Episode 12

October 21, 2020


Interview with Andrea Carbon Korsak

Interview with Andrea Carbon Korsak
Women Bridging the Gap
Interview with Andrea Carbon Korsak

Show Notes

In today’s episode, Lenya and Alexandra talk to a perinatal nurse about racial and gender bias in nursing. Andrea is a labor and delivery nurse 10 years into her dream career. She embraces the intersectionality of being a female, Filipino-American immigrant, millennial, veteran, and more. She loves fitness, her family (three pups and one great husband), and the kinds of friendships where different women can face issues of race and social justice together. Thank you to Andrea for these links: One (of many) guides to starting to address implicit bias: http://www.ihi.org/communities/blogs/how-to-reduce-implicit-bias (tips at the end of the article and in a linked “Dear IHI” question and answer at the end of the page) Harvard Implicit Bias Test https://implicit.harvard.edu/implicit/takeatest.html My favorite article on why social determinants of health/social justice should matter to nurses: Moving Toward Health Equity by Addressing Social Determinants of Health Breanna Lathrop; Published:January 05, 2020; DOI: https://doi.org/10.1016/j.nwh.2019.11.003 https://nwhjournal.org/article/S1751-4851(19)30228-4/fulltext My favorite organization that is taking subjective looks at what is happening in CA maternal health units, and where/how we can improve: California Maternal Quality Care Collaborative - https://www.cmqcc.org/ CMQCC Resources for patients - https://www.cmqcc.org/my-birth-matters Favorite labor/maternity social media accounts (with online classes for expectant parents too): www.instagram.com/mommy.labornurse www.instagram.com/bundlebirth Favorite positive nursing social media account: www.instagram.com/nursesinspirenurses -- Please **rate and review** this podcast if you enjoyed it; it greatly helps new listeners see this podcast is worth their time. You can find Women Bridging the Gap on [Apple Podcasts](https://podcasts.apple.com/us/podcast/women-bridging-the-gap/id1521503012) and [Podchaser](https://www.podchaser.com/podcasts/women-bridging-the-gap-1304390). **We want to hear from you!** Let us know how you’re speaking about these issues with your friends. **Let us know what topics you want to hear!** Join the [Facebook Group](https://www.facebook.com/groups/665585734389981) Email us at [[email protected]](mailto:[email protected]) You can find us at: [WomenBridgingtheGap.com](https://womenbridgingthegap.com) Or on Instagram: * Find Lenya at: [@Lenya_ goddess_ the_one](https://www.instagram.com/lenya_goddess_the_one) * And Alexandra at: [@a_xandra17](https://www.instagram.com/a_xandra17) and [@thewritingleap](https://www.instagram.com/thewritingleap) * And the show is at: [@women_bridging_the_gap](https://www.instagram.com/women_bridging_the_gap/) This podcast was edited by Brendan Hutchins from Podcast Advocate. Go to [PodcastAdvocate.Network](http://PodcastAdvocate.Network) or find him on [Twitter @PodcastAdvocate](https://twitter.com/podcastadvocate) to learn more.
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Episode Transcript

Lenya: [00:00:00] so this is Andrea Carbon Korsak. Did I say that right? Andrea: [00:00:01] Absolutely. And Lenya: [00:00:04] we know each other CrossFit, and I am most with the schooling that you've just finished for your nursing Andrea: [00:00:12] and your Lenya: [00:00:12] compassion. Andrea: [00:00:14] And I wanted to bring you on Lenya: [00:00:15] to talk about that. And it's also really helpful that you're a millennial because we want to talk to the young people, especially during this time check in. Alexandra: [00:00:25] Tell us Andrea: [00:00:25] about yourself. We want to Lenya: [00:00:26] know everything, including the Andrea: [00:00:28] dogs. Do not forget the dogs. Alexandra: [00:00:29] tell us that, like for listeners, what's your cultural Andrea: [00:00:33] background? I'm Filipino. sometimes I'm Filipino American. I was born in the Philippines. I was there until I was three. So, I can speak the language or at least understand. my language, when I speak to others in the dialogue and the Filipino language, you, if you're speaking to someone who's older, you use a lot of, it's I don't know the name of it. Yeah. But yeah, there's a formality. and. I always speak with that formality. I rarely speak to anyone, even though I'm older now and I speak to a lot of younger people. I always speak with that formality because that's how I learned it. So I will continue to do that. Even though sometimes like the things that I say are more or I just sound like a child when I speak the language, but I still like the language, my husband watched a couple of Netflix series with me, just so I could hear the language again. After being born in the Philippines, I grew up in the Valley. My parents moved here for work. They're also healthcare workers. My dad was an occupational therapist. My mom was a physical therapist. So they came here as professionals. We are immigrants, but, we had the privilege and honor of coming here as healthcare workers. I definitely something that I got from my parents. Is, I got a lot from them. I'm so lucky, but they always have this community. Maybe it's the Filipino side too, but very, a lot of bring, give it back to the community. When you share something about yourself, let it lift up the next person who, and let yourself be an example of I did this. You can do it too. Let me show you how, , I should say my husband and I are both veteran and he, we got a first house from his VA loan. He has the VA loan allows you to put zero down and. I never got in bad credit. and I my income is good as a nurse. So we qualified for all the good things, and that