Nursing Care for LGBTQIA+ Patients
LGBTQIA+ patients rely on nurses for compassion and understanding throughout their healthcare experience. Nurses provide critical components of successful healthcare and establish holistic practices that support every patient’s needs.
According to The National Council of State Boards of Nursing, over 226,000 nurses passed the National Council Licensure Examination (NCLEX) in 2020 to begin their nursing careers. A 2020 Gallup survey estimates that 5.6% of adults in the United States identify as LGBT, up from 4.6% in 2017. Given this growing population of LGBTQIA+ individuals, nursing education must focus on care for patients who identify as LGBTQIA+.
Profound racial, gender, and sexual diversity exists in the United States. Historical and modern anti-LGBTQIA+ practices often impact those seeking and providing care. For this reason, nurses should pursue ongoing training to support vulnerable populations, including queer community members. This way, nurses may learn to recognize, accept, and care for all individuals in support of their medical well-being.
Naturally, we can only speak in generalities about care for LGBTQIA+ patients. Each person’s healthcare journey is unique and requires individual attention.
As you seek opportunities within the healthcare industry, such as becoming a nurse practitioner, it’s important to consider all aspects of care for each patient population. Below, we explore key factors impacting LGBTQIA+ patients and their healthcare providers.
Communicate with Care
Use language that honors LGBTQIA+ individuals’ identities. This may require you to learn new terminology as people, terms, and understandings evolve. Communicating without judgment and incorporating modern insights can help build therapeutic relationships.
Language must continue to stretch and evolve. Keep in mind that some words, phrases, and definitions may hold different meanings for different individuals, especially pertaining to gender and sexual identities. The following guide offers a strong starting point for nurses caring for LGBTQIA+ patients. However, nurses may find it more helpful to ask individuals to self-identify and choose their own labels, since language shifts over time and among different people.
For more information on which terminology nurses should use with their LGBTQIA+ patients, consult this glossary of key terms on NurseJournal.org.
Language and Terminology Guide
- LGBTQIA+: Stands for lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual. The “+” leaves room for identities not included in the acronym.
- Lesbian: Commonly used to describe a woman who is romantically or sexuallyattracted to other women. However, some gay women do not identify as lesbians. Likewise, some nonbinary people do identify as lesbians, and some lesbians do not identify as women.
- Gay: This term is sometimes used to describe anyone in the LGBTQ+ community. It is most narrowly used within a gender binary, referencing men who are interested in sexual or romantic relations with other men. “Gay” may also describe women who are interested in sexual or romantic interactions with other women.
- Bisexual: People who identify as bisexual may experience attraction to people of the same gender as their own and people of different genders. Within the gender binary, “bisexual” typically describes a potential attraction to both men and women. Note that a bisexual orientation does not determine whether a person is monogamous.
- Transgender: People who were assigned an incorrect gender at birth may identify as transgender. This term broadly refers to anyone who is not cisgender, including those who are agender and other nonbinary genders. Nurses should use this word as an adjective (e.g., “transgender community”), not as a noun. Avoid the word “transgendered.”
- Queer: This term originated as a slur for people who did not identify with the heterosexual, cisgender norm. The word has since been reclaimed and could pertain to gender identity, sexual orientation, or both. Some patients may still consider “queer” to be a slur, so nurses should only use the term if they identify as queer themselves or if a queer patient requested them to use this term.
- Questioning: The “Q” in “LGBTQIA+” may also stand for “questioning” in addition to “queer.” People who are questioning may be unsure and seeking answers about their gender or orientation.
- Intersex: This term covers natural variations in characteristics related to sex and reproduction. These may include internal or external anatomy, hormones, and chromosomes. Such traits may be congenital or developed. They can also be ambiguous or resemble characteristics typically associated with both male and female sex variations. Nurses should never use the term “hermaphrodite,” which was once a common term but is now considered a slur. However, some intersex people use this term in a reclamatory way.
