Out Lesbians in Nursing: What Would Florence Say?

Journal of Lesbian Studies, 16:65–75, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 1089-4160 print / 1540-3548 online DOI: 10.1080/10894160.2011.557644 Out Lesbians in Nursing: What Would Florence Say? CARLA E. RANDALL School of Nursing at the University of Southern Maine, Lewiston, Maine, USA MICKEY ELIASON Department of Health Education, San Francisco State University, San Francisco, California, USA Research and education on lesbian health has increased substantially in quantity and quality in the past 40 years, but little of this work has been produced by nursing scholars. We began our academic nursing careers as out lesbian faculty at the same college of nursing in the late 1980s, where we collaborated on the earliest studies of attitudes about lesbians in the nursing profession. Our paths diverged in the early 1990s, but we shared similar experiences in nursing education that highlight the structural and attitudinal barriers within nursing that have inhibited lesbian health studies. The deeply imbedded lesbian phobia within nursing has historic roots that plague contemporary research, education, and practice. In this article, we discuss the inclusion of lesbian health in nursing, share some of our personal stories about the obstacles we encountered, and end with suggestions for changing this stifling climate for future generations of lesbian health scholars. KEYWORDS lesbian health, nursing education, LGBT health At present we live to impede each other’s satisfactions; competition, domestic life, society, what is it all but this? We go somewhere where we are not wanted and where we don’t want to go. What else is conventional life? So many hours spent every day in passively doing what conventional life tells us, when we would so gladly be at work. And is it a wonder that all individual life is extinguished? (Florence Nightingale, n.d.a.) Address correspondence to C. E. Randall, 51 Westminster Street, #162H, University of Southern Maine, Lewiston, ME 04240. E-mail: randallc@usm.maine.edu 65 66 C. E. Randall and M. Eliason Florence Nightingale was talking about the inclusion of women in the public workforce, but she could just as well have been talking about the experience of contemporary lesbians in nursing. Nursing education and scholarship have had a particularly uneasy relationship with lesbian studies for years, in spite of nursing’s radical foundation in women’s reformers like Florence Nightingale and Lillian Wald. It might seem that a femaledominated profession such as nursing, focused on human caring, would have been an early adopter of feminist and lesbian studies, but the reverse is true. There has been tremendous resistance to the women’s movement and lesbian health. Feminist theory has made more inroads in nursing, and there are many nursing specialties around other human differences, such as gerontological nursing. There is no unified effort to develop a lesbian health nursing body of knowledge, or even to acknowledge and support lesbians in nursing professions or lesbians as patients/clients of health care settings. Most national and international nursing organizations have no lesbian interest groups, task forces, or divisions, nor are there documents, statements, or policies that attest to the presence of lesbians on their websites. Nursing has been reluctant to embrace its own lesbian history. Lesbians probably make up the largest minority group within nursing, not because of a predisposition of nurses being lesbians but because historically it has been open to women who could remain “single” and earn a living. Until the women’s movement changed society, bringing women more fully into the workforce, only lesbians, nuns, and “spinsters” (often overlapping categories) were career nurses, but lesbians were forced to stay in the closet to protect the reputation of nursing. To highlight some of the structural difficulties of getting lesbian studies into the nursing literature, we will share some of our personal experiences that illustrate the barriers that many out lesbians in nursing face stemming from lack of policies that protect us as individuals and in relationships, lack of education of our co-workers, negative attitudes stemming from stereotypes, and lack of support for lesbian scholarship. We began our nursing faculty careers at the same university, where we collaborated on the first studies of attitudes toward lesbians held by nursing faculty and students. Our paths diverged in the early 1990s, but our experiences of trying to raise lesbian visibility in nursing education and scholarship have been remarkably similar over the years, leading one (Mickey) to leave nursing education out of frustration and the other (Carla) to focus her research within nursing education. We organized this article around four general themes in nursing related to lesbian studies: (1) lesbian patient care; (2) attitudes of heterosexual nurses/nursing students; (3) lesbian nurses’ experiences; and (4) efforts to include lesbian health in nursing education and scholarship. Out Lesbians in Nursing 67 LESBIAN PATIENT CARE Hospitals are only an intermediate stage of civilization. (Florence Nightingale, n.d.a.) Even today, hospitals are not places of progressive tolerance for patients outside the dominant culture. The first articles about lesbian, gay, bisexual, and transgender (LGBT) issues in nursing journals in the 1960s seem incredibly dated by today’s standards, and they take for granted that the “homosexual” is male, rendering lesbians invisible as patients and