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Creating an Inclusive Environment for Students, Patients, and Caregivers

Brianna Banachoski, RN, is a nurse in the Hematology and Cellular Therapy Unit at West Penn Hospital.* She identifies as a lesbian, and uses she/her pronouns. She is also a cancer survivor; she has been in remission from non-Hodgkins lymphoma since 2016. Banachoski’s experience as a nursing student and nurse was colored by her identity and her cancer diagnosis.

Education and experience with simulation

Brianna is a 2018 graduate from Edinboro University in Edinboro, PA, about twenty minutes south of Erie, PA. She started nursing school with a bachelor’s degree in hand and participated in the accelerated nursing program. This program consisted of CORE nursing classes over the course of three semesters. Brianna also took the initiative to complete a summer internship at UPMC Shadyside, on the Bone Marrow Transplant floor, during the summer of 2018 to gain additional experience. She considers her internship to be the most beneficial choice she made for her career.

“Nursing school doesn’t do much to prepare you for nursing itself,” Brianna says. “I learned most of my nursing skills during internship and during orientation.” While the hope is that the educational system prepares students accordingly, the experience for nursing students can be much different.

While Brianna says her class did participate in some simulation scenarios during nursing school, it was only about one simulation class per semester. She thinks two or three times per class per semester would have been more beneficial. The skills taught in simulation lab included working with manikins for the following:

  • Patient vital signs training
  • Head-to-toe assessments
  • Labor and delivery patient training
  • Code blue patient scenarios
  • Pediatric patient assessments
  • Patients in distress
  • NG and PEG tube placements
  • Wound care

These skills are important to tackle during simulation, as they may not be able to be performed during clinicals and results can be manipulated for better/worse case scenarios under a controlled environment.

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“I liked simulations because it gave us a chance to practice these skills without the pressure of being in a hospital and having the patients, family, and nurses watching our every move,” Brianna says. “It gave us a chance to be nervous and make mistakes without hurting anyone.” Based on Brianna’s observations, her nursing school had a lot of useful simulation technology. However, she personally feels they didn’t get to access it enough. “I believe it would have been more beneficial to spend clinical or lecture time in the skills lab to get a better handle on physical skill of nursing.”

Cancer diagnosis and coming out

Take all the stress and workload of being a student and then a nurse, then add being LGBTQ+ and beating cancer to the mix! In May of 2015, Brianna was diagnosed with Stage 2B alk+ Anaplastic Large Cell Lymphoma; she was 22 years old. Brianna had been searching for an answer to health issues she had been experiencing for months. The entire time, she was thinking in her head, “Anything but cancer.”

When she was finally diagnosed, Brianna felt a mix of relief, devastation, and numbness. “I was told it was curable and treatable and everything would be fine. But still, when you get that diagnosis and hear those words, it knocks you off of your feet.”

One day after her official diagnosis, Brianna was admitted to the hospital. She experienced rigorous and lengthy tests and central lines were placed during her first day. The following day, she started chemotherapy. Brianna says, “It was overwhelming and a lot to happen in just three short days”.

During the night Brianna was admitted, she had a complete emotional break down. Luckily, Brianna was assigned a nurse who completely changed her perspective on everything. “She came in and brought me chicken broth, which I asked for, and gave me a talk. She told me that everything is different now, and that’s a lot to take in, but you can get through this.” The nurse’s pep talk continued, “Things may never be the same again, but you can make a new normal and it can all be okay.”

This nurse, who showed such kindness, is the reason Brianna is a nurse today. “I wouldn’t be working in this hospital today if it wasn’t for her.” Unfortunately, the nurse passed away unexpectedly years later, and Brianna never got to share this story with her.

During Brianna’s cancer treatment, she met a female healthcare professional whom she realized she was very attracted to. After surviving cancer and accepting her identity, Brianna knew she had the strength to live as her true self. At 25, she began coming out to friends and family.

Overall, Brianna says she had a smooth experience. “No one was surprised but I was afraid of what people would think. I made up scenarios in my own head. I still do to this day when coming out to people.”

Read 7 Teaching Strategies for Treating LGBTQ Patients

Experience now as a nurse

Being a nurse is hard work! Being an LGBTQ+ nurse can make the work even more challenging.

“I hear other female nurses talk about their boyfriends or husbands, but I feel have to approach this with a little more caution,” Brianna says. During Brianna’s internship at UPMC Shadyside, she had shadowed a nurse who was bisexual. Brianna vividly remembers the time when this nurse was talking to a patient and was telling a story about her girlfriend but referred to her as a “friend” in front of the patient. This disheartened Brianna and she thought this would be how she had to navigate her conversations with patients when she was a nurse.

“You have to test the waters,” she admits. “Sometimes I feel like an actor.” Brianna explains that she has met patients who talk about their gay kids or wear Pride gear, so it’s easy to identify that they are an ally. With other patients, it is clear to only discuss nursing and care by their demeanor. She finds herself changing her personality depending on who the patient is and based on who they need her to be.

With staff, Brianna finds it less challenging to be herself. “Be brave, be yourself and be out! Give answers to those who may have questions and help explain if they don’t understand who you are. Educate them!”

How simulation can address concerns about inclusive environments:

Nursing school is intended to prepare students to provide life-saving care for all patients in a healthcare setting. Although Brianna says her nursing education touched briefly on minority populations, cultures, and races, it was not very comprehensive. And caring specifically for LGBTQA+ patients was not mentioned at all. Nurse educators must understand the importance to teach students how to navigate and communicate with these types of patients, as they may not have this experience outside of work or in their personal lives.

*Correction: Brianna works at West Penn Hospital, not at the Cancer Institute, as was originally published.

Kurtis Kabel is an Account Manager for the Southeast. Pocket Nurse is an LGBT-Certified Organization by the National LGBT Chamber of Commerce.

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