Policy briefing

Policy briefing: fair care for trans people

Read our policy briefing on the new RCN guidance on meeting the needs of transgender patients.

Read our policy briefing on the new RCN guidance on meeting the needs of transgender patients.


The RCN is calling on the government to ensure
the care of trans patients and those with gender
dysphoria is introduced at all levels of nursing
education. Picture: Science Photo Library 

Essential facts

Nurses feel woefully underprepared to meet the needs of transgender patients, according to an RCN survey. Despite a steep rise in numbers of transgender patients across the UK, there is a lack of training to equip nurses with the skills needed to care for them.

Three quarters of the 1,200 nursing staff questioned said they encountered transgender patients in their work, but only 13% felt prepared to meet their needs. Almost four out of five nurses have received no specialist training and just 1% said their pre-registration course included the subject.

The RCN is calling on the government to ensure the care of trans patients and those with gender dysphoria is introduced at all levels of nursing education. 

Discrimination 

Gender dysphoria is the experience of dissonance between the physical appearance and the personal sense of being a man or woman. It can take many years before an individual feels sufficiently confident and capable of describing their true gender identity to others, so some patients may be diagnosed later in life. 

In June, the college published new guidance for nurses to help them meet the needs of patients who identify themselves as transgender or trans. This sets out the treatment that a trans person may undergo as they transition to their true gender, as well as health risks they may face and information about ongoing surgical and urological care.

Previous reports have highlighted that many transgender people face discrimination when it comes to accessing health services. In January 2016, the Commons’ Women and Equalities Select Committee’s Transgender Equality report found that transgender people encountered significant problems ‘due to the attitude of some clinicians and other [NHS] staff who lack knowledge and understanding — and in some cases are prejudiced.’

Despite a clear rise in children experiencing gender dysphoria – specialist clinic Tavistock and Portman NHS Trust reported a 100% increase in referrals last year – only 14% of nursing staff said their current service was equipped to meet the needs of children who identified as transgender or non-binary.

Expert comment

Parkside Hospital, London lead nurse for genital reconstruction surgery Iffy Middleton

‘The biggest change that nurses can make for trans patients is to stop misgendering. So many patients will tell me that a nurse has called them Mr when they are women and vice versa, or at a GP surgery their name will flash up on the screen as Mr Janet Smith. At our hospital, we refer to all patients by their first name, without a pronoun.

‘If nurses are not sure how someone likes to be addressed, they should ask rather than assume. These little things can prevent a patient from having a positive experience in hospital. In trans patients, there are high rates of mental health problems, including autism and Asperger’s syndrome. Don’t focus on the procedure patients have come in for, but care for them as a whole.’

Implications for nurses

All nurses should be positive and proactive when welcoming trans patients in to services, according to the RCN.

Always treat trans patients in a respectful way. If you are unsure about a person’s gender identity, or need more clarity about how they would like to be addressed, ask them politely and discreetly.

Remember to avoid disclosing a patient’s trans status to anyone who does not explicitly need to know and discuss issues related to a patient’s gender identity in private and with care and sensitivity.


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