Nursing student fills gaps in reproductive curriculum

By Jaymee R. Cuti

Nurses serve a vital role in women’s health care. They are hand holders, counselors, and educators for their patients. Nurses test for sexually transmitted diseases and pregnancy, discuss birth control and pregnancy options, and offer post-procedure care. In Oregon, nurse practitioners are even empowered to write prescriptions and perform certain types of abortions. However, some nursing students coming out of school do not feel prepared for the job.

Jacqui Quetal, a 27-year-old nurse practitioner student at Oregon Health and Sciences University, believes that nurses should be able to talk to patients about sex, birth control and abortion. Instead, she found that nursing students could not even teach the public how to properly use a condom. Quetal helped fill that gap in 2005 when she founded OHSU's Nursing Students For Choice. The organization promotes women's health and reproductive rights through advocacy, activism, provider education and training. In 2007, Quetal co-founded the national Nursing Students for Choice organization, which is developing a Web site, board of directors and applying for national funding to educate people from around the country about how to be pro-choice nursing students.

      Since its founding, OHSU's Nursing Students for Choice has held information sessions on sexuality, queer-specific health care and abortion. In February, the group trained every undergraduate nursing student how to teach patients to properly use a condom. Quetal found that it was oversight that led to the gaps in education. “The faculty all assumed that someone else was teaching it,” said Quetal, who graduates in June.

Jacqui Quetal: I'm a community health nurse for the Washington County Health Department and a family nurse practitioner student at OHSU.

I was attracted to this field of study because I was so uninformed as a young person! I didn’t understand sexuality. I went to high school in Southern Oregon, where we had a high teen pregnancy rate; maybe 15 to 20 girls had babies in my three years there. I realized that all through my schooling, we learned nothing about sex education.

I became a member of STARS, Students Today Aren’t Ready for Sex, an educational group where high schoolers mentored middle schoolers [about abstinence]. I had a lot of questions for myself. As a counselor for this group, if the middle schoolers asked questions, we were told to say, “That’s a good question but you still shouldn’t have sex until you’re married.” I was very frustrated and dropped out of the program [because] I realized I couldn’t answer any of their questions.

I got my bachelor of science in theater from Portland State and used my degree to teach at an alternative middle school [in Gresham, Ore.] and volunteered as a teen educator for Planned Parenthood. The middle school kids didn’t have any sex ed so I got permission to teach it for five weeks. We covered masturbation and sex toys, birth control and queer issues. We just talked about everything because they had a lot of questions.

After that I was really committed to teaching teens about sexuality. I thought I could better do that as a nurse. I wanted to do primary care and have my own clinic and work with teenagers. As a nurse practitioner, you can provide abortions, put in IUDs, have your own patients and prescribe medication. Oregon is a really good place to be a nurse practitioner because you have more autonomy.

When I graduate, I want to be trained to perform manual vacuum aspiration abortions. I think it’s really important to make abortions a normal part of primary care, for people to have the continuity of coming to a practitioner if they have a cough or break their arm or if they need an abortion. It’s an easy procedure. It doesn’t need to be outside of normal care.

JQ: I founded the Nursing Students For Choice at OHSU when I was in my undergrad nursing program. I was a member of Medical Students for Choice because they have a great reproductive health elective. I learned that it was focused on doctors and I wanted to talk to nursing students, and [improve] our curriculum. I decided to start a group, which has grown to 100 members at OHSU.

For the national group, I met [nursing students] on the Winona State University campus in Winona, Minnesota and we realized we had strong chapters of Nursing Students for Choice at our schools. We thought we needed to do this on national level.

JQ: We hold various demonstrations, panel discussions and information sessions about reproductive health, [lesbian, gay, bisexual, transgender, queer] topics, values clarification, where nursing students think about how to share information without letting your own boundaries get in the way. We’ve done sessions on women and pleasure, transgender issues, tailored to what each school is missing in their curriculum.

In Portland, we need more info about LGBTQ issues because there's a bigger out population and we have a lot of transgender and homeless youth.

Nationally, we attend pro-choice lobby days and raise money for family planning clinic through Rock for Choice concerts and the Women’s Resource Center [in Minnesota].

JQ: Nurses must know how to give good options counseling, being able to talk about the options, risks and benefits that people have so the patient can make decisions that are best for them and not what we think is best for them. We don’t really learn that in school.

Nurses should feel comfortable asking questions about sexuality as a part of everyday health care. Nurses should learn to demystify talking about sex in general.

Nurses should know how [Emergency Birth Control] works and what it is. [Emergency Birth Control], also known as the morning after pill, prevents a person from getting pregnant. A lot of people still think EBC is the abortion pill. Even nurses think that. [Editor’s note: NARAL Pro-Choice Oregon will also be educating nurses throughout the state about Emergency Birth Control as part of their groundbreaking EBC Access Program – ed.].

JQ: When I was trained as a community health nurse, I would say no. Nursing students still feel there’s a gap in their reproductive education. As a nurse practitioner, I wish we learned more about abortion as a procedure. We don’t actually talk about that.

In February, for National Condom Awareness Week, [Nursing Students For Choice] asked all the nursing students if they knew how to teach a patient to use a condom properly. We went to classes for undergrad nursing students and taught them how to use a condom properly. This isn't in the nursing curriculum.

I knew they weren’t taking time to talk about contraception options or [EBC], so nursing students don’t know the difference between the ring and the pill and the patch. Maybe as women, we’re expected to know what birth control options exist out there, but we don’t. It is pretty frustrating and shocking that we don't learn that at OHSU, a really progressive, liberal, research-based university in Portland.

JQ: Before, we were getting a very brief, "abortion exists and is legal" talk, but we didn’t hear that you, as a nurse practitioner, could be an abortion provider or how to counsel someone for that.

Now, in the coming school year, a new teacher has added an extra credit to the reproductive health class so we can learn about abortion issues in depth.

By the sheer number Nursing Students For Choice members who are in the classes, we will raise our hand and ask about reproductive health issues that are missing. That has led to a lot of in-class discussions that weren’t brought up before.

JQ: From a nursing perspective, being in Portland, we’re in a really protected and liberal bubble. There are a lot of nursing students here that, when they get out into the world, realize they are in a place where people don’t think abortion should exist or where pharmacists refuse to fill [EBC] prescriptions.

As a nurse, the biggest thing that needs to change is a lack of information and [reproductive rights] curriculum in our schools. Without realizing that it’s missing, we have these encounters where patients say, “I’m pregnant and I don’t want to be,” and you have no idea what to say.

JQ: That nurses and pro-choice providers should go back to the schools they were a part of and make sure the curriculum is really supporting the choices they believe in.

OHSU's Nursing Students For Choice, NARAL Pro Choice Oregon and Cascade AIDS held Sex in PDX: Women's Sexual Health Forum on May 23 at Q Center, 4115 N. Mississippi Ave., Portland, Ore. The forum discussed sex education in schools, experiences with health care providers, pregnancy, HIV/STIs, and the best lover you've ever had. Stayed tuned for a report from the event coming soon.

Anyone interested in learning more about Nursing Students For Choice should e-mail snsfc@ohsu.edu or quelynrose@yahoo.com.