Jennifer Herman, MSN, RN, FNP-BC

Focus On… is a Q&A style interview that highlights a member, a conversation with an authoritative expert, spotlights an innovative program, or profiles a trend. If you have a suggestion for a person or topic we should consider as a future Focus On… subject, please email CANP at admin@canpweb.org.

Jennifer Herman, MSN, RN, FNP-BC, is a Family Nurse Practitioner at West County Health Center, a community health center in Sonoma County serving a diverse rural population. She manages a primary care panel in Guerneville at the Russian River Health Center and also practices at the Teen Clinic and Gender Expansive Services Clinic. Jennifer is engaged in social justice advocacy with other local health care providers in her community. She enjoys being a preceptor for an FNP student. Jennifer uses she/her pronouns.

Connections:
This year has brought many challenges — the pandemic, social unrest, and wildfires, to name a few. How has working as an NP changed during this year?

Jennifer:
In a time when everything in our world is changing — our lives, our work, our patients' lives — there are a few moments that stand out to me from this year when I understood that my work as an NP had profoundly changed. First, I recall when my clinic decided to lock its doors to patients, the day before a countywide lockdown. This ushered in the new pandemic-defined era we find ourselves in. Telemedicine, (I still work remotely from home most days), has come with challenges and also opened access to care for many patients who wouldn’t have been able to come to the clinic as often, or at all.

Second, at the end of May, after George Floyd was killed, I was sitting down to dinner when I heard helicopters over the downtown area. Knowing that there were youth leading protests, I couldn’t just sit at home — how could I provide care to this group at the Teen Clinic but ignore their grief and anger at that moment? With our N95 masks, my partner and I went down to bear witness and stand in solidarity with the protestors, led by Black and Brown youth. Later that night, police tear-gassed people and arrested many without wearing masks — both of these things increase risks of COVID-19 transmission. As an FNP, I went down to help provide eye flushes to help rinse out the tear gas powder. These uprisings have helped me see more deeply the importance of speaking out against systemic racism and police brutality as a public health epidemics. Check out Mapping Police Violence to learn more. 

Third, last month, nearly all of my patients had to evacuate from the Russian River area due to wildfires. This is the third year in a row we have been evacuating due to wildfires, floods, or power outages. I feel clear now that my role as a primary care provider in a climate crisis is to help people survive, connect to resources, and to be resilient. Because of telemedicine we really get to meet people where they are. I was able to care for people experiencing trauma and profound anxiety during evacuations, send lots of prescriptions to pharmacies outside the evacuation zones for people who left in haste, and had a phone visit with someone as they were packing their car to leave. I continue to see the echoes of prior years’ fires through my patients' experiences with substance use, job loss, displacement, homelessness, and post-traumatic mental health conditions. A large part of my work now is in helping people cope with trauma amidst inadequate resources and social isolation, which I try to do while keeping a sense of humor. Laughter can really be great medicine. 

Connections:
You openly discuss how the health care system has inadvertently created barriers for many people and your commitment to addressing health disparity. Can you elaborate?

Jennifer:
I am not so sure it is inadvertent. While health care is supposed to be helpful, it can be harmful. Although we don’t necessarily take an oath like our physician colleagues, there is an understanding that doing no harm is a core value of our practice. However, we, as medical providers, inherit a history of medical harm, along with a responsibility to repair. As a profession, we have a lot of learning to do first about the history of medical harm. I have learned only recently about the long, egregious history of racialized experimentation (I am currently reading Harriet Washington’s Medical Apartheid, which should be required reading for anyone practicing medicine) and the fact that the American Medical Association excluded Black doctors from joining for over a century and, finally, formally apologized for this in 2008. Thanks to a morally courageous nurse in Georgia, a Black woman named Dawn Wooten, there is national attention to forced sterilizations in ICE detention centers and prisons. This is part of a long history of eugenics (which is a form of genocide) in the U.S. against Black, Indigenous, Latinx, disabled, and poor people. Certainly, with this information, one can see why there is mistrust of medical systems and why as nurse practitioners we need to actively strive to provide not only ethical, trauma-informed care but to learn how we as a profession can be more trustworthy to historically oppressed communities. What would have continued to happen in Georgia if nurse Dawn Wooten hadn’t spoken up? (And what will put an end to continuing eugenic practices?)

Connections:
Why do you believe NPs are so well-suited suited to embrace and address the challenges of this time?

Jennifer:
The healthcare system exists and was created in the context of a society with systemic racism, transphobia, homophobia, ableism, xenophobia, and many, many other forms of discrimination. The question for me is: what can we do as nurse practitioners to learn about these harms and barriers to care and then work to repair and prevent them from continuing? How can we support each other in this work? I’d love to see local CANP chapters integrate social justice conversations into our work and identify ways to be a partner for social justice in our local communities and within our healthcare systems.

