Chapters Transcript Video Blueprints for Success - Nurses at the Forefront: Addressing the Demand for Equitable, Patient-Centered HIV Care Blueprints for Success Nurses at the Forefront: Addressing the Demand for Equitable, Patient-Centered HIV Care Originally Broadcast: November 13, 2020 | 12:45 pm – 1:45 pm ET Good day, everyone. My name is Deborah Wafer. I'm medical assistant and HIV prevention with Gilead Sciences. And we welcome you today to our program. I have two speakers with me, um, Dr Cherita Chandler and Miss Clover Barnes, who will be joining me and, um, you can use, but you can use anybody the chat box to put in any questions about today's conversation. So I hope you'll enjoy and be able to participate in all of the information that we're bringing to you today. We're gonna talk about nurses at the forefront of addressing the demand for equitable, patient centered HIV care. There's a lot going on in the world today, and, um, when we talk about equity, I think it's something that anyone who's been working in HIV care has been doing for a long time. And we're also in the year of the nurse and, um, e think that's important because nurses have been holding it down in HIV since the very beginning of the epidemic. So let's get started in 2020 Once cove, it showed up. We were in the middle of three pandemics. We were already dealing with HIV and through HIV. We know that systemic in the equities, and especially in communities that are black and brown. We had a problem, and then now we have cove it and in the middle of all of that is health disparities. And as we move along, let's get ready to talk about some of those health disparities. But what the symptoms are and how the social and economic inequities lie beneath all of those We know that economic stability is important. People need jobs, they need income. And then we talk about housing or the neighborhoods in the physical environment. It's hard to have decent housing if you don't have a job, and then there's education. Education deals with literacy. Language can be an issue as well as, uh, being able to read basically and then we have food. Food insecurity is a huge problem that doesn't get talked about a whole lot. But food and security definitely impacts Ah, person's health. And then we have community and social things that are happening, and I believe black lives matters showed us a lot of that this summer, and we also know that stress being under constant, constant, constant oppression for hundreds of years and dealing with micro aggressions are things that cause people to have ongoing stress. And then we have the health care system and then the health care system. The quality of care is important. Being able to get to a health care provider is important. We know that many people live in health deserts, and you put all of these things together. And they are the underpinnings off the health disparities that communities that are suffering from HIV and co bit are dealing with. So let's move on. This is a depiction of everything that's going on right now. When you look at these maps, you can see the overlapping social, economic and health conditions in certain counties that disproportionately affect black people. The first, uh, the 1st 1st map looks at property, and when we look at property, those dark areas are where the most intense property is happening. And then we go over and we look at unemployment and those two go together, right? If you're unemployed, you probably don't have a whole lot of money, so unemployment and poverty go together, and then most people get their insurance through the jobs that they have. So if you don't have insurance. That's another issue. So as we look at the maps across the top, you can see the intensity of the colors. They're all happening in the same places. And then when we look at the bottom, um, maps, we can see the cases of diabetes, of hypertension, heart disease and syphilis. And again, it's the same communities. So what do you think? The common denominator here, the common denominator hiss in many of these states, these air the same states that did not option medical Medicaid expansion or opt in to the Affordable Care Act. And so that just compounds all the problems that we have going on. Right? If you put all of these on top of each other, you see the intensity of the color. The other thing that's happening in all of these places is that this is where a concentration off black people live. And that's important to know, because the once you string all these things together and then you string waste on top of it, we can talk about what the how these problems overlap and how they impact the communities. And then let's move a little bit further on and talk about Cove, It Cove. It is the tale of two pandemics and those of us who've been working in infectious disease, No, it and have seen it and understand it. The first map, the blue map, looks at Cove it up through July of 2030 and these are the the case is, And wherever there are a lot of cases, they're going to be a lot of deaths. Last night I looked to see what the number waas because it keeps going up. I think the first part of the week it was 100,000 new cases. Now it's up to 160,000 new cases. We're talking about 10 million people in this country that has some of the best health care in the world. And then when you look over at the HIV prevalence, we see in 2018 that the colors again are all correlated. So you lay them on top of each other, and you see that the role of the social determinants of health, the things that we just talked about care, education, employment, housing and quality of care all go together. And that's what we wanted to talk about. More So let's move on and take a look at what we mean by systemic inequities. So the social determinants of health overlap with HIV rates and risk. And those of us who've been doing this. I've been working in HIV for 20 years, and this has not changed. It is not new, but everyone acts like it's something new. Everybody's got papers to write about it and new things to say about it. It's the same people. It's the same problem. And we've got to do better. Income, equality, inequality. If you don't have a job, you don't have insurance. And then you have lack of economic opportunities. Social inequality, black live matters showed us that right on TV today, not today, but over the summer, not only George Floyd, but Ray Shard, Ray Shard, Brooks and all the other people, Briana Taylor, who have, um, were