2022 has been a year of LGBTQIA+ civil liberty erosion. 

Access to care for trans patients, bathroom and sports access, even the freedom to “say gay” have all been areas of intense legislative activity. In short, nurses need to care about these issues. We know all too well what the impact on vulnerable communities will be, in terms of health equity.

Already fragile, restricting access to care—in essence giving over decision-making about one’s own body to a legislative body—further marginalizes minority groups. It widens the gaping chasm that some of our patients already traverse in order to access care now. For nurses, the attacks on LGBTQIA+ rights are the most worrisome. It’s not right, it’s not fair and we need to pull the e-brake in the name of public health—the area where we can do the most good.

 Many nurses already share the opinion that business and healthcare are a dicey mix. The amalgamation of politics and healthcare is even worse. Just as nurses have been screaming from the mountaintops—PEOPLE OVER PROFITS—we now must add a new exclamation: PEOPLE OVER POLITICS! 

No matter your political or economic affiliations, we—as nurses—must recognize these politically motivated power-grabs as public health catastrophes in the making. In this article, we will examine the stripping of LGBTQIA+ rights taking place, their impact on public health, and the role nurse advocacy can play.

Current legislative moves limiting LGBTQIA+ rights

Of all the discriminatory legislative moves to occur in the past few years, perhaps the most abhorrent center on limiting transgender rights. That is because the majority of these bans target children. Since the beginning of 2022, more than 150 bills affecting trans people have been introduced. In many states, they have become law. 

The Trans Formations Project, a group that tracks “hateful legislation proposals that threaten the health and safety of vulnerable youth and their families,” is a great resource for up-to-date information on bans-in-the-making. While past discussions of trans rights have focused in particular on bathroom access and “fairness” in sports, the majority of anti-trans legislation now takes an even more intrusive and harmful stance. 

Some focus on trans patients themselves (and the health institutions that serve them) by the criminalization of gender-affirming care. Another slew of bills target the very existence of trans people, by making it a crime to discuss gender fluidity with minors in public schools. (Ironically, the latter boldly proclaims that the rights of parents be protected above all, while the former removes the ability of parents to make private healthcare decisions for their own children.) 

In essence, these two types of bills both work to place trans people back in the closet. The very same closet where shame, isolation, and suicidality thrive.  Unfortunately for these law-makers, forbidding people to discuss the existence of trans people doesn’t erase them; nor does equating gender-affirming care to child abuse protect children. You simply can’t legislate away people’s existence.

Children with gender dysphoria deserve inclusion, support, and appropriate medical treatment, a notion shared by The American Medical Association, the American Psychological Society, and the American Academy of Pediatrics. 

Despite the clear evidence of harm, fourteen states this year have enacted laws that limit the rights of trans people—and, in particular, trans children—as well as criminalize discussion of sexual orientation. 

Why nurses should care about civil rights violations

According to the U.S. Department of Health and Human Services' Office for Civil Rights, civil rights are defined as “personal rights guaranteed and protected by the U.S. Constitution.” This includes “protection from unlawful discrimination,” and specifically names health and human service sectors including “state and local social and health service agencies, hospitals, clinics, nursing homes, and insurers….” Which is to say—the majority of places nurses work.

Nurses care about the dignity of human life. Therefore, we need to champion acceptance and inclusivity—and we need to follow the science when it comes to best practices for that purpose. While it’s great to work for an organization that publicly supports inclusivity, as nurses we know the real work is being done on the level of the individual nurse. Our conversations with colleagues and patients alike must reflect this. Our vote must support this. 

Unconscious bias and stereotyping aside, our patients rely on us to be their health advocates. While you may not understand or recognize someone’s identity, you must not allow your opinions to muddy your professional role. Which is to promote health, healing, and agency for all of our patients.

What does this look like in terms of best nursing practice?

Many nursing organizations, including the American Nurses Association, go into painstakingly detailed descriptions to guide your practice here. Care plans and nursing diagnoses and interventions are great pillars of practice to stand on, but let’s break it down to #nursingIRL.

It starts with listening to our patients’ lived experiences. It means staying abreast of current events affecting our patients. It means knowing what happens to patients who don’t have anyone on their side. It means taking an active role to address discrimination. More than anything, it means taking care of our patients in the ways they need us to, rather than the way we think is “right.” 

Finally, we assert that it involves asking existential questions of ourselves. While the law-makers designing and pushing these bans believe they are preserving bathroom privacy, sports, sexual purity, and gender assigned at birth, one must ask—when the rights of some are stripped in the name of protection for others, who are the “others?” 

If you answered “white, male, and cis-gendered” you’re beginning to unravel the true motivations of such bills…

Last time we checked, we nurses operate under The Code of Ethics for Nurses. The same one that states each and every nurse “promotes, advocates for, and protects the rights, health, and safety of the patient.” 

All patients.