Homophobia in nurse training

In the course of one of my merry little jaunts around the blogosphere I came across this.  To say that it concerns me would be to rather understate the matter.

On November 26th last year, a student nurse at a training college in Canada received the following email from one of her ‘clinical instructors’:

N*****, I’ve been thinking about the meeting in r***’s office and I feel that maybe Nursing is the wrong career for you.  As a nurse, I have to advocate for my patients, and I feel that female patients will be uncomfortable having a lesbian nurse care for them.  You do not provide a sense of security to your patients when you keep important information from them.  Your sexual orientation is something important that patients have a right to know so that they can decide if they wish to have you as their caregiver.  I myself am not homophobic at all, but I would not want a lesbian nurse caring for me when I am vulnerable.  I would just not feel comfortable with that.

I think it might be best if you see student services to explore other career options that do not involve physical interaction and intimacy.  It wuold look better if you left nursing out of your own accord, rather than get kicked out.

I am just being honest.  at the beginning of the rotation you asked me to be honest in my feedback, and I am doing just that.

A week later, this same instructor failed the student on a clinical assessment, citing as the official reasons for this that the student had a wrinkled uniform, and had shown rudeness and disrespect.  The course is structured in such a way that a failure on the clinical aspect of a particular element of the course means that the element as a whole is failed, and if the element is failed then the student is not permitted to continue with the course.  In other words, the instructor who informed the student that ‘It wuold look better if you left nursing out of your own accord, rather than get kicked out’ has, by failing the student, effectively kicked her out of nursing.

The student was unhappy with this state of affairs, and decided to lodge an appeal with the college.  The college took no action until such time as the student forwarded her appeal to the Ministry of Education, at which point the college, having been contacted by the Ministry, decided to launch an internal investigation.  The internal investigation has not, thus far, shown signs of getting very far, although in the course of pursuing it the college have informed the student’s colleagues that she is suing them for homophobia, despite the fact that she was at that stage merely pursuing an academic appeal.  Such appeals, let alone the grounds on which they are being pursued, are supposed to be confidential.

Ok, so let’s start with the instructor’s email.

The first thing that strikes me about this email is that a nurse’s sexual orientation is completely irrelevant to their ability to do their job.  All nurses – gay, straight, bisexual – are expected, as a matter of professional standards, to set aside their sexual feelings when caring for a patient.  It is a matter of absolute routine for straight female nurses to care for male patients, and for straight male nurses to care for female patients.  It is understood by both patients and nurses (and patients and doctors, for that matter) that the kinds of physical contact that take place between them are wholly different to the kinds of physical contact that take place in the context of a sexual relationship.  So why should it be any different just because the nurse has a sexual preference for their own sex?  The physical contact between nurse and patient is completely non-sexual, so the question of sexual orientation is completely irrelevant.

The instructor’s attempt to criticise the student for not telling her patients about her sexual orientation seems especially crass.  If a patient-nurse relationship is non-sexual, and so information about a nurse’s sexual orientation is entirely irrelevant, then the only reason a nurse would mention his or her sexual preference would be if they were attempting to put a sexual dimension where none should exist.  In other words, it might have been appropriate to criticise the student had she been in the habit of telling her female patients she was a lesbian, as this might make the patient wonder if the nurse were approaching their relationship in an inappropriately sexual way.

As this blog points out, there’d be something distinctly odd about a female nurse who approached a male patient and said, ‘Hi!  I’m heterosexual!’  By not telling her patients about her sexual orientation, the student is behaving exactly as her straight counterparts would, and, more importantly, is behaving in the way that is most likely to place patients at their ease; if a female patient never knows that a nurse is a lesbian, then she has no reason to feel uncomfortable.

The next most striking thing about the email is that the instructor uses the dreaded words ‘I myself am not homophobic at all, but’.  As everyone knows, words like these are almost always a preface to remarks that absolutely fit whichever prejudice is being denied.  In this case, they certainly are.  The instructor says that she would ‘just not feel comfortable’ having ‘a lesbian nurse care for me when I’m vulnerable’, and there are only two possible reasons for this discomfort.  The first is that she has legitimate grounds to feel that a lesbian nurse will initiate inappropriate sexual contact, in a way that a straight male nurse wouldn’t.  The second is that she has an irrational fear that this will be the case.  Since there are no legitimate grounds on which to be concerned that a homosexual nurse is more likely to engage in inappropriate behaviour than a heterosexual one, it follows that this must be an irrational fear based upon a lack of familiarity with, and understanding of, gay people.  This is, of course, a letter-perfect definition of homophobia.

