My amazing little man and I almost 2 years since the start of the whole battle.
As outlined and supported by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), the role of the nursing profession “promotes the health of women and newborns” (2012). The dedication to the preservation of dignity amongst childbearing women is in stark contrast to the actual practice of nursing schools. The history of educating nurses is rich with restrictions upon women and their sexuality (Nightingale & McDonald, 2005). Specifically, women in the profession who bear children are under targeted scrutiny. McIntyre and McDonald’s (2010) Issue Analysis Framework is used to discover the impact the discrimination of childbearing women within nursing has on all domains of the profession. Canadian nursing organizations like the College of Nurses’ of Ontario (CNO), the Ontario Nurses’ Association (ONA), and the Registered Nurses’ Association of Ontario (RNAO), are placing the issue of horizontal violence at the forefront of their agendas; discrimination of childbearing in education is a painful component of the violence nurses inflict upon each other (CNO, 2009; ONA, n.d.; RNAO, 2008).
Nature of the Issue
Horizontal violence, in the form of discrimination and alienation of childbearing students in nursing programs involves nurses across their career spectrum. Beginning with nursing students, as victims of targeted bullying pregnant students feel stigmatized and discriminated against by those who should provide mentorship and guidance. Their peers are negatively impacted by the issue because they witness the bullying, but feel unable to advocate for injustices inflicted on their peers because of the power imbalance between themselves and the administrative department causing the stresses.
Nursing leaders, those who are Masters and Doctorate prepared nurses, in the administrative roles within nursing education programs are the perpetrators of the discrimination. The CNO clearly outlines the role of a nursing leader within their Professional Standards document, placing importance on role-modelling for new nurses and instilling confidence in student abilities. Statements such as “unless you want to attempt the course and gamble that you will deliver a week late, I cannot identify a viable solution” (Personal communication, January 30, 2012), does not meet the requirements set out by the CNO for nurses in roles of leadership to meet.
Nurses taking on the roles of clinical teachers and preceptors are placed in an area of conflict because they become mediators between the students they are responsible for and the authority they are working for. There is a conflict of instruction from authority versus what they see as a just outcome, as well as the wellbeing of the student they are teaching. Their workplace autonomy is hindered by the restriction of critical thinking and problem solving in relation to individual student needs, which can ultimately impact their own job satisfaction (Weston, 2010).
Nursing students are part of a dual culture. They are student nurses, under the guidance of more experienced professionals, and they are university students, under the regulations of the institution they pay their tuition to. University administration possesses a hierarchical design, where the authority of the nursing department falls below that of the faculty it is nested within. The university as an institution must hold their faculty accountable for acts of discrimination against students.
Like all nursing issues, patients are impacted by the conflict between other nurses. It is well documented that patient outcomes are increased when nurses are experiencing low job related stress, of which horizontal violence is included as a stressor (Weston, 2010). Therefore, by inflicting discrimination upon students, their capacity to learn respectful and healthy inter-nurse relations and provide exceptional care to their patients is restricted.
There is no formal literature addressing this issue, though substantial information regarding policy and requirements for the treatment of pregnant women is available. The issue is one of immense importance because in the past two years alone Brock University’s Nursing department has discriminated against at least four students needing support to maintain their full-time student status while childbearing. Three of the four students were pregnant females and the other was an expectant father; the summaries of their personal experiences will be included to provide an increased understanding of the issue.
Nursing’s origin lies with Florence Nightingale. Her dedication to the profession, cultivation of knowledge, and immense impact on nursing education has placed her at the center of what new graduates, and clinical and academic nurses at any point in their career, strive to achieve. Many traditions within the profession can be linked back to Nightingale’s early research or written works. Essential attitudes and beliefs, such as the importance of infection control, still permeate the minds of nurses today. Unfortunately, there are traditions Nightingale introduced, which are still upheld despite the advancement of knowledge of the current culture we are living in.
Nightingale clearly preached that marriage prevented the pursuit of a woman’s career (Nightingale & McDonald, 2005). Albeit this was a reflection of the social context in which she lived and practiced, this belief still runs through the administration departments of current nursing schools. During the time when Nightingale was practicing, being married was the only socially acceptable way to bear children, thus to bear a child as a nurse was theoretically impossible (Nightingale & McDonald, 2005). Children could be born out of wedlock, but the repercussions of such actions are not discussed within her works. Nightingale, who is thoroughly quoted within current nursing education, often described by professors as the epitome of what nursing is, identified herself as a “single, celibate woman” (Nightingale & McDonald, 2005, p. 88). Nursing was, and still is, described as a vocation or a woman’s “calling” (p. 87), which required extreme dedication of the female, so much in fact that no other responsibilities could be taken on (Nightingale & McDonald, 2005).