has really helped. We've had few barriers I should say, which is really interesting because I'm Filipino, I'm non-majority. thank you for your service. Alexandra: [00:02:37] How was it? we have just for listeners who don't live in Los Angeles County has a, quite a big Filipino population, but I don't know that population is in the valleys. So what was it like growing up? were you othered at all or considered a foreigner with an AF. Andrea: [00:02:58] I would say, when I run that question, I was like, you know what, Andrew, you just have to be honest because I felt like I grew up in a very diverse community and, growing up and being out of those like force or as an adult being out of those. for like just out of the classroom, out of a public classroom, in like smaller groups where, the characteristics of the group may not necessarily be as diverse and as representative of the greater Valley population. I am seeing how close or experience or professionalism or having a degree. as an adult, I am knew myself in more groups where I feel other, but as a child growing up, I didn't really feel that way. I did feel like my classrooms and my neighborhoods represented. The diversity that the Valley has witches. I know I've done. I recently finished my degree. So I did the research on what the population, was when I was growing up and what it's like now, the Valley is about 44% Hispanic, I think somewhere in the forties, around 11% Asian, I think only. Three to 4% black. So yeah, very low. So I will say that I don't have a lot of black friends. So I have been in a position where I might have said, I don't really see race, or like we do have diversity, just not necessarily the diversity that includes black citizens. I find it hard to relate to other communities because there was such little representation of black people, including the problems, including the strength. so I have little understanding or a little experience of what other people, what communities are feeling, what black people are feeling, what other communities. Alexandra: [00:04:56] If the black population is only about 13%, there are going to be communities that are diverse, that don't necessarily include black Americans. And it'd be the same thing. There be communities that don't have Filipino Americans, right now you look at the media and it feels like everything is broken. And when London talks about her childhood and I talk about my childhood, we both have diversity in our own childhood that we celebrate where it worked. It might not have been perfect, but it worked and we're open-minded adults. And. That it worked for you too, is a Testament. I, and it's one of the things that, I love about Los Angeles is that it is really diverse. And so you grew up with diversity and there was a certain acceptance and that's great. Andrea: [00:05:47] in my adulthood, first time I realized. Was probably when I came to this hospital where I'm at right now, I absolutely love it. I should say, as a nurse and as a pro, as an employee, all of my views are just mine. They don't represent the hospital, but I will say, my hospital is between the Santa Clarita Valley between An area of the Valley where there's a larger Hispanic population yet it serves the, like the rest of the Valley, the North Valley and the mid Valley. it's located physically at this place. Where, cultures can meet maybe not necessarily intersect. Yeah. But, there are a lot more white nurses at my hospital. There are a lot fewer black nurses at my hospital then at the other five hospitals that I've worked at, I should say at least in my department, because it's late, my delivery tends to be. Different as well, because it's going to be a lot more women than any other department. Cause it's women's health. although there are great labor and delivery nurses who are men as well, or who identify somewhere else on the gender spectrum. it was more of a feeling of or more of just seeing that. Everyone's white, except for me. I rarely recognize if I'm code switching my grandma was a teacher as well, and they teach English in the Philippines, in schools, they teach in English. . The language was really not a barrier to me, but I will say English is my second language. So, anytime. Someone says someone throws that in. I like to say it was my late second language too, and I am fluent. I'm fluent in English now, Alexandra: [00:07:28] So it's a big thing, at the law school, which I think is important, to understand what microaggressions Andrea: [00:07:35] are. Alexandra: [00:07:36] And this comes up a lot with the Asian community where people will say, where are you from? And so, and that's really taken as a microaggression because that's making the assumption that you're not an American. have you gotten that question and do you feel it that in that Andrea: [00:07:53] way, I have in other groups, maybe not necessarily at work, but I have gotten it. And, I, maybe just my experience, I see it as my opportunity to represent, to say who I am to share who I am. and then just being confident in myself and how, what I bring to the table. I know that. I can turn this into a positive situation. Maybe that's just me and maybe that's how all of my experiences have contributed who I am now. I don't take it badly personally, unless of course It may be. It's just harder for me to remember because I'm an adult and I only want to remember the good things now, or I only want to bring positivity and constructive situations into my life that I don't really, I just let that go. If it's, if it doesn't serve me, easier said than done, today's a good morning. Nothing's happened yet. How does it Alexandra: [00:08:49] feel? Because when we asked how you identify, you said Filipino, American. And so what about the