Comment

I must air my concerns on a gender diversity in nursing article

Ella Guerin, a non-binary mental health nurse, has concerns about the content and language used in the article Gender diversity in nursing: time to think again

Ella Guerin, a non-binary mental health nurse, has concerns about the content and language used in the article Gender diversity in nursing: time to think again

Ella Guerin’s response to the article Gender diversity in nursing: time to think again (doi: 10.7748/nm.2021.e2010)

Dear Editor,

This letter concerns Nursing Management’s recent article on gender diversity in nursing written by Barry Gerard Quinn, Shane O’Donnell and David Thompson (doi: 10.7748/nm.2021.e2010) . I am a non-binary mental health nurse and want to highlight some concerns I have with the content and message of this article.

My first concern is around language used when referring to trans and non-binary people. Throughout the article the phrasing ‘men, women and trans people’

Ella Guerin, a non-binary mental health nurse, has concerns about the content and language used in the article Gender diversity in nursing: time to think again

Picture: iStock

Ella Guerin’s response to the article Gender diversity in nursing: time to think again (doi: 10.7748/nm.2021.e2010)

Dear Editor,

This letter concerns Nursing Management’s recent article on gender diversity in nursing written by Barry Gerard Quinn, Shane O’Donnell and David Thompson (doi: 10.7748/nm.2021.e2010). I am a non-binary mental health nurse and want to highlight some concerns I have with the content and message of this article.

My first concern is around language used when referring to trans and non-binary people. Throughout the article the phrasing ‘men, women and trans people’ is used. This phrasing suggests trans people are not seen by the authors and journal as ‘truly’ men or women but instead a distinct gender category.

‘There is the risk of marginalisation, discrimination, and abuse that “out” and visibly trans and non-binary clinicians face from colleagues, patients, and carers. This deterrent of an unsafe workplace should not be underestimated’

This is plainly incorrect as trans men are as much men as cisgender men, and the same applies to trans women. Even when viewed from the ‘gender critical’ perspective (which is not a perspective I hold), trans men and trans women are still men and women and not a distinct gender category.

Additional to this, non-binary people are repeatedly referred to as ‘people who identify as non-binary’, rather than simply as being non-binary. This phrasing indicates the authors and publishers do not perceive non-binary people’s gender identities to be valid. I am non-binary; non-binary is not merely a term that I identify with.

The article refers to LGBTQ+ people avoiding and delaying seeking healthcare services because they do not see themselves in their nurses and other healthcare professionals. While this lack of visibility may have some influence on health seeking behaviour, there is a growing body of literature (including Bachmann and Gooch (2018) as cited in this article) that demonstrates delayed health seeking is primarily caused by experiences and anticipation of discrimination and abuse from healthcare professionals, including nurses.

Similarly, the article states there is no data on how many trans and non-binary NHS staff there are, before immediately going on to refer to this non-existent data as showing nursing lacks ‘attraction to, visibility or inclusion’ of trans and non-binary nurses.

This claim lacks justification and supporting evidence, which is a foundational requirement for any epistemology, especially when presented in a peer-reviewed journal.

‘Men are indeed a minority in the nursing workforce. However, this is not due to a position of marginalisation in our male-dominated, cisnormative society, as is the case for trans and non-binary people'

While anecdotally, this is a reasonable point to make with poor visibility of trans and non-binary nurses, including in recruitment materials, there is much more to recruiting trans and non-binary nurses than presenting the profession as attractive.

Crucially, there is the risk of marginalisation, discrimination, and abuse that ‘out’ and visibly trans and non-binary clinicians face from colleagues, patients, and carers. This deterrent of an unsafe workplace should not be underestimated.

Finally, the article lacks the essential recognition of the complete difference in reasons men are under-represented in nursing as a whole (while being over-represented in nursing management positions) compared with the reasons trans and non-binary people are under-represented.

Men are not socialised towards caring roles and ‘women’s work’, including nursing, meaning it is seen as lesser role than those associated with masculinity.

Contrastingly, transgender and non-binary people face discrimination and an unsafe work environment. It would be wrong to conflate these two contrasting experiences as being comparable in this context.

Men are indeed a minority in the nursing workforce. However, this is not due to a position of marginalisation in our male-dominated, cisnormative society, as is the case for trans and non-binary people.

Regards,

Response from the authors of the gender diversity article

Dear Ella,

Thank you for taking the time to write your thoughts to the editor of Nursing Management. You make some important and interesting observations.

From the outset, the article was intended to stimulate discussion on the lack of gender diversity and the opportunities that exist to be a more inclusive profession, which I am glad it has done.

The article’s premise is that increasing gender diversity in nursing can help health and social care services to move beyond the stereotypical cis-gendered approach to health and help to decrease some of the marginalisation and discrimination that Bachmann and Gooch (2018) reported.

‘In the phrasing “men, trans and non-binary people”, the use of the term “trans” is being used to connote succinctly trans men and women, as groups distinct from all the other categories, and in particular, the cis women who make up a large part of the nursing profession’

The article does make reference to ‘men, trans and non-binary people’; this is in relation to the groups that we are arguing are under-represented, compared with cis women. It does not subordinate trans or non-binary people to cisgender men and women.

In the phrasing 'men, trans and non-binary people', the use of the term 'trans' is being used to connote succinctly trans men and women, as groups distinct from all the other categories, and in particular, the cis women who make up a large part of the nursing profession.

We would hope the phrasing in the conclusion, alluding to the rich history, culture and individual identity brought to the nursing profession, supports this reality.

You are correct, the article does not explore in detail the specific obstacles faced by trans and non-binary people, and how they are distinct from the reasons men are under-represented in nursing. This is something a further article might wish to explore and present.

The article's premise is that the representation of these categories in the workforce requires attention. The article does propose further analysis of the levels of equal access and opportunities in an employment context, identifying categories of candidates who meet protection criteria under the 2010 Equality Act.

While almost all trans people will maintain that they are a member of their reassigned gender, many will identify with the term 'trans', or a variation thereon. The article intends to delineate those who do administratively ‘identify’ with one of those categories. The article is not a debate about gender identity or gender theory. However, it is about access to employment, and to a workforce with an uncharacteristic gender ratio.

‘The article is not using gender terms to discuss how we experience our gender but is using them to highlight differences in backgrounds in the workforce. This is important in the context of monitoring equality and diversity’

In relation to the ‘identifying versus being’ debate: non-binary may well be ontological for some but can mean different things for different individuals. For some it means an identification with genders that may vary or remain constant, for some it can mean a complete rejection of gender.

The article is not taking issue with how people identify and unquestioningly accepts the self-identification of every individual. It is not interested in challenging how people describe their own gender. I would be afraid that we lose sight of the focus of the article which is about more inclusivity in the workplace and in training institutions. The article is not using gender terms to discuss how we experience our gender but is using them to highlight differences in backgrounds in the workforce. This is important in the context of monitoring equality and diversity.

Your comments on the differing socialisation of men and values attributed to caring professions is an over-generalisation which myself and many other men do not fully agree with. In fact, it further serves to underline the point, that the profession is not visibly challenging those cultural narratives and assumptions to assure it can attract a workforce reflective of the diversity of our society.

Once again, the article is an invitation to engage with an important conversation that a more visibly gender diverse nursing workforce might help to shift some of the overly cisgendered approaches to health and social care and be more inclusive and welcoming for all.

Regards,

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