Imagine you’re midway through a busy shift and a family comes in with their teenager. The teen identifies as transgender, and their parents are desperate for answers.
They’re asking for help — guidance, support, maybe a referral to a specialist. You want to help, but the law in your state prohibits or limits gender-affirming care for minors.
How do you help this patient without jeopardizing your license and facing other legal consequences? And if you’re conflicted personally or otherwise, how do you balance your values with your obligation to provide quality patient care?
This scenario isn’t hypothetical. It’s the reality in Texas, where three doctors are being sued by the state for allegedly violating a law prohibiting gender-affirming care and, in some cases, allegedly “misrepresenting diagnoses” in order to provide hormone treatments. The physicians are facing the potential loss of their medical licenses.
While the lawsuits target doctors, the implications for nurses are just as serious. Families often turn to us first, relying on us to explain complex treatments, provide emotional support, and connect them with resources. However, in the current legal climate, even well-meaning actions can have consequences.
Let’s break down the issues at hand, why this topic matters, and how nurses can navigate these challenging times.
What happened in Texas?
In June 2023, Texas Governor Greg Abbott signed SB 14 into law, prohibiting the use of puberty blockers, hormone therapies, and gender-affirming surgeries for minors. Violating this law, which took effect on September 1, 2023, can lead to disciplinary action, including the loss of a medical license.
Last fall, news broke that Texas Attorney General Ken Paxton was taking action against the three doctors, alleging that they provided care that violated SB 14. These lawsuits have ignited fierce debate, highlighting the legal and ethical dilemmas healthcare providers face.
What is gender-affirming care?
Gender-affirming care refers to a range of medical, psychological, and social support services that help individuals align their physical characteristics and lived experiences with their gender identity. Key aspects include:
- Mental health support - Counseling or therapy to explore and affirm gender identity, reduce stress, and build resilience.
- Social support: Guidance in navigating name or pronoun changes, social transition, and creating affirming environments at home, work, or school.
- Medical interventions - Includes puberty blockers, hormone replacement therapy, and, for some, gender-affirming surgeries. These interventions are provided based on age, consent, and individual readiness.
- Affirmative primary care - Routine healthcare delivered in a way that respects and affirms gender identity, addressing the specific health needs of transgender and non-binary individuals.
Gender-affirming care is evidence-based and endorsed by leading health organizations, including the American Academy of Pediatrics.
Why should nurses care?
As nurses, we’re often the first point of contact for patients and their families. Our roles as educators, advocates, and caregivers put us in a unique and sometimes precarious position. Laws like SB 14 make it more challenging to provide patient-centered care — even give advice or provide referrals — while protecting our licenses and careers.
Here’s why this issue hits close to home:
- It could happen to you - Whether you’re assisting in a procedure, educating a family, or simply offering emotional support, your actions might be questioned under these types of laws. If a parent asks you about gender-affirming care options, how do you respond without risking legal trouble?
- Other states have similar laws - Texas is not alone. Over 25 states have enacted or proposed similar legislation. Florida, Indiana, Missouri, and Alabama are among the states where gender-affirming care for minors is heavily restricted or under legal challenge. Travel nurses and nurses in the telehealth sector must navigate an increasingly complex regulatory environment that can vary from state to state.
- Our code of ethics comes into play - We are taught to openly and honestly advocate for our patients, protect their dignity, and provide compassionate care. But what happens when a law limits what you can say to or do for patients? How do you balance the ethical duty to advocate for your patient with the need to comply with the law?
What nurses can do to navigate these types of situations
1. Stay informed
Knowledge is power. Policies are constantly evolving, and staying informed is the first step to protecting yourself and your patients. Subscribe to updates from professional nursing organizations, advocacy groups, and trusted healthcare news sources to stay in the know on important healthcare topics.
2. Advocate for change
Whether you agree or disagree with laws like SB 14, nurses are among the most trusted professionals in healthcare, and our collective voice can drive change. Advocate for evidence-based policies that protect both patients and providers. Write to legislators, join professional organizations, and participate in grassroots efforts to influence policy.
3. Protect yourself legally
If you’re involved in any aspect of gender-affirming care, consult with legal professionals or your workplace’s compliance team. Understand your state’s laws, and if something feels unclear, don’t hesitate to ask for guidance.
4. Support patients without breaking the law
Nurses can still make a difference by:
- Providing emotional support - Using a patient’s chosen name and pronouns is a compassionate practice that helps create a safe and affirming space.
- Educating within boundaries - Share general, publicly available educational resources about transgender health, but avoid offering advice that could be interpreted as facilitating restricted care. Always document your actions thoroughly.
When in doubt, seek guidance from legal counsel or compliance officers to ensure your actions align with the law and your professional obligations. You should be able to expect your nursing leadership to be aware of state or federal laws that impact your care and to educate you on how to proceed, as well as create hospital policies that guide your actions.
Questions to consider
- How would you feel if another law is passed that affects the care you provide, such as mental health services or end-of-life care?
- How would you feel if a trusted colleague lost their license for following evidence-based standards of care that may be considered not in line with or in direct violation of state law?
- When patient needs and legal boundaries conflict, how do you balance your ethical commitment to advocacy with protecting your career?
These questions are not hypothetical — they’re the daily reality for nurses.
A call to action
The lawsuits in Texas are about more than just three doctors. They’re about the future of healthcare and the critical role nurses play in it.
For some nurses, laws like SB 14 challenge the core principles of the nursing profession: patient advocacy, compassionate care, and evidence-based practice. For others, these laws are seen as a safeguard, ensuring that children and adolescents wait until adulthood before making life-altering decisions. Regardless of their stance on this issue or other controversial issues, nurses have a fundamental responsibility to advocate for their patients.
These challenges won’t go away overnight, but we can navigate them with integrity and resilience by leaning on our training, ethics, and each other.
