Healthcare for Y’All*: The implications for nursing care in the wake of the latest Texas anti-trans legislation

If you’ve ever been part of a child-abuse case, no doubt that experience has been burned into your hard drive—you don’t forget the extreme examples of suffering and evil that nursing sometimes brushes up against. To that end, any nurse working today takes their role as a mandatory reporter extremely seriously. 

Nurses are heralded for their patient advocacy—some of the fiercest around, in fact. We sometimes risk our emotional human selves in order to protect and serve humanity. Just as physicians practice on a foundation of the Hippocratic Oath—“first, do no harm”—so too, do nurses taking The Nightingale Pledge.

Which is precisely why Texas Gov., Greg Abbott's anti-trans health care directive is so maddening. Of all the places where politics surely don’t belong, the medical decision-making between trans kids, their parents, and their care providers surely doesn’t qualify.

How did we get here, you might be asking.

Well, in late February, Texas Attorney General Ken Paxton (republican, up for reelection in 2022) issued a press release where he boldly stated, “There is no doubt that these procedures are ‘abuse’ under Texas law, and thus must be halted.” 

“These procedures” that he pearl-clutching-ly refers to, are better known as gender-affirming care like puberty-blocking treatment and hormone replacement therapy. 

Instantly, the medical community was up in arms. The American Medical Association, American Psychiatric Association, and American Academy of Pediatrics are all vocal advocates for gender-affirming care in youth. 

In the nursing world, supporting age-appropriate care for trans youth is considered best practice. As highlighted in Columbia University School of Nursing’s Certificate in Professional Achievement (CPA) in Transgender Non-Binary (Trans NB) Health Care for Advance Practice Nurses and PAs, nurses are essential “to support the health of trans NB people along the continuum of care and formulate a care plan that addresses follow-up, ongoing care, and preventative screening…”

A recent statement from National Nurses United (NNU) condemns Paxton’s remarks further, calling it an attack on transgender children.  NNU president, Zenei Triunfo-Cortez, RN, important noted that Paxton was “completely out of line with both research on gender-affirming care’s impacts and basic medical principles of providing aid.”

We know unequivocally that gender-affirming care is life-saving care . Trans kids that are nurtured and supported, validated and protected, are far better equipped to survive their turbulent teenage and young adult years.

Rates of suicidal ideation and self-harm are much lower in trans kids that are seen and listened to for who they authentically are. The families that navigate alongside them ought to be praised, not persecuted. And the same goes for the healthcare teams providing this care.

But lawmakers have been undeterred. Governor Greg Abbot doubled down on Paxton’s remarks, and signed his care directive into law. In response, some hospitals and care centers are already backing away from providing gender-affirming treatments and therapy. 

To their credit, Houston-based Texas Children’s Hospital explicitly cited concerns about punitive repercussions for their staff as the basis for this decision, and not alignment with the bill’s core message. In a published statement they said, “This step was taken to safeguard our healthcare professionals and impacted families from potential legal ramifications.”

For the kids and young adults already in the midst of gender-affirming care, or those that were about to start using puberty blockers treatment, this abrupt cessation of care will be devastating. Medically delaying the onset of puberty allows more time for young ones to sort through their gender identity exploration.

One that should be guided by themselves, their families, and their care providers. The LAST people that ought to be involved? Lawmakers.

It won’t be just nurses in Texas that must keep abreast of quickly shifting legislative sands. So far, there are 39 states and counting that have anti-trans legislation. If that surprises you, it shouldn’t. For years now, legislators have used trans adults as political weapons to assert their bold positions ahead of election seasons.

It’s no coincidence that the upcoming midterms in Texas coincide with this most abhorrent anti-trans bill yet; except now they are coming for children, and raking in neutral parties—parents and mandatory reporters—to boot. 

As nurses, we dedicate our professional lives to our patients, and most especially to underserved and vulnerable populations. Rightfully, legal advocacy groups like the ACLU have already begun to fight back against various anti-trans bills. While they hammer out the issues in the courtrooms, that still leaves parents, teachers, healthcare workers, and other mandatory reporters to muddle through a catch-22/20-questions intersection. 

For nurses, these are the questions being asked: 

How can we best provide for our trans patients, while still keeping in form with mandatory reporting? 

Does a patient’s right to privacy about their health supersede a nurse’s obligation to report?

Does a nurse’s ethical and moral conscience factor into these decisions when the “abuse” in question has been perverted for political gain?

Unfortunately, there are no simple ‘yes’ or ‘no’ answers to these questions. Nurses working for large organizations will have to follow their employers’ policies, or face termination. In the meantime, we must voice our support for our trans patients and their families. 

Nurses—stay loud, stay vocal. We cannot allow ourselves to be bullied. We cannot allow our patients to be erased.