Significantly impacting the health of today’s transgender youth population, in 2017, the Trump Administration withdrew the Obama Administration’s landmark Title XI guidance of transgender (trans) student protections (U.S. Department of Justice, 2017). Subsequently, there have recently been a rise in anti-LGBTQ legislation, such as “bathroom bills,” which prohibit trans youth from using public-school bathrooms that align with their gender identity. Reflecting an impact of “bathroom bills,” studies suggest that lack of choice negatively impacts one’s overall psychological well-being and increases the risk for suicidality (Weinhardt et al., 2017) (Seelman et al., 2017). Alarming, a recent 2018 study estimates that 51% of female to male transgender adolescents have attempted suicide (Toomey, Syverten, & Shramko, 2018). A timely and urgent matter, the current political atmosphere evidently posts a grave threat to the health and safety of trans youth. To protect the health, safety, and future of our trans community, it is ethically fundamental and imperative that nurses initiate conversations regarding social stigmas within the development, interpretation, and execution of health policy and practice.
Respectfully, however, it would be naïve to believe that trans youth are only threatened by inequitable central and state politics. While it is known that trans teens are more likely to experience discrimination, victimization, and rejection, this fact cannot discount or underestimate the gross political and social biases among healthcare professionals and within health institutions. Over the year of 2017, among transgender people who visited a health care provider, 21% report that their provider used harsh or abusive language when treating them, 12% report that their provider refused to provide transition needs, and 29% report that the provider refused to provide care altogether (Mirza and Rooney, 2018). Not to mention, this study was conducted a year prior to the Department of Health and Human Services’ (HHS) launch of a new Conscious and Religious Freedom division in 2018 (HHS, 2018). Illogical and counterintuitive of promoting health and safety, the new division underhandedly ratifies healthcare discrimination, supporting healthcare providers who site religious or moral reasons for denying care.
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As former Vice President, Joe Biden states, the fight for transgender equality has become “the civil rights issue of our time” (Biden, 2018, p. xii), and health trends among trans youth signify the unquestionable urgency to improve a biased system. While the suicide attempt rate for the general population is less than five percent, the 2015 U.S. Transgender Survey (USTS) indicates that 41% of transgender adults attempt suicide (James et al., 2015). Furthermore, 39% report that their first attempt occurred between the ages of 14 and 17 (James et al, 2015). Significantly, when health providers refuse care, suicide attempt rates increase from 41% to over 60% (Herman, Haas, & Rogers, 2014). While trans adolescents are considered most vulnerable, how can we protect their health and safety when the U.S. national government fails to adequately do so?
While it is naïve to assume no nurse is transphobic or contributes to these terrifying statistics, it is outlined in provision nine of the “Code of Ethics for Nurses” that “the profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining integrity of the profession and its practice, and for shaping social policy, health care policy, and legislation that affect the accessibility, quality, and cost of health care” (ANA, 2001). As a nurse, it is an ethical obligation, professional responsibility, and a civic privilege to be politically active and protect the health and safety of the trans community.
However, unfortunately nursing apathy in political participation is a pandemic, and fewer than 7% of nurses are members of nursing organizations (Boswell, Cannon, & Miller 2005). With limited involvement and activism within nursing organizations, the nursing profession and its values cannot effectively influence, shape, or evolve health care policy. As the largest and most trusted profession, with nearly 4 million nurses in the U.S., nurses should be at the forefront of health initiatives, leading health care reforms within national, state, local, and work place arenas. Regardless of whether you associate with a political party or none at all, if nurses fail to advocate for transgender rights, those with competing interests may be the only voices that are heard.
While historically, nurses have lacked participation and involvement in health and social politics (Boswell, Cannon, & Miller 2005), this is a call for nurses to step up, show up, and speak up for the trans community in political arenas. In advocation of trans health rights, at the very least, nurses should uphold their civic responsibility to participate in federal, state, and local elections and their professional responsibility to become familiar with inclusive practice guidelines. Nurses must hold themselves, each other, and collogues accountable to stay educated of evolving transgender health standards and practices, which are outlined in the World Professional Association for Transgender Health’s (WPATH) “Standards of Care” (Coleman et al., 2012). We must self-reflect on our own biases and hold ourselves, each other, co-workers, and peers accountable of explicit and implicit biases. Get involved, and join nursing organizations that lobby important health issues on Capitol Hill. Make your voice heard. Other opportunities for nurses to advocate politically include: contacting elected officials about social and healthcare legislation, assuming a leadership position within your institution to improve workplace policies and healthcare practices, being involved in city councils and committees, and even running for local or state office.
Ethically, nurses must be indiscriminately compassionate towards all individuals, regardless of gender and sexual orientation. The trans community is vulnerable because of our ignorance, lives are at stake, and far too many have already been lost. We need to open our hearts, eyes, and ears; we need to listen. Times are changing, and together, we can protect the health and safety of our nation’s resilient transgender community. But first, as a nurse—you must choose to opt-in the conversation.