Co-authored by Candace W. Burton, PhD, RN, AFN-BC, AGN-BC, FNAP assistant professor at Virginia Commonwealth University, and Monica McLemore, PhD, MPH, RN, assistant professor at the University of California San Francisco.
This week the United State Supreme Court hears arguments in Obergfell v. Hodges, a case that could determine the fate of hundreds of same sex marriages across the country. Even as our attention is drawn to that high-stakes process, it’s critical to consider how we can create an inclusive space in our own lives, work, and communities. One means of doing so is to recognize and attend to the needs of trans* and non-binary gender individuals in health care practice. As three nurses who work in mental health, reproductive health, and emergency care, we encounter people all along the gender spectrum and strive to provide safe, effective, and nonjudgmental care. We also understand that institutional-level change occurs about as fast as you can swim through peanut butter, but there are some simple things each of us can do on a daily basis. Small changes can make a difference in how your practice welcomes trans* and non-binary people, so here are a few suggestions.
The first thing is to understand what is meant by “trans*” and “non-binary.” The asterisk after trans* indicates that what comes after could be a variety of things: transman, transwoman, transgender—it’s a way to indicate that you aren’t just referring to one group within the trans* population. Non-binary means someone whose gender isn’t completely defined by the terms man or woman. We could try to explain that in greater detail, but non-binary means non-binary so we’re not going to try to label it more than that! You may also see “gender non-conforming” used, but that term suggests that there is some ideal of gender to which to conform—this can have very negative and shaming connotations.
Next, realize that the “T” in LGBTQI isn’t silent but is often silenced. Trans* individuals have a plethora of reasons to distrust health care providers, and “coming out” may be complicated and risky, especially if a provider isn’t routinely demonstrating gender-inclusive behaviors. So, for example, though you may be perfectly well aware that Jane Smith likes feminine pronouns and forms of address, make sure sure this is confirmed at each visit. This demonstrates that you recognize it could change and that your practice can and will support any answer.
Third, recognize that there are times that sex or gender is relevant and times when it’s not. Some of the authors of this piece have practices related to reproductive health, often called “women’s health” — but we’re aware that not all people who need gynecologic or obstetric care are women. Hormone therapy, contraception, and other concerns in this area make it important for us to know each client’s history—but if we’re treating someone for a sinus infection, there’s a lot less to consider.
Fourth, understand that cisnormativity is insidious. Cis is the opposite of trans, and means that someone’s external appearance and internal experience of sex and gender are the same. Cisnormativity is the social expectation that this is true for everyone. Trans* folks are often misgendered as a result, such as when Jane Smith is called from the waiting room as “Mr. Smith” because records identify her as a male. In such a case, Jane may leave without being seen, rather than be outed to everyone present. Consider using just last names to identify clients, and make sure there are gender-neutral restrooms available.
Finally, know your gender-neutral pronouns and use them consistently. Ze or xe are commonly used if an individual’s gender preference isn’t known (ze, zir, and zir’s; xe, xyr, and xyr’s). Some non-binary folks also use they or them, but this can sound distancing if used without thought, such as when referring to “them” or “those people”. If you model these, and make clear that inclusive language is important in your practice, others will as well. Such language may not apply to every person in your practice, but it demonstrates a culture of inclusivity that can benefit more than just trans* and non-binary individuals.
Some of these suggestions are easier to implement than others, obviously, and some may take a good deal of training and effort. Recognize, however, that for trans* and non-binary individuals, these “changes” are about making life and experience visible and valued. Doing so creates a culture of inclusivity, welcome, and support for some of the most vulnerable folks we care for. Today could be the day that someone you encounter realizes you can be trusted to be supportive, thoughtful, and nonjudgmental in your care.
Check out these links for more information that can shape good practice habits around gender with your clients: