Dec 08, 2022

Gender-Affirming Nursing is Equity-Minded Nursing

The past year has seen an onslaught of politicians and talking heads scoring points at the expense of transgender and gender-nonbinary (TGNB) people.  Today’s headlines alone included “Transgender youth health care ban approved by Florida medical boards” and “U.S. court says a pageant can exclude transgender women in its competitions.”  On the way to work, I regularly turn off the radio when story comes on about discrimination against TGNB people to preserve my own mental health. However, once I arrive, the day-to-day work of providing care to my TGNB patients reminds me of the joy and resilience of my community. Offering gender-affirming care is deeply meaningful and lifesaving work, but being a nurse advocate for TGNB patients isn’t limited to prescribing hormones.

Equity-minded nurses, regardless of their role, are well-positioned to make healthcare more safe, welcoming and inclusive for TGNB people.  Beginning this journey starts with reflection on your own gender identity.  For example, a privilege of being cisgender (people who have the gender identity expected of them based on their sex assigned at birth) includes being consistently called by the correct pronouns. One way to acknowledge and de-center this privilege is to share your own pronouns with every introduction. By doing so, you reinforce the fact that none of us know what pronouns another person uses until they tell us. You can also include your pronouns on your ID badge, in your email signature, on your business cards, and anywhere else you put your name. To create systemic change, consider who in your workplace is positioned to add pronouns to everyone’s ID, or to make sure that pronouns are a routine part of meeting introductions.

Nurses in clinical and research roles can continue to de-center cisnormativity (the assumption that being cisgender is the norm and privileged over any other gender identity) by ensuring the collection of sexual orientation and gender identity (SOGI) data. The National Academies of Sciences, Engineering, and Medicine (NASEM) released a recent report titled “Measuring Sex, Gender Identity, and Sexual Orientation,” (2022) which emphasizes the importance of asking about gender identity and sex assigned at birth as two separate questions. In this report, NASEM identified their first data collection principle as inclusiveness: “People deserve to count and be counted.” When patients and research participants are simply asked to choose between male/man and female/woman in just one question, we make TGNB people invisible. In research, studies in which TGNB participants can’t be identified perpetuate a lack of data on the health and lives of TGNB people. In clinical care, for example, this might result in a clinician failing to realize that a transgender male patient needs cervical cancer screening.

Equity-minded nurses can also contribute to systemic change through political activism and advocacy. Nurses can engage their workplaces, state associations, unions, and other professional organizations to make statements against discriminatory legislation and partner with trans-lead advocacy organizations. The National Center for Transgender Equality’s State Action Center allows you to find legislation in your state targeting TGNB people and sign up for future alerts when action is needed. In addition to fighting anti-trans bills, consider the impacts of inequity and structural racism on TGNB communities. The results of the 2015 US Trans Survey as well as the Center for American Progress’s The State of the LGBTQ Community in 2020 tell us that TGNB people are disproportionately affected by poverty, homelessness, and employment discrimination. TGNB people of color face even greater disparities. Nurses engaged in any political advocacy should ensure that the insights and perspectives of diverse TGNB community members are included. 

Making healthcare a safer place for TGNB people can start (but doesn’t end) with an action as small as introducing yourself with your pronouns in your next patient encounter.  Equity-minded nurses see the relationship between and importance of linking small-scale, individual actions such as this with large-scale social change. SOGI data collection and political activism are just two of numerous ways for nurses to advocate for their TGNB patients, neighbors, family members, students, and colleagues.

Miles Harris (he/him) is a trans and nonbinary-identified family nurse practitioner, an assistant clinical professor at the Betty Irene Moore School of Nursing at UC Davis and serves as director for Gender-Affirming Care at UC Davis Health.