- Asexual: Literally, this word means “without sex.” When used for relationships, “asexual” can describe partners who are not sexually active for any number of reasons. The term is also used as an orientation, in which context it includes an ever-increasing number of identity subcategories. Many such categories involve conditional or variable attraction or desire for sex. Being asexual, or “ace,” may indicate a complete lack of desire for any sexual activity, including masturbation. Sometimes, it describes a lack of sexual attraction to others or low desire for sexual activity, sometimes both. Asexuality is not the same as celibacy, which is a condition or status, not an identity.
- +: The plus symbol recognizes that identities not included in the acronym exist, acknowledging a broader array of individuals
- Gender Identity: “Gender” refers to an aspect of a person’s social identity that entails expectations for behavior, appearance, and role in society, among other characteristics. These expectations may differ depending on location, culture, age, race, ethnicity, disability, and other identity categories. “Gender identity,” on the other hand, covers a person’s specific gender or perception of gender.
- Sexual Orientation: A pattern of sexual attraction, commonly labeled as straight, gay, heterosexual, homosexual, lesbian, bisexual, queer, pansexual, and asexual. Avoid the phrase “sexual preference” when discussing sexual orientation.
- Nonbinary: Literally, “nonbinary” means “not binary.” This term may apply broadly to people who identify outside of the gender binary. “Nonbinary” can also be a gender on its own.
Barriers to Quality Care
LGBTQIA+ communities face many health and healthcare disparities. These may include HIV infection outcomes, along with the presentation, prevalence, and severity of eating disorders, depression, and suicide. Health providers who lack awareness of this community’s needs may offer lower-quality care.
Discrimination shows up in healthcare facilities through provider assumptions, stereotypes, and misunderstandings of individuals who identify as LGBTQIA+. These misunderstandings may cause inaccurate, and thus harmful, diagnoses, which can lead to unnecessary suffering and death. In addition, inequity within the healthcare industry can lead to LGBTQIA+ individuals not seeking medical care for long periods of time or at all.
Your nursing care should include awareness of health risks and concerns for LGBTQIA+ individuals.
Impacts of LGBTQIA+ Discrimination
Legal discrimination of the LGBTQIA+ community occurred for decades and continues in various forms today. Federal and state laws support aspects of healthcare for LGBTQIA+ individuals. However, laws discriminating against LGBTQIA+ people also exist.
Hundreds of anti-trans bills in across the U.S. legislate against transgender people’s ability to receive adequate and quality healthcare. Laws that limit healthcare can lead to unmanaged and undisclosed health issues within the LGBTQIA+ community, reducing overall health quality among those community members.
Fear of discrimination prevents many from identifying their gender or sexual orientation to healthcare providers. Some patients may also withhold medical history and other background information, limiting nurses’ ability to provide adequate care.
History of Anti-LGBTQIA+ Laws
The word “homosexual” was once used as a blanket term for all LGBTQIA+ individuals. Some still use the term in this way today. Languages around the world continue to develop more precise terminology to label LGBTQIA+ identities.
Language note: The following section highlights anti-LGBTQIA+ laws and practices from recent United States history. Some descriptions use language associated with the specific related laws and procedures to highlight the terminology of that period.
Legal LGBTQIA+ Discrimination
- President Eisenhower banned homosexual people from working in the federal government through a 1953 executive order. A 1995 order dismissed the final law from this multi-layered federal ban.
- Illinois became the first state to decriminalize sodomy in 1961.
- Until 1973, homosexuality appeared as a disorder or disturbance in the Diagnostic and Statistical Manual of Mental Disorders.
- Maryland became the first state to officially ban same-sex marriage in 1973.
- Discrimination based on sexual orientation was legal across the United States until the 1980s, when Wisconsin became the first state to outlaw discrimination based on sexual orientation.
- A 2003 Supreme Court decision officially ruled all laws criminalizing same-sex sexual conduct unconstitutional.
- In 2015, the United States federal government legalized same-sex marriage.