nurses. Juzwiak (1964) noted in this extraordinarily sexist and homophobic comment: The female nurse dealing with a homosexual patient ought to avoid behavior that, while potentially pleasing to a heterosexual male, might be irritating or seem threatening to the homosexual male. Specifically, she should avoid being flirtatious with him, or unduly pressuring (p. 57) . . . the degree to which she is able to view the homosexual person as a human being with a special problem rather than as an unspeakable and frightening ‘pervert’ will not only help her to work with such patients but will also beneficially influence the attitudes of other hospital personnel who come into contact with them. (p. 118) In the mid 1970s, the tone of articles began to change, after the Diagnostic and Statistical Manual was revised to remove homosexuality as a mental disorder. Lawrence (1975), an openly gay man, called for nurses to treat patients with respect and noted “To endure a hospital stay may be one of the most bitter and unpleasant of any of the oppressive experiences that homosexual persons are subject to daily” (p. 308). Articles in the 1980s and 1990s began to address the attitudes of care providers and lesbians’ experiences encountering the health care system, but these articles were primarily in medical journals, and nursing was conspicuously silent on these issues. In the 1990s, a few nurse educators suggested that lesbians come out to confront heterosexism and homophobia and build alliances with heterosexual colleagues to address discrimination (Randall, 1989; Eliason, 1996; Gray et al., 1996; Zurlinden, 1997). ATTITUDES OF HETEROSEXUAL NURSES Women have no sympathy and my experience of women is almost as large as Europe. (Florence Nightingale, n.d.a.) By the late 1980s and early 1990s, studies began to appear about nursing curricula and attitudes of nurses and nursing students toward lesbians and 68 C. E. Randall and M. Eliason gay men, and we were among the first to challenge the notion that all nurses were “naturally” compassionate and nonjudgmental. Carla initiated this work with her thesis (1989). She surveyed 100 mid-western nurse educators and found that 52% believed that lesbians are “unnatural,” 34% thought lesbians “disgusting,” 23% considered lesbians “immoral,” 4% would refuse to care for a lesbian patient, and 13% would not allow a lesbian nurse to care for them. Over 50% had never addressed lesbian health issues in a clinical setting or the classroom, and 10% thought that lesbians should not be allowed to teach in schools of nursing. Carla’s experience: Something not discussed in the quantitative study were the experiences I had with a couple of the faculty members who received the survey at the institution where I was working, which was different than the grad program I attended. I was called into one colleague’s office and waving the survey, she grilled me about why I was sending her this questionnaire. She seemed alarmed, scared, demanded to know how I got her name, and repeatedly asked why I had sent this questionnaire to her. (A cover letter was attached indicating that the questionnaire was being sent to all nurse educators in schools of nursing throughout the state.) In that same week another colleague stopped me in the hallway and said that she would not be answering the survey as it was too personal and she did not think it was an appropriate topic for a master’s thesis. When asked what would be an appropriate way to research the topic her reply was, “there isn’t.” Both of these individuals identified as lesbians although they were closeted within their positions at the university. A few years after Carla’s thesis, we collaborated on studies of nursing student attitudes. In the first study, 26% of students said lesbians were unacceptable and that they would try to avoid any contact with one (Eliason & Randall, 1991). A second study of nearly 200 nursing students identified common stereotypes about lesbians (Eliason, Donelan, & Randall, 1992). Nursing students worried that lesbian co-workers or patients would try to “hit on me” (38%) or “push their beliefs on me” (29%). About one-third of students thought that lesbians could be identified by their masculine appearance, and 13% objected to working with lesbians on the basis of their moral or religious beliefs. Mickey’s experience: Hearing about this publication, my faculty research mentor said, “It’s great that you are publishing in this new area, but I would recommend that you publish at least two articles in a legitimate field for every one you publish in this area.” Since our studies, only a few other studies of nursing students and working nurses have been conducted. Rondahl and colleagues in Norway (2004a, 2004b, 2006) conducted a series of studies of nursing students, working nurses, and lesbian and gay patients’ experiences with fears of being out and refusing to provide nursing care. Dinkel and colleagues (2007) found relatively low homophobia scores in a study of U.S. nursing students, but Out Lesbians in Nursing 69 speculated that the scores may have reflected neutrality and/or heterosexist attitudes rather than acceptance. Blackwell (2006) conducted a random sample survey of Florida nurses and found that 22% had high scores on a homophobia scale. Those in their 20s were the least homophobic, suggesting that there is hope for the future. LESBIAN NURSES’ EXPERIENCES I have lived and slept in the same bed with English countesses and Prussian farm women . . . no woman has excited passions among women more than I have. (Florence Nightingale, n.d.a.) Was Florence Nightingale a lesbian? We have no way of knowing, but she was definitely a woman-identified woman who today might have encountered much more resistance to her work if she were thought to be lesbian. We are quite certain that she would be appalled by the treatment of lesbian nurses today. One of the earliest articles about lesbians to appear in the nursing literature was about one lesbian nurse’s experience: I was warned by heterosexual nurses and physicians . . . that an open lesbian could not be a nurse. . . . So after seven years of being out at work, I became a closeted nursing student. The sudden reversal to a double life was jolting, because it takes different sets of skills, compromises, and self-justifications to live either openly or in the closet. . . . After nursing school, I became more secretive again, because I was afraid of losing my new career. In each of my work settings, I saw gay and lesbian patients laughed at, mistreated, or denied. I was effectively intimidated by medical, nursing, and social work colleagues who challenged my tentative efforts at lesbian and gay patient advocacy. (Deevey, 1993, p. 21) Rose (1993) surveyed 44 lesbian nurses, finding that 25% were not out to anyone at work. Half of those who were open about their sexuality at work reported that coming out had been a difficult process. Many had witnessed discriminatory behaviors by their co-workers, including refusal to care for an LGB person (25%). Giddings and Smith (2005) interviewed lesbian nurses and found seven themes: staying in the closet in nursing, isolating and hiding from self and others, living a double-life, feelings of self-loathing and shame related to keeping secrets, experiencing discrimination from others, efforts to keep safe, and being perceived as a threat to other closeted nurses. They concluded that nursing as a field claims to embrace diversity but in reality, fails to respect the differences represented by lesbian experience. Mickey and Carla’s institution: A few years before either of us were hired, the entire faculty of the college of nursing won a lawsuit against the Dean of the college, alleging that she kept records about the personal 70 C. E. Randall and M. Eliason lives of the faculty members to “root out” the lesbians. This event promoted lingering fear and secrecy rather than open dialogue and finding common ground. Years later a conspiracy of silence and non-acceptance of lesbian research remained. Mickey’s experience: I followed my mentor’s advice to publish in a “legitimate” field and had a high acceptance rate for papers on other topics, but a low acceptance rate on pieces related to sexuality. Reviewers often made judgmental comments, such as “has a political agenda,” “strident tone,” “preachy,” and “this article does not match the mission of the journal.” It was not uncommon to have an article returned without review with a note from the editor saying, “not relevant to our readership.” Eliason, DeJoseph, Dibble, Deevey, and Chinn (2011) reported the results of an online survey of 261 LGBT nurses (88% currently practicing nurses, 54% female, and three transgendered; 44% lesbians). When asked if they worked in an “LGBT-friendly” environment, surprisingly, 78% said yes, citing factors such as having openly LGBT colleagues, accepting heterosexual colleagues, and nondiscrimination policies and domestic partner benefits. However, the qualitative responses suggested that many respondents had low expectations for an LGBT-friendly environment: I guess it’s not that it’s friendly so much as not hostile. For the most part, people just accept things and do the work that needs to be done. People know and are not hostile about it. Also, they know about my partner and include her in conversations. I am not sure that this makes it a friendly environment, but I am not threatened that others know. The question is hard to answer. Nobody disdains me, or anyone else. But it is not an open environment where it is discussed as easily as any other topic. For example, I have no idea who else is GLBT in the organization. It is just not talked about. It is a sad commentary that LGBT nurses accepted such a low standard of “friendliness.” Comments from respondents who reported that their work environment was unfriendly included: I lost my job after posting my wedding in the local paper, after over a decade at the same job. Never underestimate the power of a Catholic hospital. Being outed by a colleague at a faculty party. Although all of my evaluations had been excellent and I had just completed my Masters I did not have my contract renewed. I had been teaching in the program for 9 years. It may have had nothing to do with me being gay but it was awfully coincidental. Out Lesbians in Nursing 71 Received email from nurse manager that included a ‘you should repent’ type of message. I have a senior co-worker who has been here 20+ years who deems it necessary to harass me about my sexual identity. Particularly making sexual comments and then covering with, “You know I’m kidding, right?” Carla’s experience: In 1995 I applied for a job at a Catholic College’s nursing program. I was eagerly interviewed a week before the semester started. During the interview I spoke openly of being a lesbian and welcomed the challenge to provide opportunities for students to explore nursing care with a diverse client/family/staff population. At the end of interview, the director mentioned that there would be a faculty gathering during the first week of classes and family were invited. I mentioned that I would bring my partner. The