One of the first questions nurses ask patients who visit Callen-Lorde Community Health Center in New York City is which gender they would like to be identified by.
Its not a question posed by nurses in mainstream hospitals, nor is it a query incorporated into nursing school curriculum, but at New York Citys premiere lesbian, gay, bisexual and transgender (LGBT) clinic, its the first of many measures the nursing staff takes to ensure patients receive the utmost in care and support.
We want [nurses] who have the desire to serve our type of clientele and the understanding of why people come here we want our nurses to make the world a better place for our community, says Kevin Steffens, RN, MBA, director of nursing. Its true for all patients but specifically for the LGBT community, having a place where you can get quality and sensitive care. You dont have to worry about who you are, and youre more willing to go.
Upon hiring, Callen-Lorde nurses are educated and tested on general safety and sensitivity issues and receive transgender specific sensitivity training, which has been provided by a transgender individual for the last several years. During training, staff are educated on items such as correct pronoun usage, hormones, transition surgeries and which mainstream facilities have received transgender training for referrals. Further, yearly workshops on issues relating to transgender health issues are given, Steffens says.
But the quality most desired in employees is compassion and a desire to serve the community health centers mission, which focuses on providing sensitive, quality healthcare to New Yorks LGBT community regardless of ability to pay, Steffens adds.
The come-as-you-are philosophy appeals not only to individuals who traditionally have been marginalized in mainstream settings about 25% of Callen-Lordes patients consider themselves straight, says Ed Galloway, director of development and communications.
Unique Services for Non-traditional Patients
While Callen-Lorde typically provides the same types of exams, procedures and treatments that straight, gay, lesbian and bisexual patients receive in mainstream clinics, the non-traditional services provided set it apart from ordinary healthcare facilities, Galloway adds.
For some with the fewest options, like transgender patients, were the only [clinic] in town, he says.
Among the unique services offered are gynecology care for trans-masculine patients, prostate exams for trans-feminine patients, hormone therapies and counseling on transition surgeries. Additionally, the center employs a transgender case management social worker who coordinates care for Callen-Lordes transgender clients.
The specialized nature of these services mandates the centers nurses retain an acuity of transgender sensitivities that extends beyond the clinical, explains nurse educator and adherence support nurse E. Phipps, RN, BSN.
Certainly being of trans experience can make you more sensitive toward a trans client, but not even necessarily so because there are social and clinical considerations when working with trans folks, Phipps says. A number of factors, such as discrimination and lack of training, results in a lack of ability to provide competent care.
For example, says Phipps, who identifies as a member of the transgender community, trans patients are affected by social, medical and economic discrimination, which often are insurmountable barriers to accessing healthcare. Trans, genderqueer and nonconforming people also are denied care or given poor care because of untrained providers, Phipps adds.
According to the Gay and Lesbian Medical Association, 74% of LGBT individuals have experienced discrimination in healthcare, says Callen-Lordes health education consultant, Nathan Levitt, who is enrolled in New York University College of Nursings accelerated BSN program and provides in-house as well as external transgender sensitivity training.
Providing unisex bathrooms; utilizing gender-inclusive intake forms with designated spaces for preferred name and legal name, which streamlines the insurance process; and working with insurance companies to get coverage for hormones and surgeries are among the steps taken by Callen-Lorde nurses and are advisable to become a more clinically, socially and culturally competent provider, Phipps explains.
Many times merely having a provider who identifies as a LGBT individual gives patients the confidence that theyre receiving the highest level of sensitivity.
Ive seen peoples faces light up when they see that I might be trans, Phipps says. I think a big part of what I do is just understanding peoples experiences and being able to coordinate care knowing what I know. For example, when I was doing triage, when I knew the person Im taking on is trans and I have to send them to the ER, I made sure I chose one of the hospitals that has had some level of training about trans-sensitivity.
Simply keeping an open mind while being exposed to the centers wide array of patients helps staff members achieve the compassion required at Callen-Lorde, says John Bosco, MA, a certified clinical medical assistant whos attending Beth Israel School of Nursing in New York City.
Encouraging RelationshipsThe staff at Callen-Lorde Community Health Center, located in Manhattan’s Chelsea neighborhood.
That atmosphere of transparency and sensitivity allows nurses and patients to form relationships that are virtually unheard of in mainstream facilities.
We know that if a patient is not able to talk about who they are, their behaviors, experiences, partners, violence in their life, etc., a provider cannot provide the best care possible, Levitt says. The [nurses] provide an environment where a LGBT person can truly be themselves without fear and not hide any parts of themselves.
In fact, interactions are so positive at Callen-Lorde that many patients seek employment at the center, as was the case with Levitt, Bosco and Phipps.
Certainly not every provider-patient relationship is flawless Phipps says she sought employment to increase staff transgender sensitivity but when a mistake is made, an apology is offered and the provider moves on, Steffens says.
But its the thought that theyre improving the quality of healthcare and the very lives of their patients that provides Callen-Lordes nurses the most job satisfaction.
Everyone I see I feel has been through a lot, and I feel that so often I have been lucky here to be part of this reciprocal energy exchange in the kind of work I do, Phipps says. I consider it an amazing privilege to have that.
While staff members say they hope one day society wont need places such as Callen-Lorde, the clinic reminds them that there are hopeful pockets of the world where everyone is accepted.
It helps me believe that we can create a more inclusive, empowering vision of healthcare and provide a place of belonging and home, Levitt says.
Nurses interested in receiving sensitivity training should contact Callen-Lorde. Its clinic educators are willing to teach healthcare workers and associations about sensitivity and transgender care, Steffens says. For more on the clinic or to refer a patient, visit www.Callen-Lorde.org or call 212-271-7200.