MacDonnell and Alisa Grigorovich. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gender Lesbian gay bisexual transgender and
Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace nurses experiences in the workplace work, as social determinants of health for trans people, both shape and are shaped by multiple factors such as support networks, social environments, income and social status, shelter, and personal health practices.
There is a gap in the nursing Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace in regards to research on work and health for diverse trans people and a virtual silence Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace the particular issues of trans-identified health providers.
This qualitative study used comparative life history methodology and purposeful sampling to examine links among work, career, and health for transmen who are health providers. Critical gender analysis showed that unique and gender-related critical events and influences shape continuities and discontinuities in their careerlives.
You know, should gender presentation, the way you dress… what you choose to talk about or not talk about…? Does it really disrupt… the workforce… in such profound ways?
Transman TMpage 7. Despite greater Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace and professional awareness of sexual and gender diversity and more positive work climates in recent years, lesbian, gay, bisexual, transgender, and queer LGBTQ people continue to encounter invisibility, overt and more subtle discrimination and violence, and other barriers to relevant, respectful care. Typically, transgender is used in the broadest sense to refer to people who transgress gender norms in some way [ 2 ].
Within trans communities, individuals
Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace their gender and subscribe to identities in a variety of ways. These include transmen, transwomen, and genderqueer, and trans identities may shift over a lifetime [ 4 ].
Considerable hurdles also exist to locating sensitive and knowledgeable health providers, trans-positive services and obtaining hormone therapy or surgery if so desired, especially outside of large urban cities [ 68 ]. As social determinants of health, employment, and working conditions for trans people both shape and are shaped by multiple factors such as support networks, social environments, income and social status, shelter, and personal health practices [ 67910 ].
Decisions to transition in the workplace are informed by many factors that include Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace, available support systems, and weighing the costs of job-loss or unpredictable discrimination that mark many environments for trans people [ 8911 ].
LGBTQ workplace issues have recently become high profile in North American media in relation to same-sex benefits, legal protections, and organizational policy and diversity education initiatives, and guides to support transition in the workplace are becoming increasingly visible [ 101213 ]. Yet, workplace support for gender-variant individuals and those who self-identify on the trans spectrum remains highly politicized, even within LGBTQ communities.
In Canada, inclusive change related to diversity is part of broader social policy and health professional advocacy for equity; nursing in particular has taken leadership in a Canadian context of the professions [ 1 ].
However, the policy context in which discrimination occurs for trans people is still fraught. Many are forced to leave education before completing high school due to experiences of harassment, bullying, and violence, yet there is some evidence that despite this, many are able to achieve some level of higher education [ 810 ].
Inthe Canadian Professional Association for Transgender Health CPATH also emerged to offer resources and professional support for those involved in trans health provision, creating a community for trans-identified providers and allies to be visible in a professional context.
However, few trans-identified members of the regulated health professions e. As a result, research that fosters an understanding of factors that influence the career, work, and health of diverse trans providers is needed to illustrate the complexities of their lives with the goal of creating supportive policies and practices.
In a nursing context, recent attention to the need to broaden understandings of culturally competent care in order to meet the diverse and holistic needs of patients and clients has pointed to the importance of addressing sexual diversity, and to some extent, transgender health [ 21 — 24 ].
Yet, when this is addressed, most health studies, including nursing research, focus on the context in which trans people are assumed to be patients or clients. By default, the assumption is that all care providers are not trans-identified, but cisgendered a term used to describe people who are not transgendered [ 22 ] and this has important consequences for the ways in which the health issues of diverse trans people are identified and articulated, and thus the practice strategies that are deemed relevant to supporting them.
This paper foregrounds the experiences of health providers who themselves are trans-identified and illustrates the links in their work, careers and health and wellbeing, and the complex ways that gender is implicated in their lives.
In particular, this paper focuses on how transmen who are health providers make meaning through their careerlives, that is, meaningful life activities encompassing work and personal endeavors, with implications for their health and wellbeing. This paper explores intersections of gender, health and work or career for transmen health providers in relation to their everyday lived realities. In particular, this paper explores two research questions.
This qualitative study used a comparative life history methodology design. this study in the naturalistic and critical paradigms was appropriate for this exploratory study that examined sensitive dynamics of identity, work and career, and complex aspects of power.
In this approach to policy research, the goal is to generate understandings of policy and related processes and practices through the eyes of policy actors themselves in the field [ 27 ]. In this study, careers are conceptualized as moving beyond the organizational context to encompass meaningful life activities across the lifespan [ 29 ]. Historically, sex has referred to biological characteristics that were used to determine discrete binary categories of female or male.
For transgender people, for example, binary categories of male and female are inadequate to represent the fluid and socially constructed nature of sex and gender. To understand their health requires simultaneous attention to the ways that gender norms influence gender expression and identities [ 2230 ].
It also encompasses how both material e. Although gender-based analysis has typically been used to examine how gender matters in the lives of cisgendered women and men, Johnson et al. In this study, we incorporate this gender lens from the outset of the study [ 30 ], mindful of the ways that this methodology influences the way the study is conceptualized and questions asked, the data collection, analysis, and sharing of findings.
As a type of feminist research, there is also an assumption that the research has political goals with an aim to improve everyday lives of transgender people.
Ethics approval from York University Research Ethics Board was received prior to commencing the study. At that point, a call for advisory group members for the study was sent out, and two trans-identified community members responded and provided feedback on the study materials and procedures.
The principal researcher, a health professional, conceptualized the study and was involved with recruitment, data collection, analysis and presentation of initial findings.
The authors of this article, both of whom been involved with LGBTQ advocacy and research, collaborated on analysis and developed this article. Thus the study aimed to recruit both health and social service providers who were self-identified as trans e. This paper,
Lesbian gay bisexual reports on the trans-identified providers and specifically, trans providers who self-identified as transmen.
Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace and queer/questioning nurses experiences in the workplace,
The interviews focused on career histories, everyday activities, experiences of health and work, as well as factors that shaped career and workplace decisions and practice dynamics. The advisory group affirmed the focus of these questions in relation to the purpose and scope of the project. Face-to-face or telephone semi-structured interviews were completed from April to April with four participants who self-identified as transmen. Probes were used to encourage participants to provide thick description and elaboration on the context of points raised [ 31 ].
These interviews lasted from 1 to 4 hours and were audiotaped and professionally transcribed. Participants were offered a small honorarium. Steps were taken to protect confidentiality and privacy. Conventional content analysis [ 31 ] was chosen as an inductive approach, a method that is appropriate for examining qualitative data for a study that is exploratory and whose aim is to describe a phenomenon which is not well understood.
Analysis of descriptive data emerging from the interviews was guided by the Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace analytical approach with its focus, for example, on social dynamics, gender norms, and experiences of gender variance. Both researchers independently coded the transcripts for themes and subthemes that were guided by an understanding of gender dynamics e.
Where possible, verbatim phrases were used as codes. I see both of these unfolding more in the future. Under the theme of Critical Influenceswe identified a subcategory: The two researchers these initial themes, which were then validated using consensus process and were informed by the existing literature.
When there was disagreement on emerging themes, discussion ensued with return to the transcripts until the researchers reached consensus. Thus the way gender-based analysis was used in this study considers the ways that gender normativity provides a reference point for understanding the experience of people who do not fit into the binary categories of male and female.
In this paper, analysis focuses on the career histories of four
Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace providers who self-identified as transmen.
These participants, who ranged in age from their 20s to their 50s, had varied gender histories and experiences from those who had transitioned recently, to those who had done so over 10 years previously. All currently live and work in urban centers in Canada.
The narratives represented experiences of students in professional and alternative health programs and providers with decades of work experience, some also with international experience. Because of the extremely small pool of openly trans-identified health providers and specifically those with professional credentials in a Canadian context, narrative excerpts and findings are reported in this paper in ways that will not identify participants; information such as age, profession, and place of work are omitted.
TM identifies the participant as a transman, and a page number from the transcript is cited. Themes relate to their engagement with their trans identities and careerlives with implications for fostering or challenging their health and wellbeing.
These narratives point to the ways that such dynamics can also influence their
Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace of becoming aware of a masculine trans identity as relevant to their wellbeing. All four participants shared that their engagement with a trans identity occurred as adults, with three having also incorporated a same-sex identity for most, or part of their teenaged years.
It was all really androgyny…. For yet another participant, this awareness emerged in more gradual and complex ways: And what choices can I make to be more at ease with myself? And I started to think, well maybe I was just made atypically, you know.
In each case, taking on a trans identity was incredibly affirming for these participants on a personal level, even as they
Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace unpredictable challenges for disclosure and gender expression, which prompted both feelings of elation when things were working well and also at times, deeply wrenching emotional upheaval.
Several participants spoke of what drew them to health and care-related In these ways, transmen in this study proposed that their careerlives and career choices represented a holistic, or spiritual component rooted in their gendered identities and their experiences of experiencing marginalization in social institutions. Working in contract positions or in alternative health contexts, which were not publicly funded, prompted some to take on heavy workloads and juggle several jobs—both in health or research and those that were not health-related.
At times, the connection between work and identity was complicated by the material consequences of transitioning. Pressures to conform to rigid gendered expectations for roles and appearance carried over to their presentation in professional contexts and the unease that they experienced. As one participant shared, part of his transition included a gradual change in dress and appearance while working and this visibility in relation to his gender expression was an important step towards enhancing his psychological wellbeing: I used to have long, long hair and I cut all my hair.
Another related that while commuting to work during the transition period he experienced negative incidents riding the bus: Several participants also shared stories of the struggle to get registered as a working professional or to apply to a professional program.
In each case, this professional context was a turning point for the provider. Working and transitioning, Lesbian gay bisexual transgender and queer/questioning nurses experiences in the workplace as a credentialed professional or professional-in-training, meant that these transmen had to worry about how to change their documentation and professional registration, in addition to dealing with the multiple decisions related to, and demands of, disclosing or not and living and working as a transman in various community and work contexts.
As a result of this, application to professional schools and professional bodies was fraught. terms of the work setting, another explained the complicated nature of having to determine how and when to disclose professional education and experiences obtained pretransition: What I struggled with was when to come out. And especially in social… health care… your reputation is, like, being able to verify your character is a very important part of people being able to hire you, right?
Although such processes were eventually resolved for this participant, disclosure of trans identity had significant negative impacts for other participants. Two participants reported that disclosure engendered larger questions about their credibility, mental health, maturity, and fit for the profession itself.
At times, the struggle to disclose or provide professional documentation was avoided by changing their legal name only and deferring transition until later. One participant further illustrated that even in a professional school environment that offered the potential of strong group support, disclosure and transition were not straightforward: It seems like that was too much outing to deal with at once and I knew that they would have to process it because we were social workers.
With few exceptions, trans-identified providers are invisible in health care.