In the 1980s, many organizations portrayed HIV and AIDS as diseases that plagued the gay community, particularly gay men. Stemming from this era, modern discrimination of gay men prevents some healthcare providers from offering quality care to the LGBTQIA+ community.
In a 2020 survey, 52% of nurses indicated that reforms within healthcare institutions are necessary to improve care for LGBT patients.
In addition, some religious beliefs prevent nurses from providing empathetic care to LGBTQIA+ people. An inability to provide quality care to any patient causes major disruption. Nurses must continuously assess their ability to offer therapeutic support.
In a 2020 survey, 52% of nurses indicated that reforms within healthcare institutions are necessary to improve care for LGBT patients. In order to provide comprehensive support, nurses should ensure that LGBTQIA+ people feel welcome and safe in their care.
Ensuring a Welcoming Space
As essential points of contact in healthcare settings, nursing professionals play a critical role in communication with LGBTQIA+ patients. Creating a welcoming space for LGBTQIA+ people helps establish comfort and trust.
- Names and Pronouns: Allow patients to identify and use preferred name(s), pronouns, and honorifics (if any) on all forms and in conversation. Be prepared to discuss with them how they would like you to use this information with other staff or with the patients’ family or emergency contacts.
- Bathrooms: Provide access to an all-gender or gender-neutral restroom.
- Support: Ask about the relationship to each support person accompanying a patient and how to address them.
Preparation is key to creating a welcoming space. Knowledge and education can help build your capacity to understand LGBTQIA+ individuals’ needs. The resources listed below offer vast opportunities to increase your understanding of LGBTQIA+ communities, including guidelines for care.
Use Correct Pronouns
Ask all patients how you should address and refer to them. Acknowledging each person in this manner establishes a more inclusive environment and prevents assumptions about people’s gender identities. Patients who feel comfortable are more likely to share important health information, supporting nurses’ ability to provide quality care.
Reduce discomfort by asking all patients to identify the names and pronouns they would like you to use.
Medical forms and other legally required documentation may provide inaccurate information regarding patients’ identities and preferences. Reduce discomfort by asking all patients to identify the names and pronouns they would like you to use.
Normalize the use of correct pronouns for all patients. Additionally, avoid making assumptions about patients’ friends and family, instead asking how you should refer to them. These practices can all work together to make LGBTQIA+ patients more comfortable.
Provide opportunities for patients to offer feedback about their healthcare experiences. LGBTQIA+ patient feedback can support improvements to the environment and care you provide.
Make sure your feedback forms ask specific questions related to LGBTQIA+ people and their experiences. Work with your medical team to make changes that enhance your ability to provide quality care based on feedback.
Intake Form Best Practices
Medical intake forms allow patients to provide personal and health information. However, some forms limit options for sex, sexual orientation, gender identity, and other aspects of patient history. These limitations can prevent LGBTQIA+ people from completing forms accurately, discourage them from sharing other medical information, and result in making them feel unwelcome.
If care providers can improve the accuracy with which LGBTQIA+ patients complete forms, these patients might be able to provide more medically relevant information. In turn, cisgender, straight, and closeted patients may also have better experiences.
Nurses and other healthcare providers should consider expanding choices or offering write-in options for gender identity, sex, and sexual orientation information. For example, forms requesting information about sex might offer “intersex” alongside “male” and “female.”
Some LGBTQIA+ patients may prefer not to include information about their gender identity, sex, or orientation in legal documentation or records. If this is the case, honor their wishes, which can in turn build trust and increase comfort.
Keep in mind as well that comprehensive intake forms can help you better screen for conditions common among LGBTQIA+ people.
Care for Transgender Patients
Understanding specific care practices for transgender individuals can improve your quality of care. Use accurate terminology and pronouns, making sure to invite corrections and updates. Assess patients for specific health factors common among transgender individuals.
