Examining the Experiences of Transgender and Non-binary Nurses in the Workplace
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Researcher bios and how their research backgrounds relate to this study
I am an assistant professor at the Daphne Cockwell School of Nursing. I completed a PhD in Nursing at McMaster University, where the focus of my dissertation was exploring the delivery of primary care services for trans individuals in Ontario. My primary research focus is around the barriers and facilitators accessing care for trans individuals. I have conducted multiple qualitative, qualitative, and mixed method studies exploring the experiences of trans and non-binary individuals and the health care providers that support them.
Purpose of this research project
- Explore the experiences and needs of TGNB nurses in healthcare settings
- Explore the experiences and needs of TGNB college/university nursing students
- Contribute to theoretical understandings of how TGNB and professional identity intersect with other identities to inform these experiences.
This study aims to understand the experiences and issues faced by transgender and non-binary individuals attempting to access professional nursing education as well as those working/have worked in the nursing field in Canada. This includes registered practical nurses, licensed practical nurses, registered nurses, and nurse practitioners.
The mixed method study will begin with a survey for TGNB nurse. Those who complete the survey will be invited to participate in an interview.
Potential participants will be invited if they meet the inclusion criteria: self-identify as TGNB, a nursing student or nurse (RPN, LPN, RN, or NP) for former nurse in Canada, and able to communicate in English. The survey will collect data using closed-ended questions about demographic variables such as gender identity, province/territory of work, age, type of nursing license, and workplace setting (hospital, primary care, community, public health) as well as using open-ended questions about experiences with discrimination, barriers and facilitators in the workplace, and disclosure of gender identity.
After completing the survey, participants will each be offered a $25 electronic gift card as an honorarium and asked if they would agree to be contacted for an interview in Phase 2. we anticipate interviewing 15-20 former/currently practicing nurses and 5-10 nursing students.
. Semi-structured interviews will involve using open-ended questions to explore experiences and perceptions of being a TGNB nursing student/nurse, including questions related to intersectional aspects of identity (gender identity etc.) and professional identity. Interviews will be conducted by telephone or Zoom, depending on participant preference. All interviews will be audio-recorded with consent and transcribed verbatim by a graduate student research assistant. Each participant will be offered a $50 electronic gift card as an honorarium.
How this research will help LGBT2SQ people and communities
Although researchers are increasingly focusing on LGBTQ health professionals, very few studies have explored the experiences of transgender nurses in the workplace. One exception is a study by Eliason et al. (2011a), but their sample focused broadly on the LGBT population, with 1.2% of their sample identifying as transgender. These authors reported that their participants had witnessed discrimination and harassment in the workplace, and identified a concerning lack of workplace policies to protect LGBT staff (Eliason, et al., 2011a). They replicated their study to explore the experiences of LGBT physicians in the workplace, with a similar percentage (1%) of participants identifying as transgender (Eliason et al., 2011b). That study revealed that LGBT physicians similarly encountered discrimination and harassment, in addition to exclusionary polices and lack of referrals from colleagues (Eliason et al., 2011b). LGBTQ+ healthcare professionals experience additional levels of stress working in heteronormative settings with unsupportive co-workers and patients, and those who are ‘out’ in the healthcare setting are subjected to fewer promotions, negative comments, and gossip (Eliason et al., 2018). One participant who identified as a trans/genderqueer nurse commented, “I think being out is a slippery concept in my profession life” (Eliason et al. 2018, p. 566). TGNB individuals are often expected to conform to traditional gender binaries and tend to have poor support from supervisors and leaders (Elias, 2018).
LGBTQ students in healthcare and social service programs also experience barriers related to their sexual orientation and/or gender identity (Craig et al., 2017; Frost & Regehr, 2013). Clarke (2014) found that gay nursing students struggle to negotiate their sexuality, particularly in clinical placements. Dimant et al. (2019) found that TGNB medical students, residents, and physicians experience discrimination, lack of support, and stigma; many have witnessed discriminatory care of a TGNB patient and feel the need to hide their identities. Mansh et al. (2015) found that only half of TGNB medical students disclose their gender identity during medical school. Kvach et al. (2021) found that TGNB individuals feel unsafe disclosing their gender identity during applications for medical residency programs and have experienced discrimination, misgendering, and misnaming. The discrimination faced by sexual and gender minority healthcare providers often starts in their educational program and continues throughout their career (O’Mahony et al., 2020). According to Levesque (2015) nursing faculty need to be responsible for creating an environment which is gender-inclusive and free from harm and prejudice, giving TGNB students a safe place to learn and become nurses.
The voices of TGNB nurses and nursing students have recently been emerging in traditional and social media. For example, one Twitter user leverages the platform to highlight their struggles as a TGNB nurse: “being trans in nursing is the most exhausting thing I’ve ever done” (trans nursing student, 2021); and has now started a Podcast focusing on LGBTQIA+ voices in nursing (trans nursing student, 2022). Another nurse named Angel Toledo was interviewed about her experiences as a trans nurse in the UK; she commented, “living as a trans person is not so easy and I felt I had to sacrifice who I was to do a job I loved” (Still, 2020). These voices are beginning to shine a light on the urgent need to explore the experiences of TGNB nurses within the Canadian workforce and to understand these experiences in light of personal and professional identity. Nurses are the largest group of regulated health professionals in Canada and make up half the healthcare workforce (Registered Nurses Association of Ontario, 2017). Clarifying the experiences of TGNB nursing students and nurses in the workforce will help advance nursing knowledge and support policy development to support and protect all Canadian nurses.
those who self-identify as a transgender or non-binary person who is either a nursing student, nurse (LPN, RPN, RN, NP) or former nurse in Canada
After completing the survey, participants will each be offered a $25 electronic gift card as an honorarium
those participants that complete the interview will be offered a $50 electronic gift card as an honorarium.
The following statement is on the consent form
WHAT ARE THE POTENTIAL RISKS TO YOU AS A PARTICIPANT:
The risks involved in participating in this study are minimal, but could include feeling anxious, upset or uncomfortable with questions about your experience. You do not need to answer questions that you do not want to answer or that make you feel uncomfortable. You can withdraw (stop taking part) at any time during the survey, simply close the survey browser window.
During or after the survey, if anything you think about makes you upset, you can reach out to the Distress Centre at 416-408-4357 or text 45645 or call Gerstein Crisis Centre at 416-929-5200. These agencies provide 24-hour gender-affirming counselling services.
Study participation is voluntary. We encourage participants to select a location with visual privacy. Every effort will be made to protect your confidentiality and privacy. Due to the anonymity of the survey, the researchers will not know who participated. Please note, if you contact the principal investigator which questions during the survey, the principal investigator will know that you have participated in the study but will not know which survey responses are yours.
Promoting the Study
The poster is being shared on social media (twitter, linkedin) and with Schools of Nursing