A patient refuses care from a male nurse because he suspects that this nurse is LGBTQ+. A nurse makes derogatory remarks towards a gender-fluid patient when they report discomfort identifying their sex on their paperwork. A doctor refuses to care for someone because she walked in holding hands with her girlfriend.
Scenarios like these can happen in any industry, but they are especially unacceptable within the healthcare industry tasked with healing and enhancing wellness. Properly managing them requires de-escalating the situation professionally and educating the involved parties to prevent repeat performances. To approach such conversations necessitates knowledge and the courage to speak up when you witness discrimination. Below is a short compilation of tips and ideas that nurses can follow to improve the environment at their hospital for their colleagues and patients.
First, institutional leaders must ensure that all employees share a comprehensive definition of discrimination and harassment. For example, it is unacceptable not to use a patient or coworker’s preferred pronoun; this is disrespectful and should not be tolerated. Establishing and then communicating a professional definition of discrimination, whether towards members of the LGBTQ+ community or those of a different racial or ethnic background, elucidates how varied and unrecognized the problem can be. This knowledge allows individuals to identify any bias within their thinking or behavior as well as intervene and report when they witness discriminatory behavior or language from others. Ignorance regarding this kind of behavior is unacceptable. Harassment and discrimination policies and procedures should be revisited and updated regularly as definitions and perceptions change. This vigilance will keep LGBTQ+ patients and staff as comfortable as possible. Volunteer to participate with the interdisciplinary board that writes and reviews these policies for your institution. If such a panel does not exist at your facility, approach nursing leadership about starting such a project.
Nurses and other professionals should be well-educated about the cultural considerations involved in caring for members of the LGBTQ+ community. Institutions should host workshops and seminars to prevent discriminatory behavior and to educate healthcare professionals on the process of handling it when it occurs. These workshops should include theoretical case studies in which someone is being discriminated against, and participants must practice how to speak up and step in as needed. Professional education will help staff identify discrimination and how to deal with it appropriately should it arise. This practice or role-play decreases anxiety and increases the staff’s confidence to properly approach an inappropriate colleague or patient. If your facility does not offer such training or you find it inadequate, volunteer to get one started or update and improve upon the existing materials.
Third, nurses must follow through and speak up when we see something wrong. Too often, discriminatory acts are not addressed when they happen due to fear of calling them out. Speaking up can de-escalate the situation, protects the individual being discriminated against, and educates everyone involved about why the behavior was not morally just. But speaking up requires the ability to identify the problem (see step 1 above) and an opportunity to practice our newly acquired skills in a safe and mutually supportive environment (see step 2).
And lastly, along with speaking up, nurses must also know when to take further action if voicing their disapproval is not enough. If someone continues to discriminate and harass others, even after you have approached them about it, then you must do more. This intervention may include separating a patient or staff member and temporarily relocating them to a safe area, reporting the aggressor to a supervisor, filing a complaint with the Office for Civil Rights, and requests for more training and action from nurse leadership.
Intervening in discriminatory and prejudicial situations can be incredibly uncomfortable, but they have dire effects on the victim. Nurses are healthcare providers, and we are obligated to care for the whole person. There are ways to do this without getting yourself or others hurt. By learning, practicing, speaking up, and taking action, we can be the difference for our friends, family, neighbors, colleagues, and patients.
For more information on discrimination in the workplace, please see our course on Fostering Civility and Health Work Environments in Nursing and Healthcare.
To learn more about caring for LGBTQ+ community members, check out the NursingCE course, LGBTQ: Culturally Competent Care Considerations, and for other cultural considerations when providing care to a diverse patient population, Cultural Competency.