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Transgender nurses in the workplace: how trusts are supporting gender diversity

The NHS has made rapid progress in recent years – and we all have a part to play

The NHS has made rapid progress in recent years and we all have a part to play

  • NHS organisations are developing policies to support trans people and tackle transphobia
  • While LGBT networks can be a great source of support, trusts should ensure that workplace policies are person-centred and consider the experiences of trans staff to promote inclusivity
  • This article includes a case study of a nurse who came out as trans at work, and tips on helping trans and non-binary colleagues feel safe and welcome at work

Angel Toledo moved from the Philippines to work in the NHS in January 2020.

Living as a transgender (trans) person in

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The NHS has made rapid progress in recent years – and we all have a part to play

  • NHS organisations are developing policies to support trans people and tackle transphobia
  • While LGBT networks can be a great source of support, trusts should ensure that workplace policies are person-centred and consider the experiences of trans staff to promote inclusivity
  • This article includes a case study of a nurse who came out as trans at work, and tips on helping trans and non-binary colleagues feel safe and welcome at work
Picture: iStock

Angel Toledo moved from the Philippines to work in the NHS in January 2020.

Living as a transgender (trans) person in her home country, where she was forced to wear a man’s uniform and cut her hair short, was not easy.

‘I felt I had to sacrifice who I was to do a job I loved,’ she says.

But things were very different when she arrived at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUH).

‘I was welcomed as a trans person’

Ms Toledo says the support she received there as a staff nurse has changed her whole life and how she feels about herself.

Angel Toledo: ‘I sacrificed who I was to do the job I loved’

‘I was welcomed as a trans person and never treated differently,’ she says. ‘I was called by my preferred name and allowed to wear a female uniform.’

She believes the freedom to simply be herself makes her a better nurse. ‘Being the person you are brings out the best in you,’ she says.

Trans people’s gender identity is not the same as the sex on their original birth certificate, while non-binary people do not consider themselves to have a solely male or female gender identity.

There could be up to 500,000 trans people living the UK, although the Office for National Statistics will gain a more accurate picture from its forthcoming 2021 consensus.

But it is not clear how many trans staff – let alone trans nurses – work in the NHS as this information has not been specifically gathered as part of national workforce statistics or the NHS staff survey.

Trans employees may also choose not to disclose their trans status.

Discrimination and transphobia has prompted an overhaul of workplace policies

In 2015 the LGBT+ (lesbian, gay, bisexual and transgender) charity Stonewall surveyed 3,001 health and social care staff, including nurses, in Scotland, England and Wales, and found almost one in 10 were aware of colleagues experiencing discrimination or poor treatment because they were trans.

According to Stonewall’s report, health and social care organisations have a responsibility, under the Public Sector Equality Duty, to eliminate discrimination towards, and advance equality for, LGBT people.

Awareness of gender diversity and trans issues has grown rapidly in recent years and led to NHS organisations developing policies that support trans staff and patients and tackle transphobia. Growing numbers of health and social care organisations have drawn up specific workplace policies to support trans staff.

Active support for trans staff

Victoria Miles-Gale: ‘Trans guidance helps managers discuss the support needs of individual staff’

One such trust is BHRUH, which has developed guidance for supporting staff when they decide to come out as trans, and is currently exploring the need for a wider policy for trans employees.

The trust’s head of patient experience and LBGT+ network chair Victoria Miles-Gale says the trans guidance, created in October 2019, helps line managers discuss the support needs of individual staff.

‘It is always about a conversation with the individual. What are you comfortable with? What do you need?’ she says.

LGBT+ networks like the one at BHRUH can be a vital source of support for individual employees as well as helping to shape wider policy.

Research by the University of York on LGBT+ networks in the NHS, published in October 2020, found they had the potential to play a pivotal role in raising awareness and visibility, and in helping trusts create a supportive working environment.

However, it found trans staff were under-represented in the networks.