overarching generality of Asian American? How does there was just an article in the LA times recently Andrea: [00:09:05] about Alexandra: [00:09:07] how you can possibly capture. All the diversity of an entire continent by just saying with the pastiche Asian American, Lenya: [00:09:18] the same can be said for African American. Right. So, I personally would have a problem saying Asian American because, and this is an article that I read a while back about individuality. Actually. No, I read it in white fragility, the book white fragility by Robin de Angelo. how, white Americans love their individuality. And it is something that's not afforded to the minorities. black people or Asian people. We are black people or Asian people. I can't be. And even in the census, I can't be Andrea: [00:09:54] and Hispanic, black, American, Lenya: [00:09:58] which is what I am. And you, and there's no way for you to write Filipino American. Alexandra: [00:10:03] there's nowhere for me to write a 10 million American either. Let's just be clear, the let's actually get clear that we do. I agree that as the oppressing class, that, we all love our independence, but I gotta tell you, I do find annoyance in those check marked, and I often refuse to answer because People will say Hispanic and then people from Spain, get to check that. And also people from Latin America and South America, get to check that even though there's completely. Yeah. And we're not talking when we were talking about Brown people, we are not talking about Spanish people. From Spain. we are traditionally talking about Latin America and South Andrea: [00:10:51] American people. Alexandra: [00:10:54] So I find it annoying that the original lens, the Italians don't have a place to put themselves. , that's the overgeneralization of government documents I do think is going to go away. Just because it's going to change with gender. And I do think it is changing. It's just, the list is starting to get longer. It will appreciate that. But I do take your point that I think that what's interesting is that African-American used to connote slave American black American, right. There was a period of time because you didn't know what country you came from in Africa. now that we're starting to get immigrants from Nigeria, from Ghana, I do think people are saying they Gerry in American guiding in American, but I'm still hearing most of the time, Asian American But I do agree, like you get that, you tend to get that comment, right? All like all black people look the same. All Asian people look the same. Those are horrible, racist comments that you hear all the time that you don't hear levied against , the white majority, even though I have to say I've sat in class and not be able to tell three blondes apart at all. Andrea: [00:12:15] What are your Lenya: [00:12:17] feelings, Andrew? Andrea: [00:12:18] know. I really agree with everything that you guys said. It's, I really wish that we could represent people's individuality and there are big differences between the Filipino culture and the Korean culture. For example, my husband is half. White American or Polish mayor Polish from Poland. And, that's where my last name is from. And my mother-in-law is from Korea. So, . He grew up mixed also, and there's really different, a lot of differences and a lot of similarities as well. And I think that's why I appreciate my husband, why I get along with him so well, we started off just on a really similar, Understanding of where each other came from and each other's parents. , I don't mind that much, either just being a part of, because. Asian, I think generally speaking, Asian communities, like to make that togetherness to make that together and like to feel included. And if that's the best place for us to be included in a big group, I don't really have anything against that. Plus there's a lot of, influence from Chinese culture to Filipino culture. Yeah, I personally don't mind that much, but again, I'm from so many intersections. I don't take that much offense. Alexandra: [00:13:34] how did you meet your husband? Andrea: [00:13:37] We met on the internet. Sorry. Mom did not want to hear that out loud. We met on the internet and 2013. So this was like right before Tinder. I worked my shift and when I go out, I either just want to go out and have a good time with my friends. I don't really actually know how to meet people in public, I guess. And I'm from that generation where, Easiest for us to express ourselves in writing digital and digital writing. So, yeah, and then I have been on the internet cause , he started going to school at Cal state Northridge when he left the army. And so he was newer to the area. He didn't know anyone either. and yeah, we connected when I'm and I loved him from the moment that I met in. he touched my hand and our like, skin temperature was like the same. Alexandra: [00:14:22] Do you mind if I ask a personal question? Why? Andrea: [00:14:27] Because I want it to be the same as him and my maiden name also. why would Alexandra: [00:14:32] he changed his name for you? Andrea: [00:14:35] I think mainly it was the tradition. That's what I pictured. And as much as we, I think we are my husband and I were, we are still at that intersection of Keeping tradition and trying new things. we're not just full on millennial of doing our own things and not doing what old people tell us to do. wait Lenya: [00:14:55] a minute. Okay. So let me just, Andrea: [00:14:56] so my first husband, he Lenya: [00:14:58] changed his name to me to mine, Andrea: [00:15:01] but Alexandra: [00:15:01] when we divorced. Lenya: [00:15:03] he kept Jones Andrea: [00:15:04] and it irritated me. Lenya: [00:15:05] It irritated me. But then when I Andrea: [00:15:07] married