unjustly killed mostly for being black. That was the first reason in no value for black lives. And then we look at the lower rate of prep uptake. Prop uptake is one of those things that again we have. I just had a conversation about that this morning. Do we keep going to the same places, having the same conversations about what prep uptake should be about, Or should we be talking about prep in some new places and talking about it in a way that people see it as a part of wellness? Then we have racial. We have residential segregation. So what does that mean? That means that people who have been poor people who have been without the people who have been impacted by the legacy of slavery and racism wind up in the same communities where there are no jobs where there are no grocery stores where there are no health care providers. And you put all these things together and we want to know why there is a lower it uptake of prep. I say that we have got to doom or going to those communities, educating people about what prep is and try to understand. What is it about that about prep that they don't understand, or what is it about prep? They need to know more about it instead of thinking that people are going to come to us and find and ask us about what prep ISS and we'll talk about that some more in a minute. Let's go to the next slide. So when we think about the local and the micro epidemics Aziz, we showed you earlier. The hotspots are in the in the south and the counties, in the south and in large urban areas. There's a big difference in regions, and there's a lot of things that we need to keep in mind. Number one, the health system infrastructure. There are places and I think Cove it is showing it even mawr. There are places now where we know that there are no intensive care units, and so there may be hospitals. But then there may not be the staff to take care of people. And I think that goes for HIV, too. People are not looking for HIV, and some of these counties and people are not talking about HIV. We know the stigma can be a problem, and stigma is not so much just about the patient. It's about the providers who even push more stigma about the way they approach people in the way they talk about it and and then we have funding. There's lack of funding. If you, if people didn't opt into the affordable care act than this possibility off. Having Medicaid available for people didn't happen, and it's a shame. And I think it's one of those things that we and healthcare need to talk a little bit more about when we're talking to local authorities, about how can they work on expanding Medicaid in their state because that would create more resource is and then there's laws and policies. We know that there's some states where being HIV positive and having sex with someone is considered a crime, and people could actually go to jail for that. So again, these new infections are highly concentrated among men who have sex with men, men who have sex with men who are black and brown mostly. So let's make sure we get that right. And then we're talking about those that live in the Southern states, and those especially those Southern states where no one opted into the states, did not into the affordable care act. Okay, let's keep moving here. Um, history repeats itself, and it repeats itself, especially if people don't know the history. And if people don't talk about the history and I think that's important, because when you think about slavery in the South, where it was considered, um, where they're all these conservative policies are happening. That's where the disparities air happening. And that's where the lack of the workforce is to kind of address cove it the lack of work force to address HIV. And then we have disparities and access in the health care system, along with what I just talked about the lack of prep uptake, especially in people of color, and then the historic mistrust of health care and health care providers. So let me just take a minute and talk about mistrust and talk about distrust. I just recently was in a meeting, and we had this conversation. What's the difference of mistrust and distrust, and how should we be using those terms? And what I learned from a Nantha apology linguistics professor was that mistrust is when I'm not sure if I can trust you and distrust is, you lie once before and I don't trust you. And so I think it's important that we understand how we use those terms because everyone is not distrustful. But a lot of people are mistrustful, and if people have been, have not been treated well in the health care system, they may have more distrust, so let's move on and keep this party going. So the other thing we want to talk about a stigma. We know the stigma is a big driver of lack of prep in tow, uptake, lack of HIV testing and lack off adherence. And certain groups experience HIV related stigma. More in the United States. When we think of women, when more women than men experience stigma, and I think that's for a long time, because when people are diagnosed, HIV positive folks asked, How did you get it? Nobody asked people how they got diabetes and nobody asked people how they got breast cancer. But with women, the stigma of were you having sex with lots of people? Were you using drugs and that they make it be about the woman instead of about the diagnosis? And then people with low incomes have stigma about HIV, and a lot of that is connected to the lack of health care, the lack of experience with the health care system and just the lack of knowledge. I'm not saying all people who have low incomes are not educated, but a lot of people who have low incomes don't get the same kind of prevention or the same kind of exposure to the medical system. So stigma relating to disclosure of your HIV status status and to public attitudes around HIV was higher among black people, compared toa white people. And I wonder why that might be. I think you guys all know why that ISS right? There's all the, you know, the stigma of being black, being poor, being a woman. Did you use drugs? You know, have you been in jail? You know, men who have sex with men on the down low? I mean, all of these things figure into that and put negative words attached to it rather than HIV is a virus that you can get infected with. Or I don't mean to say infected that you can acquire. And you can acquire HIV from having sex. So people who are not on HIV treatment don't take their HIV medications regularly. And if they're not taking their