Nursing Care for LGBTQ+ Patients: Tips and Resources

Providing compassionate healthcare to members of the LGBTQ+ community requires an understanding of basic terms and definitions, along with an awareness of the various barriers LGBTQ+ patients often face when seeking competent, inclusive healthcare.

Nursing professionals can improve their competency and create an inclusive healthcare environment by educating themselves on the needs of LGBTQ+ populations.

Important Terms and Definitions

Many people often conflate sexual orientation with gender identity and expression. However, these two terms differ in important ways, according to the National LGBT Health Education Center.

Sexual orientation usually refers to a person's romantic or sexual preferences and includes labels like gay, straight, queer, lesbian, bisexual, and heterosexual, among others. Healthcare professionals should remember that a patient's sexual orientation does not inherently define their gender or gender expression or that of the patient’s partner(s).

But for many, sexuality and gender expression are related. When this information is important for treatment or trust-building, ask the patient what labels they use, if any, and prompt them to define those for you.

Gender identity refers to how a person manifests or expresses their gender, which includes identities like man, woman, and nonbinary, which can be a label or a category of other identities. Nonbinary individuals do not identify with a binary gender, such as boy, girl, woman, or man. Instead, they can be of any gender, which some perceive as on the spectrum of binary genders or more expansive than what is represented on a line. Some common identities often recognized as nonbinary include gender-fluid, genderqueer, and agender.

Beth Niernberg, a mental health counselor who works with child and adult members of the LGBTQ+ community, says that patients may appear to you as male or female, but they may not be.

"Their gender expression may not give you clues as to how they identify," Niernberg says. "So don't assume because they have polished nails and makeup on their face that they identify as a woman."

Niernberg further points out that healthcare professionals should not make assumptions about the patient's gender or partner based on previous visits or records.

"Gender identity is deeply personal and may change across a lifespan, so you may treat someone who identifies as they/them at one visit and he/him the next," Niernberg says. "It's our job to check in at every visit."

Barriers to Care for the LGBTQ+ Community

Unfortunately, members of the LGBTQ+ community face many barriers when seeking care. These barriers may include a lack of access to basic healthcare, which can stem from a lack of health insurance, fear of harm if hostile providers or staff identify them as part of the LGBTQ+ community, or a lack of nearby healthcare providers offering specific services LGBTQ+ patients may need.

Caroline Dorsen, the nursing chair of GLMA: Health Professionals Advancing LGBTQ+ Equality, mentions that a history of stigmatization and discrimination from healthcare workers presents a common barrier. Dorsen, an assistant professor at NYU Rory Meyers College of Nursing, focuses her research on aiding and educating underserved populations, including the LGBTQ+ community.

To aid in reducing these boundaries, Dorsen recommends that providers maintain a list of LGBTQ+-inclusive and affirming mental health resources to offer their patients.

LGBTQ+ patients who have had negative interactions with healthcare professionals may not continue to seek the care they need for fear of reliving those experiences. Niernberg says to be mindful of the trauma transgender and nonbinary people may hold from experiences in medical or psychiatric care settings.

"When encountering someone who may be defensive or struggling with PTSD, it's helpful to take a moment before you enter the room to read the chart carefully and think about the person in front of you," Niernberg says.

Creating an Inclusive Environment

Creating an environment of intentionality and accountability is crucial to caring for the LGBTQ+ population. Healthcare professionals should educate themselves on LGBTQ+ terminology and prepare to provide relevant health services to members of this community.

Mistakes in providing compassionate care, such as misgendering and making incorrect assumptions about patients' lives, can have serious negative impacts on LGBTQ+ patients. LGBTQ+ patients require as empathetic and educated an approach to care as straight patients — but providers have historically been undereducated about LGBTQ+ experiences. Maintaining intellectual and cultural humility when practicing medicine can help healthcare professionals provide these patients with competent, necessary services.

Niernberg notes that one simple way to create an inclusive environment from the start is to ensure the patient forms have the appropriate fields for patients to specify and describe their pronouns, sex, gender, and relationships. Having this capacity also allows all patients to better communicate their experiences to their providers, regardless of whether they are part of the LGBTQ+ community.

"The best way to begin a successful visit is to make sure all of your forms reflect the diversity you see in your setting," says Niernberg. "Every form should be welcoming to every person."

Nurses and other healthcare workers benefit from adopting common best practices for maintaining the best environment for both patient and provider.

Best Practices for Working with LGBTQ+ Populations

Providing the best care possible for LGBTQ+ patients starts with adopting care practices specific to these populations. The following tips provide some details on how to better communicate with LGBTQ+ patients and meet them where they are to serve their healthcare needs in a competent, educated environment.

