4 Ways to Improve Perioperative Care for Transgender and Gender-Diverse People

In a cultural environment where transgender and gender-diverse (TGD) people may be forced to justify their identity (or are denied it), nurses must speak up and demand zero tolerance for this form of psychological harm, especially in surgical care, said Paula M. Neira, MSN, JD, RN, CEN, FAAN. Ms. Neira recently shared those sentiments and more with The Periop Life ahead of Lesbian, Gay, Bisexual, Transgender and Queer+ (LGBTQ) Pride Month this June.

Ms. Neira is well known for her work supporting acknowledgement of TGD people’s authentic identities. She advocates this human right in healthcare through her role as the Johns Hopkins Medicine Program Director of LGBTQ+ Equity and Education in the Office of Diversity, Inclusion and Health Equity.

In her call to action for nurses leading this zero-tolerance charge, she said, “it’s a time to be courageous and it’s a time to lead.”

We recently asked her what nurses can do today - and every day - to improve the health care environment for transgender and gender-diverse people. And her answer was simple: “Validate a person’s identity and speak up when others don’t.”

In daily practice, she suggests four ways nurses can step up for transgender and gender-diverse people:

1. Validate a Patient’s Identity

Ask a patient for their pronouns and be conscious not to misgender people.

“Building a strong nurse/patient relationship is integral to a positive outcome, especially for perioperative nurses who have a limited window to build this relationship. When you misgender someone or don’t use correct pronouns, this can give off the attitude that who they are isn’t real, which can undermine your ability to connect with your patient,” Ms. Neira explained.

2. Embed SOGI in Your EMR

All electronic medical record systems in US hospitals have the functionality to include sexual orientation and gender identity (SOGI), but a hospital must first turn on this functionality and each state may differ on this as a requirement.

 “If your facility doesn’t have SOGI embedded in your EMR, talk to leadership about why this demographic information has important clinical implications for providing safe patient care.”

3. Establish Zero Tolerance and Ongoing Training

Nurse leaders can lead by example to reinforce the importance of validating a patient or employees’ identity in the way they speak to staff and patients. Provide regular, formal training around cultural awareness of TGD people, as well as appropriate clinical education specific to TGD care.

“This training cannot be a one-and-done,” she emphasized.

4. Create a Work Environment that Supports TGD Identity

“When people can bring their authentic self to work, they don’t feel the need to hide or think colleagues don’t have their back. And this gives them more energy toward the mission of the hospital to work as a team to make their organization as productive as possible,” Ms. Neira said.

This TGD-supportive workforce also translates into money in the form of decreased turnover and a reduced chance for sexual discrimination lawsuits, she said.

In the end, Ms. Neira said a TGD-supportive work environment translates back to the patient. “If you allow a work environment where staff can discriminate against each other, your patients will pick up on it and wonder if their care team is paying attention to their needs.”

Looking for additional resources and training on this topic? Watch Paula Neira’s education session “What Can I Do? Improving Perioperative Care for Transgender and Gender-diverse People” available through the AORN Expo 2023 Virtual Pass.