Efforts
www.capecares.org

PhD Candidate and Research Fellow
Boston College
William F. Connell School of Nursing
Enrolled: Center for Human Rights and International Justice
Lynch School of Education
Jonas-Blaustein Scholar Cohort 2018-2020
walshjm@bc.edu

 

 

Nurses’ Concerns with COVID19: Update April 17, 2020


The COVID19 pandemic continues to be quite an issue in New York, with over 14,000 deaths reported. I found this link to the New York Times to be helpful in assessing where we are with official numbers of reported testing and deaths (NYTimes CVOID19), though in many states we know that testing remains very limited and accuracy of tests is still only at about 67-70%.

PPE: Nurses are still without proper PPE. While the federal government claims to have distributed millions of masks and gowns, frontline workers are still faced with shortages and putting themselves at risk. Now we are seeing surges in the cost of PPE, with costs going up over 1000%, according to a report published last week by the Society for Healthcare Organization Procurement Professionals. Competitive bidding for these supplies both internationally and within our own county has compounded the issue, and if we had federal government oversight and processes in place, it is likely these issues could be addressed in ways that would help to prevent price inflation ( CNN review of the inflation of PPE cost).

This video that appeared on CBS’s 60 minutes made it clear that nuses like New York nurse Kelley Cabrera are beginning to speak out. Nurse Cabrera works at Jacobi medical center in the Bronx. She makes the point that when nurses are required to reuse N95masks for up to 5 days, they are literally being provided with medical waste to be used as PPE. Nurse Kelley Cabrera 60 minute’s interview

Nurses Stories: Meanwhile, I have heard the stories of nurses continuing to work without proper PPE and we reultantly have high numbers of nurses testing positive in areas like Ohio.

Nurses have started to reject the idea that they be considered to be angels or heroes. They didn’t become nurses to die, and they don’t want to be martyrs. While the 7 pm clapping and cheering ritual in New York City seems to have built a community spirit, some nurses experience this differently. One New York City nurse wrote: ” I ask that you do not pity me, that you do not call me a hero. I do not wish to be made into a martyr….Clap for me and other healthcare workers at seven o’clock if it makes this pandemic feel more bearable. I concede, your cheers help us trudge on. Just know that cheers and hollering don’t change the outcome. This is my fervent plea – that we change what we can after all this is over”.

Fallen Nurses: The loss of nurses becomes hard to track as the numbers increase. NYSNA has set up a memoriam page: Fallen Nurses Memoriam

A 28-year-old pregnant nurse in the UK passed away on 4/12, RIP nurse Mary Agyeiwaa Agyapong. Her father passed away two weeks before she died. Mary’s baby daughter was delivered via cesarean section before Mary died.

27236508-8226319-Mary_Agyeiwaa_Agyapong_28_pictured_died_on_Sunday-m-13_1587050953040

Many other nurses and hospital staff in the UK have also died (daily mail review of nurse and staff COVID19 deaths).

Two nurses in Palmetto, Florida have also died from work related exposure to COVID19. Nurse Danielle Dicensio leaves behind a 4 year old son and hubsand. Nurse Earl Bailey also worked at the same hospital, Plametto General Hospital, and he passed away from CVOID19 a few weeks ago. Both nurses complained about not having access to proper PPE, which the hospital denies (two nurses die of COVID19 ). 

A colleague of Nurse Cabrera’s (mentioned above), Freda Orcan,  who worked at Jacobihospital in the Bronx passed away March 28.

image

 

ANA’s response to COVID19:

The Ameican Nurses Association has issued a statement that nurses should be reporting when then experience retaliation around their raising concerns regarding their personal safety in the workplace, as these are OSHA violations (OSHA and retaliation issues). While hundreds of complaints have been filed, it’s difficult to determine specifically how OSHA is responding to reports made. There is a plethora of information on their website regarding COVID19 issues (https://www.osha.gov/SLTC/covid-19/),

The ANA has created a page of resouces for nurses (ANA COVID19 page). There have developed a corona virus response fund for nurses. There is also a section about ethical guidelines for nurses that may help some in their decision making process and calls forward the bigger ethical issues that nurses are facing, and  links that show all of the steps that ANA is taking in advocating for nurses.

