June 4, 2025 • 50 mins
TXT us your feedback!! <3 your fayce!
This week on The Ritual Nurse, we're celebrating Pride not just with rainbows, but with radical accountability, affirming care, and professional truth-telling. What does it really mean to practice nursing with equity—not just equality? How do we ensure that LGBTQIA+ and especially transgender patients receive safe, trauma-informed care, even when someone’s personal beliefs might conflict?
Spoiler alert: it’s not about opinion—it’s about ethical practice.
We cover:
- The difference between gender and sex (and why that matters)
- What cisgender and transgender actually mean
- Why using inclusive language is clinical best practice, not “going above and beyond”
- What to do when your personal beliefs and professional role collide
- Real resources for continuing your education as a safe, affirming nurse
- Plus: our “Clinical Pearls for Affirming Care” checklist and a rainbow-wrapped Coffee, Crystals, and Divination segment 💫
Whether you're here to learn, unlearn, or just feel seen—welcome home.
These are real, evidence-based, affirming organizations and tools for clinicians:
LGBTQIA+ Healthcare & Transgender Care
- WPATH – Standards of Care for the Health of Transgender and Gender Diverse People
- The Fenway Institute – LGBTQIA+ Health Education Center
- GLMA: Health Professionals Advancing LGBTQ+ Equality
- U.S. Trans Survey
- OutCare Health Provider Directory
Inclusive & Trauma-Informed Nursing Practice
- ANA Code of Ethics – Provision 8
- Healthy People 2030: LGBTQ+ Health Goals
- National LGBTQIA+ Health Education Center – Glossary of Terms
- The Joint Commission: Advancing LGBTQIA+ Patient Safety & Equity
Further Professional Development
- LGBTQIA+ Curriculum Toolkit (AAMC)
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Love your FAYCES!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:11):
Welcome to the Ritual Nurse, where healing meets
humor, science and a touch ofmagic.
Hey, nurses, besties, healersand hope holders, you've clocked
into the Ritual Nurse, thepodcast that stitches together
science, sacredness andself-reclamation've clocked into
the Ritual Nurse, the podcastthat stitches together science,
sacredness and self-reclamation.
I'm your host, reba, nurse,executive, educator and proud
(00:32):
queer woman, and this week we'relighting up the floor with a
Pride Month episode.
That isn't here to play small.
We're going to talk about whatit means to not just wave the
rainbow flag, but to practicepride in our care.
Whether you're an ally, whetheryou're queer, whether you don't
have any idea, Through advocacy, equity and unapologetic
(00:53):
humanity.
That's how we practice withpride.
If you're a nurse, this one'sfor you.
If you're a queer nurse, maybethis one's especially for you.
You, if you're a queer nurse,maybe this one's especially for
you.
So let's break down what itreally means to offer equitable
care and how.
Treating everyone the same isnot the gold standard.
So equality gives everyone thesame resources.
(01:20):
I talk to my students aboutthis all the time in
understanding the differencebetween equality and equity.
So equality is everybody canwalk through the door.
Equity, however, ensures thateveryone gets the right
resources for their needs.
Equity ensures that everyonegets the care they need, not
(01:44):
just sure they can walk throughthe door and ask for it.
So when we practice with prideagain, whether you're straight,
whether you're queer, whetheryou are unsighted, practicing
with pride is something everysingle nurse has to do, and it's
ensuring that our professionalconduct offers our patients both
(02:08):
equity and equality across theboard, irregardless of their
race, their gender, theirreligion, their sex, their
beliefs.
So the ANA Code of Ethics,provision 8, says collaboration
for human rights and thereduction of health disparities.
The Code of Ethics are actuallysomething that we, as nurses,
(02:32):
are professionally obligated touphold, and collaborating with
each other and interprofessionalteams on behalf of human rights
and the reduction of healthdisparities are an ethical
provision we actually have touphold.
So when we say health equity,what we're meaning is that our
(02:53):
care must account for thesystemic oppression, trauma and
barriers that our patients face,especially those who are queer,
trans or multiply marginalized,are people of color, are
marginal populations, areindigenous populations, are
Black patients and colleaguesand coworkers.
(03:13):
The Healthy People 2030 has aninitiative goal to eliminate
health disparities and advanceequity, and, as nurses, we're
the frontline runners to be ableto do that, to be able to
advance culture, to be able toreverse and eradicate the
(03:33):
systemic disparities and oursocial barriers to healthcare,
our social inequities andhealthcare disparities.
We're the frontrunners to beable to combat that, and it's
really important that werecognize from the very
beginning, no matter again whatour personal beliefs are, that
(03:56):
our professional licensure andresponsibility ethically
requires that we uphold theseprovisions and that we provide
care with both equity andequality in the face of these
disparities, despite thedisparities and eradicate them.
One of the ways that we do thatas nurses is educating
(04:20):
ourselves, and that's reallywhat this podcast is about.
This podcast, this episodespecifically, is about education
and understanding personalbiases and really encouraging
you to take a look at how yourpersonal beliefs may be
influencing and causingprofessional bias.
(04:43):
See, here's the thing I willabsolutely fight for your right
to have your beliefs, whetherthey be religious, whether they
be personal, whether they becompletely opposite of mine or
in accordance with mine orsomewhere in the middle.
I absolutely will fight foryour right to have them.
(05:03):
What's really important,however, is that we're able to
discern whether any of thosepersonal beliefs cause a
professional bias and harm ourpatient.
The way we do that is witheducation.
Implicit bias is something that,psychologically, every single
human has, and implicit bias isunique in that we actually are
(05:29):
subconsciously unaware that wehave them.
There's specific tests that youcan do that are designed to
uncover implicit bias and revealthem to yourself.
But, aside from working with aprofessional or, you know,
completing testing that isdesigned to uncover implicit
bias, we're not aware of it onany level, and these biases are
(05:54):
created by the culture thatwe're raised in, the
psychosocial and socioeconomicpatterns and context that we
grew up in, that our formativeyears were surrounded by that.
The choices we learned to makeas we grew up were governed by,
if you will, that createdpatterns of behavior and
(06:18):
understanding of the contextualworld around us that actually
almost predetermine ourresponses to things and color
our perception of things.
So unless we do the in-depthwork of uncovering our implicit
biases, a we're completelyunaware that we have them and, b
(06:40):
they influence our actionsbefore we even think about
taking them.
They color our perceptionsbefore we've even had a chance
to examine what we perceivedabout the situation.
So, as nurses, we're really kindof obligated to do this work as
(07:00):
we advance in our practice andas we offer care to other people
.
Reason being is our job existsas a power dynamic.
Every patient that comes to seeyou joins in that power dynamic
with you.
As a nurse, and because we're anurse, we actually have the
upper hand in the power dynamic.
And I don't mean that solelyfrom a control perspective,
(07:23):
because, you know, we give ourpatients, we empower them to
have autonomy, we empower themto advocate and take part in
their own care.
But it has to do with trust andvulnerability.
And when your patients come toyou, most of the time, 99.9% of
the time, they're not there fora happy reason.
(07:45):
I mean, yes, of course thereare some areas in medicine that
are happy looking at you, ellenB, but for the most part they're
coming to you in a situationwhere they are the vulnerable
one and they have to sharethings with you and go through
things with you.
Where you have the upper handand the power dynamic.
(08:05):
That means that we have anenhanced ethical responsibility
to do our best to do no harm.
You know the gold standards,beneficence, all that.
Those are actually ethicalobligations that we have to
uphold as nursing professionals.
Now notice, I keep talkingabout ethics and not morals.
(08:28):
Interestingly enough, they'revery separate things and
people's morals can be differentwhile they ethically uphold the
same standards.
That's actually a realpossibility.
Your morals are just aredecided by many of the beliefs
that you hold, especially corebeliefs, given that most human
(08:50):
beings don't share the same corebeliefs, and their formative
experiences and years have endedup with them, you know,
believing different perspectivesabout maybe even the same
topics.
People's morals will vary andthey'll differ, and that's
actually okay.
The ethical obligations andprofessional standards that we
(09:12):
have to adhere to, however,those all have to be the same.
So doing the educational workto uncover your biases and
understand differentperspectives so that you can
meet the ethical andprofessional obligations of
being a nurse and a healthcareprovider are something that we
(09:32):
have to do.
We owe it to ourselves, we oweit to our patients, and the only
way to do that is to educateourselves by exposure, by
investigation, byself-reflection, by
self-awareness and by having theemotional maturity to have
really hard conversations withourselves.
And when we know better, we dobetter, and we have to make
(09:55):
space for other people to do thesame thing.
So that's really what thispodcast episode is about, in
addition to glitter and sparklesand all sorts of fun things.
But let's kind of take a lookhere at Transgender and Gender
Affirming Care 101.
Now I know these are somereally wild trigger words lately
(10:16):
, but again we've got tohighlight some of these things.
We've got to highlight some ofthese actions and implicit
biases and how those don't matchup with the ethical and
professional standards that wehave to meet.
So we're going to talk aboutthings like dead naming and
misgendering andmicroaggressions that are
(10:36):
actually clinical harm.
We're going to talk about theimportance of asking pronouns
and documenting them in charts.
We'll talk about hormonetherapy basics and knowing when
to refer to gender affirmingspecialists.
In the show notes there's goingto be some resources for you to
, you know, look up things.
If this podcast episode doesn'tanswer some of the questions
(10:57):
that you have, you're alwaysfeel feel free to email me and
ask me.
