Expert Viewpoint

Research + Practice + LGBTQ+

The UIC College of Nursing is home to some of the country’s foremost experts on sexual and gender minority health. We brought two together to discuss how research and practice meet to inform care for this population.

Wendy Bostwick (W.B.): We know that sexual and gender minorities do experience discrimination, mostly in the form of microaggressions. We know that trans and gender-nonconforming or non-binary people are especially likely to experience discrimination in health care settings.

Paige Ricca (P.R.): I hear these types of stories working with youth. I’ve been on the wellness team for the Illinois Safe Schools Alliance–Action Camp [a five-day camp that brings together LGBTQ+ youth leaders and allies] four times. Youth come from all over Illinois. They tell me they drive two hours or more from the middle of Illinois to go to Howard Brown Health in Chicago [a federally qualified health center serving the LGBTQ+ community], because that’s where they feel the safest. They’re not going to seek care elsewhere because they don’t want to be traumatized by a discriminatory experience.

W.B. We tend to think of “health care” as a solution to disparities. That’s not always the case. Sometimes health care creates, promotes and exacerbates disparities. Research shows that discriminatory experiences in a health care setting will cause people not to go back, or to delay seeking care, which can worsen problems to such an extent that people only show up in the ER. It’s a bad cycle; that’s not what we want to be happening, especially if we’re trying to think preventatively.

In a city like Chicago, yes, we do have plenty of places that are LGBTQ-focused. There can still be quite a dearth of either allied or actual queer providers in rural areas.

P.R. When I worked with 360 Youth Services out of DuPage County [which offers housing, counseling and prevention services], there was only one provider that the director felt she could recommend to her LGBTQ+ or non-binary youth. In DuPage County, a pretty populated county, that’s kind of scary.

W.B. Welcoming and affirming health care settings are not just about the nurses and the physicians. It’s also about the literal environment. What are the posters on the wall? What sort of signage is on your bathrooms? Do they say “all genders,” or do they say men and women? What do your forms say? How does your front desk staff treat people?

We have many alums who are in higher-level positions that can advocate for ensuring these policies are in place. There are administrative-level things that even non-practicing nurses can be engaged in. Advocacy is a huge part of what we’re talking about here. It’s not just practice. There’s a whole host of things that happen before someone even gets into the examination room.

P.R. This was exactly the focus of my DNP project, which involved creating a quality-improvement tool to enhance LGBTQ+ sensitivity in a clinic setting. That included having a leader who champions the continuation of trainings and other policies.

W.B. I think there’s room to grow within colleges of nursing, in terms of to how and when we train our nurses on LGBTQ+ health issues. We need to ensure that principles of equity—whether that’s racial, gender or queer equity—are integrated into our curriculum starting the minute our students walk in the door.

P.R. We need to infuse it early in the process, and we are getting better. I can speak to one example. I coordinate and teach in the pediatrics/OB course for prelicensure master’s students. When I first got here in 2018, I talked to the coordinators about making one of the simulations involve a transgender child—in the middle of transitioning—presenting in the ER with signs of dehydration. We also included LGBTQ+ cultural sensitivity training prior to simulation day.

In our community health courses, we’re introducing students to more gender-nonconforming patients so that we can use a more affirming approach, an approach that enhances cultural safety. We’ve also gotten better about hiring authentic actors who are gender-nonconforming and trans for standardized patient simulations.

W.B. I want to point out that while there’s absolutely a need for trans- and gender-focused trainings, it’s also the case that the needs of all sexual minority people [including those in the ‘L,’ ‘G’ and ‘B’ categories] need to be considered, affirmed, recognized and acknowledged. There is variation within the [LGBTQ+] population, and good training will make the space to identify those distinctions for students so that they’re not treating LGBTQ+ patients as a monolithic population.

For practitioners, I go back to my number one rule, which is basically, don’t be a jerk [laughs]: Make no judgment about sexual partners or behaviors, mirror people’s language, don’t make assumptions.

P.R. I’m still growing as an expert, so I rely on other experts who have given me a lot of guidance about translating knowledge into clinical practice. The National LGBTQIA+ Health Education Center [Bostwick is adjunct faculty with The Fenway Institute, which runs the center] has fabulous mini seminars for training. “The Clinician’s Guide to LGBTQIA+ Care” is a gold mine. [Clinical assistant professor] Randi Singer is a co-editor.

W.B. So much has changed in 20 years. I work in this area, and I am the first to admit that language is changing very quickly, but staying abreast of language is important, because how we address people is a fundamental sign of respect.

P.R. It’s dynamic. It always has been and always will be.

W.B. I think there’s a lot of opportunity within our own College of Nursing when it comes to sexual- and gender-minority health. I certainly see more and more students open—and having a desire—to focus on these sorts of issues in all areas of practice.

P.R. It’s important to recognize faculty from the college who were earlier leaders, like [professor emerita] Tonda Hughes, Charlie Yingling and Carrol Smith.

W.B. We have a lot of people in the college who are interested, willing and already working on this. And it’s just a matter of fostering and supporting those collaborative endeavors.

READ MORE Go to go.uic.edu/BostwickRicca for a longer version of this conversation.