Ensuring representation in LGBT+ networks

Anna Einarsdottir: ‘Understanding of identities that were different from lesbian and gay was sometimes lacking’

York Management School research lead Anna Einarsdottir explains: ‘The two groups that were least represented were bisexual and trans people, and understanding of identities that were different from lesbian and gay was sometimes lacking.’

Dr Einarsdottir says the findings raised questions about how welcoming networks were to different groups.

The research included a survey of more than 4,000 NHS employees at 212 trusts in England, plus case studies of LGBT+ networks at nine NHS organisations in England, Scotland and Wales.

Survey respondents included 516 LGBT+ employees, 29 of whom were trans.

The study found networks did not always have the information they needed to be effective and were often vague about the make-up of their membership and the workforce they represented – especially when it came to trans staff.

Dr Einarsdottir says the formal nature of meetings – and the fact they are often attended by HR professionals and managers – can get in the way of ‘personal sharing’, and there was often little discussion of sexual and gender identities.

‘It is important to have a mixture of activities such as training sessions, social and cultural events,’ she says.

Employers should ensure staff can access LGBT+ networks

Another key message was the need to ensure staff had time to run – and take part in – networks on top of their day jobs.

At BHRUH, the LGBT+ network has expanded rapidly in the past 18 months from just three members to about 30 – including trans staff – and is now more active and visible, explains Ms Miles-Gale.

The NHS rainbow badge promotes inclusivity

Staff can sign up to the national NHS rainbow badge and lanyard initiative via the network to demonstrate their commitment to challenging discrimination and respecting the feelings, wishes and identity of LGBT+ patients and staff.

The LGBT+ network has also played a key role in the recent launch of equality, diversity and inclusion champions at the trust, and is developing LGBT+ staff training featuring the life stories of LGBT+ employees, including Ms Toledo.

Mersey Care NHS Foundation Trust launched its policy for supporting trans and non-binary staff and patients in November 2017.

The policy covers key areas including recruitment, confidentiality, staff records and information-sharing, transition in the workplace, and the support on offer for individuals.

Harmful comments should not be dismissed as ‘banter’

George Sullivan: ‘It’s about civility and respect’

The policy is being reviewed by the trust’s equality and human rights adviser for forensic social care George Sullivan, who is a nurse by background.

Some of the terms used to describe trans people have changed since the policy was created so it will need updating, says Mr Sullivan, who understands why people worry about doing or saying the wrong thing.

However, he argues it is easy to overcomplicate matters.

‘For me it is about civility and respect,’ he says. ‘Understand that the questions you need to focus on are no different to what they would be for any other patient or member of staff.’

Hurtful and harmful comments are sometimes excused as ‘workplace banter’, says Mr Sullivan, who believes face-to-face staff training has an important role to play in raising awareness of gender diversity and tackling discrimination.

‘My biggest fear was I would lose my job if I came out as Rachael’

Staff nurse Rachael Ridley has worked at North Cumbria Integrated Care NHS Foundation Trust for about 20 years.

Staff nurse Rachael Ridley at the Cumberland Infirmary, Carlisle Picture: SWNS

She transitioned and underwent surgery while working at the trust. Although the experience was not always easy, she found the vast majority of colleagues were very supportive.

‘My biggest fear was I would lose my job if I came out as Rachael because I’d heard horror stories from nurses in similar positions in other organisations,’ says Ms Ridley, who works in trauma and orthopaedics.

A learning experience for the trust

She recalls the moment she told a senior sister she was planning to transition.

‘When I told her what I was going to be doing she said “Is that all?” so that broke the ice and took the pressure off,’ she says.

‘I gave the ward staff plenty of time and I met them a couple of times as Rachael socially so they could get used to me’

Ms Ridley, who is a diversity champion and learning representative for the RCN, says the support she got from her union was ‘fantastic’.

She says her situation was a learning experience for her trust because it ‘hadn’t come across it before’.