Shane, I wanted to have, I wanted all of us to have the Lenya: [00:15:12] same last name, including our dogs. Be family. Andrea: [00:15:15] Cause that's Lenya: [00:15:16] what I'm used to. And so I took Wilson, never Andrea: [00:15:18] did that before. Alexandra: [00:15:19] I did not know your first husband took your name and now I just love you more. I love you more if possible. I got to say I would never change my name But I also didn't believe him. I don't believe in marriage. And I do think there's this tremendous entrepreneurial spirit about millennials that I definitely admire. But I find them to be very traditional where, it's marriage, it's owning a home in your thirties, it's saving money because of the economy being you don't have the, you have grown up in the shitstorm of instability. And so that is more of a value. So I'm not casting, I'm not putting anything on that at all, but, and even so many, changing their last name. And I find that stunning as a feminist, that women are doing that. and I have to say I'm deeply uncomfortable with it. It is a, it's a, I get it for children, but I am deeply uncomfortable with women giving away their identity. When the history of giving away your name was a man owned you and could rape you at. At any time and I have to be honest, that's what it was in the eighties. so, it was still lawful in some States for husbands to rape their wives in the nineties . So when I think of this and I think about this tradition, I personally just struggle with it. I liked the romanticism of it. Like we're sharing the same name, but it is still a woman subjugating to a man. And I can't, it just is. Andrea: [00:17:01] I definitely, we understand, but I would, what I've picked up is that. Part of feminism is just doing what's right for you. And, not that I completely want to tell you, what you've had is not right for me. another part, maybe this is my culture coming through as well. Filipinos, like a lot of Spanish cultures, European Spanish cultures, keep their mother's made a name or keep their maiden name in it too. So my, I have my it's not hyphenated, but, My maiden name is my middle name now. Alexandra: [00:17:36] Could I push a little bit and say, you should say birth name because even the maiden totally sexist, right? Because flying you were a Virgin before you married. And it's your maiden name that you gave over to your married name? When you became a possession of your husband, where it's your birth name? That is now your middle Andrea: [00:17:55] name. My birth name, Alexandra: [00:17:59] in the end. I do agree you do whatever everybody should do what they need to do to make them happy. Lenya has shared so many great articles with me about racism in the healthcare system. And so. What's been your experience you're on the ground. Andrea: [00:18:16] Yeah, it's really hard to identify. What's what I will say that as a system would all these different factors. In there it's hard. the system is definitely flawed. It's definitely imperfect. sorry if that's news, if that's a rude awakening to anyone who already is scared of having poor health and then has to come to us for healthcare, it's flawed. We're just humans being influenced by our society and the problems with society. . It's a lot of us don't have practice checking those things out the door before we go and do this job that is so intimate and where we take care of vulnerable people. I think that a lot of women do lose their voice when they come to the hospital to give birth because, and from my perspective, from my 10 years in perinatal nursing, I think a lot of women are poorly educated about childbirth and their options when they come in, or I should say their, what they have learned, doesn't apply to the way that we practice in our facilities. The way hospital births are, they read something on the internet that applies to a birth center, but didn't realize that the regulations for practicing obstetrics in a hospital are different than the regulations for other places that where you can give birth. like a lot of moms asked for walking up a dural, but not every hospital gives walking up a drill. That's when you get, anesthesia and you're back to block your pain receptors. You don't want as much medicine so that you would be able to walk, but that becomes a liability because how, from a hospital litigation perspective, how, what have you bought? Yeah. Alexandra: [00:20:12] who's coming in and having birth at the hospital? Andrea: [00:20:16] I think like 98 or 99% of births are still in hospitals. but a lot of moms definitely a home birth or birth center birth are more, most accessible for people who have the finances, financial resources for it. That's for sure. But I am seeing a lot of, either younger people who maybe don't aren't necessarily in the upper class, but. They can find the money somewhere to pay for a birth center birth or, people in more marginalized groups that are so scared of what they've heard, that they would rather. Pay for it. Like they make it a priority to pay for birth in a different setting other than in a hospital. Lenya: [00:21:06] Okay. So I'm just gonna tell you my birth story so you can understand, initially I wanted to have a birthing Alexandra: [00:21:13] center Andrea: [00:21:14] breath. Lenya: [00:21:15] I was still young. Gish. I was 25. So, I could do this. my, I had a nurse, no, I don't remember what they're called. I had a doula. I had a nurse Andrea: [00:21:25] midwife, that's it, Lenya: [00:21:26] my midwife. and I had midwife up until the day was like, perfect candidate. This is going to be great. This is going to be great. And then like Andrea: [00:21:34] about Lenya: [00:21:35] at the seven month Mark, I had a Andrea: [00:21:37] slow leak. Lenya: [00:21:39] And then from that moment, you start going into the risk category and when you start going to the risk category, then they start pushing you to the hospital. Alexandra: [00:21:47] Right. Lenya: [00:21:48] and so, but I was still being monitored and then between, and like at that point, my son started also, his birth weight was quite low. remember that only a forefoot, I'm a four foot, nine woman. And at that Andrea: [00:22:05] time Lenya: [00:22:06] I was weighing the most I've ever weighed in my life, which is like the same amount as what I weigh today. But yeah. Alexandra: [00:22:11] Anyway, Lenya: [00:22:11] you said that I'm still just really small and, and then the push was for the hospital and then it just became this one day where, I started going into labor and it was early. And so, and it was a snow storm. And so I got, I had to happen that took me directly Andrea: [00:22:28] to the hospital. Lenya: [00:22:29] So, but I did not want Andrea: [00:22:31] the hospital. Lenya: [00:22:33] And even in 1993, I knew that if I went to the hospital, I would need to have somebody with me because I was going to need to advocate. The whatever I wanted to have the birth that I wanted in the way that I want it. Do you know what I mean? Like it was, and it was a struggle because they would push for the C-section and I really was like, I don't want to have a C-section because I, at that point in time thought maybe I'd have more children and I didn't want to have a C section and. At no point in time, did they ever say that either my son or myself were Andrea: [00:23:09] in danger? Lenya: [00:23:10] If they had said that we were in danger, I would have been like, okay, right. For the C section, but they didn't use those Alexandra: [00:23:15] words. So I was Lenya: [00:23:15] like, no, and even in the doctor Alexandra: [00:23:18] kept talking over Lenya: [00:23:20] me and it gained to a point where, I had to scream. I am not having a C-section unless you tell me I'm going to die. Am I going to die? And he was like, and then I said, I want a different doctor. Alexandra: [00:23:31] I want my midwife. Andrea: [00:23:32] I Lenya: [00:23:32] was just like, I became hysterical. And, eventually my Andrea: [00:23:36] midwife finally made it Lenya: [00:23:38] because nobody even called her. Andrea: [00:23:40] But Lenya: [00:23:40] finally she made it and everything went smoothly, and I gave birth to came in the hospital and they were Alexandra: [00:23:46] wonderful to Lenya: [00:23:47] him, even after, but. In 1993, I still knew that there was going to be a struggle. And then when I read the articles about Serena Williams, and how she had to strongly advocate for herself, and we almost lost her because of this blood Alexandra: [00:24:02] clot, Lenya: [00:24:03] it really it just really then triggered me, again, it's like, why are we Alexandra: [00:24:07] still. Lenya: [00:24:09] And I don't think it's a Alexandra: [00:24:10] black woman Lenya: [00:24:11] thing. I'm sure it probably race has something to do with it. I think it's a woman Andrea: [00:24:15] thing. Alexandra: [00:24:16] I think Lenya: [00:24:16] as women we're just not listened to. And then as a black woman, I'm doubly not listened to. and then there's all these misconceptions about how Andrea: [00:24:25] black people Lenya: [00:24:25] don't feel pain and, Andrea: [00:24:27] it's Lenya: [00:24:27] just one of the it's just so it's very distressing to me. And that's just one, another reason why I wanted you to come on, because after reading about Serena, I was like, I really want to hear what your views on, about how women having to advocate for themselves in the middle of their childbirth and how that plays out with everything, race, womanhood, misogyny. Andrea: [00:24:49] I have no idea how Serena Williams. how they almost missed it. I have no idea why anyone would knowing her history and I'm sure that's in her chart. They should have been aware of that. maybe there was, I will say that there are transitions of care. Like when you go from labor, sometimes you have to end up having a C section. So that's one transition. You might get a different nurse or you might get two different people on your team. Trying to take care of you and maybe they didn't have the whole picture. Maybe they here, this is a situation, but they didn't get to talk about every piece of the background. Oh, she has a history of clotting issues or blood clots belonged blood clots. so maybe that's something that didn't get passed on in the transition. And that is scary. That's the scary part of the way our healthcare system works right now. That happens. I don't know why, or I, we have policies in place we're supposed to be following those policies. but this is childbirth. This is humans and humans. I think we always have to advocate for ourselves always. I think when a person can advocate for themselves, it shows that they no that's okay. That they may have some awareness of what their situation is, and that just makes it easier to, decide and agree on our plan of care. because especially in labor and delivery and childbirth, you have to make decisions really quickly. This it's not a robotic simulated scenario. So, I really don't know why that happened to her. I know, in my experience sometimes we'll see a high blood pressure and we know, high hypertensive issues are one of the ways that, nursing or health care can really minimize maternal morbidity and mortality. Yet we see a high blood pressure and we brush it off, or we say We make excuses. we used to do this even more about it. I've heard personally that many times, don't make excuses follow up with it. This is one of the ways where we can make the biggest difference. So be personally, you don't have to tell