When a woman did decide to leave her calling for marriage it was addressed in a polite way, even though Nightingale’s core values reflected the outlook that leaving the profession was near blasphemy (Nightingale & McDonald, 2005). Her teachings explicitly opposed pursuit of both profession and family (Nightingale & McDonald, 2005). O’Malley, as mentioned in Nightingale and McDonald in 2005, quoted her words from an 1846 journal entry stating “it is much better to educate the children who are already in the world and can’t be got out of it than to bring more into it”, which exhibits her attitude towards childbearing, (O’Malley, n.d., p. 89-90).
As societal attitudes towards women, professional endeavors, marriage, and childbearing and rearing have changed to incorporate equality among men and women, Nightingale’s teachings still permeate current nursing education administration. Central to the issue is the educational institution’s policy regarding pregnant students, and the overall attitude of “our hands are tied” when it comes to the accommodation of students. The challenge for students is that resources are not provided to advocate for themselves, and acquiring adequate information regarding their rights is difficult, if not impossible, while managing full-time student status, pregnancy, and undergoing stigmatizing discrimination. When questioning the department regarding the policy to accommodate their needs, the response given was “…no written policy specific to the course… My knowledge from coordinating the course on two occasions provides the basis for my comments…” (Personal communication, January 30, 2012).
Solutions to this issue are plentiful, should individuals make it a priority. Unfortunately, during the time of horizontal violence, student nurses have many priorities higher than advocacy, legal action, and professional body support. Therefore it is imperative for clear documentation to be made during the experience, if it cannot be solved at the time, to support future action. Two important political and legal actions to take are filing a human rights violation and filing a complaint with the appropriate governing body regarding the actions of the nurse in question.
Ethical and Legal Analysis
Women within Canada are protected by law and supported by international organizations to bear children free from discrimination (Human Rights Commission of Canada [HRCC], n.d.). As outlined in Pregnancy and Human Rights in the Workplace: Policy and Best Practices (n.d.), the Canadian Human Rights Act “prohibits discrimination based on sex” (p.15) which, as of 1989 includes pregnancy; and the Canadian Charter of Rights and Freedoms states equality of rights for women. Should women face discrimination, regardless of the form it takes on, the Commission provides support to file a formal complaint and follow through until a resolution is found (HRCC, n.d.). The HRCC’s policy highlights international initiatives to protect women through motherhood. The Convention on the Elimination of All Forms of Discrimination Against Women, The Universal Declaration on Human Rights, the International Covenant on Economic, Social and Cultural Rights and the Beijing Platform for Action, the United Nations Fourth World Conference on Women all state that pregnancy is to be experienced without discrimination (HRCC, n.d.).
In the United States, there are institutional policies in place to outline pregnant student rights for administrative staff, educators, and students (National Women`s Law Center, 2011). The document states that students are entitled to: protection from being forced to drop out; being excused from academic responsibilities without penalty for pregnancy related reasons; and an opportunity to regain credit for attendance or in-class assignments missed due to the pregnancy.
Social and Cultural Analysis
Longstanding within nursing culture there has been the tendency for more experienced peers to harass and bully others (King-Jones, 2011). Student nurses are not sheltered from the issue of horizontal violence. Novice nurses are particularly vulnerable to this type of harassment. Within the lecture hall, students are taught of the dangers peer-to-peer violence possesses and how to prevent and resolve conflict. However, professors fail to discuss the issue of horizontal violence towards students from faculty members amongst the nursing education department. Gaps between education and practice are commonly discussed within the classroom, though this issue is an incongruence of practice within education. In King-Jones’ 2011 research, students reported that “rudeness, abusive language, and humiliation” were the most frequent forms of harassment from faculty, including clinical preceptors (p. 82). The same study found that 17% of students felt that learning opportunities were obstructed as a consequence of faculty bullying (King-Jones, 2011). It is unacceptable that students learn to accept horizontal violence within their education, where they normalize the behaviour before they even begin their career.
Post-secondary institutions are in a position to benefit financially from students who become pregnant and experience discrimination during their studies. If departmental administrative staff, such as the chairperson, restricts a student’s education through discriminatory action, the student may possibly leave the program with tuition already paid in full.
Through recognition of the Human Rights of pregnant students, an array of individuals and groups will benefit. Utmost, the pregnant student, her unborn child, and any other family involved will directly benefit. Pregnancy is a time of intense physical, psychological, emotional, and social change (Pilliterri, 2010). These changes are experienced differently in each pregnancy, but it is universal that some amount of stress will be experienced by the woman. External stresses, such as relationship distress, environmental stressors, and workplace stress are documented to contribute to negative outcomes such as preterm labour, low birth weight, and post-partum depression (RNAO, 2005). University students already report higher levels of stress than the general public, therefore efforts should be made to reduce or eliminate any additional sources of stress to promote a healthy pregnancy progression (Stallman, 2010).