If you don't feel comfortableposting them on socials or as a
comment, you can always reachout to me and ask me.
If you don't feel comfortableposting them on socials or as a
comment, you can always reachout to me and ask me these
questions, but I'll make surethat there's resources in the
show notes so you can continueyour learning and investigation
and exploring other perspectivesif these things are things that
(11:17):
you're unaware of.
So transgender care reallystarts with language and why
words matter.
Let's start with the basics,because before you can offer
safe, affirming care, you needto understand the language, and
not just what the words mean,but what they signify in a
patient's lived experience.
We're not expected to beexperts in everything, but we
(11:40):
are required to provide safe andrespectful care, and that
starts with learning.
So if you don't know thedifference between cis and trans
, or sex versus gender, that'sokay.
Get curious, get educated.
That is our job, and thispodcast episode will hopefully
answer those questions for you.
Let's start with gender versussex first.
(12:01):
So biological sex refers tophysical characteristics.
A person is born withChromosomes, hormone levels,
internal and external anatomy.
We're all nurses and medicalprofessionals.
For the most part.
There are a lot of welcomeindividuals that are not
medically trained that do listento this podcast and get benefit
from it.
So I'm going to kind of coversome of those things.
(12:22):
But when it comes to biologicalsex first of all, according to
science, there's not just onlytwo genders.
That's not opinion, that's nottinfoil hat wearing conspiracy
theory, it's not woke, and we'lltalk about that expression in
(12:43):
another episode, but it's justscience, there's multiple
combinations of chromosomes thatresult in actually more than
just two genders.
Science usually refers to justtwo genders to simplify things
because, for the most part, thathappens to be the predominant
(13:03):
gene expression for our species,but it isn't the only kind.
So we need to make sure thatwe're not using science to
justify unethical,unprofessional and harmful
behavior.
Gender, however, is a socialand psychological identity.
(13:25):
It doesn't have anything to dowith what your biological sex is
.
Sometimes people's genderexpression matches their
biological sex, sometimes itdoesn't, and sometimes it
changes.
So gender is how someoneunderstands themselves and moves
(13:45):
through the world, expressingthemselves.
So you could be born abiological male.
However, your understanding ofyourself, your perception of
self, how you feel inside yourgender may be female.
So you move through the world,expressing yourself as the
gender you understand yourselfto be, which is female,
(14:07):
regardless of being biologicallymale at birth.
The same goes for the reverseof that and the middle of that
as a spectrum.
There are some people thatdon't feel like either gender,
and there are some people thatsometimes feel like one gender
and sometimes feel like theother, and that's okay.
If you don't understand it, youdon't have to understand it,
(14:30):
unless it's your body and yourlived experience.
Not only do you not have tounderstand it, but to provide
ethical and professional care,we don't have to agree with it
either.
Care we don't have to agreewith it either.
We just have to treat thatpatient with respect and care
and ethically and professionallymeet the standards of care that
(14:52):
we are required to give.
So, personally, you honestlydon't have to understand
everything about it and, quitefrankly, unless it's your lived
experience, you're not going to,and you also have the right to
not agree with it.
What you don't have the rightto do, however, is harm patients
or deny care or providesubstandard care or withhold
(15:17):
care because of your personalbeliefs.
So biological sex is assigned atbirth.
It's an old standard.
They did it for classificationreasons.
It was easy that way and,believe it or not, even the
non-male, non-female, othergenders are also assigned at
birth.
They just aren't talked aboutas much.
(15:37):
Gender, however, is how thesepeople live and, as people get
older, sometimes people know itearlier on in life, sometimes
people discover it later on inlife, but the two don't always
match and sometimes it changes,and that's 100% okay.
That has absolutely nothing todo with our ethical obligations
(16:02):
and the professional standardsthat we have to meet.
Let's talk about cisgenderversus transgender.
So the word cisgender simplymeans your gender identity
matches the sex that you were atbirth.
Cis just means same.
Transgender means that yourgender identity doesn't match
the sex that you were at birth.
(16:23):
And cisgender is not a slur,it's just a neutral, descriptive
word, like saying you'reright-handed or left-handed or
ambidextrous.
It's been used in academictexts for decades and decades.
It's not new.
It's not political either.
It's just language, and asnurses, we have to make sure
(16:44):
that we understand medicine andscience apolitically.
It is not within our ethicaland professional scope of
practice to wield the politicalhammer against anybody, not when
we're providing care topatients.
Now, can you have your ownpolitical beliefs?
(17:06):
A thousand percent, yes.
I will absolutely fight foryour right to have your own
political beliefs and religiousbeliefs and personal beliefs.
To have your own politicalbeliefs and religious beliefs
and personal beliefs, absolutely.
What you can't do, however, isharm others because of those
personal, political, religiousor other beliefs.
So, now that we understand whatthe terms mean, what does
(17:30):
transitioning mean?
What does it mean to transition?
Transitioning is just theprocess that someone may go
through to live in alignmentwith their gender identity.
I personally am cisgendered, soI don't have personal lived
experience with being abiological gender that I don't
relate to or don't understand orfeel foreign in.
(17:53):
I don't have body dysmorphia orgender dysmorphia, as it were.
In that regard, however, fromwhat I've learned in talking to
transgendered individuals andpatients is that the range of
experiences for them being adifferent gender than they
(18:14):
understand themselves to be orknow themselves to be is
everything from uncomfortable tojust the most miserable lived
experience they can describe.
The gender dysphoria is, fromall descriptions that I've heard
, is just an awful, unbelievableexperience for them, for many
(18:38):
of them.
And transitioning is theprocess that they go through,
matching the two so that theirgender, their understood and
lived expression matches thegender they feel, and that may
not match their biologicalgender or sex there, rather, but
that's okay.
Transitioning is just a processthat they go through to align
(19:01):
themselves, and this can includesocial transitioning, like
changing their names, theirpronoun, their presentation.
It can include medicaltransitioning, whether that be
hormone, whether that besurgeries, both, none, all of it
.
Transitioning is a spectrum andthe person that's going through
transition, they're going totransition to whatever extent is
(19:22):
right for them.
There's no template for it.
There's no right or wrong forit.
But when it comes totransitioning, a transgender man
is someone who was assignedfemale at birth, who identifies
and lives as a man.
Their gender, that they knowthey are inside, is male, even
though they were biologically afemale at birth.
A transgender woman is someonewho was biologically male at
(19:46):
birth, who identifies and livesas a woman.
Their understood gender andexperience is that they're a
woman, even though biologicallythey may have been a male at
birth.
So not all trans peopletransition medically and not all
want to.
In fact, some transgenderedpeople don't transition socially
like other transgendered people.
(20:06):
Some may be okay with theiroriginal name.
Some may not use their originalname whatsoever and consider
that their dead name.
They may want a different namethat accurately reflects the
gender that they are.
They may change their pronouns.
They may not change theirpronouns.
Again, transitioning for anindividual is very personal to
(20:29):
that individual and is along aspectrum and it's whatever fits
or is right for them.
And again, not having thislived experience, if you're not
transgender, you may notunderstand aspects of it and
that's okay.
Becoming educated about how toprovide care to transgender
(20:50):
individuals doesn't inherentlymean that you have to understand
every aspect of it, that youhave to agree with every aspect
of it.
It means that you're educatedon the ways that you can show
your transgender patientsrespect, provide the appropriate
care for your transgenderpatients and meet the ethical
(21:11):
and professional standards thatwe are required to as
professional nurses.
So your patient's transitionhonestly isn't our business
unless it's medically relevant.
And even then ask, respectfully, use the name and pronouns.
They give you period.
Just to give you an example, wedo that all the time for
(21:35):
patients who aren'ttransgendered.
You can have a patient thatcomes in whose name is William
and tells you please call meBill.
I hate the name William.
It reminds me of my dad andhe's a really bad person.
So just please call me the nameBill.
Well, bill isn't the name onhis driver's license or birth
certificate.
That's not actually his name.
(21:56):
But we call him Bill withouteven hesitating or thinking
about it.
It's no different for atransgendered person to tell you
their name is Bill and theywere actually born as Jane.
There's no difference, nonewhatsoever.
(22:16):
We use different pronouns forpeople all the time we have
since the advent of the Englishlanguage, we use the word they
indiscriminately across theboard to refer to a singular
person, multiple people, all thetime.
There's really no reasonwhatsoever to have any problems
(22:38):
with the use of pronouns,especially if you speak English
on a regular basis.
You use pronouns all the time,day in and day out.
So refusing to use pronounsthat someone tells you they
prefer, refusing to use pronounsthat someone tells you they
(23:00):
prefer there's not a single goodreason to do so.
Why language matters inhealthcare is really important.
Let's talk about patient safety, because when we misgender, we
deadname or we're dismissive ofpatients, it's not just rude,
it's actually clinical harm.
Transgender and non-binarypatients often avoid
preventative care Things likepap smears, mammograms, prostate
(23:21):
exams, sti testing of enteringinto that power dynamic where
they have to sit there incomplete vulnerability and
endure mocking, disrespect,dismissal and sometimes worse is
(23:45):
an awful thing to put a humanthrough who has come to you for
help.
The 2022 US Trans Survey showedthat nearly one in three trans
people delay or avoid medicalcare due to previous
mistreatment and fear of furtherdiscrimination.
How many patients are notgetting the care that they need
(24:09):
Because the healthcare system isfull of people that have made
it such a miserable experience?