It also concerns me that the instructor seems to base her objections on the fact that ‘As a nurse, I have to advocate for my patients’.  This is certainly an important part of the job of a nurse, however it seems to me that a nurse can only speak of advocating for their patients if they are confident of their patients’ interests.  This nursing instructor seems to be proceeding on the assumption that all female patients will be as ‘uncomfortable’ as she would be in being cared for by a lesbian nurse.  She would seem to be unwilling or unable to consider the possibility that some, a majority, or, indeed, all female patients would experience no awkwardness in being cared for by a lesbian nurse.  Advocating on behalf of patients is all well and good, but it would seem that the instructor here is more likely to be advocating on behalf of herself, and her own personal feelings with respect to lesbians.

Another thing which struck me about the email is that the second paragraph is based on the assumption that being a lesbian is a legitimate reason for being ‘kicked out’ of nursing.  I am not particularly familiar with Canadian anti-discrimination law (I think it may vary from province to province), but Section 15 of the Canadian Charter of Rights and Freedoms seems to have been interpreted as outlawing discrimination on the basis of sexual orientation, and this would seem to mean that any province which did not extend workplace discrimination laws to cover lesbians and gay men would themselves be liable for prosecution.  In any event, I note that, when she failed the student, the instructor did not cite homosexuality as the grounds for this.  This would seem to suggest either that the instructor’s decision to fail the student had nothing to do with her sexual orientation, or that the instructor was fully aware that lesbians are in fact permitted to work as nurses.  In this light, the ‘advice’ to voluntarily leave nursing rather than risk being kicked out in the context of a discussion of the student’s homosexuality begins to look rather like a threat, and one that hopes to intimidate a student who is unaware of the legal position.

There is, of course, another other aspect to this whole affair which is rather disturbing – that the matter has not been promptly and effectively addressed.  Clearly, as a complete outsider I have no knowledge of whether or not the student’s performance was adequate to ensure a pass or not, although I do note she had (according to her own account) been passing other elements of the course with marks above 80%.  However, the existence of the email does suggest that there has been some conflict, or at least heated discussion, between the student and her instructor.  One would expect that the college authorities would be keen to satisfy themselves at the earliest possible opportunity that the failed clinical assessment resulted from clinical failings on the part of the student, and not the result of prejudice on the part of the instructor, or a personal clash between the two of them.

I have already drawn attention to the fact that the appeal was not progressed until the student made authorities outside the college aware of the situation, and that the ‘internal investigation’ has been proceeding for over three months with little to show for it.  In addition to this, the college authorities have demanded access to the student’s privately-owned desktop computer, laptop, and hard drives.  I have given this some thought, and have found it difficult to understand how access to these items would facilitate the investigation of an appeal against a clinical assessment, in which a student nurse is (presumably) assessed on the basis of their clinical practice, not what they have or have not used their personal possessions for outside the clinical environment.  I have some concerns that access to the computer equipment may have been demanded, not in the interests of getting to the bottom of the academic appeal, but as part of an attempt to find other grounds upon which the student can be removed from her course.  This sort of action, coupled with the apparent decision of the college to inform the student’s colleagues of confidential information, seems to suggest that the college is more concerned with punishing the student for making a complaint than they are in investigating the substance of the complaint.  Indeed, it seems almost to add up to a pattern of behaviour that might perhaps be described as bullying.

As I see it, there are really three main areas of concern here.  Firstly, I am outraged by the suggestion that the fact of being lesbian should be considered a problem if a woman is considering a career in nursing.  Secondly, I am deeply concerned by the possibility a nursing instructor may have abused her authority by attempting to halt the training of a student nurse as a result of her own homophobic prejudice.  Finally, I am very worried that it would seem that this matter has not been promptly and appropriately investigated by the authorities at the college where these events may or may not have taken place.  In many ways, it’s that last issue that most concerns me – it suggests that this may not have been an isolated incident relating to an individual instructor, but a rather more widespread problem.