Communication Basics

Education on communication basics is a crucial aspect of providing compassionate care to LGBTQ+ patients. Nursing professionals should consider the following tips:

• Avoid assuming a patient's sex, gender, gender identity, or sexual orientation. Assumptions based solely on a patient's outward expression may be incorrect and result in malpractice and unintentional disrespect toward that patient's identity.
• If the patient's charted information does not match what they have reported on their forms, never ask for their "real" or given name. Instead, consider asking for the name listed on their insurance and then continue to refer to them by the name they provided.
• Follow the patient's lead. Use the information they give for their name, sex, gender, and sexual orientation.
• Ask patients who they wish to invite in the exam room.

Pronoun Usage

When it comes to personal pronouns, "ask first" serves as the best rule of thumb for nurses, Niernberg says. The way patients look, their names, and the procedures they undergo may not indicate their gender. Asking is the only way to know a patient's preferred pronouns.

In early interactions with a patient, avoid using gendered pronouns at all. The National LGBT Health Education Center recommends using the patient's preferred name or referring to them as "you" rather than "miss" or "sir."

Sharing their own pronouns is another way nurses can provide a comfortable, welcoming care environment at the beginning of a visit.

"Always introduce yourself with pronouns — even if you think your patient knows yours already — as they can use the opportunity to share theirs, which may have changed since you last saw them," Niernberg says.

Patient Support

When working with vulnerable populations, nurses and healthcare professionals must take note of their patients' preferred contacts and support systems.

"The LGBTQ++ community has historically relied more on 'families of choice' (as opposed to biological family) than heterosexual, cisgender persons," Dorsen explains. "It is important to ask LGBTQ++ patients who their social supports are, who should be contacted in case of emergency, and if there is anyone who should not be contacted."

Understanding Intersectionality

Intersectionality, when referring to identities, describes how different facets of identity, including race, gender expression and identity, sexual orientation, socioeconomic class, and other characteristics, are inseparable and affect each other. In healthcare settings, nurses and other healthcare professionals can apply this theory to respond to each patient as an individual, not a manifestation of a stereotype, especially not one based on only one aspect of their identity.

When providing care to LGBTQ+ patients, understand that identity markers, including gender expression and sexual orientation, remain fluid and may change. To foster an inclusive environment, maintain a non-judgmental attitude and follow the patient's lead. Remain mindful of body language and respond in thoughtful ways.

Creating this type of inclusive environment takes intentionality and consistency, Niernberg says.

"Building a relationship is key in creating a seamless treatment environment," she notes. "If they can know who they will see when they come in, they are more likely to seek treatment rather than avoid it."

Helpful Resources for Nurses

Learning about caring for LGBTQ+ patients requires flexibility and a willingness to adapt and become educated. Fortunately, nurses can take advantage of available resources to better understand the needs of the LGBTQ+ community, along with how to foster a safer, inclusive healthcare environment.

Meet Our Contributors

Caroline G. Dorsen, Ph.D., FNP-BC

Caroline G. Dorsen, Ph.D., FNP-BC, is an assistant professor at NYU Rory Meyers College of Nursing. As a nurse scholar, nurse educator, and family nurse practitioner, Dorsen's passion is the interface between health and social justice. Her research focuses on health promotion, disease prevention, and reduction of healthcare disparities among underserved populations, including new immigrants, the homeless, drug users, and sexual and gender minorities. Her current research project explores the impact of gender affirmation on risk and resilience among transgender and gender-diverse people.

Dorsen has been a primary care provider at many community health centers. In her current clinical practice, she provides primary and gynecological care to homeless adolescents and adults. Dorsen serves as the vice-chairman of the Board of Directors of the Community Healthcare Network, the nursing chair of GLMA: Health Professionals Advancing LGBTQ+ Equality, and a senior associate editor of Annals of LGBTQ+ Public and Population Health. She is also the nursing lead for SARET, a National Institutes of Health-funded interprofessional substance use training program housed at the NYU School of Medicine.

Beth Niernberg, LMHC

Beth Niernberg, LMHC, has worked as a practicing mental health counselor since 1999. In the past 21 years, she has honed her skills as a trauma clinician working in group homes and residential settings, Boston Medical Center and Children's Hospital, The Trauma Center, and Children's Charter. She has also provided consultation to the Brookline Police Department and countless human service agencies.

As clinical director at My Life My Choice, she used her trauma-informed skills to support sexually exploited children. Niernberg has developed her private practice while working with people in the LGBTQ+ community, along with transgender and nonbinary children and adults. Niernberg provides training and support to schools, agencies, and service providers regarding best practices when working with LGBTQ+, transgender, and nonbinary children and adults.

Page last reviewed on June 16, 2023