We, as nurses we're often thefirst point of contact in a care
setting.
That means we hold the power tomake it safe or make it
traumatic, and that's aresponsibility we have to take
(24:30):
seriously.
It's our ethical andprofessional responsibility to
take it seriously and treat allof our patients regardless of
race, sex, gender, religion.
We have to treat themrespectfully and with equity,
not just equality.
So some tips for really safe,respectful practices Ask what
(24:55):
name and pronouns do you use andthen use them.
Don't assume gender based onappearance or the biological sex
that's listed in the chart.
When in doubt, neutral languageis perfect.
The word patient folks.
They partner humans.
Neutral language is perfectlyacceptable and easy to use.
(25:16):
Affirming care is clinical care.
It's evidence-based, it'sliterally science-based.
It reduces harm, it increasesfollow-up, it improves health
outcomes.
This isn't about personalbeliefs, it's about best
practices.
It's about best practices.
So if you're going to pausehere and go back to shift end of
(25:40):
shift give report, whatever itis that you're doing.
If you're going to pause here,then we wish you the best of
shifts or the safest drive.
If you are going to come backto us after the break, well,
hydrate, take some deep breathsand remember your care is sacred
.
When you come back, we're goingto dive into the real talk
about bias.
You, you, you.
Speaker 2 (26:16):
I've been beaten to the ground, dragged across the
dirt, I've been scared to live,cause some people never learn,
but they're not gonna, not gonnawatch me burn, cause baby, I
got you, you, you, you.
There's a new beginning and abetter life.
There's no new beginnings and abetter life.
There's a dancing underneaththe disco lights.
(26:39):
They can try, but they cannever take me down.
Ooh, ooh, ooh, I'm not afraid.
I'm not afraid.
I'm not afraid to love.
Not afraid to love, I'm notafraid, I'm not afraid.
All right, welcome back myhydrated lovelies.
Speaker 1 (27:12):
Let's kick this off with some clinical pearls, shall
we?
Clinical pearls for affirmingLGBTQIA plus and transgender
care?
So these are tangible tips thatare evidence-based,
trauma-informed and life-savingfor many of your patients, that
every nurse can start usingimmediately, and they're super
easy.
Honestly, if you don't work inan area where you have a lot of
(27:36):
exposure to the queer communityor transgendered patients,
there's a lot of education anddifficult conversations and
context that you may not beexposed to all the time, and
that's okay.
Part of this education is,hopefully, to give you tips and
give you language to use thatmake you more comfortable in
these situations, and sometimesit can be really hard to ask.
(27:56):
I mean, social media isabsolutely brutal these days, so
you really, honestly, may notfeel safe to ask questions about
things that you don't haveexposure to or don't have a good
understanding of, and that'sokay.
Hopefully this podcast episodeanswers some of those.
Again, you can always email meif you want to ask questions
about other things and don'tfeel safe to do so in the
(28:18):
comments or on socials.
But let's check out some ofthese clinical pearls.
The first one is always ask.
Never assume you just want toask every patient what name and
pronouns would you like us touse?
Super simple, super fast.
You can even add it to the topof your nursing brain to help
you remember.
Document them in a visiblesection of the chart.
If your EMR allows, if itdoesn't, maybe advocate for a
(28:41):
change.
Use neutral language if youdon't know which language to use
, or until your patient directsotherwise.
You can say parent.
You can say caregiver.
You can say partner.
You can say parent.
You can say caregiver.
You can say partner.
We can say everyone, team,folks, human.
(29:04):
Tons of different neutrallanguage choices that are not
awkward, that are super easy andjust roll right off the tongue.
And, honestly, the more youpractice it, the easier it
becomes.
So an example would be hey, I'myour nurse today.
What name and pronouns should Iuse for you?
Hi, folks, I'm Reva, I'm yournurse today.
I'm here to take care ofeverybody.
What name and pronouns can Iuse for you?
Super easy to use neutrallanguage.
(29:24):
Third, be prepared to understanddifferent types of hormone
therapy.
Guys, we do this all the timefor all of our patients across
the board that have differenthormone therapy, regardless of
whether they're transitioning ornot.
So there's really no differencein working with a menopausal
(29:46):
cisgendered female who's dealingwith hormone therapy and giving
them the best care possibleversus somebody who's
transitioning and giving themthe best care possible versus
somebody who's transitioning andgiving them the best care
possible, or vice versa, likethere isn't any difference and
there shouldn't be.
So we should really be preparedto understand hormone therapy,
no matter what genre of medicineyou work in, because hormones
(30:09):
affect everything about ourhomeostasis, about our metabolic
balance in our body, everythingabout our homeostasis, about
our metabolic balance in ourbody.
So one of the things thatreally impacts patient care for
our transgendered patients andqueer patients is understanding
hormone therapy and preventativecare that might be necessary or
how medications might impacttheir hormone therapy.
(30:31):
One of the things, for example,is that trans men they may be
on testosterone.
Trans women may be on estrogenand an antiandrogen like
spironolactone or, you know,finasteride.
So understanding their hormonetherapy and their levels will
give you a really good clue tounderstand how medications are
(30:52):
going to affect their body, howthey may interact, if there's
pharmacokinetics or polypharmacythat may happen, and signs and
symptoms, even preventativescreenings.
So one of the things that'sreally important is to discuss
preventative screenings withyour transgender patients,
depending on what biologicalanatomy they have.
They may or may not needcertain preventative screenings.
(31:15):
And here's another tipCisgendered people don't always
have the same anatomy either,and it doesn't make them any
less of a male or female human.
So having different internaland sometimes external anatomy
for cisgendered people, we'venever allowed that to make them
(31:36):
less than what they are.
So for transgendered people,that shouldn't make them less
than they are either.
There shouldn't be a doublestandard.
Just ask about the biologicalanatomy.
You can even ask them.
You know, hey, I want to makesure that you don't experience
any you know gender dysphoria orinvalidation during this visit,
(31:59):
but I do have to ask you aboutbiological anatomy to make sure
we're getting you the safestcare possible.
Is there a way for me to dothat that validates your
experience and makes this a goodexperience for you and your
patients will really appreciateit?
Good experience for you andyour patients will really
appreciate it.
Don't just assume that yourpatient, whether transgendered
(32:20):
or cisgendered, has certainbiological anatomy.
You actually have to askbecause every human is different
and not all of them have theanatomy that you would expect.
So with hormones andunderstanding hormone therapies,
you know know what labs toexpect, like estrogen, lowers
hemoglobin testosterone, and notevery time, but it can.
(32:43):
Testosterone increases itsometimes.
So you want to know on theirlabs for abnormals to look for,
for polypharmacy orpharmacokinetic effects to look
for, and you know, be aware ofthat for your patients.
Another clinical pearl is torecognize dysphoria triggers in
care settings, and this alsogoes for our trauma patients.
(33:04):
So wearing gowns or changinginto gowns, pelvic exams and
disrobing can be triggering fora lot of our patients, not just
our transgendered patients, butespecially for our transgendered
patients, but especially forour transgendered patients.
Offer choice in who performsthe exam or who's there for it,
and narrate your actions withconsent, and this goes for all
(33:25):
of your patients, no matter whatgender or biological sex they
are.
An example of that would besaying hey, would you like me to
explain each step before Ibegin?
Or asking your patient is thereanything I can do to make you
feel more comfortable?
(33:48):
Pearl number five don't deadname or misgender.
But if you do own it, you cansay I'm sorry, I used a wrong
name pronoun.
Thank you for correcting me.
Then move on.
Don't make it about you becauseit isn't about you.
Don't over-apologize, don't getdefensive.
Just move on and do better.
That's all.
Clinical Pearl Six privacymatters.
Never out someone to family,other providers, coworkers
(34:13):
without explicit consent.
Outing someone can lead to real, lasting physical and sometimes
fatal harm.
It's not our information toshare.
Clinical Pearl 7, advocate forinclusive systems.
Does your intake form allow formore than male or female, to be
(34:34):
marked for gender?
Does your EHR have fields forchosen name and pronouns?
Are your waiting rooms safespaces or are they landmines?
We're nurses.
We absolutely have voices andpower.
You can say something.
You should say something,affirming care isn't extra, it's
(34:58):
just ethical, it's professionaland it is absolutely essential
nursing practice.
So let's talk about beliefsversus bias.
The ethics of care.
This is hard truth time, myloves, hard truth time.
Personal beliefs, includingreligious ones, do not justify
(35:19):
biased care.
The Joint Commission says thatdiscrimination based on gender
identity or sexual orientationis a violation of patient rights
.
Even if you're not in theUnited States, I'm pretty sure,
pretty sure, that othercountries have regulating and
safety bodies, just like thejoint commission, that have much
(35:41):
the same statements.
Personal beliefs are yours.
Your professional actions,however, are regulated by
licensure, ethics and the lawethics and the law.
I'm going to say this clearly Ifyour belief system includes
denying care, respect or dignityto any patients.
(36:03):
You are in the wrong profession.
This is a job that requiresheart and humanity and does not
allow for harm.
The ANA position statement isreally clear Nurses must not
(36:27):
discriminate.
Now, implicit bias is a realthing and unless you uncover
your implicit biases and do thehard work of correcting them,
you may be discriminating andnot even intend to.
You may be discriminating andnot even intend to, but when we
know better, we do better.
(36:51):
Like I said before, this isn'tabout forcing you to change your
beliefs.
