Adopted 2005 Action Reports
Recognizing Domestic Partnerships in the Clinical Setting
EXECUTIVE SUMMARY: There is anecdotal evidence of same-sex couples in situations where one partner was hospitalized and the nursing staff enforced the “family only” visiting policy, therefore denying (over the objections of the patient) the patient’s partner the privilege of visitation. On some occasions, the hospitalized person was critically or terminally ill. It is not acceptable to practice and/or passively permit discrimination in any setting, under any circumstances, in particular a clinical setting, regardless of the type of setting.
That the Georgia Nurses Association will:
1. Initiate dialog among its members concerning issues related to caring for lesbian, gay, bisexual, and transgender clients.
2. Educate registered nurses that families include traditional and non-traditional structures and recognition of family composition is crucial to the patient’s well being.
3. Educate registered nurses that Domestic Partnerships are considered a family structure by some clients.
4. Make a request to the Georgia Hospital Association that the GHA recommend that all member hospitals amend their visiting policies to recognize domestic partners as family members.
POSITION: The American Nurses Association Code of Ethics states, “the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of the health problem.” Although sensitive to their employer’s policies, nurses have an obligation, by virtue of their profession, to advocate for patient’s rights, regardless of socioeconomic status or their own personal beliefs. Clearly, denying visiting privileges to domestic partners, is in violation of the ANA Code of Ethics, even if it means acting contrary to institutional policy. As Misener, Sowell, Phillips, and Harris (1997) said, “Nurses must ensure that policies are established to prevent personal and professional discrimination toward a person merely because of sexual orientation.”
BACKGROUND: In 2004 this action report was considered by the Georgia Nurses Association House of Delegates. There was some disagreement about whether or not the report should be passed. There is minimal or no cost associated with passage of the report depending or how the education is provided. In light of the passage of the amendment to the Georgia State Constitution to ban gay marriage in November of 2004 and the stipulations outlined in Section B of the amendment, Durable Medical Powers of Attorney may no longer be legal. The importance of this issue is greater now than in 2004. Nearly 30 years ago the American Nurses Association took the position that nurses should not discriminate against clients or co-workers based on sexual orientation (ANA, 1978).
There have been instances where a Durable Medical Power of Attorney has not been acknowledged, permitting the designated individual (the partner) to make the necessary medical decisions when the patient could not. Living Wills have not been respected because the person speaking on behalf of the patient was his/her same-sex partner.
JCAHO standards define “family” as the “person(s) who play a significant role in the individual’s life [which] may include a person(s) not legally related to the individual” (Minority Nurse, 2003).
Hawaii, Vermont, and California are three states that recognize a domestic partner as “spouse” for the purpose of visitation and making medical decisions (Chen & Glazier, 2003). The city of Cambridge, MA allows domestic partners to register at the City Clerk’s office. Benefits include hospital visitation, as well as sick and bereavement leave.
The Association of Nurses in AIDS Care (ANAC), recognizing the problem of same-sex couples not being afforded the same rights as heterosexual couples with regard to hospital visitation and medical decision-making, adopted a position statement in 2000 that states,
It is the position of the Association of Nurses in AIDS Care that:
* Domestic partnerships be recognized. These partnerships consist of both same-sex as well as unmarried heterosexual couples.
* Domestic partnerships are entitled to the same rights afforded married couples including but not limited to insurance coverage, hospital visitation and medical decisions, rights of survivorship, sick and bereavement leave, immigration rights/ sponsorship, Federal and state tax benefits, and adoption rights and responsibilities.
To accept a standard of practice that permits discrimination of any sort, on any level, undermines the ethical and moral fabric of the profession of nursing. It would set a societal precedent that would be virtually irreversible and irreparable.
The essence of nursing has always been caring. Caring does not contain conditions or stipulations.
Nursing is considered the grassroots of the health care system. Nurses are the guardians for social health; they have the responsibility and the power to initiate change in policy and affect the status quo in the health care arena.
Nursing, as both a science and an art, promotes healing and wellness. Through education and participation, nursing consistently maintains an internal reflection of itself, while realizing the world around it.
Currently, the nation is wrangling with the issue of “gay marriage.” This issue will not be resolved quickly. In the meantime, nurses are the gatekeepers for visitation and often can advocate for the partner being recognized as the appropriate decision maker.
The following came from the American Cancer Society web site:
During treatment for breast cancer, Jean Ward went to an Atlanta hospital four times for pre-surgery tests and paperwork-and each time, she dreaded the questions. “Married or single?” (She was in a 20-year committed relationship with a woman.) “Is your husband here with you?”
