Hi, my name is Siȃn Munson. I am a Community Clinical Nurse for people with long term conditions. I am also an NZNO delegate, a mum, a friend, a lesbian and many other things too of course.

My journey to nursing

My Grandmother and one of my cousins are nurses, so nursing was always a possibility for me, however my journey to nursing took a while! I left school after the 6^th form, went to the UK for year and applied to take an enrolled nurse course when I got back. That didn’t end up happening. Instead I got married and had three wonderful children, one of whom has significant learning and support needs. I also did an extramural degree over 6 years at Massey University. I majored in Women’s Studies which gave me a passion for women’s health.

I got divorced and made a decision to move to Palmerston North to do my nursing training. I studied at UCOL when my children were 7, 9 and 10 and I was a solo mum. I tell you what – if you can handle being a solo mum, you can handle anything!

When I started I thought I wanted to work in Mental Health but over the course of my studies I realised I wanted to focus on Women’s Health.

After a few years of working as a civilian Army Nurse in a women’s and sexual health role, I got my current role. I’ve been here for three years now and I love it.

Starting post grad study

While I was working in sexual health I began my Masters Degree at Massey University. I started with the Women’s Health paper and it snowballed from there. During my study I realised that there was very little New Zealand literature about lesbian women’s experience of healthcare – and what I was seeing in my practice made me think something needed to be done about that. As a result my final paper was the Research Report and I graduated in 2015.

I was extremely lucky to have a wonderful supervisor, Dr Catherine Cook, who is a senior lecturer at Massey University.

Coming out at work

When I started at Central PHO my manager was really supportive of my studies and when I knew what my research topic was going to be I thought I should probably “come out” to her. So, I officially told her I identify as a lesbian.

It’s a big deal to come out to someone, especially your manager. I mean, sometimes you know people know, or it’s an open secret or whatever, but actually officially telling someone you are queer is pretty scary. If you are not queer it might be hard to understand that, but people who are lesbian or bi or gay will understand that being “out” and “coming out” is something that happens every single day. Every day we have to evaluate our personal and professional safety and comfort in every single situation we are in. And that includes with patients as well as colleagues.

In this case, it was the best decision I ever made! It’s been a really positive experience for me to be out at work with my colleagues, although with patients it’s still a case-by-case thing. I’ve heard people say things like “no one needs to know” or “I don’t know why gay people have to come out”, but believe me, it matters. Being in the closet is awful. You’re constantly second guessing everything you say. You’re editing your life. It’s tiring and it’s soul destroying. I didn’t know until I came out how important it is to come out and how life affirming it is to live an authentic life. Not to hide who you are. And most importantly to be accepted for who you are in all your rainbow glory. Life is far better since I came out. One of the great things I’ve gotten to do since I came out was to attend Wellington Pride Parade with NZNO – Out At Work.  Three years ago I’d never have done that!

My research

Anyway, my research… My research topic was “Cloaked in Invisibility – Experiences of Lesbian and Bisexual Women in their Encounters with Health Professionals for Cervical Screening and Sexual Health”. For this research I interviewed six lesbian and bisexual women about their experiences receiving sexual and gynaecological healthcare in New Zealand. There is very little research on lesbian and bisexual women’s health in a New Zealand context, and this research adds to and expands that knowledge.

It was such a privilege to hear their stories.

My findings show that lesbian and bisexual women suffered quite major barriers to receiving timely and culturally-appropriate healthcare.

The healthcare system is heteronormative – healthcare professionals make (probably unconscious) assumptions that everybody is heterosexual. For example, if your GP asks about your husband, that’s heteronormative and it means that the patient is instantly having to make a heap of decisions instead of being able to focus on the appointment: “O, should I say I’m a lesbian? Is it not worth it? Shall I just leave it? Maybe I should say? Why is he/she making assumptions? Etc “

There is both implied and overt homophobia in health care. While being gay is becoming more socially acceptable, not all of society is accepting. Some of the participants had experienced horrific homophobia from health care professionals which had seriously impacted their lives.  Experiencing homophobia makes it difficult to return for further health care.

There is a conundrum of safer sex – What does safer sex look like for women who have women sexual partners? Many lesbian and bisexual women assume they are having safer sex because they are not having sex with men. Some believe they can’t contract sexually transmissible infections. There are no specific barrier protection methods for use by women having sex with women, and the current choices such as latex gloves, dental dams and condoms are not very user friendly for safer sex between two women.

Engagement with health promotion – it’s hard to engage with public health promotions when you are invisible in them. There is very little sexual health information available for lesbian and bisexual women. There are no posters on the walls at surgeries that depict lesbian families. Women found ways of finding the health information they needed when they didn’t feel ok about seeking advice from health professionals.

Resilence – the amazing thing I found was that, despite the barriers, lesbian and bisexual women do find ways of navigating the health system, through friends and the queer community.

I find this fascinating! I can see so many ways that we can change our thinking and practice to become inclusive and start providing care in a more appropriate and equitable way to our patients. Even understanding that there ARE queer patients on your books, even if they are not out to you, is a good start. My research found that when a woman has a positive experience coming out to a health professional it makes it more likely that she will come out to another health professional.

And I want to get these learnings out as widely as I can. I want to change practice. The thought of my work gathering dust in a library somewhere gives me the shivers. That’s why I have written a journal article with my supervisor.  That’s why I am speaking out about it. My research report has been published this month in the Journal of Clinical Nursing. It’s exciting to be adding to the body of knowledge in this under-researched area. If you have ideas about how we can create inclusive environments for our patients and clients I’d love to hear them. Please add your thoughts in the comments.

Munson, S. and Cook, C. (2016), Lesbian and bisexual women’s sexual healthcare experiences. Journal of Clinical Nursing. doi: 10.1111/jocn.13364

http://onlinelibrary.wiley.com/doi/10.1111/jocn.13364/abstract