I will absolutely fight foryour right to have your beliefs,
even if they are opposite mine.
I wholeheartedly, heart andsoul and mind agree with you
having your beliefs.
You have that right.
However, your personal beliefshad better not impact your
professional practice.
Denying care, withholding care,substandard care,
(37:16):
discriminating in care, denyingrespect, denying dignity,
denying dignity those are notacceptable behaviors.
As healthcare providers, asnurses, when we enter into that
power dynamic with our patientswho sit with us in vulnerability
(37:37):
and trust, we are ethically andprofessionally obligated across
the board to offer equity andequality in non-discriminatory
care.
I hope that this podcast episodehas really helped you guys
understand different terms,maybe different perspectives.
(37:57):
Like I said, there's going tobe resources in the show notes.
And I know, I know that thispodcast made some of you
listening upset, angry,uncomfortable, and that's okay.
I don't shame you for havingthose feelings.
I know that this podcast, thisepisode, contradicted with some
(38:19):
of your personal beliefs, andthat's okay too.
I champion your right to havethem as they are.
I'm just hoping that thispodcast helped to educate you on
meeting the ethical andprofessional standards that you
have to as a nurse andhealthcare provider, regardless
(38:39):
of the personal beliefs that youhave.
Let's get into our coffeecrystals and divination segment.
It's pride month, so rainbowsand sparkles and everything
lovely are in full abundancethis month, um, and I absolutely
(38:59):
love it, and not just becauseI'm queer, but just because I
love those things in general.
But for our coffee crystals anddivination segments, coffee
this week it's all about theiced coffees.
I don't know about you, butsummer has hit with a vengeance
here and one of the things thatI've been struggling with is any
kind of normal intake in themorning.
(39:20):
So I'm really kind of back tovibing on those protein coffees
and really trying to figure outdifferent ways to combine really
good iced coffee with proteinshakes, protein powder Ah I, if
you have a really good proteinpowder, then recommend it,
(39:42):
because the ones I've triedeither they taste awful and have
like this weird chemicalsaccharine kind of aftertaste
which is gross, or they don'tblend well with iced coffee.
Even if I put it in there andit's cold because I don't want
to use hot coffee because it'lldenature the protein, but it's
just grainy and that is not theexperience or the vibe that your
(40:03):
girl is trying to go for here.
I want smooth and creamy andrefreshing and delicious.
I do not want my coffee time tobe a struggle.
So premier protein is one of myfavorite protein shakes.
Especially the fact that I canget them in bulk at Costco makes
life easy.
And the dark chocolate one isepic.
If you haven't found it, pleasego find it, it's amazing.
(40:24):
The chocolate peanut butter onehas been like mega on my list,
and even the vanilla one is justphenomenal.
All of those mixed with coffeeare really, really good.
But if you have a protein blendthat you recommend that doesn't
taste like chemicals or feellike some weird gritty sand got
(40:45):
in your iced coffee, then letyour girl know, put it in the
comments and socials, hit thattext link in the show notes and
send me a text with it.
Um, I will absolutely try themand give my review on them.
Um, or if you have like afavorite coffee protein recipe,
(41:05):
hit me up with that too.
I've been seeing a lot ofadvertisements for um like a
coffee extract.
Um, it J, a, v, y is the nameof the company.
I don't know how to pronounceit.
I don't know if I don't knowhow to pronounce it, I'm not
even gonna try, but I've seenthat as kind of a coffee
additive.
So it's really concentratedcoffee extract or coffee
(41:28):
derivative and you add a littlebit of that to protein shakes.
I don't know if that one isbitter.
I do know that I've tried acouple cold brew coffee brands
in like the refrigerated sectionof the grocery store and have
not yet found one that wasn'thorrifically bitter.
So I've kind of just stuck tomaking my own coffee um and
(41:50):
going about it that way.
So any tips or tricks that youguys have for iced protein
coffees, let me know, cause Iwould love it.
I would love it.
Let's pull our crystal Oraclecard for the week and see what
they have to say.
I love doing this.
(42:19):
This is literally my favorite,favorite section, and right
before the close of this podcastepisode, I have a little hint
that I'm going to give you guysabout a project that I'm working
on.
Wow, okay, that card flew outof my hand.
Oh, serpentine explorationAgain, totally irrelevant, I
couldn't have planned this if Itried.
Exploration is the card.
(42:43):
This is really cool.
I don't know if you guys haveever seen serpentine in person.
Um, I usually get the namewrong and my friends laugh about
it, but it is a really coolstone.
Um, and a lot of times it's gotlike a velvety feel to the
pocket of the serpentine.
But it signifies new beginnings, resilience and independence.
Serpentine but it signifies newbeginnings, resilience and
(43:03):
independence.
Pack your bags and get readyfor the adventure of a lifetime.
This card invites you to scalenew heights with a spirit of
independence, curiosity andresilience.
Because of its deep connectionto the earth, serpentine
enhances your bond with theenergy of nature that surrounds
you.
So bring your sense ofadventure, explore your
(43:24):
surroundings, open your heart tonew opportunities and navigate
life's twists and turns withdetermination, much like
conquering a grand mountain.
If that description isn't asummary of us approaching the
topics we covered in thispodcast episode, I have no idea
(43:45):
what else could be unbelievablyaccurate.
I love it.
Serpentine is not, um, not ausual stone for people to have.
It has become more popular, soI'm pretty sure that you can
find it in shops near you, um, alot of times.
The really cool thing about itis it's shaped like well, I call
them dragon eggs, but they'reegg shaped.
(44:05):
However, I still prefer to callthem dragon eggs, um, and it
just makes an incredibly cooldisplay piece to have these, uh,
stones and they look like eggsand the the druzy pockets in
them are usually kind of shapedlike these really cool crevices
or cracks and it's just a reallycool look.
All right, let's take a look atour tarot for this week and see
(44:29):
what kind of message we getfrom our tarot would help if I
didn't drop half the deck and nobesties.
I'm not reading or doing 52card pickup with the tarot cards
.
Maybe someday I might do anepisode or maybe I'll go live on
TikTok and, you know, do somelive readings for anybody that
might be interested in that.
You'll have to let me know.
That would be some greatfeedback to get on.
(44:50):
That would be some greatfeedback to get on.
Socials is whether you guyswould like something like that
or not on TikTok.
We're trying to become moreactive on TikTok.
It's not our usual format forsocials, so I've been kind of
struggling with that a littlebit.
We're used to YouTube and ofcourse we're used to posting,
(45:13):
you know, information andinfographic style stuff on
Instagram.
But you know, and there's acard.
Youtube is, um, primarily likethe, the video format that we're
the most used to.
So it's going to be a two forone this week because while I
was talking to you, an oldfriend of ours decided to show
up and then a actual card showedup in terms of the draw itself.
(45:39):
So I'm going to read both um,just to follow the cards lead, I
guess.
So the first one is the nine ofpentacles are bumblebee Jasper
that decided to show up and it'ssuch a beautiful card.
(45:59):
I got amazing feedback aboutbumblebee Jasper.
I got amazing feedback aboutBumblebee Jasper Last, the last
podcast episode.
One of the listeners wrote inthat while the episode was
happening, you know, like whileI was reading the card, they
literally were in the process ofpicking up a Bumblebee Jasper
(46:21):
that had been sitting next tothem.
When I announced that that'swhat the card was was really
cool synchronicity there.
So nine of Pentacles financialindependence, comfort and
gratitude.
Bumblebee, jasper, is acelebration and positive
attitude and abundance Treatyourself.
You worked so hard to createall of the abundance in your
life, so don't be afraid tosplurge and enjoy the fruits of
(46:41):
your labor.
Celebrate your achievements.
You deserve it.
This is really kind of a themefor pride month.
So definitely, um, enjoyyourselves and celebrate and
enjoy summer.
Celebrate the warmth.
Um.
If you're in winter on theother side of the planet, I'm
sorry.
Um, no, I say that justingly,but winter is not my favorite
(47:04):
season.
Um, come over to the other sideof the planet, where there's
summer and sun and beaches.
Um, the next one is the 10 ofcups.
So this one decided to jump outwhile I was talking to you guys
.
And the 10 of cups is spiritcourts, and this is happiness,
relationships, reunion.
(47:25):
Spirit court signifies unity,harmony and spiritual growth.
Life is good.
The 10 of cups embodies joy andharmony, especially in domestic
and family relationships.
Take a moment to appreciate andshare the love with those that
are close to you.
This is completely apropos forour episode today, because we're
(47:47):
talking about how to fosterunity and harmony, how to
spiritually grow, and this isall based on relationships with
others, direct relationshipswith others, um, in both
domestic and family, um, andseeking joy in it.
So these are your cards anddivination for this week and the
(48:11):
next week to carry with you theNine of Pentacles, the Ten of
Cups.
I would be interested, if youhave decks of your own, to hear
what your decks have to sayabout those cards or your
interpretation of those cards.
To say about those cards oryour interpretation of those
cards?
Um, every person that readstarot, uh, has a lived
(48:31):
understanding, if you will, ofwhat certain cards mean and
don't mean to them or their deck, and I always find those really
interesting.
I always learn a lot from those.
If you do happen to haveserpentine and you have a really
cool one, take a picture of itand tag us.
I would love to see it.
And if you don't guess what,you now have an excuse to go to
the crystal shop and buy morecrystals.
Don't tell anybody that.
I told you that, but I think itwould be a great idea.
