Guest Column by Abigail Swartz | Penn Nursing needs to require a class on LGBTQ healthcare

Nurses have a responsibility as health care providers to administer holistic care to their patients. Holistic care is a philosophy dating back to the 1850s — spearheaded by Florence Nightingale — that emphasizes caring for the patient as a whole, not just their physical body. It is one of the very first concepts that nursing students at Penn are taught. It is ingrained into the nursing practice to ensure that we care for the patient’s mental, emotional, and physical health equally. However, we cannot properly care for patients of diverse backgrounds if we are not adequately educated. A majority of our classes either assume that all of our patients are going to be cisgender and heterosexual, or perform the bare minimum of education regarding LGBTQ patients.

As a queer person with a trans partner, I feel it is my duty to bring these concerns to light. I have the privilege of understanding certain aspects of LGBTQ healthcare, simply because I or my partner have lived them. Finding supportive providers and dealing with insurance issues relating to transgender care are very challenging. I don’t claim to be an expert on LGBTQ healthcare, but the fact still stands that important aspects of our education as caretakers are being allowed to fall by the wayside. I can recall multiple instances when a student’s question about LGBTQ-specific healthcare was not adequately answered. It’s also highly likely that there are questions about how aspects of healthcare apply to the LGBTQ population that students just aren’t asking because it hasn’t occurred to them or they don’t know how to ask. Furthermore, there are important considerations regarding the unique healthcare needs of the LGBTQ community, especially hormone replacement therapy and gender-affirming surgery for trans people. Many forms of gender-affirming care change a person’s risk factors for future illnesses and impact what medications they can be given.

A critical role of the nurse is patient education. We explain diagnoses, treatment options, procedures, and more. We are responsible for answering all of our patient’s questions to the best of our ability. This includes treatments like hormone replacement therapy and at least a base understanding of how gender-affirming surgery works. Nurses are also responsible for discussing sex with their patients — making sure they know how to have safe sex if they are sexually active. When a provider is visibly uncomfortable discussing sexual activity with a patient, the patient will be less likely to open up. As someone who has been assumed to be in a cisgender heterosexual relationship before, it’s infuriating, and it makes you want to end the conversation. Having a compassionate nurse that knows how to talk about sex in a way that isn’t exclusively cisgender and heterosexual makes a significant difference. The sad truth is that many high schools don’t adequately teach safe sex practices. It becomes the role of the nurse to fill this gap and educate adolescent patients on safe sex. In order to fill this role, they need to be equipped with knowledge of inclusive sex education.

As nurses, we are the caretakers of a patient’s mental and emotional well-being. LGBTQ people are almost three times as likely to face mental illness. The suicide attempt rate among transgender people ranges from 32 to 50 percent across countries. It’s a simple fact: being queer isn’t easy. When my mom found out I was bisexual, she told me not to tell anyone. This is a mild reaction compared to those that some people face, and in my experience, a majority of queer people have a similar or worse story about coming out. Many queer people have been subjected to conversion therapy, ostracized by their communities, and thrown out of their homes simply because of their identity. There is a unique kind of trauma associated with that and we as nurses need to understand this about our patients.

My goal here is not to criticize the School of Nursing or my professors. Each class makes an effort to include LGBTQ patients in their teachings, but it’s not enough. LGBTQ patients deserve to have equally competent and caring nurses as straight, cisgender patients. My proposal is this: rather than only scratching the surface of LGBTQ issues in classes, nursing students should be required to take a course on LGBTQ healthcare. As the first ranked nursing school in the world, Penn Nursing has a social responsibility to set the standard for nursing care to be inclusive.

ABIGAIL SWARTZ is a sophomore from Oakdale, Conn. studying Nursing. They are a member of Student Nurses Understanding Gender and Sexuality and Vice President of the Alpha Delta Phi Society. Their email is aswartz@nursing.upenn.edu