New Legislation Hinders Nurses’ Ability to Care for Transgender Patients

In the last two years, legislators have introduced more than 100 bills to limit LGBTQ+ access to gender-affirming healthcare, with the greatest emphasis on hormonal treatment and surgery. The legal details vary, with some defining gender-affirming care as child abuse, others defining it as malpractice, and others simply prohibiting such treatments.

The intended impact is clear: Legislators are blocking patient access to the care that their physicians deem necessary for their health.

Supporters of these measures say that youth are not capable of understanding the long-term impact of their choices and that youth go through phases of confusion about their identity, leading to potential regret over gender-affirming care that would be difficult to reverse.

There is limited research on regret among adults who had transition surgery as youth because these procedures are relatively new. However, most studies show low levels of regret among adults who have transition surgery.

The legislation is designed specifically to create barriers to or end transgender care for minors. In Tennessee, for example, the law “prohibits a healthcare provider from performing on a minor or administering to a minor a medical procedure if the performance or administration of the procedure is for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex.”

North Dakota introduced an emergency measure making any kind of surgical or pharmaceutical gender-affirming care for minors illegal.

States are also introducing or have passed legislation making gender-affirming care more difficult or risky for providers, without banning it outright. In Arkansas, for instance, while the ban on providing this care to minors was blocked, the legislature introduced a bill to discourage providers from offering care. Currently, patients have a two-year window to sue for malpractice, but in the case of a minor who had gender-affirming care, they could sue their provider for malpractice for up to 30 years after the treatment once they turn 18.

While most of the legislation targets the physicians and nurse practitioners who prescribe gender-affirming treatment, it also affects all nurses by limiting their ability to provide appropriate healthcare to a vulnerable population.

As Joanna Fuller-Crawford, RN, points out, “Refusing care to anyone violates the nursing code of ethics. And criminalizing healthcare of any type may deter nurses from providing care to certain patients, or even deter them from continuing to practice nursing altogether.”

The American Nurses Association released a statement in 2022 expressing its opposition to any kind of barrier to gender-affirming care.

The American Academy of Nursing, American College of Nurse-Midwives, Endocrine Nurses Society, and National Association of Nurse Practitioners in Women’s Health have also recently expressed their support for full and equal access to healthcare for people who are transgender.

Caitlin Goodwin, DNP, describes the direct impact on the health of transgender persons. She says, “Blocking gender-affirming care can significantly impact people’s mental health.” People who are transgender may already suffer from stigma and a sense of isolation, which can worsen.

Goodwin continues, “This may not seem like a life-or-death situation, but it absolutely is. Transgender and gender-nonconforming patients are at increased risk for suicidal ideations.”

Maria Regan, RN, warns that the implications go beyond just the lack of access to medical transitioning care. “Since transgender individuals often face discrimination in healthcare settings, these laws can further contribute to the already existing stigma surrounding accessing medical services,” Regan says. “This can lead to a decrease in preventive healthcare visits and may result in an increased prevalence of preventable diseases or illnesses due to a lack of treatment or delayed treatment options.”

In South Dakota, medical care providers must immediately stop providing puberty blockers or hormone therapy. People currently receiving treatment are required to taper off medications by December 31st of 2023. It also forces their care providers, including nurses, to do something that evidence-based medical practices demonstrate is harmful.

This can cause nurses to experience moral injury, the distress of having to observe or participate in an action that goes against one’s conscience.

Fuller-Crawford emphasizes that this is a deeply troubling situation for nurses without an easy answer. “It’s really difficult to suggest any specific action for nurses to take in these circumstances,” she says. “Legislation that forbids care or criminalizes it puts nurses in a ‘lose-lose’ situation, essentially forcing nurses to choose between breaking the law or breaking their code of ethics. Neither is a feasible or desirable option, really.”

Just like nurses promote healthy practices to prevent disease in the first place, the best solution for nurses is to educate themselves and others on transgender issues and care. They can also work to prevent legislators from coming between patients of any age and medically or psychologically necessary care. They can also support transgender youth and adults who are afraid of the impact of this legislation by showing respect and understanding.

Nurses in any location can demonstrate inclusive nursing care for LGBTQ+ patients, such as using key LGBTQ+ terms, and continue to educate themselves on issues and nursing resources affecting the transgender community.

Regan further recommends, “By staying informed about current legislation, advocating for transgender rights, and creating a safe and inclusive environment, nurses can play an important role in ensuring that all individuals receive the quality of care they deserve.”

Page last reviewed March 23, 2023