medications regularly, we cannot get to U equals you or we cannot get to prevention is treatment. And we can't get to the viral suppression in the community so that the virus stays suppressed. And that's very key, because I I understand. And I you talk to people. People generally are kind and want to do the right thing. And I think if Mawr communities understood what viral suppression is, there would be mawr uptake of people being on treatment, finding out their HIV status and keeping their virus suppressed. All right, let's go on. So a way forward, we have some help. We have some hopeful signs. Most of the people on this call probably know about the Ryan White program, and we know that that program is a federally program and it's designed to as a safety net for people so that they can get access to the treatment that they need. And then we have the veteran health program for Cove it that shows the same health outcomes for black and white and let Latin or Latin X veterans. And then, you know, some of the other things that are happening and are hopeful is that we recently had a Supreme Court ruling that upheld the protection of gay and transgender people and immigrants. We have some social changes. I was very proud to see what happened after George Floyd's death. The number of people who came out and started spontaneous movements and marches, people all across the country, from all economic brackets and from all races. And I say kudos to the young people who say they're not gonna take this anymore even though we just had an election, it showed that the country is 50% divided. I do think that the social attitudes are changing, and then the other thing is that we're having Mawr innovated community Senate responses around ending the epidemic and making some inroads, and we want to keep that going now. I would like to bring in, um, our two guests for this conversation. And so let's go to our guests, Rashida and Clover. What do you think are some of the important steps that we need to do to deal with these epidemics that we are dealing with right now? I'll go to you first, Rashida. First tell us who you are and where you work and what you do. And, uh, uh, absolutely. I'm Rashida Chandler. I'm an assistant professor at Emory University in the School of Nursing, and, um, I also work as a nurse practitioner at the Center for Black Women's Wellness. So that's a little bit about me. Um, and I'll go ahead and respond, and and then I'll let Clover introduce yourself and respond. Um, so as far as the challenges, thank you for reminding us about, you know, where we are in some hopeful giving us some hope that we can continue to move forward and make progress. Um, I do appreciate the opportunity to speak, be to you all relative to these very timely and important topics. Um, I always do this, especially in a panel discussion when we're talking about such sensitive information and and just request a moment of silence for those who have been killed or who have died as a result of these endemic. So if we could just take one second to do that and then just to continue in that vein, I want my responses throughout this discussion to be solution based and speak from the resilience perspective because I know we could talk all day about the problems that we want to try and provide some solutions and ideas about how we can move forward. Um, I wanna say that nursing is the largest health care profession. According to American Association of Colleges of Nursing, we have about 3.8 million registered nurses nurses nationwide. So you know what? Nurses can change. Some s for systems H for health policy, I for ignorance and t for things together. And, yes, I have created the T shirt. We can wear it as a reminder to execute it. Um, in more detail, we know that the systems like you reminded us Deb systems systems were created toe enhance the lives of one group and disregard the humanity of others that exists. Put communities. These consistence that do exist do put, put communities of color at a disadvantage. And so nurses can be the thought leaders and change agents to counter the inequities in the health care system. We have the numbers, and we certainly have the intellectual capacity. Currently, the systems are, to me a patchwork of attempts at equity like a mirage ultimately, which consistently reveals inequality, Whether in the criminal justice system, healthcare system or educational system, you can name it. Um, there are inequities. Um, And so for those who are unaware, it's not because we don't work hard or because we don't want better for ourselves. But it's because there was no intention from the inception of this country for people of color to be more than property. So what we need to do is have more camaraderie between nursing organizations to harness our power and collective, Uh, and collectively, we need to demand that change. Um, so I'll let clover go. I don't wanna keep talking and and take off all the time, so thank you. Lower Tell us who you are and where you Where you talking to us from? Today. Thank you so much. Both of you. My name is Clover Barnes, and I am the chief of Karen treatment at the D. C. Department of Health. I work in the HIV AIDS, STD and TV Administration, and I am happy to be talking to you from Washington, D. C today the heart of where a lot of things were happening at this point and I agree wholeheartedly with what Rishi to see it. And I would, uh, implore us to do the things that we can do to be the change that we need without within our organizations. I think as nurses often were the big, biggest and best advocates for our clients and for people who are underserved and disproportionately, uh, affected by these pendant pandemics and systemic, uh, inequities. And I think that we no, the voice of the patient and we have a voice and a standing within our inter disciplinary teams on within our organizations to be able to move the needle on how we need to see things change within our systems. If we aren't pushing the boundaries of where we want to go on where we need to go, then we're doing a disservice to our patients into our oath of nurses. I think we have the power and and the energy and the education and the trust of our patients to do so. And I think it's part of our responsibility to do that, to move the systems forward. I agree. You know, I also think just to add to what you guys are saying is that you know, as nurses and a za black nurses working in the community, you were thought leaders for