me twice. I will do it. And I have so many amazing nursing coworkers who are really on it. When I got to this hospital, I was like, Hey, they are on it. I need to get enough sleep. When I get here, I really had to like carve out space for my professional life, because I want to Excel as a nurse. I want to be there for my patients. I can't come to work, hung over. I haven't done that in a long time. I can't even handle hangovers, but I, in my. twenties, when I was working as a nursing assistant, I couldn't be out partying the night before and then go to work the next day. and maybe some nurses don't, we're in a pandemic. Some people are like going through divorces or going through financial issues and sometimes you just can't check it out the door. Hopefully that's not the nurse who gets a really high risk assignment that day. Alexandra: [00:27:31] You mentioned something that, I wanted to loop back. People in marginalized communities have heard so many stories Andrea: [00:27:41] that Alexandra: [00:27:42] they save up the money to go to a birth center. what are those stories or rumors? Lenya: [00:27:47] Yeah, Andrea: [00:27:48] It seems to be prevalent in patients who come from Hispanic cultures, they say that the epidural gives you back pain, the doctors push you for it to have a C section when you don't want to have a C-section. and that's enough to scare people. Alexandra: [00:28:03] Because everything I've been listening to so far, definitely just applies generally across the board, not just to mothers having babies, but just the medical establishment right now. That everybody needs to bring a patient, have a kid with them because it's just rushed. It's hard. my mother was ill for 15 years and I have horror stories of nobody talking to one another and me trying to communicate to everybody. some of that, what might've been because she was a woman, Or just older. because certainly we're reading it in the newspaper, that there is racism and other ism going on. so have you really seen any of that inaction that you've been bothered by in your whole history of schooling intern? Anything? Andrea: [00:29:00] It is happening. I think. nursing needs to realize that it's happening own it, work on ourselves and do better. Take that extra moment to listen to your patients. If you feel like they, your first impression and your first, your like that implicit thing that comes up or implicit thing that just happens when you first get put in a situation, you need to take an extra moment to check that if you find yourself in a scenario where you're taking care of someone who maybe have a history of drug addiction, maybe is poor, maybe doesn't speak English or is black it's. You need to just take that extra moment we get a lot of patients who are like, I want no pain meds. I want no epidural. And then you say, okay, did you get to take any birth class? Did you, what have you done to prepare yourself? breathing? what, how do you plan? Sure. We're sure we're not going to give you meds if you don't want to, but like what do you plan to do? Yeah, they have no real plan. And that's just, I have not worked for anyone, but I know that it hurts and you can't just lay there, you have to do something. the breathing work, the breathing, the great Lenya: [00:30:08] So if someone does ha, I feel like if you are racist or have this implicit bias against certain communities, should you even be going for an, a job? That a nurse or a doctor or someone that has to deal with the public and not know whether they're going to have that black person or that person who Hispanic, or the person who doesn't speak English or the drug addict or whatever, should they even have those jobs? like I feel like police officers and doctors and nurses, these are people where vulnerable. People will come to contact with them. And if they already have this implicit bias, That is where these situations happen, where someone gets hurt. should they even have those jobs, but then again, how do you test for that? I don't know. I just feel like if you have an implicit bias, you shouldn't be a nurse because that affects. And I've had nurses who have been wonderful and I've had nurses who have been very dismissive of me because of whatever reason. have you in your, in work, seeing someone who doesn't even realize they have this implicit bias and then just goes ahead and they perform their duties in this dismissive manner. Andrea: [00:31:19] Unfortunately. Yes. And it happened and it happens in all of these industries, like you said, like in law enforcement and in health care. and I absolutely holds nursing to the same accountability that I expect from law enforcement. I expect us to. therefore use our fiscal resources as accountably as I expect law enforcement to, I want to hit those standards. Absolutely. recently I was reflecting and my, because I'm I'm calling people out at work a lot for a lot of different things. Definitely about race and about classism and about just being judgy. in California, you get insurance. As a pregnant woman, it doesn't matter. You get mad Cal you, it doesn't matter if you're how much you made. It. Doesn't matter how many babies you have, whatever. and you get the same health care and you don't have to pay for it. Whereas my coworkers who are nurses. and they have to pay for insurance and have a high deductible or copay or whatever it is, have to pay for their care. Yet you come to the same hospital and you get the same nurses and you get the same physicians, et cetera. some would argue, why should I be working 40, 60, 80 hours a week? where someone else gets everything that they need without. Working. I wanted to reframe that and say, do you think that there's not enough to do you think that someone else gets in