(48:51):
So this week I want you to tagus and share what pride and
practice means to you.
Share this episode with yourclassmates, coworkers and, yes,
even your nurse manager.
Equity is a team effort and itstarts with one shift, one
patient and one brave nurse at atime.
And to every LGBTQIA, plusnurse, student and human
(49:12):
listening.
You belong here.
You make nursing better.
You make life better.
You're not just celebrated thismonth, you're sacred every damn
day.
It's pride 365 over here at thecode team, over at mythical
family and especially at theritual nurse podcast.
Just like always, love yourfaces.
(49:34):
This is your ritual nurse, reva.
Thanks for tuning in to theritual nurse podcast.
You can find us wherever youlisten to podcasts, so don't
forget to subscribe and stayconnected For all our social
links, free education classes,blogs and podcast notes with
resources head over to tcthorg.
(49:56):
Until next time, love yourfaces.
Welcome to the Ritual Nurse, where healing meets
humor, science and a touch ofmagic.
Hey, nurses, besties, healersand hope holders, you've clocked
into the Ritual Nurse, thepodcast that stitches together
science, sacredness andself-reclamation've clocked into
the Ritual Nurse, the podcastthat stitches together science,
sacredness and self-reclamation.
I'm your host, reba, nurse,executive, educator and proud
(00:32):
queer woman, and this week we'relighting up the floor with a
Pride Month episode.
That isn't here to play small.
We're going to talk about whatit means to not just wave the
rainbow flag, but to practicepride in our care.
Whether you're an ally, whetheryou're queer, whether you don't
have any idea, Through advocacy, equity and unapologetic
(00:53):
humanity.
That's how we practice withpride.
If you're a nurse, this one'sfor you.
If you're a queer nurse, maybethis one's especially for you.
You, if you're a queer nurse,maybe this one's especially for
you.
So let's break down what itreally means to offer equitable
care and how.
Treating everyone the same isnot the gold standard.
So equality gives everyone thesame resources.
(01:20):
I talk to my students aboutthis all the time in
understanding the differencebetween equality and equity.
So equality is everybody canwalk through the door.
Equity, however, ensures thateveryone gets the right
resources for their needs.
Equity ensures that everyonegets the care they need, not
(01:44):
just sure they can walk throughthe door and ask for it.
So when we practice with prideagain, whether you're straight,
whether you're queer, whetheryou are unsighted, practicing
with pride is something everysingle nurse has to do, and it's
ensuring that our professionalconduct offers our patients both
(02:08):
equity and equality across theboard, irregardless of their
race, their gender, theirreligion, their sex, their
beliefs.
So the ANA Code of Ethics,provision 8, says collaboration
for human rights and thereduction of health disparities.
The Code of Ethics are actuallysomething that we, as nurses,
(02:32):
are professionally obligated touphold, and collaborating with
each other and interprofessionalteams on behalf of human rights
and the reduction of healthdisparities are an ethical
provision we actually have touphold.
So when we say health equity,what we're meaning is that our
(02:53):
care must account for thesystemic oppression, trauma and
barriers that our patients face,especially those who are queer,
trans or multiply marginalized,are people of color, are
marginal populations, areindigenous populations, are
Black patients and colleaguesand coworkers.
(03:13):
The Healthy People 2030 has aninitiative goal to eliminate
health disparities and advanceequity, and, as nurses, we're
the frontline runners to be ableto do that, to be able to
advance culture, to be able toreverse and eradicate the
(03:33):
systemic disparities and oursocial barriers to healthcare,
our social inequities andhealthcare disparities.
We're the frontrunners to beable to combat that, and it's
really important that werecognize from the very
beginning, no matter again whatour personal beliefs are, that
(03:56):
our professional licensure andresponsibility ethically
requires that we uphold theseprovisions and that we provide
care with both equity andequality in the face of these
disparities, despite thedisparities and eradicate them.
One of the ways that we do thatas nurses is educating
(04:20):
ourselves, and that's reallywhat this podcast is about.
This podcast, this episodespecifically, is about education
and understanding personalbiases and really encouraging
you to take a look at how yourpersonal beliefs may be
influencing and causingprofessional bias.
(04:43):
See, here's the thing I willabsolutely fight for your right
to have your beliefs, whetherthey be religious, whether they
be personal, whether they becompletely opposite of mine or
in accordance with mine orsomewhere in the middle.
I absolutely will fight foryour right to have them.
(05:03):
What's really important,however, is that we're able to
discern whether any of thosepersonal beliefs cause a
professional bias and harm ourpatient.
The way we do that is witheducation.
Implicit bias is something that,psychologically, every single
human has, and implicit bias isunique in that we actually are
(05:29):
subconsciously unaware that wehave them.
There's specific tests that youcan do that are designed to
uncover implicit bias and revealthem to yourself.
But, aside from working with aprofessional or, you know,
completing testing that isdesigned to uncover implicit
bias, we're not aware of it onany level, and these biases are
(05:54):
created by the culture thatwe're raised in, the
psychosocial and socioeconomicpatterns and context that we
grew up in, that our formativeyears were surrounded by that.
The choices we learned to makeas we grew up were governed by,
if you will, that createdpatterns of behavior and
(06:18):
understanding of the contextualworld around us that actually
almost predetermine ourresponses to things and color
our perception of things.
So unless we do the in-depthwork of uncovering our implicit
biases, a we're completelyunaware that we have them and, b
(06:40):
they influence our actionsbefore we even think about
taking them.
They color our perceptionsbefore we've even had a chance
to examine what we perceivedabout the situation.
So, as nurses, we're really kindof obligated to do this work as
(07:00):
we advance in our practice andas we offer care to other people
.
Reason being is our job existsas a power dynamic.
Every patient that comes to seeyou joins in that power dynamic
with you.
As a nurse, and because we're anurse, we actually have the
upper hand in the power dynamic.
And I don't mean that solelyfrom a control perspective,
(07:23):
because, you know, we give ourpatients, we empower them to
have autonomy, we empower themto advocate and take part in
their own care.
But it has to do with trust andvulnerability.
And when your patients come toyou, most of the time, 99.9% of
the time, they're not there fora happy reason.
(07:45):
I mean, yes, of course thereare some areas in medicine that
are happy looking at you, ellenB, but for the most part they're
coming to you in a situationwhere they are the vulnerable
one and they have to sharethings with you and go through
things with you.
Where you have the upper handand the power dynamic.
(08:05):
That means that we have anenhanced ethical responsibility
to do our best to do no harm.
You know the gold standards,beneficence, all that.
Those are actually ethicalobligations that we have to
uphold as nursing professionals.
Now notice, I keep talkingabout ethics and not morals.
(08:28):
Interestingly enough, they'revery separate things and
people's morals can be differentwhile they ethically uphold the
same standards.
That's actually a realpossibility.
Your morals are just aredecided by many of the beliefs
that you hold, especially corebeliefs, given that most human
(08:50):
beings don't share the same corebeliefs, and their formative
experiences and years have endedup with them, you know,
believing different perspectivesabout maybe even the same
topics.
People's morals will vary andthey'll differ, and that's
actually okay.
The ethical obligations andprofessional standards that we
(09:12):
have to adhere to, however,those all have to be the same.
So doing the educational workto uncover your biases and
understand differentperspectives so that you can
meet the ethical andprofessional obligations of
being a nurse and a healthcareprovider are something that we
(09:32):
have to do.
We owe it to ourselves, we oweit to our patients, and the only
way to do that is to educateourselves by exposure, by
investigation, byself-reflection, by
self-awareness and by having theemotional maturity to have
really hard conversations withourselves.
And when we know better, we dobetter, and we have to make
(09:55):
space for other people to do thesame thing.
So that's really what thispodcast episode is about, in
addition to glitter and sparklesand all sorts of fun things.
But let's kind of take a lookhere at Transgender and Gender
Affirming Care 101.
Now I know these are somereally wild trigger words lately
(10:16):
, but again we've got tohighlight some of these things.
We've got to highlight some ofthese actions and implicit
biases and how those don't matchup with the ethical and
professional standards that wehave to meet.
So we're going to talk aboutthings like dead naming and
misgendering andmicroaggressions that are
(10:36):
actually clinical harm.
We're going to talk about theimportance of asking pronouns
and documenting them in charts.
We'll talk about hormonetherapy basics and knowing when
to refer to gender affirmingspecialists.
In the show notes there's goingto be some resources for you to
, you know, look up things.
If this podcast episode doesn'tanswer some of the questions
(10:57):
that you have, you're alwaysfeel feel free to email me and
ask me.
If you don't feel comfortableposting them on socials or as a
comment, you can always reachout to me and ask me.
If you don't feel comfortableposting them on socials or as a
comment, you can always reachout to me and ask me these
questions, but I'll make surethat there's resources in the
show notes so you can continueyour learning and investigation
and exploring other perspectivesif these things are things that
(11:17):
you're unaware of.
So transgender care reallystarts with language and why
words matter.
Let's start with the basics,because before you can offer
safe, affirming care, you needto understand the language, and
not just what the words mean,but what they signify in a
patient's lived experience.
We're not expected to beexperts in everything, but we
(11:40):
are required to provide safe andrespectful care, and that
starts with learning.
So if you don't know thedifference between cis and trans
, or sex versus gender, that'sokay.
Get curious, get educated.
That is our job, and thispodcast episode will hopefully
answer those questions for you.
Let's start with gender versussex first.
