In good faith: American Muslim RNs reflect on challenges

When some patients see Aisha Hasan-Rasool's long sleeves under her lab coat and her headscarf, they want to know where she's from. "I tell them Buffalo, New York," said Hasan-Rasool, RN, WHNP-BC. Hasan-Rasool is a nurse practitioner at a small women's health clinic in Duluth, Ga. Like nearly half of all Muslims born in the U.S., she converted to Islam. If people want to know more about her faith or customs, she readily answers questions, but often it goes no further than the initial inquiry. "I haven't ever had anybody say anything offensive," she said. "There are people who have different opinions and beliefs from me on a lot of things. I have to approach them wherever they are, not imposing my outlook on anybody."

Respecting diversity

Nurses of all faiths have a responsibility to respect the religious diversity of their patients, and for most people sick or in pain, the religious beliefs of a caregiver are not as important as whether the person is caring, competent and compassionate. But some American Muslim nurses who openly practice their faith through their dress or style of prayer said media reports of atrocities by groups identifying themselves as Islamic and a general misunderstanding by the public about Islamic faith means they sometimes find themselves correcting misconceptions when they can. They show by example to their patients, colleagues and employers the many positive and healing aspects of their faith and how it informs their care. "Islamophobia is huge," said Arshia Wajid, MBA, MPH, founder and president of American Muslim Health Professionals, which seeks to "empower Muslim health professionals to improve the health of Americans." "There's a lot of anti-Muslim sentiment in the media." Since the World Trade Center was destroyed by members of Al Qaeda in 2001, news reports mostly have focused on negative images of extremist Islamic groups while ignoring the positive contributions of Muslims, said Wajid, a healthcare consultant at the Chicago-based Huron Consulting Group. Sometimes American Muslim nurses experience a backlash. Najah Bazzy, RN, a clinical transcultural nurse in the Detroit area, recalled how a nurse called her in tears, saying a patient refused care from her because she was wearing a headscarf. Bazzy, an American-born Muslim whose family came from Lebanon, empathized with the caller's pain and agreed the rejection was wrong. "But [the headscarf] is a symbol and no matter what we believe, some people are going to reject that." For Bazzy, the answer is a transcultural perspective, putting the patient's comfort first, even if it means they want another nurse. "It allows you to consider a human being as a human being," she said, and helps her decide when to accommodate and when to negotiate, considering the needs of patients and the ability of providers. Bazzy, founder of Zaman International, a humanitarian organization for marginalized women and children, sees her role as a patient advocate and go-between for providers and patients of all cultures and faiths. For instance, she said, if a pregnant Muslim woman in a teaching hospital requested a female provider and the resident assigned to her was a man, Bazzy might suggest to the care team that accommodating the request for a woman to deliver the baby would decrease the patient's stress considerably and help achieve the positive outcome of a joyful mother and healthy infant. But if the birth was to take place in a small rural hospital, where the only on-call provider was male, she might explain to the patient that under the laws of their Islamic faith, God's will is that she have a healthy child no matter who delivers the baby, and that Bazzy would stay in the room, keep the patient covered, and make her as comfortable as possible through the process. "It's using the faith to help me navigate those issues. I want to create a good outcome. I'm a patient advocate. But my faith is what informs all of that. Being Muslim is what makes me the best nurse I can be." American Muslims, like Americans of other faiths, vary greatly in how they practice, which is why it's important for healthcare providers to ask all patients about their needs and preferences, Bazzy said. Muslim nurses reflect the general population. Some wear headscarves and cover everything except their hands and face. Some pray five times daily. Some observe fasting and dietary restrictions. Others do not. About 20% of U.S. adult Muslims are African-American, many of whom converted to Islam as adults. Some of them see Islam as connected to a culture that goes back to Africa, said Saisa Neel, MSN, RN-BC, adjunct faculty at Prince George's Community College in Largo, Md. They have a different perspective than someone from the Middle East or South Aisa who was raised as a Muslim. Some American Muslim nurses say though patients rarely refuse care from them, they have seen subtle forms of avoidance. Samiya Siddiqui, BSN, RN, who spent six years in inpatient care at Phoenix Children's Hospital before working at the hospital's outpatient GI clinic, said she noticed her young patients and families pressed their call buttons more often when other nurses cared for them. She started talking and listening to them more, doing things that went beyond standard care whenever she could. "You have to spend extra time just to make sure your patients are comfortable with you," she said. When they asked, Siddiqui, who was born in the U.S. to Pakistani parents, explained that she chooses to wear the scarf for modesty, no one forces her to do it, and that Islam is a peaceful religion that does not promote nor condone violence. "Some of the patients are afraid when they see someone with a headscarf," said Zainub Rasheed, RN, who works at Florida Hospital in Tampa. "They