our communities and people trust us. I always think back about W E. B. Du Bois and his saying about, you know, everybody might not get a chance to get the education that we got. But those of us who have it, it is our obligation to bring it back and translated and help our communities. Because I know in my in my family, and I'm sure in yours, I have a trusted voice. You know, people will go to the doctor and come back and say blah, blah, blah. This happened e should do. And I was like, Did you go to the doctor? Yeah. What did they say? Well, I want to hear what you have to say. And I think that I think about that a lot. And, you know, in my clinical care. And in my work here, Juliet, I always think I always have a couple of patients on my shoulders when having discussions about what would they think about this? And how would this impact them? And so our role Aziz nurses are really important for our families, for our computer communities, for the jobs that we have And for the people who are impacted by cove, it and HIV. But this year is here. The nurse, right? So with the year of the nurse, what role? What might we play on helping shine some more light on the needs of patients and communities. You talked about a little bit, but let's go a little bit further. What are some of the unique things we might be able to do as nurses? Rashida. Yeah. So you know, we're talking. I'm one of the points. Um, sorry. Thio go up, go backwards a little bit. But I think all of the comments are, um, certainly aligned and and where it's a natural flu, but I just wanted to make the comment about, um it's faras the Harris, the Biden Harris Transition Cohen 19 advisory board. Um, there's not a nurse. And we know that nurses are performing most of the intimate interactions with the patient and facilitating the engagement with their social support systems. So that's what I mean by being at the leadership table, helping us to change health policy. I really think that as, um, you know, I was very honored to hear, um, and that we actually had, um, representative Underwood with us. Um, for our plenary, um and just we need more bad. We need to have mawr leadership. We need to have nurse led organizations building that infrastructure to help fund, groom and promote Bible nurse candidates for these elected positions so that things like the cures Act can be closer to being passed or be passed toe help resolve some of these, uh, disparities that exist. So lack of house, including security, access to health services, the things that you named in your introductory presentation. You know, when nurses are making some of the decisions, we can come from our perspective and do it in the best interest of our patients. So I just wanted to kind of throw that in there. We got to be at these, um, leadership tables and making health policy and the things that we have to abide by in the health care system. Um, to answer your question, I had a little bit more to go on about that. A few points that nurses could do. I think we already provide exceptional care, and and we are the most trusted profession in the hours of our patients. And I had a point about that as well with having family and friends. Once they know you're a nurse, you like, uh, you're the one who has to give the check off whether they've gone to ah, doctor's appointment or not. So I I agree with that wholeheartedly. Um, so I wanna I want to remind nurses that we are human e No. We we might feel superhuman at times, but we experience We are also experiencing this endemic in much the same way as other people. And it was a little disturbing to me when I heard that one of the Dakotas. I wanna say North Dakota, um, where they were, you know, asking nurses to, um, still provide care. And they were also covert 19 positive with no symptoms. But you know where people and we have families as well. Self self care is really important. Um and, you know, providing that having personal time taking off when you're sick. Journaling, um, a way for you to debrief what? Whatever helps you relax, crow saying yoga, Whatever it is we have to be, we have to be healthy in order to ensure the health of our patients. So Okay, how about you clover? Talk to us about your of the nurse? I agree wholeheartedly. We as nurses are the center of most things. We're most of us are women were always the center of our homes and of our families, and were the center of that interdisciplinary team that needs to work together to pull together to care for our patients. And I think as such we have to be advocates and crafting messages and ways Uh, thio get to the communities that are most impacted by these conditions and these inequities. And in that I think we have to make sure that we're using messages and putting messages in place where the people who need them most are receiving. And I think we definitely have to use culturally affirming and, uh, gender neutral, affirming or gender affirming pronouns and messages that we're getting out thio the communities and I think that we have to be consistent and we have to hold our partners and our colleagues accountable, to be consistent and to and to use those gender affirming and culturally affirming messages as we go through. I also think that we need to push our organizations to be more involved in the places where people are most disproportionately affected. It's great to set up clinics and hospitals in downtown or booming, booming suburbs, but how are you going to get to the people who really need it most who can't get there. There's no public transportation. There's no way for them to get over there. They don't even know about it. You know, sometimes we have to get outside the comfort of the four walls of our clinics or hospitals or offices to really get to the people and understand what they need and to bring the things that they need to them. We have to meet people where they are. And I think as nurses were uniquely, uh, able and talented enough to be able to do that and to get those things to the people where they need the most when they need them most. May I add that the Year of the Nurses every year because we were voted the number one trusted profession for the last 25 except for 9 11, which was firefighters and other first responders, which was quite understandable. But it's every year that we are our profession, is, is is recognized to be the most trusted, and so I think that's an honor in and of itself. I agree 100%. Thank you. Thank you. You know, the the other thing that