Do not assume that the personal information in a patient’s medical history accurately reflects their identity. Ask patients, no matter their identity or background, to share the name and pronouns they would like you to use in the care setting. Using a person’s correct name and pronouns can go a long way in establishing a trusting therapeutic relationship.
Hormone Therapy and Gender Affirmation Surgery
Some transgender patients may use hormone therapy to affirm their gender. Testosterone and estrogen therapies alter physical appearances. For example, individuals might experience genital and breast tissue changes, or differences in sexual function.
Hormone therapy can increase the risk of certain cancers and diseases. Understanding the different types and stages of hormone therapies allows you to better support trans patients in your care.
Questions or concerns about gender affirmation surgery may arise in your care of transgender patients. Some gender-affirming surgeries include chest reconstruction or top surgery, genital or bottom surgery, and facial reconstruction or feminization surgeries.
Make sure to care for transgender patients’ biological and anatomical health needs. Ensure that you support their gender needs as well. Building a relationship of trust helps you better navigate patient conversations with empathy and care.
Care for LGBTQIA+ Youth
Some adolescents may not wish to share their gender or sexual identities with those escorting them to appointments. They may fear judgment, discrimination, or other negative consequences when disclosing their gender or sexual identities to family members or friends.
Healthcare providers are bound by HIPAA laws. These laws may vary among states, so review your state’s HIPAA protections regarding youth patients. Ensure you follow regulations when sharing information between the LGBTQIA+ youth in your care and your patients’ support people.
Minors can make certain decisions regarding their medical care with or without the consent of a parent or guardian. Youth can disclose specific medical information as desired.
Watch for signs of bullying and depression in your care process. Higher rates of suicide and suicide attempts exist among LGBTQIA+ youth. Alert other health professionals as needed to guide youth with support for their mental health needs.
Safer Sex Education
LGBTQIA+ youth may feel excluded from safer sex conversations, or they may not be out to friends and family. Adolescents, regardless of gender or sexual identity, benefit from safer sex health education.
Ask LGBTQIA+ youth about their concerns and needs regarding sexual practices. Allow time for them to ask questions. Provide nonjudgmental safer sex education as necessary.
Riskier sexual behaviors may stem from a lack of education. Allowing the LGBTQIA+ youth in your care to trust you and feel safe can lead to more open discussions about sexual behaviors.
Care for LGBTQIA+ Elderly
In many cases, LGBTQIA+ patients who are older than 30 have lived through decades of discrimination and trauma because of their identities. Some may feel accustomed to hiding to protect themselves.
Fear of judgment and discrimination may keep some elderly LGBTQIA+ individuals from sharing information about their gender or sexual identities. Compassion and understanding of the lasting effects of anti-LGBTQIA+ legislation and discrimination can help patients build comfort in your therapeutic relationship.
Fear of judgment and discrimination may keep some elderly LGBTQIA+ individuals from sharing information about their gender or sexual identities.
For a variety of reasons, not all LGBTQIA+ partners hold marriage certificates. However, many still desire the benefit of legal protection and decision-making, should one or both become incapacitated. Provide guidance for obtaining a healthcare proxy or power of attorney as necessary.
Resources for LGBTQIA+ Care
Modern nursing programs require courses in the management and care for youth and adult health. These courses provide foundational knowledge of supporting LGBTQIA+ individuals and families. Information and course content vary.
Continuing education provides opportunities to deepen your knowledge and stay current on the healthcare needs of the LGBTQIA+ community. In addition to nursing education programs, independent organizations and research institutions offer comprehensive learning opportunities.
Guidelines provide a wealth of accessible information regarding the care of LGBTQIA+ people. These resources offer ways to integrate knowledge into best practices.
- Top Health Issues for LGBT Populations: Resource Kit
- Inclusive Services for LGBT Older Adults
- Providing Inclusive Services and Care for LGBT People: A Guide for Health Care Staff
- Providing Services and Supports for Youth who are Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex or Two-Spirit
- Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients
- A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals
An array of courses exists to teach best practices of clinical care for LGBTQIA+ people. These courses also discuss barriers to healthcare and ways to identify and address discrimination. Some provide continuing medical education credit as well.
