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Respecting Patient Pronouns and Using Gender-Affirming Language in Medical Care

Greater acceptance of individual self-expression is requiring the removal of outdated social norms and assumptions around gender expression. Healthcare settings are having to adapt in order to provide optimal care to all patients. Using gender-affirming language is crucial to helping patients feel safe and comfortable.

The following are five ways nurses can incorporate gender-affirming language into their everyday practice:

1. Start With Admission Forms

During an initial health assessment or admission intake, nurses must use a two-step approach to address gender identity, even if your organization's forms or electronic health records (EHR) are not updated. Ask questions like: What is your sex assigned at birth? What is your gender identity? 

Birth sex answers are usually binary — either male or female. However, people may be intersex, which means someone is born with sexual organs or genitalia of both genders. While it's possible to surgically alter one's body to better fit the physical "male" or "female" classification, not all intersex individuals choose to undergo such transformations.

Responses to gender identity are typically male (man) or female (woman). Others may respond that they identify as non-binary (without a gender), FTM (female to male), MTF (male to female) or trans (transgender). Use open-ended questions about gender identity to promote discussions without any predetermined definitions. Taking this approach helps patients feel safe and seen.

Ask Your Patient About Their Pronouns

Introduce yourself with your pronouns. For example, "Hi, I'm Leah, your night shift nurse, and my pronouns are she/her. How may I refer to you?" or "How may I address you?" An open-ended question leaves room for them to state their preference.

If your team members share patient pronouns in change-of-shift reports, rephrase your introduction to signal cohesive care. For example, "Hi, I'm Leah, your night shift nurse, and my pronouns are she/her. Josey, your day shift nurse, told me that you prefer they/them. Is that correct?"

Practice this introduction regularly until it feels natural. If patients think it is odd or they ask, you can explain that you want to help all patients feel comfortable discussing gender with their care team.

2. Consider a Chart Sticker

Until pronoun preferences are available in all areas of the EHR, within all team communication, and clear on all forms, nurses can improve patient care by improving access to a patient's pronouns within the care team. If you use a paper chart or report form, consider adding a chart sticker to include patient pronouns/gender identity by their name or modify your form. For example, signature blocks or profiles on LinkedIn often have the person's name, with their preferred pronouns next to their name, like so: "Jane Smith (she/her)."

Role Model for Your Colleagues

Be a role model when doing team rounds or communicating with colleagues. Ask about the patient's preferred name and pronouns, or state them if you know what they are. If you are doing a change-of-shift report at the bedside or chairside, consider starting the information with the patient's legal and preferred names and pronouns. For example, "This is Susan Hillman, who prefers to go by Suzie and uses pronouns xe/xem. Suzie is a non-binary 26-year-old who is on day two of admission for a fractured left tibia/fibula from a skateboarding accident." 

It's common for people to go by names other than their birth name, such as "Bill" for "William" or "Mike" for "Michael." It's affirming to call someone by a name they use, which fits them. However, it can be offensive or disorienting if you use a name that they don't use and that doesn't fit them. For example, your patient's legal name in the EHR is "David Jones," but you discover the patient prefers "Denise Jones" because the patient is transgender. Using the wrong name may sour the relationship and make the patient uncomfortable before you've even begun to establish trust. It's best to check with the patient and communicate the patient's preference to others on the care team.

3. Try to Avoid Gender-Specific Terms

Try to avoid gender-specific terms until you know a patient's preferences. For example, if you are on the phone, use their first and last name. Say "Hello, Sally Johnson" instead of "Hello, Ms. Johnson." Leave off words like "ma'am" and "sir" from your offer to help. Say "How may I help you?"

Some cultures see phrases like "yes, sir" or "no, ma'am" as signs of respect. However, in the modern world, it can be offensive or uncomfortable for the person on the receiving end when you use salutations or gendered titles. Retraining your brain to avoid gendered language is a process and will take conscious effort.

Healthcare organizations should update all communication so that staff can access gender identity information. However, until gender inclusion change is universal throughout healthcare, nurses can promote health equity by using gender-affirming language. Focus on one patient at a time and seek to be inclusive in everyday practice. You can show patients that you respect their identity by using gender-inclusive language and asking questions if you are unsure or confused. Escalate your ideas about improving patient-centered care to your manager to help facilitate organizational change.

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