COVID-19 confirmed the existing realities of healthcare disparities among marginalized communities. Patients of different races and ethnicities experience discrimination and social injustice more than white patients. Those belonging to the LGBTQIA community also experience health disparities, many encountering discrimination in healthcare and finding it difficult to find healthcare providers.

"To me, diversity means inclusion and involvement of people with a wide range of different backgrounds including but not limited to gender, cultural, social and sexual orientation," says Jeffrey Ryan, a registered nurse.

 

Diversity, equity, and inclusion (DEI) in nursing is important because nurses care for patients of different ethnicities, races, and sexual orientations. Studies show patients have better outcomes when cared for by providers that represent them. There are also better outcomes when nurses are educated and trained to understand the specific needs of the LGBTQIA community. 

In this article, we will discuss:

• The importance of LGBTQIA representation in nursing
• Barriers the LGBTQIA community faces when accessing healthcare
• How nurses and nurse leaders can increase diversity, equity, and inclusion in nursing

The importance of LGBTQIA representation in nursing

The U.S. National Library of Medicine defines healthcare disparities as "the differences in access to or availability of facilities and services." The LGBTQIA community has a long-standing history of healthcare disparities and experiencing discrimination in healthcare. 

According to a 2018 CAP survey, 8% said that their doctor or healthcare provider refused to see them based on their perceived or actual sexual orientation. Many belonging to the LGBTQIA community also lack access to healthcare or choose to avoid it altogether. 

Although healthcare leaders and stakeholders are making strides in prioritizing the importance of DEI, there is still a lot that needs to be done. To date:

• About half of LGBTQIA people still live in states that do not protect them from job discrimination.
• According to a Harvard poll, 57 percent said they've been subject to anti-LGBTQ slurs, and 53 percent said they've been subject to offensive comments about their identity.
• More than one in six LGBTQ adults report avoiding healthcare due to anticipated discrimination.
• Discrimination against the LGBTQIA community has been associated with high rates of psychiatric disorders, depression, substance abuse, and suicide. 
• The LGBTQIA community continues to experience denial of civil and human rights. 

In the U.S., about 4.1% of the general population, which is close to 10 million adults, identify as LGBTQIA. Representation in nursing is essential because nurses should reflect the community they serve. The patient population in any given setting is diverse.

"Incorporating diversity encourages cultural competence and reduces health disparities," says Ryan. "A patient is more likely to give their complete health and social history if they feel comfortable and safe with the healthcare workers they have access to."

 

Barriers the LGBTQIA community face in the nursing profession

A barrier, Ryan believes, is nursing schools lacking the resources to care for the LGBTQIA community.

"There is not enough emphasis on LGBTQIA-directed care in nursing school," he says. "Nurses are going out into the field not knowing how to properly communicate and care for these patients and their specific health conditions."

 

Nurses who belong to the LGBTQIA community also experience barriers or biases within the nursing profession. They include:

• Exclusion from peers
• Discrimination
• Societal stigma

One bias Ryan faced was the stigma in healthcare towards the queer community. Ryan wasn't out during the first five years of his nursing career.

"People spoke freely around me on their opinions, not knowing I was queer," he says. "It was disheartening to listen to providers speak in such ways."

 

How nurses and nurse leaders play a role in increasing diversity, equity, and inclusion in nursing

It's imperative that nurses and nurse leaders make DEI a priority to prevent delays and denials of medically necessary care to the LGBTQIA community. Lack of access to care and discrimination leads to higher risks of health conditions such as:

• Heart disease
• HIV
• Sexually transmitted diseases
• Obesity
• Breast, cervical, or anal cancer 

Nurses and nurse leaders are playing a role in increasing DEI in nursing. Here are a few initiatives:

• In 2018, the American Nurses Association put out a statement reinforcing the recognition that nurses must "deliver culturally congruent care and advocate for lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) populations." 
• The code of ethics for nurses includes nurses practicing with compassion and respect regardless of a patient's sexual orientation or gender identity. 
• The American Association of Colleges of Nursing (AACN) advocates for increasing DEI in nursing and offers webinars and events for nurses and healthcare providers to expand their training and knowledge on DEI. One webinar focuses on Caring for the person: LGBTQIA+ palliative care. They also offer a toolkit for faculty to include DEI into their curriculum.
• Healthy People 2030 is a national healthcare initiative to help guide disease prevention and promotion. Its vision is also to eradicate healthcare disparities and inequities experienced by the LGBTQIA community.

"A patient is only cared for as well as they are represented," Ryan says. "Shifting the culture to incorporate more diversity in staff as well as diversity training will only result in an overall better experience for patients and staff alike."

 

To have an inclusive workforce, nurses and nurse leaders need to focus on their own implicit biases. Implicit bias is when we have preferences or attitudes towards people and label stereotypes without knowing it. Mandatory hospital and facility-focused information sessions on DEI are a necessary step in helping eliminate some of the barriers the LGBTQIA community face.