(12:01):
So biological sex refers tophysical characteristics.
A person is born withChromosomes, hormone levels,
internal and external anatomy.
We're all nurses and medicalprofessionals.
For the most part.
There are a lot of welcomeindividuals that are not
medically trained that do listento this podcast and get benefit
from it.
So I'm going to kind of coversome of those things.
(12:22):
But when it comes to biologicalsex first of all, according to
science, there's not just onlytwo genders.
That's not opinion, that's nottinfoil hat wearing conspiracy
theory, it's not woke, and we'lltalk about that expression in
(12:43):
another episode, but it's justscience, there's multiple
combinations of chromosomes thatresult in actually more than
just two genders.
Science usually refers to justtwo genders to simplify things
because, for the most part, thathappens to be the predominant
(13:03):
gene expression for our species,but it isn't the only kind.
So we need to make sure thatwe're not using science to
justify unethical,unprofessional and harmful
behavior.
Gender, however, is a socialand psychological identity.
(13:25):
It doesn't have anything to dowith what your biological sex is
.
Sometimes people's genderexpression matches their
biological sex, sometimes itdoesn't, and sometimes it
changes.
So gender is how someoneunderstands themselves and moves
(13:45):
through the world, expressingthemselves.
So you could be born abiological male.
However, your understanding ofyourself, your perception of
self, how you feel inside yourgender may be female.
So you move through the world,expressing yourself as the
gender you understand yourselfto be, which is female,
(14:07):
regardless of being biologicallymale at birth.
The same goes for the reverseof that and the middle of that
as a spectrum.
There are some people thatdon't feel like either gender,
and there are some people thatsometimes feel like one gender
and sometimes feel like theother, and that's okay.
If you don't understand it, youdon't have to understand it,
(14:30):
unless it's your body and yourlived experience.
Not only do you not have tounderstand it, but to provide
ethical and professional care,we don't have to agree with it
either.
Care we don't have to agreewith it either.
We just have to treat thatpatient with respect and care
and ethically and professionallymeet the standards of care that
(14:52):
we are required to give.
So, personally, you honestlydon't have to understand
everything about it and, quitefrankly, unless it's your lived
experience, you're not going to,and you also have the right to
not agree with it.
What you don't have the rightto do, however, is harm patients
or deny care or providesubstandard care or withhold
(15:17):
care because of your personalbeliefs.
So biological sex is assigned atbirth.
It's an old standard.
They did it for classificationreasons.
It was easy that way and,believe it or not, even the
non-male, non-female, othergenders are also assigned at
birth.
They just aren't talked aboutas much.
(15:37):
Gender, however, is how thesepeople live and, as people get
older, sometimes people know itearlier on in life, sometimes
people discover it later on inlife, but the two don't always
match and sometimes it changes,and that's 100% okay.
That has absolutely nothing todo with our ethical obligations
(16:02):
and the professional standardsthat we have to meet.
Let's talk about cisgenderversus transgender.
So the word cisgender simplymeans your gender identity
matches the sex that you were atbirth.
Cis just means same.
Transgender means that yourgender identity doesn't match
the sex that you were at birth.
(16:23):
And cisgender is not a slur,it's just a neutral, descriptive
word, like saying you'reright-handed or left-handed or
ambidextrous.
It's been used in academictexts for decades and decades.
It's not new.
It's not political either.
It's just language, and asnurses, we have to make sure
(16:44):
that we understand medicine andscience apolitically.
It is not within our ethicaland professional scope of
practice to wield the politicalhammer against anybody, not when
we're providing care topatients.
Now, can you have your ownpolitical beliefs?
(17:06):
A thousand percent, yes.
I will absolutely fight foryour right to have your own
political beliefs and religiousbeliefs and personal beliefs.
To have your own politicalbeliefs and religious beliefs
and personal beliefs, absolutely.
What you can't do, however, isharm others because of those
personal, political, religiousor other beliefs.
So, now that we understand whatthe terms mean, what does
(17:30):
transitioning mean?
What does it mean to transition?
Transitioning is just theprocess that someone may go
through to live in alignmentwith their gender identity.
I personally am cisgendered, soI don't have personal lived
experience with being abiological gender that I don't
relate to or don't understand orfeel foreign in.
(17:53):
I don't have body dysmorphia orgender dysmorphia, as it were.
In that regard, however, fromwhat I've learned in talking to
transgendered individuals andpatients is that the range of
experiences for them being adifferent gender than they
(18:14):
understand themselves to be orknow themselves to be is
everything from uncomfortable tojust the most miserable lived
experience they can describe.
The gender dysphoria is, fromall descriptions that I've heard
, is just an awful, unbelievableexperience for them, for many
(18:38):
of them.
And transitioning is theprocess that they go through,
matching the two so that theirgender, their understood and
lived expression matches thegender they feel, and that may
not match their biologicalgender or sex there, rather, but
that's okay.
Transitioning is just a processthat they go through to align
(19:01):
themselves, and this can includesocial transitioning, like
changing their names, theirpronoun, their presentation.
It can include medicaltransitioning, whether that be
hormone, whether that besurgeries, both, none, all of it
.
Transitioning is a spectrum andthe person that's going through
transition, they're going totransition to whatever extent is
(19:22):
right for them.
There's no template for it.
There's no right or wrong forit.
But when it comes totransitioning, a transgender man
is someone who was assignedfemale at birth, who identifies
and lives as a man.
Their gender, that they knowthey are inside, is male, even
though they were biologically afemale at birth.
A transgender woman is someonewho was biologically male at
(19:46):
birth, who identifies and livesas a woman.
Their understood gender andexperience is that they're a
woman, even though biologicallythey may have been a male at
birth.
So not all trans peopletransition medically and not all
want to.
In fact, some transgenderedpeople don't transition socially
like other transgendered people.
(20:06):
Some may be okay with theiroriginal name.
Some may not use their originalname whatsoever and consider
that their dead name.
They may want a different namethat accurately reflects the
gender that they are.
They may change their pronouns.
They may not change theirpronouns.
Again, transitioning for anindividual is very personal to
(20:29):
that individual and is along aspectrum and it's whatever fits
or is right for them.
And again, not having thislived experience, if you're not
transgender, you may notunderstand aspects of it and
that's okay.
Becoming educated about how toprovide care to transgender
(20:50):
individuals doesn't inherentlymean that you have to understand
every aspect of it, that youhave to agree with every aspect
of it.
It means that you're educatedon the ways that you can show
your transgender patientsrespect, provide the appropriate
care for your transgenderpatients and meet the ethical
(21:11):
and professional standards thatwe are required to as
professional nurses.
So your patient's transitionhonestly isn't our business
unless it's medically relevant.
And even then ask, respectfully, use the name and pronouns.
They give you period.
Just to give you an example, wedo that all the time for
(21:35):
patients who aren'ttransgendered.
You can have a patient thatcomes in whose name is William
and tells you please call meBill.
I hate the name William.
It reminds me of my dad andhe's a really bad person.
So just please call me the nameBill.
Well, bill isn't the name onhis driver's license or birth
certificate.
That's not actually his name.
(21:56):
But we call him Bill withouteven hesitating or thinking
about it.
It's no different for atransgendered person to tell you
their name is Bill and theywere actually born as Jane.
There's no difference, nonewhatsoever.
(22:16):
We use different pronouns forpeople all the time we have
since the advent of the Englishlanguage, we use the word they
indiscriminately across theboard to refer to a singular
person, multiple people, all thetime.
There's really no reasonwhatsoever to have any problems
(22:38):
with the use of pronouns,especially if you speak English
on a regular basis.
You use pronouns all the time,day in and day out.
So refusing to use pronounsthat someone tells you they
prefer, refusing to use pronounsthat someone tells you they
(23:00):
prefer there's not a single goodreason to do so.
Why language matters inhealthcare is really important.
Let's talk about patient safety, because when we misgender, we
deadname or we're dismissive ofpatients, it's not just rude,
it's actually clinical harm.
Transgender and non-binarypatients often avoid
preventative care Things likepap smears, mammograms, prostate
(23:21):
exams, sti testing of enteringinto that power dynamic where
they have to sit there incomplete vulnerability and
endure mocking, disrespect,dismissal and sometimes worse is
(23:45):
an awful thing to put a humanthrough who has come to you for
help.
The 2022 US Trans Survey showedthat nearly one in three trans
people delay or avoid medicalcare due to previous
mistreatment and fear of furtherdiscrimination.
How many patients are notgetting the care that they need
(24:09):
Because the healthcare system isfull of people that have made
it such a miserable experience?
We, as nurses we're often thefirst point of contact in a care
setting.
That means we hold the power tomake it safe or make it
traumatic, and that's aresponsibility we have to take
(24:30):
seriously.
It's our ethical andprofessional responsibility to
take it seriously and treat allof our patients regardless of
race, sex, gender, religion.
We have to treat themrespectfully and with equity,
not just equality.
So some tips for really safe,respectful practices Ask what
(24:55):
name and pronouns do you use andthen use them.
Don't assume gender based onappearance or the biological sex
that's listed in the chart.
When in doubt, neutral languageis perfect.
The word patient folks.
They partner humans.
Neutral language is perfectlyacceptable and easy to use.
(25:16):
Affirming care is clinical care.
It's evidence-based, it'sliterally science-based.
It reduces harm, it increasesfollow-up, it improves health
outcomes.
This isn't about personalbeliefs, it's about best
practices.
