Nursing Care of Transgender and Gender Fluid Youth in Diverse Settings

By Dr. Jan Kaminsky

Larger numbers of children and adolescents are identifying outwardly as transgender or gender fluid, and they are being seen in a wide variety of healthcare settings where nurses are present. Transgender and gender fluid youth are a highly vulnerable population and are at risk of poor health outcomes up to and including suicidality. Self-injurious behaviors such as cutting, burning, substance use, and unprotected sexual activity are unfortunately common (Spack et al., 2012). Nurses hold a unique position of trust and are therefore perfectly situated to support these youth at every health-related interaction.

Transgender is defined as of, relating to, or being a person whose gender identity differs from the sex the person had or was identified as having at birth. Gender fluid is defined as of, relating to, or being a person whose gender identity is not fixed. These are both distinct from sexual orientation, which refers to whom a person is romantically or sexually attracted to (Merriam-Webster).

Nurses interact with transgender and gender fluid youth in a diverse array of clinical settings, including primary care, the emergency department, and other hospital units, as well as in schools, community settings, and most other areas of care. It is incumbent upon us to have at least basic working knowledge of how best to support the care of these young people. For example, I have heard of parents of children as young as six years old being asked what hormones they are taking or what gender-affirming surgeries they have had. This demonstrates a knowledge deficit that healthcare facilities must urgently correct.

We must first be sure to affirm the gender expression of the child, and to always use their preferred name and pronouns when referring to them. This is essential for all staff of a healthcare facility, and can mean the difference between this child developing trust for the healthcare establishment, or being afraid to seek care later on because of the fear of being treated disrespectfully.

For example, simple changes to your care of all children can be made to unlink gendered assumptions from such items as toys or prizes that are used in your care area. Asking open-ended questions such as “Which sticker would you like?” as opposed to “I know you would love a princess sticker!” can help to neutralize your assumptions about the child’s perceived preferences. There should be gender neutral bathrooms available in all facilities, and they should be easy to find. Because of the breadth of our practice, we have a unique opportunity to intervene positively even in small ways in order to improve health outcomes later.

Increased education on language and terminology, utilization of preferred pronouns and names, and general sensitivity to the lived experience of transgender and gender fluid youth is essential in all care areas. All nursing education programs should implement at least a basic level of education on these issues into their curriculum, and hospitals and healthcare facilities should implement and improve policies on working with transgender and gender fluid youth. Future nursing research should include determining best practices for working with these youth. They are among our most vulnerable patients and should be treated as such, with respect and with dignity. 

About Dr. Jan Kaminsky

Jan Oosting Kaminsky, PhD, RN, is an Assistant Professor of Nursing at CUNY School of Professional Studies. Her clinical background is in pediatric intensive care and she completed her PhD at The Johns Hopkins University School of Nursing. Her research interests include vulnerable populations of children in the healthcare system, including gender fluid and transgender children, children of incarcerated mothers, and children in an ICU setting.

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