As nurse practitioners, I think we are especially well-suited to embrace the challenges of these times because of our background as nurses (the most trusted profession for 18 years per Gallup surveys) and with our influence as medical providers. We have difficult discussions with our patients every day. We are trusted with their stories. What can we do with this collective knowledge to affect change? Are we truly trustworthy if we know of our patients suffering but are not moved to push for systems that do not harm or neglect? In Guerneville, I care for many people experiencing homelessness, and I hear daily many stories of how people struggle — how violent poverty is on each human life. It took many stories before I finally decided to join organizers in my community to try to change the systems that keep people from getting housing and leave them without adequate services. I have learned so much from homeless advocates and service providers, including the grit and persistence required to sustain a push for justice year after year. 

Connections:
Can you talk about the importance of gender-affirming care?

Jennifer:
Gender identity and gender expression are a core part of who we are as humans. Identifying as gender-expansive — that is, expanding outside rigid ideas of being only male or female — changes how you move through a world with transphobia and homophobia. This kind of marginalization itself is harmful to physical and mental health. Last year, the American Medical Association declared an epidemic of fatal anti-transgender violence where most victims were Black transgender women. If someone cannot access gender-affirming care they need (meaning they may not get called by their name and pronouns or access the hormones, surgery, legal document changes, connection to community resources) they need, they may not be alive a few years down the road due to violence, suicide (the rate of known suicide attempts in Trans communities is 41%), and many other health disparities. When gender is affirmed, people often thrive; especially for young people having a gender-affirming parent can be life-saving (A 2017 UCLA Study found that 27% of teens in California identify as gender non-conforming). So as a nurse practitioner, I see that my role is also to support loved ones of gender-expansive folks as well by sharing resources and helping them to be gender-affirming.

As nurse practitioners, we each can incorporate gender-affirming care into our clinical practice (such as asking all patients the gender of their partners and kids which lets people know you are a safe person for their families and that you understand the importance of gender affirming-care). Trans medicine should not be something that patients need to teach us, and there are many wonderful resources for learning (UCSF National Transgender Health Summit, Fenway’s annual conference).

Personally, as a queer person and cisgender lesbian, I am indebted to Trans people of color, who started the Stonewall Riots over 50 years ago, and have led the way for, but not equally benefited, from LGBTQ liberation for years; as an NP, I want to see more of us commit to creating a profession where every gender-expansive person who interacts with an NP feels not only safe and affirmed, but really seen, celebrated, and honored!  

Connections:
What is the best way for those who want to advocate to become involved?

Jennifer:
We first need to shift our understanding of our role as NPs. We have a moral and ethical obligation to work for social justice. Learn about anti-racism, disability justice, trans-liberation, immigrant rights, workers' rights, and fat justice with the same dedication as staying up-to-date on diabetes management. How can we help someone manage their diabetes if they aren’t able to access care? Learn about and support the liberation workers and community organizers in your community. It is an honor for those of us who will get to care for them as their medical providers. We can start by questioning our educational foundations, both as learners and as educators. Use CME and free time for learning about social justice. When you go to a CME webinar or learn in an NP program, consider who is the default patient in these case studies. Speak up when there are no trans or nonbinary people or when all the patients are white (this will happen!). For every lecture or talk that you put together: are you uplifting historically oppressed communities and using appropriate terminology? What more do you need to learn to do this? When we speak of marginalized communities, we cannot leave them on the margins; we need to de-marginalize, with our words and our actions, and put them in the center, upfront! There is no one way to engage in social justice advocacy. We must start by connecting to our peers who also want to do this work and help each other learn how to be impactful outside the traditional NP roles of healthcare, especially in this time of upheaval and societal change. 

Connections:
Are there any final thoughts that you’d like to share?

Jennifer:
As clinicians, we learn that an important part of our patient interaction is getting a clear history. And if the diagnosis seems wrong, go back to history. As nurse practitioners, we must learn the history and realities of medicine — both the harms and the repairing of harms. Physicians have several organizations to join including Physicians for Social Responsibility, Physicians for Human Rights. Where are the nurse practitioner-led social justice initiatives and organizations? Many important changes in medicine — such as research ethics boards and informed consent — came from community outrage and advocacy for systemic changes after medical harms and neglect had been done. How can we see more clearly the harms and neglects being done now and support systemic changes that uphold human rights, such as the right to access healthcare without discrimination? 

In early June of this year, CANP President, Karen Bradley sent out an email on social inequity where she called on us to embrace our responsibility in addressing complex challenges and working toward racial justice. This call, along with calls from the Black Lives Matter organizers for white people to not only show up at protests but to work to make changes in the systems where we work have moved me to see that answering these calls is core to my work as an NP. 

Lastly, I’d like to see, in the next month, that Governor Newsom signs AB 890 and that CANP will be freed up to shift some of our amazing advocacy work from NP practice related advocacy to social justice-related advocacy — there is so much potential for us to be powerful and effective change-makers!