what they need is going to prevent you from getting what you need and wants and are able to earn for yourself? There were a lot of voices in that particular discussion. So I didn't get to someone thought that I just meant to raise, the minimum wage and have a universal, basic income. I don't think we should get into that at work. I think it's really heated and I think it's very distracting and I also called out some of these same people for talking too much and being really distracted at work. We should just be more focused and we should just do better for ourselves, for each other as a nursing team. and that is a hard discussion for me to have with people during that pandemic during an election year, during racial reckoning and the reckoning of injustice that a lot of my. White coworkers are not ready for. Why Alexandra: [00:33:49] aren't they. Andrea: [00:33:51] they're ready to face it, but they're not ready to. they can do the work. Everyone can do the work. We can do the work we can and should be doing the work, but, You have to get to a better place before you can come to work and do a better job without, without taking it really personally. And without being really struck, when someone tells you, Hey, you need to do better. like I, not people, I, they were shocked. They were shocked when I turned around and said, Hey, you need to stop. Doing this, that and the other, Alexandra: [00:34:25] the other Andrea: [00:34:27] the example that I'm thinking of, we were just having a day where some people's patients were really busy and one person did not have a job to do so she was not helping. It's not. Discussion was not specifically on being women or race necessarily. I wish I had said more during the, when the topic was about politics. I wish I had said more to say, this is not a good place for that. I wish I had said more about that. I will give another example cause you add, cause you asked them. I really, I thought about this earlier. we had a patient or this can be any scenario I want to make it. As anonymous as possible, but there's a patient. Who's had a lot of pregnancies and had six kids in a two bedroom apartment and, their other primary caregiver is the grandmother. we were saying, we were talking about how tough that is and how probably no one else in this woman's life has ever told her she was worth anything. no one has ever lifted her up. No one has, helped her to be more than a baby factory or someone who has unprotected sex. and then during that discussion, someone said, are they all from the same dad? And I was like, that is irrelevant. I don't see how that's irrelevant. Alexandra: [00:35:47] that's great empathy. And I'm glad you spoke up because there are all sorts of assumptions that go into that. Lenya: [00:35:57] Yeah. Alexandra: [00:35:58] is your hospital doing any implicit bias training, Andrea: [00:36:02] I wish and do more and I wish it would be more in like a one on one setting. I can't remember if it was your podcast or if it was with, it was in, Nikki Kendall's, hood feminism book, but they were talking about how. You really need to work with people and you really need to work with people's individual experiences to reframe and to draw out that empathy because yes, you can send people to a cult cultural competence class. Yes. You can send people PowerPoints and make it mandatory. But, if we're not talking about it, like we are now, if we're not. honoring where we came from and recognizing the different factors that contribute to who we are and how we practice our jobs and how we participate in our communities. we're missing a big part of it and we're possibly missing the actual solution Alexandra: [00:36:55] point. how at work, if you were in charge, Lenya: [00:37:02] if you were the Dawn, Dawn is like the big job. And is that what you are going for? I'd like to know after you answered Alex's question. Alexandra: [00:37:11] what would happen? To not overt racism where there's discriminate, overt, intentional discrimination going on, but now we've reframed the conversation where we are analyzing everything by the impact on the person, right. Receipt on the receipt. And so. How would you handle employee situations with the nurses that worked under you or the doctors that worked under you? We've only been talking about nurses, but doctors are included to here. What would you do with that implicit bias? Andrea: [00:37:51] I would have ongoing. Implicit bias, like a cost like a coffee talk. I proposed that in my, capstone project for my masters. I surveyed as many coworkers as I could. And I said, would you benefit from a regular monthly or every other week, session where you just talk about these. specific issues. and most, I think everyone said, yes, everyone said they would want to talk about, these issues. I wish we could say you have too much implicit bias. first of all, you have to test for it. Implicit means that it's not. You don't know that you have a, you don't know that you're racist or you don't know that you have those forms of racism. I don't see why you would want to be a nurse and do. But as hard of a job for 12 hours as we do, if you really didn't like people like my husband, he was a combat medic, but when he came to the civilian side, he's I don't like people enough. I can't be in healthcare. And I. And it's not that he doesn't like it. He actually probably has a bigger heart than me, but he just doesn't eat. He doesn't want to do it for work. cause it's a lot it's this job is about, you're already there trying to be there for a woman who's lost her child or a woman who's coping with the fact that she needs this new section for her health. And you're trying to like just, empathize with her and be there and say, you know, I'm honoring your