- LGBTQ Fundamentals and Beyond: Workshops and professional development trainings for healthcare providers covering implicit bias, inclusive practices, and generational health considerations
- Taking an Affirming Sexual History: Recommendations for discussing sex and the physical body with LGBTQIA+ people and using a trauma-informed approach to address barriers to care
- LGBT Training Curricula for Behavioral Health and Primary Care Practitioners: Training curricula for building cultural sensitivity to assess, treat, and refer patients
- HIV Testing, Prevention, and Treatment: A Stepwise Approach: Continuing medical education course focused on the prevention of HIV infection and caring for individuals with HIV
- Delivering HIV Prevention and Care to Transgender People: Assists health providers in creating a welcoming environment for transgender people seeking HIV prevention or care
- Healthcare for Transgender and Gender Diverse People: Healthcare basics including terminology, demographics, and disparities connected to gender affirmation care and treatment
- Clinical Care for Transgender and Gender Non-conforming Patients: Health disparities and clinical best practices of care to address discrimination, stigma, and quality care
These comprehensive websites inform, educate, and guide healthcare providers through care for LGBTQIA+ patients. Some sites focus on specific groups within the LGBTQIA+ community, and others offer more expansive care resources.
- GLMA.org: Advocacy, education, and research organized to support health equity for LGBTQ and sexual- and gender-minority people
- HisHealth.org: Training and continuing education resources centering Black gay men
- LGBTQIAHealthEducation.org: Educational programs and resources in support of quality healthcare for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual- and gender-minority people
- HRC.org: Resources that support equality and inclusion of all LGBTQIA+ populations
- IPEDSnursing.org: Pediatric nursing resources to support LGBTQIA+ youth and provide quality care
- NCIHC.org: Resources for healthcare providers and interpreters supporting LGBTQIA+ individuals with limited English language proficiency
Fellowships and Conferences
Fellowship programs and conferences offer nurses an opportunity to study further and practice skills related to the care of LGBTQIA+ populations.
- The Keith Haring Nurse Practitioner Postgraduate Fellowship in LGBTQ+ Health
- UCLA LGBTQ Healthcare Fellowship Program
- Advancing Excellence in Transgender Health
- GLMA Annual Conference on LGBTQ Health
- LGBT Health Workforce Conference
Empathetic LGBTQIA+ Care
Empathetic and comprehensive nursing care helps close healthcare gaps for LGBTQIA+ patients. Continue your education of LGBTQIA+ needs, regularly reviewing the information described above and using the resources below. Your knowledge supports informed care for the LGBTQIA+ community.
Elizabeth Clarke, FNP, MSN, RN, MSSW
Elizabeth Clarke (Poon) is a board-certified family nurse practitioner. A native of Boston, Massachusetts, Clarke tired of the cold and snowy winters. She moved to Coral Gables, Florida, to complete her undergraduate degree in nursing at the University of Miami. After working for several years in the UHealth and Jackson Memorial medical systems in the cardiac and ER units, Clarke returned to the University of Miami to complete her master of science in nursing. Since completing her MSN degree, Clarke has worked providing primary and urgent care to pediatric populations.
Elizabeth Clarke is part of the paid review network for RV Education, ensuring our content is relevant and accurate.
Angelique Geehan works to support and repair the connections people have with themselves and their families, communities, and cultural practices. A queer, Asian, gender binary-nonconforming parent, Geehan founded Interchange, a consulting group that offers anti-oppression support. She organizes as part of several groups, including the National Perinatal Association’s Health Equity Workgroup, the Health and Healing Justice Committee of the National Queer and Trans Asian and Pacific Islander Alliance, QTPOC+ Family Circle, and Batalá Houston.
Angelique Geehan is a paid member of the Red Ventures Education freelance review network.
Featured Image: Fly View Productions / E+ / Getty Images
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