about being a nurse is that being trusted, having training, having the information and knowing, um what what the issues are that people are living with. So with that, Rashida, I'm recommending that you write to the Biden Harris ticket and let them know left unimportant peace. I'll take that challenge on Alright, alright. And let me also just remind, um, the audience that you can, um that you can ask us questions and you can go to the bottom of the screen to submit any questions that you have. So statistics show that the main beneficiaries of HIV prevention are white men. What can we do to widen the availability of these services for men and women of color? But she tha do you wanna us take on that question first? Sure. Uh I say just do it. I said there is No There is not a magic answer to this. What? I say what was done to ensure white men receive services. They do that for communities of color. Men and women. Ask those communities what are barriers to a accessing prevention services and work with them to remove those barriers. Um, that is what I do do in my research. In my practice, I asked the community about their HIV prevention needs and through community emergence work together with them on solutions. So what happens most often is the smart people. They wanna tell communities of color. What is good for them in prevention tools are not well received because of that. And so, like many of us, we want to be active participants in what we consume in that includes health care services. Okay. My thing is, just do it and talked with the community about how to do it. Good. I I agree. Um, as someone said to me once, You know, if you go and talk to communities, I don't think they describe themselves as marginalized. And this is e Wanna ask not Thio heard it. Yeah, you might wanna ask them how they describe their community. So how how can we better reach women of color? Um, and and get them and get them the information they need to understand HIV risk and the appropriate HIV treatment and prevention options. You have some ideas about that? I do. I have a few. One thing that we know is women of colors that we know what needs to be done. We know what you know, what needs to happen, what needs to happen for our bodies, for our families. We usually know what needs to happen for everybody. But what we also know is that we are usually the leaders of our families, and we are kind of the control center that makes everything go. We make it go for the kids. We make it go for the men. We make it go for our parents, sometimes grandchildren, the whole nine yards. And as such, we put everybody's needs before ours. And so I think we have to make sure that we're reinforcing the fact that you can't pour from an empty cup. And as much as we move forward and and work Thio, make orchestrate everything else that needs to go on in our lives. We have to help women, especially black women, understand that they need to focus on their own health and take a few minutes to do things for themselves and weigh the ways that we can do that. It's for example, in my position I am the P I for the Ryan White Grants in the District of Columbia, both the Iemma as well as the Part B. And we make a concerted effort to fund programs who focus on women of color, transgender women, black women, Latin women, black and brown people in communities that we want to make sure that they have programs that are culturally affirming and that are focused on those women of those people so that we're impacting their health in a different way. And sometimes that means that those programs have to be active in places that are outside the box. We had a program that held screenings at a P T A meeting. You would come there anyway. These are places that people already go because you're invested in your Children's education and your active, and so they would have ah, screening at the P t. A meeting. Come get your screen and go right into the meeting and still do everything that you were there to do. We have a pop up clinic that rolls around to different grocery stores After hours in the evening, everybody goes to make groceries. You could pop in and get your screening. So thinking outside the box to get people to get care where they are as opposed to X zooming that everybody's gonna be able to come to you and come during your 8 to 5 hours and come to the time that you need them to come and wait if you're running behind, etcetera, etcetera. So we, um, just have to make sure that we are going outside our norms and not expecting people to be able to come to us at the same time that they're working and doing other things to make sure there their families are cared for. I love that. I love that. I wanna pin to that. I'm sorry, Dad. I mean, you cut y'all, but I just got so excited. I got so excited to hear, you know, hear the the fact that you're putting the money where the needed and you know I can't. That's kind of a pet peeve of mine Is that sometimes the resource is our monies that are awarded for certain things. Um, mainly, uh, in my world, research are always awarded to the people who are on the ground doing, you know, the day to day. So I appreciate that you guys are actually implementing it in that way and being creative about making sure, um, individuals get the resources they need where they are. I think part of that as well as making sure that we as nurses, are moving up the leadership chain and are sitting at the tables where these decisions are made. So I'm a nurse and I have an MBA, and I make the decisions about where this round white money goes. But as a nurse, I'm uniquely, um, you know, situated that I understand what happens on the patient care side, you know, and not just a paper pusher who's moving money around, regardless of the people who are impacted. So I think we as nurses, also need to make sure that we're always putting ourselves in the right places at the table in order to impact the decisions that are being made and even be the decision makers. If that is your calling, I so much agree. I mean, I think we can be the glue right between the patients and access so many times. You know what I also heard you say, going to the places where people are in testing. I think a lot of times people want to know how many people tested positive and how many people did this. But what you're doing is raising awareness, right? And so, for people who haven't heard about this, just seeing it more and more helps drive down the stigma and helps raise the awareness at the