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10 Responses to Homophobia in nurse training

  1. Heidi says:

    I have read a few blogs on this subject over the day today. I just had to say thank you for doing such a levelled post, where you clearly set out the different points that need to be addressed, without becoming too emotional/angry over it, and letting that cloud your words.

    For this student’s sake, I hope it gets resolved.

  2. lsnduck says:

    The issue of appeals and investigations in academic institutions is an interesting one. Historically, teaching/academic staff simply declared their authority over everything and anything that happens in the area, and to question that authority was an exercise in smashing your head into a brick wall. Things are slowly improving in this country (obviously I can’t speak for Canada); appeals procedures are becoming more robust and formalised, bodies and individuals willing to advocate for students are becoming more professional and powerful. In my institution at least, I have seen positive changes in the six or so years since I was a student, and in comparison to earlier times it is a different world.

    However, you will still face the normal issues of any organisation not wishing to admit that it made a mistake. Academics still live in their own little worlds (I don’t mean that in an entirely derogatory fashion, but it does have its downsides). Having said that, it is usually the professional departments (nursing, social work, medicine, and so on) that have tended to have the most rigorous approach to such things).

    This is one (of the very few) positive to have come from the introduction of higher Tuition Fees; there is a far greater desire for accountability and fairness from all sides.

  3. Zarathustra says:

    That’s appalling, and inexcusable.

    I’ve worked with some excellent nurses and doctors who were gay, lesbian or bi. Their orientation is nobody’s damn business but their own.

    I hope the student takes the college to the cleaners.

  4. cellar_door says:

    “I myself am not racist at all, but I would not want a black nurse caring for me when I am vulnerable”

    Why do I feel the equivalent sentance above would have got a much faster response from the college….


  5. lsnduck says:

    “Why do I feel the equivalent sentence above would have got a much faster response from the college”

    I doubt it would have done. If Canadian institutions are similar to British ones then complaints/appeals procedures and certain of the academics* that oversee them really are that capable of ignoring, dismissing, or ‘losing’ such a complaint whether grounded in sexuality or race.

    *I by no means wish to attack any and all academics. Many are wonderful people who care a great deal. There does seem to be a higher proportion of arseholes stuck in a 1950s mindset than in other areas though.

  6. bluesilk says:

    I am amazed at this. I can’t imagine how the college got away with it, given that the student had the email as proof.

  7. Mandy says:

    I am not surprised by that communication or ‘homophobia’ still being alive and kicking in all walks of life.

    My only comment about sexuality and MH services is that I don’t give a monkey’s what sexuality a mental health professional is..I want them to be capable and empowered to do their jobs properly. Simple as! or maybe not…hmmmmm

  8. aethelreadtheunread says:

    Thanks for all the comments, and sorry for the delay in replying.

    Heidi – thank you. I have to admit, though, it did take quite a long time and a lot of re-drafting to get the anger out of the post. I agree with you – i hope for the sake of the student it does get sorted out.

    lsnduck – I think you’re spot on when you talk about the organisation not wanting to feel they’ve failed. I think colleges are far more comfortable talking about preventing things going wrong in the future, and drawing up equal opps policies, than they are admitting things went wrong in the past, and that the sanctions listed in the equal opps policy need to be applied.

    I’m pleased to hear that things are improving, in the UK at least.

    Zarathustra – thank you for being appalled. That sounds like a slightly weird thing to say, but it’s nice to get confirmation that a serving nurse is as outraged as i am. :o) I agree with you, i hope the student gets plenty of compensation, but i also hope the instructor learns never, ever to do it again.

    cellar_door – I certainly think that the story would have got a lot more attention a lot more rapidly outside academia if it had been alleged discrimination on the basis of race rather than sexuality. But i can also see lsnduck’s point that, within academia, racism might be as hard to challenge as homophobia. Certainly the student speculates in her account of events that the tutor may be racist as well as homophobic.

    bluesilk – well, the ‘internal investigation’ is still ongoing, so the college does still have some opportunity to save face. Hopefully they won’t get away with it – certainly the email would seem to be pretty damning.

    Mandy – exactly. :o)

  9. Ooooh indeed she should wear a big badge that alerts people to the fact that she is gay, so they can stay away from her evil gayness if they so choose. How about an armband with a pink triangle?

  10. aethelreadtheunread says:

    DeeDee Ramona – well, quite.

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