Defusing Bigotry at the Bedside

By Fidelindo Lim DNP, CCRN and Daniel Borski, BA, BSN, RN

          In more than a decade nurses have earned the public’s trust and has garnered the highest rating in honesty and ethical standards among the professions (Gallup, 2013). The onus is upon every nurse to remain true in treating every patient with unrestricted compassion and respect (ANA, 2008).  All health care professions subscribe to similar code of conduct that upholds the primacy of the patient’s interest (ANA, 2008). As health care become more complex and complicated, these ideals are sometimes tested during patient-provider interactions.

          A New York Times article about a racist verbal attack by a patient against a physician has revived age-old questions on how health providers should respond when they become the target of racial epithets (Jain, 2013). A variation on the same theme is what if the patient is homophobic? Last year, a senior male nursing student and I walked to the bedside of a 65-year-old patient who was admitted for a fractured humerus. After the customary introduction, the patient rolled his eyes and contemptuously said (to no one in particular) “I have a broken arm and two gay guys just walk in; I’m screwed”. There was fury in his face and I was flushed with anger. Holding ourselves in check, the student and I ignored the patient’s comment and focused on inspecting his broken arm. Inwardly, I seriously doubted whether I can sincerely continue caring for this patient. Getting out of the patient’s sight was a great relief.

          How do nurses in general; lesbian, gay, bisexual, and transgender (LGBT) nurses in particular, remain the ambassadors of goodwill and live up to the public’s trust under anti-gay verbal aggression? Was our experience an isolated incident? Recent findings indicated that the overwhelming majority (92%) of a national sample of LGBT persons reported that society has become more accepting of them in the past decade and anticipate that even greater acceptance will be felt in the next decade (PEW, 2013). Likewise, the attitude of the general population towards LGBT is increasingly positive, with 59% of those surveyed reporting that LGBT relationships are morally acceptable (Newport & Himelfarb, 2013). This favorable shift in social attitudes may suggest that future LGBT workers might find themselves in more welcoming and inclusive environment than their predecessors. However, the demographic and cultural disparities between providers and patients may cause occasions for socially conditioned prejudice to manifest under stressful situations. Younger LGBT health professionals who have never experienced prejudice and are “out” at work may have acquired a sense of false assurance that everyone is an LGBT ally. Homophobic and racist remarks whether uttered by a patient or a colleague casts a long shadow and LGBT nurses may not have considered its possibility.

          The exact number of LGBT nurses cannot be fully known. Extrapolating from the current consensus that approximately 5 to 10% of the population is LGBT (Grant, Grant, Koskovich, Somjen, Frazer, & Bjerk, 2009), there could around 170,000-340,000 nurses who are LGBT out of the 3.4 million nurses (RNs and LPNs) in the U.S. (Health Resources and Services Administration, 2013). In spite of this significant number, very little is written about their experiences with regards to patient interactions. Reflecting on my experience, I wonder what other LGBT nurses would have done under similar circumstances.

          With national polls now showing that majority of the nation supports gay marriage, one might think that homophobia is a thing of the past. However, homophobia, along with other prejudices such as racism, anti-Semitism and sexism, is still present in our society. Being subjected to homophobic remarks from those under our care, whose dignity we are sworn to uphold, creates a morale distress and needs further exploration in health care. How should an LGBT healthcare provider interact with an outwardly homophobic patient under their care?  A review of current literature offers very little guidance on how to cope with such situations. Does the provider “cover” to avoid a possible confrontation? Do they ignore the patient’s aggression, either verbal or physical? Do they have the patient re-assigned; can the nurse request a different assignment? How do these dynamics impact patient health outcomes and staff job satisfaction?

            Other prejudicial situations are similar. A patient could be racist and refuse care from a staff of a particular race. A sexist patient may devalue the skills of workers of a certain gender.  These examples are different from homophobia in that the basis of the discrimination comes from outwardly recognized characteristics. Sexual orientation and gender identity are less obvious though it spans across all races and ethnicity. LGBT nurses who “pass” in their outward appearance of the gender they identify with (e. g. a masculine gay nurse or a feminine lesbian nurse) may be assumed to be heterosexual. As a result, unsuspecting patients and colleagues might express homophobic remarks around them, forcing them to remain in the closet or lead a double life (Giddings and Smith, 2001). For transgender nurses, particularly those who do not “pass” for the gender they identify with, their experiences might be very different, though very little is reported in the literature. It is likely that minority stress may be experienced by closeted nurses and for those who are advocating for inclusiveness but are unsupported or spurned by administrative leaders or colleagues.

          Reporting homophobic aggression perpetrated by a patient may go unreported due to staff fear of unwanted attention, lack of system process for reporting incidents and from the continued emphasis that health care is about the patient – not the staff. Balancing on the limits of what the staff is willing to compromise will prove to be a litmus test for LGBT nurses that go beyond making excuses for our patient’s intolerance and prejudice.

Found in the October 2015 Issue of Nursing 2015 Magazine
Lim, F. A., & Borski, D. B. (2015). Defusing bigotry at the bedside. Nursing, 45(10), 40–44. http://doi.org/10.1097/01.NURSE.0000469238.51105.20

References

Gallup. (2013). Honesty/Ethics in Profession. Retrieve February 5, 2014 from http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx

Giddings, L. S., & Smith, M. C. (2001). Stories of lesbian invisibility in nursing. Nursing Outlook, 49, 14–19.

Grant, J. M., Koskovich, G., Frazer, S., & Bjerk, S. (2010). Outing age 2010: public policy issues affecting gay, lesbian, bisexual and transgender elders. Washington, D.C.: National Gay and Lesbian Task Force Policy Institute.

Health Resources and Services Administration. (2013). The U.S. nursing workforce: Trends in supply and education. Department of Health Human Services.

Jain, S. (2013). The Racist patient. Annals of Internal Medicine, 158, 632.

Newport, F., & Himelfarb, I. (2013). In U.S., Record-High Say Gay, Lesbian Relations Morally OK. Gallup Politics. Retrieved February 14, 2014 from http://www.gallup.com/poll/162689/record-high-say-gay-lesbian-relations-morally.aspx

PEW Research Center. (2013). A survey of LGBT Americans: Attitudes, experiences and values in changing times. Retrieved February 14, 2014 from http://www.pewsocialtrends.org/2013/06/13/a-survey-of-lgbt-americans/1/