same time. You know, it kind of normalizes it a little bit. Yeah, We just started at home testing program where people can a website and request the test kit. And, you know, honestly, we don't always get the results because they're doing it themselves, and then they choose to engage with us and request, um, you know, follow up for a proper for, you know, getting into care if their test was positive than that window is there and we give them all the resource is to do that. But more about knowing your status and knowing your own health awareness and knowing what you're doing. And being safe in that is what's most important more so than it is for us to be able to report out that so many percentages of people did this and did that. We really want our people to be well and to have the best and safest care that they can have and to be able to be their best Selves and their most well cells in everything that they do well, what? We are cancerous spirit now, I was just about to say we haven't and we just farther than at home testing option. We dio HIV and other STDs. Um, right now, because I have tow no balance the research far with what I do, we dio you know, try and interact with them and do a telemedicine visit once they get the results. But they you know, they get them, and then we can eat, prescribe if they need treatment and things of that sort. So I think that's another service. The women in our clinic, Um, which, by the way, is probably about 90% black women. They really have taken to that option. And I think it helps reduce stigma and having to be in the clinic setting around this topic. Um, they have been very receptive to it, right? You know, machine, you said something about research, and I want to just go back to that because, um, I think that when we think about research, how can we get more nurses, black and brown nurses doing what you're doing in terms of research. So it's a two part question is we need for people like you doing research. But we also need to be training more nurses, right? And I mean, I think that the profession, when I looked at the numbers, the numbers of nurses who are African American, is something like, I don't know, I think I said, out of all the nurses, it was less than 10. Bleak on then the number of Brown nurses was even left, you know, half of what it ISS. So what are some of the things that we number one? What you know, how do you get into research as a nurse on Ben and Clover? I'll come back to you and you talk about how can we get more people, more people getting involved in nursing? I would say that I've had experience with several different programs that I thought were great ways to engage individuals who are, you know, black and brown, um, to transition into the research, and I can use myself as an example. It was not something I thought I wanted to do. I just I didn't I never knew about the option. And so I had someone who knew me and was like, Well, you know what? I think you should try this. So having trusted people who who know about you, um, to give you that encouragement to move, to go further in your career and pursue something like the ph. D they have a number of they have now the DNP, which is more clinically focused. Um, however, one of the programs that I think are extremely, um would benefit Ah, lot of institutions would be to partner with hbc use in their schools of nursing. Most of, um, we know that HBCU produced a number of professionals and, um, different professions, but certainly a nursing. I'm an HBCU grad, and so is our new vice president elect. I mean, so you know, I think having that pipeline between HBC use and other institutions that that actually have PhD program, even some HBCU do have PhD programs that if they don't have in some kind of pipeline, in order for, um, individuals who are interested also internships. I've worked with students from Spelman. I've worked with students from Morehouse because I partner with faculty from there as well. So I mean, I think just relationship building and those individual Spelman doesn't have a nursing school, but some of their, um, students are very interested in becoming nurses. So, like, that would be an I ideal pipeline between Spelman and another institution like emery toe. Have, um, you know their students to matriculated into our programs so that that's a suggestion and then mentor ship is extremely important. Just mentoring the next generation. We have a lot of aspiring nurses I get, you know, quite often, people who find me on in different platforms linking or social media. And if they ask you a question, I try my best to answer and encourage them and give them, you know, guidance. So I think, you know, we could do better with mentoring, especially in our nursing organizations. Off people, uh, you know, black and brown individuals to try and increase that pool of individuals who who can potentially become the next generation of leaders in the in the nursing profession in clover. What about how do we get more black and brown nurses? I mean, what you know, where do you think it's important to tap people are, you know, to how do we get them coming in through nursing education programs? I think it starts with mentoring. I think Rashida hit the nail right on the head there when I was I'm from Milwaukee, Wisconsin. So in some of my, uh, you might hear some of my euphemisms that air from the Midwest. But we had a program that mentor teens coming out of high school and promoting them, going to college and being successful in college. And so part of what I did was mentor young people who want to go on health care profession. So I want to be doctors. I want to be nurses. Many of those that wanted to be doctors became nurses through their schooling because sometimes you have to understand that your undergraduate degree can be in anything and you could go to medical school, So why not get it in something that is a profession in itself and not just major and a science that if you don't go to med school, you have to figure out what you're gonna do it right? So I have some mentees who graduated from nursing school. I went to medical school or went on to become the MPs and as such. But I think we have to start in high school to catch them young and to really be present and be aware. You know, I didn't have a a person of color as a nursing professor, your any of my nursing school, you know, for them to see nurses who look like them to know that they can be. Sometimes you have to see one to know you could