With hindsight some things could have been improved, including the fact she had to attend medical and counselling appointments in her own time.

‘It had to be taken slowly because some of my colleagues weren’t aware and some found it difficult,’ she says. ‘I gave the ward staff plenty of time and I met them a couple of times as Rachael socially so they could get used to me.’

Since Ms Ridley transitioned fully in 2005, trust policies have moved on.

‘It’s about me being me’

‘We now have an LGBT+ policy and LGBT+ network,’ she says. ‘When I was coming out I had to use the visitors’ toilets. It didn’t bother me at the time but nowadays we’re more enlightened.’

She can only recall a couple of instances of discrimination from a patient or family member of a patient.

‘It’s like saying “I don’t want a black nurse to look after me”. It is not acceptable. If that happened now my managers would simply explain “Rachael is a professional qualified nurse like any other”,’ she says.

Ms Ridley adds that the key to supporting trans staff – and all other employees – is to see them as individuals with individual needs.

‘It is not just about me being a trans nurse but about me being me,’ she says.

Trust policies should be person-centred and consider the experiences of trans staff

Gendered Intelligence is a trans-led charity that provides training and consultancy to organisations including NHS trusts.

Simon Croft: ‘A trans nurse comes to work to be a nurse and not a trans educator’

The charity’s professional and education services director Simon Croft, who prefers to be known as Simon thereafter, says policies to support trans staff need to be supported by guidance and training for managers and others.

Policies to support staff through transition should be ‘person-centred, flexible and very visible’ so that someone thinking of transitioning at work can see there is a policy, process and support, Simon says.

But he urges organisations to think beyond this and ensure all policies – including staff assistance schemes, those covering medical and compassionate leave, and dress and uniform codes – take into account the needs of trans staff.

Organisations also need to be aware some staff may be non-binary or gender fluid.

‘Involve your LGBT+ staff network or trans network to ensure it takes account of real experiences in your setting,’ Simon adds. ‘Trusts can also involve organisations like Gendered Intelligence to ensure guidance is well-structured and nothing important is missed out.’

Read more from RCNi’s LGBT resource collection

How to help trans and non-binary colleagues feel safe and welcome at work

Simon Croft, director of professional and education services at the trans-led charity Gendered Intelligence, offers some tips for nurses on supporting their transgender (trans) or non-binary colleagues.

Don’t make assumptions ‘There is often a notion we will always know if we’re talking to or working with somebody who is trans, and that is not the case,’ Simon says. ‘You never know when a trans person is around or when you are talking to or working with a patient or colleague with a family member or friend who is trans. If you do know someone is trans then “How can I support you?” is a good starting question.’

Transition is a process ‘Certain things can take place overnight like name and pronoun change, but other changes are part of a process over a much longer period of time,’ he says. ‘We tend to treat that time when people come out and share the information they are trans as a starting point, and this misses the fact that people may be questioning their gender or need support long before that.’

Avoid burdening individual trans employees It should not be up to individual trans staff to answer questions or fill gaps in people’s knowledge. ‘A trans nurse comes to work to be a nurse and not a trans educator,’ Simon says. ‘There is often an expectation people will step up, know loads of stuff, be able to speak on behalf of their community and do it all for free.’ He says there are many other ways to obtain information, including online resources.

Build on existing anti-discrimination policies and procedures The nursing profession has plenty of experience in tackling discrimination. Efforts to combat transphobia are an extension of those to prevent and address racism, sexism and homophobia, Simon says. ‘Build on the things you already have in place and talk to LGBT+ and trans groups to find out what they would find useful,’ he adds. ‘This is also about being clear to patients what is and is not acceptable behaviour.’

Use the right language People are often worried about using the right words or terms with reference to trans or non-binary staff, such as the pronouns he, she or the gender neutral pronoun they. ‘We can’t be sure of anyone’s pronoun or title without asking,’ he adds. ‘The right term to use is the one a person asks you to use.’


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