Sunday, January 26, 2014

Coming Out in the Workplace

As most of us know, a job in the healthcare field is unlike any other with its own set of very unique challenges.  Today, I'd like to discuss a particular challenge of being a queer nurse.

One of the fundamental tasks of being a nurse, or any healthcare worker, is to create a therapeutic relationship with your patients.  Establishing this connection is important in being able to effectively communicate with your patients to help empower their health choices.  And often times, it is the simplest gestures that helps to establish this bond; sitting down with your patient, therapeutic touch, and listening.  It is very difficult to maintain a one-way direction for this relationship and many times patients will want to get to know you too.  Do you have any kids? Are you married? If you're not married, anyone special? These are often the introductory questions that patients will ask you.  But these can be loaded questions for the queer identified nurse.  The nurse may have to choose between keeping private about their life (a valid option for queer and non-queer folks alike) and possibly make the patient feel shut out or answer them and out themselves to their patient.  And if your patient is homophobic and you answer honestly, you may run the risk of destroying that therapeutic relationship you've been working so hard to build.

Much research attention has been focused towards the interaction of the healthcare worker with the LGBT population.  However, based on PubMed perusing, very little, if any focus, has been placed on examining the other direction i.e. how patients interact with LGBT healthcare workers.  In fact, only one study, reported perceived discrimination by LGBT physicians, though numbers were not reported on perceptions of discrimination by patients towards LGBT docs.  And though it was noted that the burden of dealing with a discriminatory patient is far worse for the nurse, who must spend more time with such a patient, the research so far has been only physician focused.

The quandary about caring for patients who may hate you has been discussed elsewhere, but its primary focus has been race based.  There's been little exploration about how queer healthcare workers deal with the constant question of outing themselves to their patients.  There are many strategies and I would never fault another nurse for not being out to their patients (or even their co-workers) because every person has a right to their privacy.  But this is honestly not something I've ever discussed with other queer healthcare providers.  I am very curious to know how others deal with this and what their rationale is.  I, personally, have adopted the notion to answer the previous questions honestly (No I don't have children.  No I'm not married, but I do have a special partner.  What does he do?  She's a grad student...)  because I believe in normalizing the queer experience to everyday people.  As of yet, it's gone pretty well and no one has "fired" me from being their nurse, though I've had people become intensely more awkward and quiet.  But generally, people are still receptive and appreciative of the quality care that I work hard to provide.  I've actually had some amazing dialogue with patients about what it's like to be a queer nurse/person and it has even facilitated a better therapeutic relationship.

What I'd like to know is: how do other queer identified healthcare workers deal with this situation?  What have been your experiences, positive and negative?  And can we get some research done on this, especially looking at nursing?

Citations (non-APA style because hey, I'm not a student and this isn't a paper for class):
LGBT docs experiences: http://www.ncbi.nlm.nih.gov/pubmed/22029561
When the patient is racist (original article): http://annals.org/article.aspx?articleid=1676460
When the patient is racist NY Times editorial: http://well.blogs.nytimes.com/2013/07/25/when-the-
       patient-is-racist/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1
Editorial on the role of nursing in LGBT care: http://ppn.sagepub.com/content/12/2/71.long

1 comment:

  1. Hey there. I am a lesbian L&D RN, and there are quite a few of us where I work, docs as well. For me, it's a political stance, always, to be honest. Like, in your example, if someone asks, I don't try to cover it up. And sometimes it does cause an awkward moment, but then I feel like, if this person doesn't want a lesbian taking care of them, they should appreciate the fact that I told them I was one! Very important to me is also being able to provide care for other lesbians, oftentimes they really appreciate having me there.

    ReplyDelete