Ward felt comfortable with her identity as a lesbian, but from experience she feared awkward or hostile treatment if the clerk learned her sexual orientation. “You can feel their energy shift, their body language, everything. This wall goes up,” explained Ward. “You have to navigate that. How much can I reveal?”
Such prejudice plays a role in putting lesbian women and gay men at increased risk for cancer, according to oncologist Kate O’Hanlan, MD, who has researched the issue. Prejudice, poor access to health care and several other risk factors add to a growing concern about cancer in the lesbian, gay, bisexual, and transgender (LGBT) community.
O’Hanlan says insensitive treatment is fairly common, even from well-intentioned doctors, so lesbians and gay men may avoid the medical system completely. “Many lesbians have anticipatory fears, so they don’t come out,” she explained. “The gal who works at the doctor’s office is the sister of the gal who works in your bank and you get fired.”
O’Hanlan wants prejudice rooted out of the medical community from top to bottom. Medical specialty groups could help, she says, by writing policy statements confirming that homosexuality is a normal expression of human sexuality; that lesbians and gay men are normal, healthy citizens of American society. “The public perception of homosexuals is still characterized by revulsion and disdain,” said O’Hanlan.
Those attitudes filter down to checkups, according to O’Hanlan, where routine questions can be humiliating for a lesbian, especially if she doesn’t want to reveal her sexual preference. “At checkups they get these questions,” explained O’Hanlan. “Are you sexually active? Do you use birth control?” If not, “Why not?”
Traci Hollis remembers how uncomfortable those questions made her feel as a young woman. “I said, ‘I’m not using any birth control,’ and the medical assistant started to quiz me about that . . . I said, ‘I haven’t been having sex with men.’ Then came, ‘Well when was the last time you had sex with a man?’ She acted like I was some sort of deviant.”
Adoption of this Action Report will send a message to Georgia nurses to abide by our professional Code of Ethics and to recognize these loving, committed relationships in the same way we recognize a heterosexual marriage in the health care setting.
GNA support of the Recognition of Domestic Partnerships will make a statement about the need to revise policies where they prohibit such recognition and encourage nurses to respect all of their patients, including those in same-sex partnerships.
“We need to adjust to changing times, while hanging on to unchanging principles”, as suggested by a quote in a painting at the Carter Presidential Center.
American Cancer Society. (2005). Sexual orientation and cancer. Retrieved 5/6/05 from: http://www.cancer.org/ docroot/SPC/content/SPC_1_Lesbian_Gay_Community Cancer Risk.asp
American Nurses Association. (1978). American Nurses Association Resolution #51. Kansas City, MO: The Association.
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved 5/6/05 from http://nursingworld.org/mods/mod580/cecde04.htm.
Association of Nurses in AIDS Care. (2000). Domestic Partner Benefits. Akron, OH: The Association.
Chen, R. T. & Glazier, A. K. (2003). Can same-sex partners consent to organ donation? American Journal of Law & Medicine, 29 (31-44).
Domestic Partnership. Retrieved 06/09/2004 from http://www.ci.cambridge.ma.us/~CityClrk/domesticpartnership/factsheet.html.
Lambda Legal (2002). Hospital visitation-A right for all families. Retrieved June 9, 2004 from http://www. lambdalegal.org/cgi-bin/iowa/documents/record.
Misener, T. R., Sowell, R. L., Phillips, K. D. & Harris, C. (1997). Sexual orientation: A cultural diversity issue for nursing. Nursing Outlook, 45 (178-181).
O’Hanlan, K., Cabaj, R. B., Schatz, B., Lock, J., & Nemrow, P. (1997). A review of the medical consequences of homophobia with suggestions for resolution. Journal of the Gay Lesbian Medical Association, 1(1), 25-40.
The Center for Ethics and Human Rights (2001). Code of Ethics for Nurses-Provisions. Retrieved June 9, 2004 from http://www.nursingworld.org/ethics/chcode.htm
The Portland Phoenix. (2001). Under the dome-Dying with the one you love, retrieved June 9, 2004 from http://www.portlandphoenix.com/archive/feature/01/05/ 04/tji/under.html.
Vital Signs. (2003). Gay advocacy groups campaign for same-sex hospital visitation rights. Minority Nurse. Summer, p. 12.
Recruitment of Middle and High School Students in Georgia into Careers in Nursing
EXECUTIVE SUMMARY: There is a need to promote a positive, realistic view of nursing and the work of a professional registered nurse among young people in Georgia, particularly middle and high school students who will be making career decisions and entering college. Much of the information about nursing available through the media is inaccurate or stereotyped. Middle and high school students may not all have access to career information about nursing through school guidance counselors. A number of successful programs and models have been developed to address the need to reach middle and high school students who may have an interest in pursuing a career in nursing.