The latest ANA/ AHA/AMA letter witten calls for the government to address the issue of minorities and the disparities they experience with receiving adequate care for their COVID19 issues. (ANA letter to the Secretary, US Department of Health and Human Services). The letter in part reads:

“As organizations that are deeply committed to equity in health status and health care, we have long recognized differences in the incidence and prevalence of certain chronic conditions, such as diabetes, asthma, and hypertension — conditions that are now known to exacerbate symptoms of COVID-19. We also recognize that other factors, including but not limited to socioeconomic status, bias and mistrust of America’s health care system, may be resulting in higher rates of infection in communities of color. Lack of access to timely testing and treatment will inevitably lead to worse outcomes for these patients.

As America’s hospitals and health systems, physicians and nurses continue to battle COVID-19, we need the federal government to identify areas where disparities exist and help us immediately address these gaps.”

While ANA has been interacting at the national level, my perception from the nurses directly working with patients on the frontlines is that they feel under-represented and that ANA is not providing them with the voice they need. One time letters to federal authorities seem to make little measurable immediate impact. around what matters for nurses being able to practice safely. They also feel that many of the practicing nurses don’t belong to ANA exactly for this reason: that there is somehow a gap between the reality of nursing practice and the work and publications of the ANA. The crisis is far from over.

May all nurses and all beings know some peace and ease.

Nurses’ Concerns COVID19: Update March 23,2020. Take Action.


Today in social media land, nurses state that they are being told to not use PPE for MRSA and VRE and other contact precaution patient care situations. I think we all know the dire implications around this.

Some are claiming that in other countries they have contacted nurses and doctors who do have access to adequate PPE.

Additionally, many are discussing at what point do you refuse to work because you don’t have proper PPE, or any PPE at all. Some nurses are grateful to be working and still have an income, others are worried and exhausted, some haven’t seen their kids or family in a week out of fear of exposing them to COVID19.

There are private companies that are helping hospitals and healthcare systems access more PPE for their needs. A former state legislator from Maine, Diane Russell, has been working as a broker to help state legislators from Massachusetts to procure PPE. So, instead of the federal government helping to ensure that the people on the front lines are protected, states and healthcare systems are having to turn to private organizations for assistance in just finding PPE: https://www.bostonglobe.com/2020/03/21/metro/message-maine-massachusetts-yields-much-needed-medical-supplies/?  I do not know much about the company, I don’t know if the pricing is fair, but I do know they are able to provide many with PPE. https://noblemedicalsupply.com/products

It’s still early on the east coast, but I am not expecting the president to take action on the Defense Production Act today. I implore you to do the grassroots things and contact our representatives.

Be direct and clear; state your name, where you live, your contact information, your profession, and that you are asking them to ensure that the federal government takes action on the Defense Production Act so that healthcare workers have access to Personal Protective Equipment and patients have access to ventilators.

I suggest both phone and email messaging. I suggest leaving messages with the president’s office, and each of your representative federal lawmakers. It took me about 30 minutes to organize myself, write out my message, and both call and email the president, my governor, my federal legislators.

The full list of how to contact all of your federal and state lawmakers is found here on this main landing page: https://www.usa.gov/elected-officials

This link takes you to your house of representatives legislator and provides phone and email contacts: https://www.house.gov/representatives/find-your-representative

This link takes you to the senator’s contact information: https://www.senate.gov/general/contact_information/senators_cfm.cfm

It’s also important to contact your state government and aks them to request that the federal government take action. You can find your state government links here: https://www.congress.gov/state-legislature-websites and also from the main landing page, including your governor’s information.

*Thanks to those of you who dialogued and posted yesterday, though I haven’t had the energy to respond. I am trying to take good care of myself, as I still have a sore throat, headache, runny nose, body aches, no fever. All of the symptom checkers say it’s not COVID19. I wish you all wellness and peace.

Nurses’ Concerns with COVID19: March 20, 2020


Like many of you reading this, I have a range of emotions and feelings as the pandemic of COVID19 grows in the USA: anxiety, fear, and anger. Today (and for the last several days), I am angry about the lack of Personal Protective Equipment (PPE) available for nurses who are being called to care for those who are most ill and the most contagious. The following is my attempt to express my personal concerns and align them with nursing’s guiding ethical principles.

There may be flaws in my thinking and I am open to respectful dialog about these issues. I understand that emotions are running high and that we may not agree, but we can and should have civil discussions and dialogs.

Lack of Personal Protective Equipment. On February 7, 2020, the World Health Organization warned of a shortage of Personal Protective Equipment in China and beyond. As that was 6 weeks ago, there has been time to ramp up the production of PPE. Meanwhile, state’s governors from Maine to Wisconsin to Florida and Washingon are asking to access the federal stockpiles for access to PPE:

https://www.penbaypilot.com/article/governor-mills-urges-federal-government-vice-president-release-personal-protection-eq/131972

https://www.nbc15.com/cw/content/news/Evers-asks-federal-govt-for-much-needed-supplies-from–568975621.html

https://www.propublica.org/article/heres-why-florida-got-all-the-emergency-medical-supplies-it-requested-while-other-states-did-not

https://www.doh.wa.gov/Newsroom/Articles/ID/1117/Addressing-shortages-of-Personal-Protective-Equipment-PPE

Nurses Quitting: A few days ago, one of my Facebook friends quit her job because she was no longer being provided the proper PPE, She was not directly caring for COVID19 patients, but she needs proper PPE to keep herself and her patients safe during the provision of care,  and her quitting her job got me thinking, considering ethical issues, advocacy, the role of the nurse, and so on.  I respect her decision, and I hope this post makes it clear that during these frightening and murky times, the decisions we make as nurses are going to be hard ones.

image.png

I want to say, from an ethical perspective, it is perfectly acceptable for nurses to quit their jobs and/or refuse to work without proper PPE. Refer to my previous post of the ANA calling for the CDC to provide evidence when they make guidelines, and consider the recent use of bandanas and reuse of face masks protocol from the CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html. This flies in the face of everything we know about the transmission of viruses.

Ethical Principles: The overarching ethical principles at play here that help to guide nurses’ decision making are beneficence (doing the good thing, moral obligation to do the right thing, what is best for the patient) and nonmaleficence (do no harm to patients). When we work without proper PPE, there is a very real risk that not only might we harm ourselves, we potentially spread pathogens to patients. When we don’t have proper PPE, our stress, fear, and anxiety can be magnified and potentially may harm patients.

Additionally, The code of ethics for nurses (https://www.nursingworld.org/coe-view-only) requires a lot of us.  To begin with, we must be deeply familiar with The code and how it guides our decision-making processes. The following are some excerpts from The code that guide our decision making at this time:

The code: 3.5 Protection of Patient Health and Safety by Acting on Questionable Practice 

This concept is all about the reporting of inappropriate and questionable practices. We may become stymied when even our boards of nurses are aware of dangerous and non-evidence-based practices, but they may see no way around them. We can report the issues, but when the governing bodies we report to are not holding up our own ethical standards, the field is put at greater risk for collapse (from infection spreading and/ or providers quitting).

Even as standards are relaxed, entities such as the Oregon Board of Nursing should be taking more responsible action and not placing nurses and patients at risk. The following is a statement by the Oregon Board of Nursing that states that nurses cannot refuse assignments because of sub-par PPE that does not align with CDC or WHO regulations. In other words, in this case, the BON is either not considering the greater harm for both patients and nurses by not recognizing the greater ethical concerns and personal risks nurses are being asked to take, or they simply see no other solutions. The paragraphs about the social contract and evidence-based approaches contradict the highlighted area regarding changes in PPE approaches and the right to refuse assignments.

