Diversity in Nursing: More Than a Checkbox.

Kestral Gaian (@kesgai) is a transgender mental health and child student nurse and published author.  Associate Editor @nurseswift came across Kestral in another twitter chat we were hosting and knew immediately that they had something wonderful to say and stimulating to discuss.

This is a blog that is linked to a twitter chat that will take place on Wednesday 20 March at 8pm UK time. To join in the chat follow #ebnjc

The word diversity isn’t a new to any of us. Whether you’re a first-year student or a seasoned matron, chances are you can remember a lecture or a seminar about inclusion, the makeup of the workforce, and how to treat patients with dignity no matter their background or lifestyle.

But for many of us starting out on our nursing journeys, diversity is more than a box that needs ticking. As a proud member of the LGBT+ community, I had very real fears and concerns starting my training: would my peers accept me? Would I be misgendered on placement? Would my patients feel uncomfortable around me?

The Facts

In the NHS there are detailed studies about racial diversity in both medical and non-medical roles. In the nursing workforce, for example, we know that 24% of band 5s are not white, compared to 16.9% of band 6s. But where are the statistics around LGBT+ staff, and why do they matter?

According to a recent report, over half of NHS staff don’t think sexual orientation is relevant to healthcare, and one in every fourteen members of NHS staff say they would feel “uncomfortable” working alongside a trans colleague.

From a patient perspective, another recent survey stated that lesbian, gay, bisexual and transgender (LGBT+) patients face inequalities in their experience of NHS healthcare. The survey estimates that one in five LGBT+ people are not out to any healthcare professional about their sexual orientation when seeking general medical care, and one in seven LGBT+ people have avoided treatment for fear of discrimination.

The Staffing Perspective

Having a more diverse workforce demonstrably makes us all better, but with 34,260 current nursing role vacancies in the UK it’s more than a ‘nice to have’. As someone training to be a nurse, one of my biggest concerns was how a transgender person like me would be treated in the NHS, or whether I’d face discrimination if I were to decide to wear a rainbow NHS badge. Indeed when I started my first placement, the personal questions soon came – and I found myself terrified of answering them honestly at first.

If this is the terror I feel, as an otherwise out-and-proud person, then what must it be like for those who are just getting to know their own identities? The NHS EDC (Equalities and Diversity Council) set up a focus group in 2015 to ensure all staff are supported, and they were named the most improved in staff performance in Stonewall’s 2017 workplace awards. But there’s still a long way to go.

The Patient Perspective

The Stonewall survey didn’t just reveal inequalities in care. One in eight LGBT people (13%) have experienced some form of unequal treatment from healthcare staff because they’re LGBT+. This all within a community that faces far higher rates of mental health issue (52% of LGBT+ people suffer from depression, while over half of trans people have attempted self-harm in the past year).

The NHS rainbow badge project started by Dr Michael Farquhar (@DrMikeFarquhar), aims to increase the visibility of LGBT+ medical and non-non-medical NHS employees (as well as allies) with a view to increasing patient confidence and raising awareness.

The initiative, which is being rolled out across certain hospitals on a trial basis, emphasises that wearing the badge is a responsibility to “understand the different health needs of LGBT+ people, and the challenges they may face in accessing healthcare.”
In a world where trainee doctors and nurses are leaving education with very little training on or exposure to the issues that LGBT+ people face in healthcare  and with increasingly alarming statistics on the perils that LGBT+ people face as patients, the simple public statement that wearing a rainbow NHS badge provides is sorely needed.

So What?

As the NHS prepares to implement The Long Term Plan  it’s important not just to think of the changing face of the illnesses and diseases we’re fighting, but of the changing and evolving nature of our patients.

As a student nurse who also happens to be LGBT+, celebrating and catering for diversity is always at the front of my mind. In order to serve our future patients, and ensure that we are providing excellent levels of care to everyone we treat, we all need to care about making LGBT+ patients feel safe, able to be themselves, and cared for by us and our NHS.

Some questions for our chat on 20 March 2019 at 8pm UK time #ebnjc

1. How can we work together to support and celebrate our diverse workforce?
2. What can we do to make sure all patients, feel welcome, particularly those who feel least supported (i.e. transgender patients)?
3. What advice do you have, or resources can you share, that you think can help break down these barriers?

Twitter chat summary:

Huge thanks to everyone who took part in the amazing twitter chat on Wednesday 20th March! The discussion was positive and vibrant, with a key theme of allyship and sharing best practice throughout.

  1. How can we work together to support and celebrate our diverse workforce?


One of the biggest blockers to supporting a diverse workforce is unconscious bias, claim many participants in the chat. People shared their thoughts on where this comes from – be it lack of familiarity with people different to them, or someone’s personal beliefs clouding their openness. Sometimes even ‘banter’ which seems harmless can be a problem.


Many people within this discussion agreed that opening ourselves to understand the lived experiences of others can significantly help to increase our awareness and understanding, but all acknowledged that it’s hard for people to be open about themselves when they are unsure that the environment that they’re in is safe.

  1. What can we do to make sure all patients feel welcome, particularly those who feel least supported (i.e. transgender patients)

 Responses to this question focussed on leading by example and maintaining open dialogue with our patients. The NHS Rainbow Badge was discussed as an initiative to make LGBT+ support visible in a subtle way, but many people in the discussion questioned whether wearing one would just be paying ‘lip service’ to the idea, and wouldn’t actually make them a safe ally for patients and staff to talk to.

The new cervical screening advert focussing on lesbians was raised as a good starting point for patient inclusivity, and opens a door for people to begin to feel safe. Consistency in care was a key discussion topic here too – with the idea that you shouldn’t have to “come out” to every new healthcare professional you see.

What advice do you have, or resources can you share, that you think can help break down these barriers?

 Visibility and awareness campaigns were called out in the discussion as key winners in various healthcare settings. Kate Ward shared a poster that they use in their workplace (https://twitter.com/Katewardleeds/status/1108470183218290688) as well as sharing their contact details (https://twitter.com/Katewardleeds/status/1108467979161923587), and as general discussion was had around how to be a good ally.

The overall conclusion of the chat was to listen and learn, and amplify voices from marginalised communities so that we can all use the lived experiences of others to grow into better healthcare providers and improve our standards of care for all.

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