Training and knowledge in transgender issues being left to chance

Just 13% of nurses feel prepared to meet the needs of their transgender patients, according to a survey by the RCN

Just 13% of nurses feel prepared to meet the needs of their transgender patients, according to a survey by the RCN. 

Nurses should avoid disclosing a patient’s trans status to anyone
who does not explicitly need to know. Picture: PA

The UK-wide research involving more than 1,200 nursing staff found this could be due to lack of training, despite over three quarters encountering transgender patients in their work, and 56% caring for them directly.

Nearly four out of five nurses reported having no training at all in this area, and only 1% said they covered the subject during pre-registration training.

Referrals to gender identity clinics have risen significantly over the last decade, and the RCN is calling on the government to ensure the care of transgender patients is introduced at all levels of nursing and across healthcare education.

Tailored guidance 

The RCN recently released its ‘Fair care for trans patients’ guidance, prompted by an RCN congress resolution. The resolution was put forward by staff nurse Rachael Ridley, who has herself undergone gender reassignment.


The number of RCN members who took part in the survey.

Ms Ridley, who contributed to the guidance, says: ‘This latest research highlights the situation.

‘When I put forward the resolution, I noticed that a lot of nurses were unaware of trans issues, and there was a need for colleges and universities to do something about it in spite of the funding pressures they are under.’

The guidance for nurses and healthcare assistants includes respectful treatment of trans patients at all times. 

If unsure about a person’s gender identity, or if clarity is needed on how a patient would like to be addressed, then nurses should ask politely and discreetly.

They should also avoid disclosing a patient’s trans status to anyone who does not explicitly need to know.

Ms Ridley, who works in Cumbria, says rural locations can be particularly isolating for transgender patients, with more restricted access to voluntary services. She said she would like to see more nurses specialising in transgender issues in rural localities.

‘Gender identity clinics can be difficult to access,’ she says. ‘I know someone who worked for the NHS and couldn’t get a pension recently because they did not have a gender identity certificate.

‘They needed to be referred to a clinic for an assessment and for all the paperwork to be signed, but the waiting list was months. They were relying on their pension for income and were distressed to the point of considering suicide.’

Left to chance 

East and North Hertfordshire NHS Trust equality and diversity lead Anne Wells, who also involved in writing the RCN guidance, says: ‘This is not about nurses doing something different, it’s about them understanding.

‘It is about treating everyone with respect and asking them what they would like to be called, as you should do with every patient.

‘Very rarely is the subject mentioned during training and I have witnessed some appalling behaviour towards trans patients. It has to be taught in universities, not left to chance.

‘Some of these children are young and need to have the specialised services to meet their needs.’

The Equality and Human Rights Commission (EHRC) found that transgender people experience severe disadvantage in accessing appropriate healthcare in a timely way.


have cared for transgender patients directly.

Welcoming the RCN research, an EHRC spokesperson said: ‘We hope that steps are taken quickly to address concerns, including improving the evidence base in order to better understand the experience of transgender patients. Training for healthcare professionals should be made a priority.’

‘Failing’ on transphobia

Earlier this year, the House of Commons Women and Equalities Select Committee published its Transgender Equality report, which found the NHS is ‘failing to ensure zero tolerance of transphobic behaviour’.

NHS England responded to the report, stating that it had increased funding and conducted a review of gender identity services to decrease waiting times. It said it had also brought together a range of national bodies and patient groups to address many of the problems trans people face accessing general health services.

Royal Glamorgan Hospital clinical nurse specialist in sexual health and HIV Stewart Attridge says: ‘It is important for nurses to remember that there can be two different aspects of gender which need to be taken into consideration: physical and psychological.

‘I know of some patients who have tried self-medicating with hormones on the internet due to frustration with the NHS and delays in the system.

‘Mandatory training needs to cover these topics. It may go into great detail about using the correct recycling facilities, but won’t mention the importance of addressing patients by the correct pronoun.’

Young people

The Tavistock and Portman NHS Foundation Trust Gender Identity Development Service (GIDS) is the only such NHS-funded service in the UK for children. It is for children and young people, and their families, who experience difficulties in the development of their gender identity.

A total of 1,419 people were referred to the clinic in 2015-16, compared with just 97 in 2009-10.


said they had received no training in caring for transgender patients.

A trust spokesperson says that some of these patients feel uncomfortable with the gender they were assigned at birth, while others are unhappy with the gender role that society expects. Some may go on to identify as transgender or gender variant, others as people who are simply different.

The GIDS works closely with University College London Hospitals NHS Foundation Trust, where patients can be referred for treatment and supported by specialist nurses.


GIDS director and consultant clinical psychologist Polly Carmichael says: ‘The work we do here is highly specialised and the staff who see the young people are qualified. It’s our role to provide a safe, therapeutic space where people can speak to a range of professionals about their circumstances. We do this without judgement.

‘We are working hard to recruit more staff to meet demand, and ensure we are able to see young people within reasonable timescales.

‘While we’re seeing an unprecedented rise in referrals to the service, we have to keep this in perspective. Around 1 in 10,000 young people are referred to our service. Not all of those will fulfil the criteria for a diagnosis of gender dysphoria, and not all of those will decide to transition.

 ‘We can’t identify a single reason for the increase, but we have certainly seen a cultural shift, and thankfully more acceptance in terms of how we think about gender and greater recognition of transgender and gender variant people.’

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