Nurses encounter vulnerable populations daily, and the LGBTQ community warrants a high level of cultural competence, sensitivity, and evidence-based knowledge in order for nurses to meet these patients with compassionate professionalism. 

Context and Perspective

Long before the gay rights movements of the late 20th century, homosexuals, bisexuals, lesbians, and those identifying as transgender were pathologized, shamed, and disregarded in many societies. Many LGBTQ individuals around the world continue to experience violence and  discrimination by governments and fellow citizens, and in many countries being discovered as gay can be life-threatening. In the United States, violence against African American trans women has been labeled epidemic. 

American gay rights organizations date back as early as 1924, but being gay, transgender, lesbian, or bisexual long retained the stigma of mental pathology. According to The Human Rights Campaign, homosexuality was removed from the 2nd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA) in 1973. That resolution stated, “We will no longer insist on a label of sickness for individuals who insist that they are well and demonstrate no generalized impairment in social effectiveness.” This was a landmark moment, yet the struggle continued. 

At this time, we are slowly seeing growing openness towards gender non-conformity and other ways of living that are not in step with societal norms of the male-female binary model of gender identity and behavior. Gay marriage, service in the military, as well as openly gay members of Congress or professional sports and entertainment are contemporary examples of the ongoing push for recognition, freedom, and parity. 

Guidance for LGBTQ Cultural Competence 

Culturally competent LGBTQ nursing care can feel confusing to the uninitiated. Nomenclature can seem to change too quickly for a clinician to stay current, and nurses may feel incompetent during patient encounters.

Terminology is indeed one place to begin in seeking confidence for speaking with patients. The Human Rights Campaign’s glossary of terms is one helpful resource. Some examples include: 

  • Cisgender: A term used to describe a person whose gender identity aligns with those typically associated with the sex assigned to them at birth.
  • Gender expression: External appearance of one’s gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.
  • Gender identity: One’s innermost concept of self as male, female, a blend of both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth.
  • Non-binary: An adjective describing a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. While many also identify as transgender, not all non-binary people do.
  • Transgender: An umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, etc.

In 2013, The Joint Commission published Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. The guide includes terminology; laws and regulations; information about community, individual, and family engagement; and guidance on the provision of care. The Joint Commission mandates the following:

  • Inclusivity of LGBT patient needs into new or existing policies
  • Inclusive patient visitation rights
  • Non-discrimination regulations
  • The monitoring of organizational efforts regarding the advancement of LGBT care
  • Identifying and supporting staff members with subject matter expertise 
  • Gender-neutral language on all paperwork and EMRs
  • Equitable treatment for LGBTQ employees
  • Staff training in issues related to LGBTQ care 

The Centers for Disease Control and Prevention offer their own resources, and the organization known as Health Professionals Advancing LGBTQ Equality (previously known as the Gay and Lesbian Medical Association and still known by the acronym GLMA) is also valuable.  

Nurses’ Role in LGBTQ Care

If equity, quality, and patient-centered care are three of many aims of culturally competent LGBTQ care, nurses can play a large role in that regard. One study states, “Nurse professional development (NPD) practitioners can assess for lesbian, gay, bisexual, and transgender (LGBT) cultural competencies in healthcare settings and initiate interventions to increase competencies as indicated.”

In terms of LGBTQ competency, nurses can proactively serve as formal and informal leaders by: 

  • Demonstrating curiosity and open-mindedness towards these vulnerable communities
  • Taking responsibility for educating themselves and their colleagues
  • Using non-gendered language when discussing patients’ relationships
  • Making no assumptions about a patient’s gender, sex, or sexual orientation
  • Understanding the spectrum of transgender expression
  • Pressuring employers and nursing organizations to provide up-to-date education 
  • Remaining as current as possible regarding the latest nomenclature used by these communities, and relying on asking patients for guidance when confused or uncertain

Human beings exhibit richly nuanced behaviors and beliefs, and must morally and ethically receive equal treatment within the healthcare system. As the largest segment of the healthcare workforce and the most trusted professionals in the United States year after year, nurses are in a position to be messengers of tolerance, cultural competence, and compassion towards all. And when it comes to the LGBTQ community, nurses can lead the way as they do with other vulnerable populations needing enhanced awareness and sensitivity in an increasingly complex world. 

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