whole tone of the interview changed, the director hesitated, seemed awkward and uncomfortable. Not being shy I asked if other faculty would be bringing their spouses and was told yes. I replied that I would bring my partner and would expect her to be received with respect and common courtesy. Hearing nothing about the job offer a few days later, I called to inquire. I was told, “you are not what they were looking for in a faculty member, we don’t think you would fit in here.” I inquired why this was the case and was told that being a lesbian was the problem. I filed a complaint with the state human rights council, but nothing could be done as sexual orientation was not a state or federally protected class and religious schools are exempt from these laws had they been in place. In 2003 I spoke to a person in human resources at the university where I was recently hired, about the inequity the university supported in having to pay income tax on domestic partner benefits. Benefits are given a dollar value and in turn taxes are withheld, at the same time I am not allowed to claim costs or expenses on my tax returns. The HR person dismissed me with the comment, “well you should be glad you can get health insurance at all.” Throughout the years we both have found supportive people among our straight co-workers, sometimes our bosses and supervisors, and occasionally from other out lesbian nurses. That said, we continue to bemoaned the lack of structural and institutionalized support and the negativity that surfaces regarding LGBTQ civil rights. NURSING EDUCATION AND SCHOLARSHIP I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results. (Florence Nightingale, n.d.a.) 72 C. E. Randall and M. Eliason Most nursing textbooks do not address sexual orientation, gender identity, or the effects of stigma on health and wellbeing, and seldom, if ever, mention LGBT persons or communities beyond including sexual orientation in a list of forms of diversity. A study of the top ten nursing journals by impact factor revealed that in a five year time period, only .016% of the articles (8 out of nearly 5,000 total) were about LGBT issues (Eliason, Dibble, & DeJoseph, 2010). This silence in nursing scholarship stems from a number of factors, including active discouragement of young scholars who wish to conduct studies on LGBT issues, and a lack of mentoring of those who do engage in LGBT studies. Carla’s experience: In 1985 when I was deciding if and where to go to graduate school I interviewed colleagues where I was working. I said I wanted to study the attitudes of nursing faculty members toward lesbians. I deliberately asked both lesbian and straight faculty members their opinions. I was told by one of the department chairs who I knew to be lesbian that I could do research in this area if I approached it in a “professional” manner and another faculty member (straight) told me I would have to work twice as hard to have my work accepted and then it would still be difficult. I decided this university would not be a safe place to work, be a student, and be an out lesbian. I decided to attend another program 90 miles away. There I received a very different reception. I was encouraged to do my research and was told it was important and ground breaking work. Working at the same institution in 1990, I invited a woman of color to a post clinical conference to speak about her experiences as a lesbian and woman of color within the health care system. Many of her stories focused on her experiences with nurses. This was apparently unsettling to a student who spoke to the course coordinator, who in turn provided me with a written reprimand and informed me that I could not invite people of color or lesbians to post clinical conferences since these were not topics discussed in the course syllabus. This was a third-year nursing clinical course within a medical/surgical and mental health nursing department. I was told that I could not initiate these topics and could only have such conversations if initiated by the students. Mickey’s experience: In 1972, I had my psychiatric nursing rotation at a state mental hospital. On the ward I was assigned to were three gay men who were there only because they were gay. They had been there for more than 10 years. Years later, I read a book about the circumstances that lead to these men’s incarceration, Neil Miller’s Sex Crime Panic (2002). At the time, nothing was said about sexual orientation in lectures, except that homosexuality was a mental disorder. In 1996, I went up for tenure and promotion and hit the lesbian phobia wall. The senior faculty and dean voted against granting me tenure, in spite of having over 40 peer-reviewed research articles, 13 in nursing journals, and a book, Who Cares? Institutional Barriers to Health Care for Lesbian, Out Lesbians in Nursing 73 Gay, and Bisexual Persons, published by the National League for Nursing Press (Eliason, 1996). I also had stellar teaching evaluations, and more than the average amount of service and grant funding. The reason given for the denial? My scholarship was “not nursing.” Higher authorities overrode the decision, but the experience was demoralizing and traumatic. Later, another faculty member told me that I was “airing dirty laundry” about nursing. In 2005, I went to a conference where a gay male faculty member was presenting his research on attitudes of heterosexual nurses about LGBT patients. He handed out a bibliography and proudly announced that he had done a comprehensive review of the literature on attitudes about LGBT patients. Although I had published 