That the Georgia Nurses Association:
1. Disseminate information about existing models and programs for recruitment of middle and high school students into nursing; for example, through an article in Georgia Nursing;
2. Continue to support legislation to increase funding for nursing education and scholarships, and for preparation of additional nursing faculty;
3. Support GNA District/unit involvement with local middle and high schools to assist existing health careers recruitment programs;
4. Encourage nurses of all backgrounds including those employed by local hospitals, medical facilities, health departments, and educational facilities to be open to providing students with opportunities to learn about nursing through mentoring programs or other modalities; and
5. Encourage and/or facilitate contact between nursing students and middle and high school students in Georgia.
BACKGROUND: The nursing shortage both nationally and in Georgia is well documented. The 2004 Georgia Nurses Association House of Delegates approved Action Report 8 addressing the “Nurse Staff Shortage in Georgia.” The current action report: “Recruitment of Middle and High School Students in Georgia into Careers in Nursing” supports the 2004 Action Report.
According to the Health Care Personnel Shortage Task Force (2004, Washington State): “The most effective strategy for ensuring youth are exposed to health careers and have the opportunity to prepare adequately is to provide intensive work-based learning and career exposure combined with academic preparation during middle and high school or even earlier” (pp. 2-3). In Georgia, the Health Occupations Students of America (HOSA) program provides opportunities for high school students to have “structured, ongoing dialogue on the health care professions” (Health Care Workforce Policy Advisory Committee [HCWPAC], 2003, p. 25).
The Area Health Education Center (AHEC) system in Georgia has developed many excellent recruitment resources and programs. For example, Nursing Recruitment Strategies: A Resource Manual, prepared by Magnolia Coastlands Area Health Education Center, contains information on recruitment strategies such as the Day in the Life of a Nurse Program, lesson plans and health careers games for children, scholarship and career information, and contacts for nursing education programs in Georgia. The Southeast Georgia Area Health Education Center (SOWEGA-AHEC) has produced “Health Careers in Georgia,” an online guide to health careers for middle and high school students. Additional recruitment efforts include the Teachers Exploring and Advocating Careers in Health (Teach) Academies for high school counselors and teachers, health careers camps, and health careers fairs (HCWPAC). The Georgia Health Careers Resource Clearinghouse (2004) provides a comprehensive online resource for individuals interested in health care workforce recruitment and retention activities.
Recruitment efforts over the past five years have clearly been successful in that schools of nursing nationwide are now unable to accommodate all of the qualified nursing school applicants (American Association of Colleges of Nursing, 2005). Substantial continued efforts are needed to address the shortage of qualified nursing faculty and to increase nursing education capacity. However, a shortage of 10 million workers is forecast in the United States by 2010. This shortage will result in “fierce . . . competition for new entrants into all professions and worker categories . . .” (Nursing Education Master Plan Steering Committee, 2005, p. iii). Therefore, continued support by registered nurses of efforts to recruit young people into nursing profession is needed. According to the HCWPAC, “the impact of these [recruitment] materials will be limited, absent any steady exposure to the health professions over time (p. 25).
American Association of Colleges of Nursing. (2005, June). Nursing Faculty Shortage. Retrieved August 31, 2005 from http://www.aacn.nche.edu/Media/FactSheets/ facultyshortage.htm
Georgia Health Careers Resource Clearinghouse. Available from the Georgia Health Careers Resource Clearinghouse Web site, http://gain.mercer.edu/ghcrc/
Health Care Personnel Shortage Task Force [Washington State]. Progress 2004: A Report of the Health Care Personnel Shortage Task Force. Retrieved August 30, 2005 from http://www.wtb.wa.gov/hcrpt05.pdf
Health Care Policy Advisory Committee (HCWPAC), Georgia Department of Community Health. (2003, August). Condition Guarded. Atlanta, GA: Georgia Department of Community Health.
Magnolia Coastlines Area Health Education Center (n. d.). Nursing Recruitment Strategies: A Resource Manual. Statesboro, GA: Magnolia Coastlines AHEC. Available from http://www.mcg.edu/ahec/mcahec/
Nursing Education Master Plan Steering Committee. (2005, January). A Report of the Nursing Education Master Plan Steering Committee. Nashville, TN: Tennessee Center for Nursing. Retrieved August 30, 2005 from http://www.aacn.nche.edu/Media/NsgWrkFrcReps. him
Southeast Georgia Area Health Education Center (2004-2006). Health Careers in Georgia. Retrieved August 31, 2005 from http://www.sowega-ahec.org/ career_guide/
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