It's about best practices.
So if you're going to pausehere and go back to shift end of
(25:40):
shift give report, whatever itis that you're doing.
If you're going to pause here,then we wish you the best of
shifts or the safest drive.
If you are going to come backto us after the break, well,
hydrate, take some deep breathsand remember your care is sacred
.
When you come back, we're goingto dive into the real talk
about bias.
You, you, you.
Speaker 2 (26:16):
I've been beaten to the ground, dragged across the
dirt, I've been scared to live,cause some people never learn,
but they're not gonna, not gonnawatch me burn, cause baby, I
got you, you, you, you.
There's a new beginning and abetter life.
There's no new beginnings and abetter life.
There's a dancing underneaththe disco lights.
(26:39):
They can try, but they cannever take me down.
Ooh, ooh, ooh, I'm not afraid.
I'm not afraid.
I'm not afraid to love.
Not afraid to love, I'm notafraid, I'm not afraid.
All right, welcome back myhydrated lovelies.
Speaker 1 (27:12):
Let's kick this off with some clinical pearls, shall
we?
Clinical pearls for affirmingLGBTQIA plus and transgender
care?
So these are tangible tips thatare evidence-based,
trauma-informed and life-savingfor many of your patients, that
every nurse can start usingimmediately, and they're super
easy.
Honestly, if you don't work inan area where you have a lot of
(27:36):
exposure to the queer communityor transgendered patients,
there's a lot of education anddifficult conversations and
context that you may not beexposed to all the time, and
that's okay.
Part of this education is,hopefully, to give you tips and
give you language to use thatmake you more comfortable in
these situations, and sometimesit can be really hard to ask.
(27:56):
I mean, social media isabsolutely brutal these days, so
you really, honestly, may notfeel safe to ask questions about
things that you don't haveexposure to or don't have a good
understanding of, and that'sokay.
Hopefully this podcast episodeanswers some of those.
Again, you can always email meif you want to ask questions
about other things and don'tfeel safe to do so in the
(28:18):
comments or on socials.
But let's check out some ofthese clinical pearls.
The first one is always ask.
Never assume you just want toask every patient what name and
pronouns would you like us touse?
Super simple, super fast.
You can even add it to the topof your nursing brain to help
you remember.
Document them in a visiblesection of the chart.
If your EMR allows, if itdoesn't, maybe advocate for a
(28:41):
change.
Use neutral language if youdon't know which language to use
, or until your patient directsotherwise.
You can say parent.
You can say caregiver.
You can say partner.
You can say parent.
You can say caregiver.
You can say partner.
We can say everyone, team,folks, human.
(29:04):
Tons of different neutrallanguage choices that are not
awkward, that are super easy andjust roll right off the tongue.
And, honestly, the more youpractice it, the easier it
becomes.
So an example would be hey, I'myour nurse today.
What name and pronouns should Iuse for you?
Hi, folks, I'm Reva, I'm yournurse today.
I'm here to take care ofeverybody.
What name and pronouns can Iuse for you?
Super easy to use neutrallanguage.
(29:24):
Third, be prepared to understanddifferent types of hormone
therapy.
Guys, we do this all the timefor all of our patients across
the board that have differenthormone therapy, regardless of
whether they're transitioning ornot.
So there's really no differencein working with a menopausal
(29:46):
cisgendered female who's dealingwith hormone therapy and giving
them the best care possibleversus somebody who's
transitioning and giving themthe best care possible versus
somebody who's transitioning andgiving them the best care
possible, or vice versa, likethere isn't any difference and
there shouldn't be.
So we should really be preparedto understand hormone therapy,
no matter what genre of medicineyou work in, because hormones
(30:09):
affect everything about ourhomeostasis, about our metabolic
balance in our body, everythingabout our homeostasis, about
our metabolic balance in ourbody.
So one of the things thatreally impacts patient care for
our transgendered patients andqueer patients is understanding
hormone therapy and preventativecare that might be necessary or
how medications might impacttheir hormone therapy.
(30:31):
One of the things, for example,is that trans men they may be
on testosterone.
Trans women may be on estrogenand an antiandrogen like
spironolactone or, you know,finasteride.
So understanding their hormonetherapy and their levels will
give you a really good clue tounderstand how medications are
(30:52):
going to affect their body, howthey may interact, if there's
pharmacokinetics or polypharmacythat may happen, and signs and
symptoms, even preventativescreenings.
So one of the things that'sreally important is to discuss
preventative screenings withyour transgender patients,
depending on what biologicalanatomy they have.
They may or may not needcertain preventative screenings.
(31:15):
And here's another tipCisgendered people don't always
have the same anatomy either,and it doesn't make them any
less of a male or female human.
So having different internaland sometimes external anatomy
for cisgendered people, we'venever allowed that to make them
(31:36):
less than what they are.
So for transgendered people,that shouldn't make them less
than they are either.
There shouldn't be a doublestandard.
Just ask about the biologicalanatomy.
You can even ask them.
You know, hey, I want to makesure that you don't experience
any you know gender dysphoria orinvalidation during this visit,
(31:59):
but I do have to ask you aboutbiological anatomy to make sure
we're getting you the safestcare possible.
Is there a way for me to dothat that validates your
experience and makes this a goodexperience for you and your
patients will really appreciateit?
Good experience for you andyour patients will really
appreciate it.
Don't just assume that yourpatient, whether transgendered
(32:20):
or cisgendered, has certainbiological anatomy.
You actually have to askbecause every human is different
and not all of them have theanatomy that you would expect.
So with hormones andunderstanding hormone therapies,
you know know what labs toexpect, like estrogen, lowers
hemoglobin testosterone, and notevery time, but it can.
(32:43):
Testosterone increases itsometimes.
So you want to know on theirlabs for abnormals to look for,
for polypharmacy orpharmacokinetic effects to look
for, and you know, be aware ofthat for your patients.
Another clinical pearl is torecognize dysphoria triggers in
care settings, and this alsogoes for our trauma patients.
(33:04):
So wearing gowns or changinginto gowns, pelvic exams and
disrobing can be triggering fora lot of our patients, not just
our transgendered patients, butespecially for our transgendered
patients, but especially forour transgendered patients.
Offer choice in who performsthe exam or who's there for it,
and narrate your actions withconsent, and this goes for all
(33:25):
of your patients, no matter whatgender or biological sex they
are.
An example of that would besaying hey, would you like me to
explain each step before Ibegin?
Or asking your patient is thereanything I can do to make you
feel more comfortable?
(33:48):
Pearl number five don't deadname or misgender.
But if you do own it, you cansay I'm sorry, I used a wrong
name pronoun.
Thank you for correcting me.
Then move on.
Don't make it about you becauseit isn't about you.
Don't over-apologize, don't getdefensive.
Just move on and do better.
That's all.
Clinical Pearl Six privacymatters.
Never out someone to family,other providers, coworkers
(34:13):
without explicit consent.
Outing someone can lead to real, lasting physical and sometimes
fatal harm.
It's not our information toshare.
Clinical Pearl 7, advocate forinclusive systems.
Does your intake form allow formore than male or female, to be
(34:34):
marked for gender?
Does your EHR have fields forchosen name and pronouns?
Are your waiting rooms safespaces or are they landmines?
We're nurses.
We absolutely have voices andpower.
You can say something.
You should say something,affirming care isn't extra, it's
(34:58):
just ethical, it's professionaland it is absolutely essential
nursing practice.
So let's talk about beliefsversus bias.
The ethics of care.
This is hard truth time, myloves, hard truth time.
Personal beliefs, includingreligious ones, do not justify
(35:19):
biased care.
The Joint Commission says thatdiscrimination based on gender
identity or sexual orientationis a violation of patient rights
.
Even if you're not in theUnited States, I'm pretty sure,
pretty sure, that othercountries have regulating and
safety bodies, just like thejoint commission, that have much
(35:41):
the same statements.
Personal beliefs are yours.
Your professional actions,however, are regulated by
licensure, ethics and the lawethics and the law.
I'm going to say this clearly Ifyour belief system includes
denying care, respect or dignityto any patients.
(36:03):
You are in the wrong profession.
This is a job that requiresheart and humanity and does not
allow for harm.
The ANA position statement isreally clear Nurses must not
(36:27):
discriminate.
Now, implicit bias is a realthing and unless you uncover
your implicit biases and do thehard work of correcting them,
you may be discriminating andnot even intend to.
You may be discriminating andnot even intend to, but when we
know better, we do better.
(36:51):
Like I said before, this isn'tabout forcing you to change your
beliefs.
I will absolutely fight foryour right to have your beliefs,
even if they are opposite mine.
I wholeheartedly, heart andsoul and mind agree with you
having your beliefs.
You have that right.
However, your personal beliefshad better not impact your
professional practice.
Denying care, withholding care,substandard care,
(37:16):
discriminating in care, denyingrespect, denying dignity,
denying dignity those are notacceptable behaviors.
As healthcare providers, asnurses, when we enter into that
power dynamic with our patientswho sit with us in vulnerability
(37:37):
and trust, we are ethically andprofessionally obligated across
the board to offer equity andequality in non-discriminatory
care.
I hope that this podcast episodehas really helped you guys
understand different terms,maybe different perspectives.
(37:57):
Like I said, there's going tobe resources in the show notes.
And I know, I know that thispodcast made some of you
listening upset, angry,uncomfortable, and that's okay.
I don't shame you for havingthose feelings.