be one. And so if you can get out there and be active with young people and schools, be active in the universities, in the professional associations, black nurses, Hispanic nurses, there are lots of organizations item enter from the black nurses. That's how I made it through nursing school because you know she was there to help push me through and guide me and really keep me motivated because there's a school can be discouraging. It's not easy. And so you know, you always need somebody there in your corner. And so she, my mentor from the Black Nurses, was in my corner the whole time. I still meant her nursing students and young people to this day. Even those that aren't gonna be nurses that you know, decided to go another way. I don't cut him off because they still need to be stared in the way to go right. So e think it's important that we each reach back and pull somebody up because somebody helped us get here. Also, think once they get there, that it's still important to maintain some sort of relationship with them, to keep them motivated and keep them moving forward and whatever they're calling it. So you know, like I said, about moving people into leadership, that's where my passion is into leadership and management and making sure that we're at the table where the decisions are made. But whether your passion is at the bedside and making sure that the patients are getting the best and safest care they could get is to always follow your passion and to be fulfilled and happy and what you're doing in your role. Nursing has a myriad of different ways that you can operationalize your degree. If you don't like people, you could be an operating room. You could work in insurance company. You could push papers. I mean, there are lots of things you can dio, but find your passion in it and and go there and stay there because happier nurses create better outcomes. And if you're engaged in what you're doing, you're gonna have better outcomes for everybody. That's an excellent point because you hear people say, Well, I don't like blood, right? And that's all nursing ISS. I'm glad for. The bedpan did way. All have are things that bother us, right? But suctioning was mine. I hate sexual Oh, me too. That was the one that drove e think what that point is. Very important that a nursing degree opens many doors, you know, little side note. I had a gig where I work at a at a resort, was the nurse and didn't have to pay to be there, you know? So you know, there are lots of different things that you can dio. But there's a question from the audience, because I think right in line with where we are now. How do you go about providing suggestions and recommendations for progress when personnel and higher up positions failed to acknowledge those recommendations? E. I'm saying I'm happy to get my opinion on it. um I think every organization is different. Um, and how you move about and try to maneuver. Um, it's, um it's unfortunate if you feel as if you're unheard and in organizations and and that you can't, um, kind of influence. You are. Hopefully your higher ups would want to hear what you have to say. Um, you know, I have been, um, in positions. Um, and my resolution for is often times I mean, you know, I stand until I can't say any more than I try to find a place that, you know, going to be conducive to me And, um, provide opportunities for me to, you know, give insight because I feel like I can, um, contribute to, uh, any organization in a way to I'm an asset to an organization. I think we have to know that, um, unfortunately, uh, you know, not everyone will want to hear what we have to say, and and we just have to know that, and we have to make a decision about whether or not that's a place that we, you know, want t o b. And And if we have to be in that place, we may have to endure, but there may be some wait for you to be kind of an activist. Um, that's kind of where you put your activists had on, and you might do some Some get some people like minded, um, and start to demand, uh, some one to listen to your ideas, especially if it has a new impact on patient outcomes or things that you know would really benefit the organization as a whole. If if you have some individuals that you guys you know, can pull your pull your collective thoughts together and organized, then that's how you make change. Um, you could I mean, I think they have alluded to before. Black lives matter. Some of the other social movements that you know, people get together, they make their voice heard. They organized, and and then that's when you get people's attention and they start to listen. So what do you do clover when you're if have you ever been in that kind of situation and how do you have to live? I sure have. And sometimes the person that you're going to is not hearing you, but you have to find the person who will hear you the person who is receptive to your message. And sometimes that person may be outside your hierarchy. You know, often their officers of diversity, inclusion that are in organizations or people who are like minded that you may not even be aware of. But as you start to have the discussions and you bring up, you ask the hard questions in the rooms. Then sometimes you find your allies. And for me, that has been my best, uh, action. Moving forward is Thio. I always say what I need to say now, whether they receive it or not. You know it's a different situation, but it will be said in the room where everybody use it. And often when you say the hard thing that everybody's thinking and nobody else is willing the same, you find your allies, they come to you behind closed doors. They send you a text message. They leave a note under your door because they're not willing to say it publicly. But they agree with what you're saying, and from there you can organize and you can form a little coalition to make things move forward. And once you have mo mentum, you can actuate change as nurses. We know that our scope is large and it is wide. And there are times that we can push those boundaries and walk right up to the edge of our school and and and the boundary that were supposed to be in and and really pushed toe move the needle for what we're trying to do. And so I would encourage people to step out to say what is right. And and thio voice what needs to be heard because a close mouth doesn't get fair. So if you don't say anything, there's no way to actuate the change. So you have to start by making the noise. And from there you will find allies