The profession of nursing can no longer afford to discriminate based on tradition. Pregnant women, regardless if they consider themselves a biological birth parent or an active mother, bring a unique quality to their practice that their peers cannot.
Impacting a young family by restricting post-secondary education completion has the potential to affect the life of the entire family for the rest of their lives. The social determinants of health clearly outline the implications of low education has on social functioning and lifelong (Stamler & Yiu, 2012). Administrative choices have the potential to place a family within a low-income status , approximately earning a combined family income of $20, 000, rather than the upper-middle combined family income earning range of $50,000 to $100,000 a completed university education would provide them with (Statistics Canada, 2009; Macionis & Gerber, 2010). The RNAO is well-known for its advocacy to reduce poverty in Ontario to improve the health of the province; nursing leaders within university institutions who are denying students opportunities to complete their education are potentially contributing to the problem rather than working to eliminate this disparity.
Critical Feminist Analysis
Power imbalances between administrative faculty and nursing students are central to the issue and its resolution. The university structure supports faculty to maintain a position of power over students, ultimately influencing their feelings of self-efficacy and potential power to advocate for themselves.
Impact of Issue on Self
My entire life has been focused on academia; I judged my own happiness on my success within the academic world. I once believed that who I am was reflected through grades and positive reviews from my peers and teachers. The disillusionment ended when I realised my years of hard work and overachievement meant nothing when I needed support the most.
The summer prior to my transition to Brock University from Loyalist College, I received the Brock-Loyalist Collaborative Nursing Program Scholarship, delivered 71 babies (20 independently) in Arusha, Tanzania on an independent nursing elective, and then conceived my son. My dedication to my education and motivation to advance my skills in my soon-to-be profession was blatantly disregarded by the nurse leader responsible for the department I was learning in. This individual was also a leader within the nursing community as a whole, being part of an elite few to have earned their doctorate degree. I was never given an invitation to prove myself as a student, or even a human being. Instead I felt as though I was labeled as a traitor, my academic strength and excellence in clinical skills was replaced with the stigma of choosing a family over my vocation.
The timeline of my personal battle began October 23, 2011 when I first contacted the department with my concerns, including my due date and goal of graduating with my classmates in 2013. I was told that I “may want to book an appointment with the faculty member overseeing the course closer to the start of spring term” (Personal communication, October 26, 2010). The response gave me the impression that there would be a simple solution to accommodate my needs. I discovered that there was no simple solution three months later, when after contacting the chairperson of the department with three well thought out solutions, I was refused. At that point I chose to document: all communications I had with any member of the faculty; my pregnancy progression; and my own mental health.
I was not satisfied with the answer I received from the chair of the department. After discussing my problem with other parents in my nursing program, I discovered there were other individuals who had been bullied as well when dealing with childbearing and study completion issues (Anonymous, personal communication, February 2012). Realising she had attempted to take advantage of other vulnerable students, I chose to fight for accommodation to complete my year. I utilized the Brock University Students’ Union ombudsperson, which supported me to contact the Associate Dean of Applied Health Sciences. This self-advocacy lead to the solution of condensing my intersession placement into two 48 hour clinical weeks, plus a few shifts to complete 120 hours in total. My peers completed the hours over five weeks, and at nine months pregnant I completed double the amount of work they did. Instead of supporting me to take on a lighter workload, no overtime, or safer and lighter duties as suggested by the Human Rights Commission Best Practices (Canadian Human Rights Commission, n.d.), I was given the ultimatum to accept the offer or risk placing myself a year behind in my studies. I was not told at the time that I would be expected to complete double the amount of written assignments as my peers. On April 23, 2012, one week prior to my commencement of intersession and six months after my initial contact with the nursing department, I was notified in the presence of both of my clinical instructors that I was responsible for writing two case study assignments and three learning plan goals. I was told my peers completing the course in five weeks would only be responsible for one case study and two learning plan goals. The advocacy of my instructors helped me to be treated equally; on top of the intense in hospital hours, I completed a case study and two learning plan objectives.
I can proudly say that my work ethic and cooperative cervix allowed me to complete all of the assigned hours. I was also able to contribute to a peer’s learning when she attended my labour and subsequent Caesarean birth during her intersession rotation at West Lincoln Memorial Hospital. Fortunately, both my son and I experienced a happy and healthy delivery, even though it was via surgical birth. But post-partum depression settled in quickly and impacted the bonding experience with my son, the relationship with my spouse, and my view of myself as a mother. I often wonder if I had given myself time to relax physically, mentally, and emotionally, prior to my labour and delivery if the outcomes would have been different. I cannot dwell on what could have been, because my family is in the present, and I cannot hang onto animosity towards others that will affect my day-to-day interactions with them.
I plan to aggressively pursue justice for the horizontal violence, stigmatization and discrimination I experienced during my pregnancy as a nursing student at Brock University. As a nurse of the near future I will not accept perpetuating horizontal violence as the norm within our profession.
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