Asking a transgender patient what their preferred pronoun is can go a long way towards improving their healthcare experience, says mental health nursing student Sami Hillyer   

I am a trans woman, and I am a nurse. Sometimes it feels like these are unrelated, other times they feel inextricably linked. 

Trans people occupy a wide spectrum of internal experience, my own being that I am feminine and wish to be seen as such. Among safe spaces and queer circles, being able to say ‘this is who I am’ can feel liberating, propelling trans people forward and equipping us with the language to define ourselves. 

I have reached a point where I feel confident enough to know who I am. On my last placement, I was out as somebody who is transgender and could enjoy the Christmas party in my feminine presentation. 

Gender identity

But I didn’t want my team to have the ‘burden’ of explaining my gender to service users. We work with vulnerable people, and this is a difficult conversation to have. To expect service users to take on the language of what is often criticised as that of ‘social justice warriors’ can be a bit much. 

What I can do – and what all nurses can do – is use reflection to improve practice and make services more accessible to transgender people. A recent RCN survey of more than 1,200 nursing staff found that 87% felt untrained or unequipped to meet the needs of patients who are transgender, identifying an urgent need to improve training in this area. 

One simple way to improve the healthcare experience for transgender patients is to not assume someone’s gender and to ask people what their preferred pronoun is. 

Self-definition

Person-centred care is at the core of the nursing profession and mental health nurses promote recovery, helping people to live their lives as defined by them. Questioning people about their preferred pronoun affirms this experience, both for trans people and those who may have never thought about what their own experience of gender is. 

We live in challenging times, and as a trans woman I feel I am riding on the edge of what is acceptable and what is reversible.

The recent BBC documentary ‘Transgender Kids: Who Knows Best?’ presented itself as the sharp end of the debate around trans rights and equality. But many trans people thought the programme was not objective, built around mistruths that young transgender people are fast-tracked to gender reassignment surgery. Nurses have a duty to speak out against these untruths. 

The importance of pronouns

Children and young people cannot access gender reassignment surgery but they can be prescribed puberty blockers which prevent hormones developing. These allow for changes, such as the development of breasts or facial hair, to be delayed until the young person is of an age where they can make decisions for themselves. 

I intend to go forward as an out and open trans women in my nursing career. I feel there are opportunities for learning for myself and for others, but the world is changing and all the rules we feel we have played by are being challenged. 

I implore everyone reading this, particularly nursing students, to educate themselves on the needs of the transgender population, including the use of pronouns. 

What may seem small and inconsequential to you and I can often be a life-affirming step in the right direction for people who experience gender variance. 

About the author

Sami Hillyer is a mental health nursing student in south London