and you'll be able to move your agenda for right. I think allies air very important, right? Very okay, s. So I'm gonna just change subjects because we have a question from the audience about what are some of the strategies to that you have used? Um, she tha this is to you read some of your work to increase prep awareness uptake in black women. Um, so we have done a number of things, so we are in the process of creating some Elektronik tools and cool kids Thio distribute to black women. But we've gotten feedback from them. We've done like things such as infographics. Um, we have done, um, uh, you know, in person or online kind of educational modules to help women. Um, and we're trying to do something a little bit more permanent. That's in the works. It is something that we're actually developing with women. Um, a mobile app that will help Thio provide them with this information, um, along the way or whenever they need it. Instead of having to, um, relies simply on when you know there are educational opportunities available to them or Googling or and not knowing the resource is available. I'm excited because there looks like some promise with the long acting. And many of the women that I work with are eager for that option. They're not king on a, um, everyday pill. They don't like to even do that with birth control. So I'm very optimistic, and I'll start doing some work around kind of getting their feedback. But yeah, we've done a number of things. Like I said, um, from infographics to electronic information dissemination, um, of this to make women aware as faras uptake. I'm gonna be honest. The people that I've, um the young women that I work with are very hesitant. Still, I think maybe this long at acting option may be something that we can leverage, um, for them. But as of now, the one a day, you know, peel consistent, consistently taken a pill is not, um, not something they're interested in. Thank you. Thank you for sharing that. That's that's important information. And, uh, in clover. What can we do to improve care of black and Latin X transgender women who are disproportionately affected by HIV? And by that I mean the stigma and the discrimination. You have some ideas about that? I do. We actually have ah whole transgender program here in the district. Thio try to make an impact on the health and wellness of the transgender people who live here. And first I think transgender women must be affirmed regardless of what they look like, regardless of what you think. Regardless, if their name is still legally a male name, you have to affirm them in there. Woman this regardless of their outward appearance, I think we have to check our own personal biases and really, you know, think about him, come prepared to treat them with respect and dignity when they walk in the door. And I think that also means preparing our team's Ah, lot of times when people feel stigmatized or have issues, it's with the people at the front desk or, you know, the person, not the care provider. You know, usually that's the most warm relationship, and that's why they're there. But it's the other members of the team who often are the ones who do things that make them feel uncomfortable. And so I think it's important that we're working with our whole team to ensure that we are being affirming and what we're doing. And I also think this is a place where Telehealth is really important and can make inroads. You know, a lot of times that takes that middle person out, it takes away the ancillary staff and there's just a direct conversation with the provider and in cases where there is nothing that needs to be done, you know, physically in person, telehealth is an excellent way to continue to keep transgender women engaged in care, right? I think that's That's, uh telehealth is, uh, got a whole new light on it now for sure. Maybe, uh, people might have been resistant. And now with the disruption of cove, it it is what people doing. So, um So Rashida, can you talk a little bit? About what? Improvements. Uh, can we make it our own practices to ensure that we're welcoming diversity and I'm talking, and then this is kind of off of We just talked about transgender, and I think, you know, including that's all a part of the diversity discussion that we're talking about in our practice. Can you talk about that a little bit? How can we Yeah, of course. I feel that a so faras diversity is concerned. If you want to appear to be inclusive and welcoming of diverse backgrounds, you need to reflect that in your practice. I mean, individuals need to look like the people who are coming in. I'm not saying everyone, but if you're saying that you're trying Thio have a diverse environment. Um, there needs to be a work force in your practice that that reflect diversity. So I think that most people respond this to what they see you do rather than what you say. Um, and so you might say I support the first day and no one in your office looks like them, or no one in your office is from a diverse group, whether it's race, gender, identity, etcetera. So I just say that, um, that needs to be reflected not only in the, you know, people who may be dealing with the patients, um, ancillary staff or provide providers leadership within that clinic like it should be from top to bottom. So, you know, let let what you say about diversity be reflected in your office. I'm getting a six. We've got to wrap this up, and I'm so engaged. I think I lost track of time. Things has been wonderful, and I don't know if you guys have one or two words you want to say at the end. So Clover, Is there anything you want to say about today's discussion? Just in 10 seconds to wrap this up quick. 10 seconds. I just want to say that we all need to work from all angles to create a system that is right and just for all and everybody needs to do their part and you be the change that you want to see. Alright, Rashida, You wanna add anything? Just one last thing. I wanted to remember that nurses can change systems, health policy, ignorance and things together. So just remember that we can make the change. Thank you for the opportunity. Oh, God. This has been a pleasure. Thank you for taking time out of your busy schedules and having this discussion because I think this is something that everyone got something out of. And it was a pleasure today working with you guys. So answer for your questions and your participation as well. And with that, I think we're going to close it out. Thanks a lot. Created by