Screen Shot 2020-03-20 at 8.55.47 AM.png

Regardless of what our boards of nursing state, Provision 4 makes it clear that we are ultimately responsible for our own practice:  “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions, and takes action consistent with the obligation to promote health and to provide optimal care”. Specifically, Provision 4.1 states that “Nurses bear primary responsibility for the nursing care that their patients and clients receive” and “Nurses must always comply with and adhere to state nurse practice acts, regulations, standards of care, and ANA’s Code…”. This does lead to interesting paradoxical issues with the Oregon Board of Nursing, as one could view this as a regulation, but it contradicts further statements in The code, including:

Provision 4.3: “Nurses are always accountable for their judgment, decisions, and actions: however in some circumstances, responsibility may be borne by both the nurse and the institution. Nurses accept or reject specific role demands and assignments based on their education, knowledge, competence, and experience, as well as their assessment of the level of risk for patient safety. Nurses in administration, education, policy, and research also have obligations to the recipients of nursing care” and “Nurses must bring forward difficult issues related to patient care and/or institutional constraints upon ethical practice for discussion and review”.

Most importantly, The code calls for us to take good care of ourselves so that we can take care of others. We see this shown in Provision 5, particularly:

Provision 5.2 Promotion of Personal Health, Safety, and Well-Being

“…nurses have a duty to take the same care for their own health and safety. Nurses should model the same health maintenance and health promotion that they teach and research, obtain health care when needed, and avoid taking unnecessary risks to health or safety in the course of their professional and personal activities.” The sticking point here is arguing whether or not the risks of not wearing proper PPE, which include risks of death for oneself or other patients who have not yet been exposed, is necessary or not. From my perspective, I can see where working without proper PPE could be too large of a risk to oneself and the communities served.

And I get concerned when nurses seem to think it’s only about them be willing to take on the personal risk for themselves, forgetting about how they may also become the vector.

One last ethical issue, we have to do our own self-care during these challenging times. As nurses, we are required to take care of ourselves. Provision 5.2 continues: “Fatigue and compassion fatigue affect a nurse’s professional performance and personal life. To mitigate these effects, nurses should eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, engage in adequate leisure and recreational activities, and attend to spiritual or religious needs…it is the responsibility of nurses leaders to foster this balance within organizations”

Now onto a round-up of current COVID19 issues for nurses as I am seeing on social media:

Masks: Some nurses are being told to store their 1 daily mask in a paper bag and remove/ doff between patients, and replace/don the old mask for new patients. Of course, the bag and the mask would all be potentially contaminated; the bag actually creates a source of contamination and risks for greater transmission. I also heard rumors on social media of nurses being told to share masks, and I am hoping this is simply just false information, as I couldn’t verify that claim. I did hear that eye shields were being shared. I have confirmed that nurses who are normally required to wear masks because they have not been vaccinated for the flu are now being told to not wear masks because there is a shortage of masks. I have also confirmed that having a doctor’s note regarding why one must wear a mask (verification that they are immunocompromised) may work in some settings to either ensure masks are available to the person or excuse them from work.

image.png

We are vulnerable: Nurses are humans and many of us are vulnerable, whether that means we have chronic health conditions and co-morbidities, or we are at risk because of age.

Nurses are also fighting amongst themselves about whether it is okay to quit the workplace now. We have to recognize that these are complex decisions; nurses are real people who have their own health issues. Getting angry about people not willing to take the risk is not productive in both the short and long term.

It’s okay to choose your life and your well-being over the “duty” or social contract to work. It’s okay to make those tough decisions, like quitting your job, and, for some folks, they may be willing to risk their license by refusing assignments where they can’t keep themselves or their patients safe, even if their board of nursing disagrees.

Many nurses will carry on, work hard, provide excellent care, and do their best.

It’s also okay to feel vulnerable and scared in these uncertain times and to question your decisions and the decisions of administrators, regulators, and leaders.

It’s okay to organize and advocate for our needs, whatever that looks like.

Always remember, you have ethics on your side.

image.png