think automatically that you're a terrorist." But unless they ask for a different nurse, Rasheed, who was born in India and has lived in the U.S. for 30 years, considers it a personal challenge to overcome their trepidation by making them as comfortable as possible, including encouraging questions about her culture and faith. Once they get to know her, she said, many specifically request she care for them. "It's the job of Muslims to let people know who we are." Asma Hanif, RN, ANP, executive director of Muslimat Al Nisaa, a domestic violence shelter that serves mostly Muslim women in Baltimore, said she never encountered discrimination from patients because of her faith. But when she worked in hospitals in the mid-1970s, she said, her employers complained that she prayed too much and that she was "not a team player" because she avoided staff parties. "I wasn't a party person anyway, but they saw it as related to my being Muslim," she said. Hanif now speaks to providers at conferences and education events about respecting the beliefs of Muslim women -- offering them a head covering or letting them keep theirs on during labor, asking before touching someone of the opposite sex, and understanding that Islam has never advocated oppressing or being violent to women. "It's very uplifting," she said of these cultural competency talks, "because it shows people want to learn." Shazia Memon, BSN, RN, CCRN, works in a pediatric intensive care unit at New York-Presbyterian Morgan Family Children's Hospital in Spanish Harlem. She often senses relief in her Muslim patients and families when she introduces herself as their nurse. She likens it to the way she sees Spanish-speaking patients relax when they talk to a Spanish-speaking nurse because they feel a connection and a sense of comfort. But sometimes if a child is beyond recovery and physicians talk to the families about turning off life support, the family might say, "We don't want to let go, we want to leave it in God's hands," she said. "A lot of nurses have a hard time understanding that. But I understand that faith in God. I don't know what I myself would do." She tells them she will pray for them and will support any decision they make, but when they ask for spiritual advice, Memon feels out of her depth. "That's when I need an imam (a Muslim spiritual leader)," she said. Besides offering cultural competency training, hospitals can help make facilities more inviting to Muslim patients and staff by offering places to pray and hiring a Muslim chaplain or establishing a close connection with a local mosque, Wajid said. Many Muslims pray five times a day during specific time periods, and depending on the time of year, two or three of those prayer times fall during a 12-hour work shift. Some nurses said they pray in their facility's chapel, but for others the chapels are in another building, taking them far from their patients, so they go to a locker room or look for an empty conference room or other space. Memon is working with her facility to create a "sacred place" on her floor, where staff and family members of all faiths can pray or meditate without being far from children they are caring for. Ajarat Bada, BSN, MPH, MA, RN, was born and raised in Nigeria, went to nursing school and worked as a nurse in the U.S. and is now completing health policy studies in Qatar, a predominantly Muslim country. Though she does not work as a nurse in Qatar, she is familiar with the country's healthcare system where all hospitals have places to pray, imam chaplains and same-gender providers, she said. But in the U.S., when she worked as a travel nurse, finding a place to pray at work was a challenge at some hospitals. "I plan my life around my prayer time," she said, "so going to work and not being able to pray is very constraining." Hasan-Rasool said she never had a problem finding time or a place for prayers after she explained the need for them. Now colleagues often remind her when it's time for her to pray. She and other Muslim nurses said the time they spend praying and reflecting -- about 10 minutes a session -- allows them to return to their patients as kinder, calmer, more grounded nurses. "It helps you put things into perspective," Hasan-Rasool said. That perspective is important, Muslim nurses said, because they want to be remembered as those who provided comfort and care to people when they were sick and vulnerable. "They're going to see something different than what they're seeing on that 30-second clip on the nightly news," Hasan-Rasool said. "It might make them want to know a little bit more."

Who are American Muslims?

Muslims make up about 1% of the U.S. population, according to a recent report by the Pew Research Center. They are the fastest growing religious group in the country, and the percentage is expected to double by 2050. Christians make up 78%, with another 16% of Americans unaffiliated, according to the report. http://www.pewforum.org/2015/04/02/religious-projections-2010-2050 http://www.people-press.org/2011/08/30/muslim-americans-no-signs-of-growth-in-alienation-or-support-for-extremism The Muslim population in the U.S. is extremely diverse. Just under two-thirds of adult Muslims were born outside of the country, 24% came from Middle Eastern and North African countries and others from South Asia, Europe and Sub-Saharan Africa, according to a 2011 Pew Center study. Nearly half of U.S.-born Muslims -- one fifth of all U.S. Muslims -- are African Americans, many of whom converted to Islam. About 70% of U.S. Muslims and Christians say religion is very important in their lives, and about half say they attend weekly religious services. About half of all Muslims reported they make all five of their prayers daily. Cathryn Domrose is a staff writer. To comment, email [email protected].