15 articles on this topic, none of my work was included, nor was Carla, Sharon Deevey, or any other lesbian scholar included. I attributed this omission to the nursing curriculum that kept our work hidden and marginalized. Nursing textbooks still do not provide meaningful information about LGBTQ communities. Nurses need information about heterosexism, homophobia, heteronormativity, oppression, internalized homophobia, legal issues, the coming out process, normal growth and development, bereavement concerns and research findings about the health care needs of LGBTQ people. Even today, lesbian nurses are underrepresented in scholarship on lesbian health. A recent book edited by a nurse (Sue Dibble) and a physician (Patty Robertson, Lesbian Health 101, 2010) had 31 chapters, authored by 28 physicians, 13 PhDs, MSWs or other professionals, and only four nurses (Mickey was one). Mickey’s experience: The “last straw” came when I talked to my dept chair about going up for full professor. By this time, I had 75 peer-reviewed journal articles, three books, 12 chapters in books, was on a national advisory board for a federal agency, and had amassed about two million dollars in grants and contracts. She looked at me in puzzlement and said, “You have to be a scholar to get promoted to full professor.” I thought this was an isolated case, but another senior faculty told me that I had to write a theory book to get promoted, and another said I had spent too much time writing articles and getting grants and not enough trying to run for office in a national nursing organization. Luckily, I found a new job where my work is actually valued. Few of my lesbian nurse colleagues can say the same thing. CONCLUSIONS So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself. (Florence Nightingale, n.d.a.) What would Florence Nightingale say about our stories? She would likely be concerned that there is a lack of acceptance in nursing of lesbian nurses and 74 C. E. Randall and M. Eliason lesbian patients/clients. In the spirit of being practical and taking small steps to make broad changes in the discipline, if only one national nursing organization would publicly change their nondiscrimination policy to include sexual orientation and gender identity, that would send a message to the field. If only one major nursing journal put out a call for papers on lesbian health, or only one nursing program developed a certificate in lesbian or LGBT health, the seed could germinate. If one of the major medical-surgical textbooks integrated LGBT content, the field would begin to change. For real change to occur, interventions must be undertaken in at least four areas. First, nursing education needs to address lesbian health in textbooks, curricular inclusions that support questioning of heteronormativity, and support for lesbian/LGBT students. Second, nursing professional organizations need to issue statements related to health disparities, social justice and lesbian health, and change their policies and procedures to be more inclusive by specific naming of LGBTQ persons and issues. Lesbian or LGBT interest groups, task forces, and committees are needed. Third, health care settings need to have inclusive policies that improve the treatment of lesbian nurses and patients. Extensive staff training is needed to improve the treatment of lesbian nurses and clients. Finally, there are few specific nursing groups for lesbian or LGBT nurses. Recently the Gay and Lesbian Medical Association broadened its membership to include all health care professionals and has a nursing interest group (www.glma.org). National and international nursing organizations such as the American Nurses Association, Sigma Theta Tau (honor society for nursing), the National League for Nursing, and the International Council of Nurses need to take steps to address the consequences of heterosexism and homophobia within nursing education and practice (see Eliason et al. (2010) for other recommendations for improving the situation for lesbians in nursing). Nursing today could learn much from history. Radical reformers like Florence Nightingale urged women to demand a place at the table and not settle for the “conventional” life. What would Florence say? We will never know, although we could speculate that she would say everyone needs to be understood, cared for, and treated with respect and dignity. REFERENCES Deevey, S. (1993). Lesbian self-disclosure. 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Journal of Advanced Nursing, 47(4), 386–392. Röndahl, G., Innala, S., & Carlsson, M. (2004b). Nursing staff and nursing students’ emotions towards homosexual patients and their wish to refrain from nursing, if the option existed. Scandinavian Journal of Caring Sciences, 18(1), 19–26. Röndahl, G., Innala, S., & Carlsson, M. (2006). Heterosexual assumptions in verbal and non-verbal communication in nursing. Journal of Advanced Nursing, 56(40), 373–381. Rose, P. (1993). Out in the open? Lesbianism. Nursing Times, 89(30), 50–52. Zurlinden, J. (1997). Lesbian & gay nurses. Albany, NY: Delmar. CONTRIBUTORS Carla E. Randall, R.N., Ph.D. is currently an Associate Professor in the School of Nursing at the University of Southern Maine. She has taught nursing for the past 25 years. Mickey Eliason, Ph.D. is an Associate Professor in the Department of Health Education at San Francisco State University. She has conducted applied research and taught courses in sexuality studies for over 20 years. Copyright of Journal of Lesbian Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. View publication stats