strengths. I know you're making this decision out of love even though it's not. What your plan was, and your emotions are just, you need a lot of emotional energy for that. And then you have to switch over to, then dealing with someone who you don't want to deal with. Alexandra: [00:39:26] my senses is that that all of this is so immediate and it's human on human and there's touch involved and it's very intimate. And so the idea is with implicit bias is the remedy is to pause. And so while as a teacher, I can work with that because I'm not as intimate with my students as you are with your patients. So I can try to incorporate into my performance or into my teaching persona pauses. So I don't. Step on anything by accident because bias also changes. And so I don't think I have any implicit bias, but of course I do. You know what I mean? I've had to work out my implicit bias with millennial generation. Do you know what I mean? Like where I finally had a student say to me, You're always making fun of millennials, but you know, gen X raised millennials. And I was like, oops, you know, like, Oh, it's my fault. but it was a really great pushback for me to say, Oh my God, Alex, shut up with your own implicit bias. but again, as a nurse dealing in this situation, you don't have the opportunity to pause, which makes it so much. Harder, I think for a nurse and in any kind of emergency situation to sit and think about whatever bias is going on. Andrea: [00:40:51] like when you do run into a room and have to make decisions, You're you can say you can very easily facing this calm wave. Right? It does help the situation because then you'll, you'll get people to act quickly and it doesn't make tensions higher for an already acute situation. and. Thankfully in nursing, there's so much teamwork. I never run into a room. There's always someone else right behind me, ready to, while I'm talking to the patient who I already have a relationship with, they're doing the other interventions, so that we can act quickly and hopefully, fix the situation before it gets worse. So I think that's, if we build up the people who are willing to learn and who are willing to minimize their bias, I think that will. Positively impact culture. So, I guess that's another way that I could answer lanyards question and for, and propose a solution is to really work with the people who get it. and really use them as a strength too. And as a catalyst to impact our culture positively and impact the environment positively to do better for our patients. cause there are a lot of people who get it. There are a lot of coworkers, even my same coworkers who maybe got a little frustrated and are starting to lean a certain way because the election's coming up. believe that all of my coworkers deep down just wants to help. just barriers that have been created, that are blocking us from doing the simple. Not bad thing that we tended to do. , I'm trying not to focus on the fear of the barriers and the, the systemic injustice that caused these barriers. I am trying to just get really down to the heart level, like you guys say and just. I'm only going to be here for 12 hours. Can I maximize that? Do I need to fix the healthcare system and the country in my 12 hour shift? Maybe not, but I can ask them for 12 hours today for 12 hours tomorrow for 12 hours. The next day I can be there for. My patients COVID About how Lenya: [00:43:03] you're, how it's impacted, especially maternal health, because Andrea: [00:43:07] I know Lenya: [00:43:08] now for women that Andrea: [00:43:10] have given birth during this Lenya: [00:43:11] time, Andrea: [00:43:12] he just had a different Lenya: [00:43:13] experience. So, which I thought was unbelievable. I would've thought it would've been, across the board the same sort of thing because of the, The precautions, but it's not like one Alexandra: [00:43:24] person had her husband in the room and Andrea: [00:43:25] another Lenya: [00:43:26] person there has been couldn't be involved. Andrea: [00:43:27] How does this change hospital, the Lenya: [00:43:29] hospital, Alexandra: [00:43:30] how you give birth to a child Andrea: [00:43:33] changed also, once we knew more a week, We tried to let, as many of the normal things happen as possible. so I think for the most, the biggest change is that there's only one visitor allowed in me. I try to say, don't go back and forth. A lot of moms, a lot of communities have really love that because then you don't have a ton of visitors going at once. That's a huge, that cultural, like the visiting part that I feel like that impacts nurses a lot too, because we don't, I don't want to be a bad guy. We don't want to interrupt family bonding with. Our nursing care, but we want to check. We want to make sure too. So, it's simplified it for nurses and I hope that most women can see that there is a benefit also in just that specific bonding time. I have another leg, beautiful little story where just, I still hear the voices on the video chat when the rest of the family sees the baby for the first time and everyone is still so filled with, it's still warms my heart, even if it's digital, I can't speak on the small grief or that like that, Oh, I wish you were here in person. I can speak to that. That women must feel, but I will say just hearing that joy and that love it's still there. It's still there. It'll be there. you'll get it in 24 to 48 hours when you go home. But I'm so sorry, not in the hospital, but no, your nurses are still here for you. Alexandra: [00:44:54] we appreciate you Andrea: [00:44:57] so much for coming. Thank you for the opportunity. Thank you so much.

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Episode 49

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