I know that this podcast, thisepisode, contradicted with some
(38:19):
of your personal beliefs, andthat's okay too.
I champion your right to havethem as they are.
I'm just hoping that thispodcast helped to educate you on
meeting the ethical andprofessional standards that you
have to as a nurse andhealthcare provider, regardless
(38:39):
of the personal beliefs that youhave.
Let's get into our coffeecrystals and divination segment.
It's pride month, so rainbowsand sparkles and everything
lovely are in full abundancethis month, um, and I absolutely
(38:59):
love it, and not just becauseI'm queer, but just because I
love those things in general.
But for our coffee crystals anddivination segments, coffee
this week it's all about theiced coffees.
I don't know about you, butsummer has hit with a vengeance
here and one of the things thatI've been struggling with is any
kind of normal intake in themorning.
(39:20):
So I'm really kind of back tovibing on those protein coffees
and really trying to figure outdifferent ways to combine really
good iced coffee with proteinshakes, protein powder Ah I, if
you have a really good proteinpowder, then recommend it,
(39:42):
because the ones I've triedeither they taste awful and have
like this weird chemicalsaccharine kind of aftertaste
which is gross, or they don'tblend well with iced coffee.
Even if I put it in there andit's cold because I don't want
to use hot coffee because it'lldenature the protein, but it's
just grainy and that is not theexperience or the vibe that your
(40:03):
girl is trying to go for here.
I want smooth and creamy andrefreshing and delicious.
I do not want my coffee time tobe a struggle.
So premier protein is one of myfavorite protein shakes.
Especially the fact that I canget them in bulk at Costco makes
life easy.
And the dark chocolate one isepic.
If you haven't found it, pleasego find it, it's amazing.
(40:24):
The chocolate peanut butter onehas been like mega on my list,
and even the vanilla one is justphenomenal.
All of those mixed with coffeeare really, really good.
But if you have a protein blendthat you recommend that doesn't
taste like chemicals or feellike some weird gritty sand got
(40:45):
in your iced coffee, then letyour girl know, put it in the
comments and socials, hit thattext link in the show notes and
send me a text with it.
Um, I will absolutely try themand give my review on them.
Um, or if you have like afavorite coffee protein recipe,
(41:05):
hit me up with that too.
I've been seeing a lot ofadvertisements for um like a
coffee extract.
Um, it J, a, v, y is the nameof the company.
I don't know how to pronounceit.
I don't know if I don't knowhow to pronounce it, I'm not
even gonna try, but I've seenthat as kind of a coffee
additive.
So it's really concentratedcoffee extract or coffee
(41:28):
derivative and you add a littlebit of that to protein shakes.
I don't know if that one isbitter.
I do know that I've tried acouple cold brew coffee brands
in like the refrigerated sectionof the grocery store and have
not yet found one that wasn'thorrifically bitter.
So I've kind of just stuck tomaking my own coffee um and
(41:50):
going about it that way.
So any tips or tricks that youguys have for iced protein
coffees, let me know, cause Iwould love it.
I would love it.
Let's pull our crystal Oraclecard for the week and see what
they have to say.
I love doing this.
(42:19):
This is literally my favorite,favorite section, and right
before the close of this podcastepisode, I have a little hint
that I'm going to give you guysabout a project that I'm working
on.
Wow, okay, that card flew outof my hand.
Oh, serpentine explorationAgain, totally irrelevant, I
couldn't have planned this if Itried.
Exploration is the card.
(42:43):
This is really cool.
I don't know if you guys haveever seen serpentine in person.
Um, I usually get the namewrong and my friends laugh about
it, but it is a really coolstone.
Um, and a lot of times it's gotlike a velvety feel to the
pocket of the serpentine.
But it signifies new beginnings, resilience and independence.
Serpentine but it signifies newbeginnings, resilience and
(43:03):
independence.
Pack your bags and get readyfor the adventure of a lifetime.
This card invites you to scalenew heights with a spirit of
independence, curiosity andresilience.
Because of its deep connectionto the earth, serpentine
enhances your bond with theenergy of nature that surrounds
you.
So bring your sense ofadventure, explore your
(43:24):
surroundings, open your heart tonew opportunities and navigate
life's twists and turns withdetermination, much like
conquering a grand mountain.
If that description isn't asummary of us approaching the
topics we covered in thispodcast episode, I have no idea
(43:45):
what else could be unbelievablyaccurate.
I love it.
Serpentine is not, um, not ausual stone for people to have.
It has become more popular, soI'm pretty sure that you can
find it in shops near you, um, alot of times.
The really cool thing about itis it's shaped like well, I call
them dragon eggs, but they'reegg shaped.
(44:05):
However, I still prefer to callthem dragon eggs, um, and it
just makes an incredibly cooldisplay piece to have these, uh,
stones and they look like eggsand the the druzy pockets in
them are usually kind of shapedlike these really cool crevices
or cracks and it's just a reallycool look.
All right, let's take a look atour tarot for this week and see
(44:29):
what kind of message we getfrom our tarot would help if I
didn't drop half the deck and nobesties.
I'm not reading or doing 52card pickup with the tarot cards
.
Maybe someday I might do anepisode or maybe I'll go live on
TikTok and, you know, do somelive readings for anybody that
might be interested in that.
You'll have to let me know.
That would be some greatfeedback to get on.
(44:50):
That would be some greatfeedback to get on.
Socials is whether you guyswould like something like that
or not on TikTok.
We're trying to become moreactive on TikTok.
It's not our usual format forsocials, so I've been kind of
struggling with that a littlebit.
We're used to YouTube and ofcourse we're used to posting,
(45:13):
you know, information andinfographic style stuff on
Instagram.
But you know, and there's acard.
Youtube is, um, primarily likethe, the video format that we're
the most used to.
So it's going to be a two forone this week because while I
was talking to you, an oldfriend of ours decided to show
up and then a actual card showedup in terms of the draw itself.
(45:39):
So I'm going to read both um,just to follow the cards lead, I
guess.
So the first one is the nine ofpentacles are bumblebee Jasper
that decided to show up and it'ssuch a beautiful card.
(45:59):
I got amazing feedback aboutbumblebee Jasper.
I got amazing feedback aboutBumblebee Jasper Last, the last
podcast episode.
One of the listeners wrote inthat while the episode was
happening, you know, like whileI was reading the card, they
literally were in the process ofpicking up a Bumblebee Jasper
(46:21):
that had been sitting next tothem.
When I announced that that'swhat the card was was really
cool synchronicity there.
So nine of Pentacles financialindependence, comfort and
gratitude.
Bumblebee, jasper, is acelebration and positive
attitude and abundance Treatyourself.
You worked so hard to createall of the abundance in your
life, so don't be afraid tosplurge and enjoy the fruits of
(46:41):
your labor.
Celebrate your achievements.
You deserve it.
This is really kind of a themefor pride month.
So definitely, um, enjoyyourselves and celebrate and
enjoy summer.
Celebrate the warmth.
Um.
If you're in winter on theother side of the planet, I'm
sorry.
Um, no, I say that justingly,but winter is not my favorite
(47:04):
season.
Um, come over to the other sideof the planet, where there's
summer and sun and beaches.
Um, the next one is the 10 ofcups.
So this one decided to jump outwhile I was talking to you guys
.
And the 10 of cups is spiritcourts, and this is happiness,
relationships, reunion.
(47:25):
Spirit court signifies unity,harmony and spiritual growth.
Life is good.
The 10 of cups embodies joy andharmony, especially in domestic
and family relationships.
Take a moment to appreciate andshare the love with those that
are close to you.
This is completely apropos forour episode today, because we're
(47:47):
talking about how to fosterunity and harmony, how to
spiritually grow, and this isall based on relationships with
others, direct relationshipswith others, um, in both
domestic and family, um, andseeking joy in it.
So these are your cards anddivination for this week and the
(48:11):
next week to carry with you theNine of Pentacles, the Ten of
Cups.
I would be interested, if youhave decks of your own, to hear
what your decks have to sayabout those cards or your
interpretation of those cards.
To say about those cards oryour interpretation of those
cards?
Um, every person that readstarot, uh, has a lived
(48:31):
understanding, if you will, ofwhat certain cards mean and
don't mean to them or their deck, and I always find those really
interesting.
I always learn a lot from those.
If you do happen to haveserpentine and you have a really
cool one, take a picture of itand tag us.
I would love to see it.
And if you don't guess what,you now have an excuse to go to
the crystal shop and buy morecrystals.
Don't tell anybody that.
I told you that, but I think itwould be a great idea.
(48:51):
So this week I want you to tagus and share what pride and
practice means to you.
Share this episode with yourclassmates, coworkers and, yes,
even your nurse manager.
Equity is a team effort and itstarts with one shift, one
patient and one brave nurse at atime.
And to every LGBTQIA, plusnurse, student and human
(49:12):
listening.
You belong here.
You make nursing better.
You make life better.
You're not just celebrated thismonth, you're sacred every damn
day.
It's pride 365 over here at thecode team, over at mythical
family and especially at theritual nurse podcast.
Just like always, love yourfaces.
(49:34):
This is your ritual nurse, reva.
Thanks for tuning in to theritual nurse podcast.
You can find us wherever youlisten to podcasts, so don't
forget to subscribe and stayconnected For all our social
links, free education classes,blogs and podcast notes with
resources head over to tcthorg.
(49:56):
Until next time, love yourfaces.
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