In February 2021, Gallup reported that 5.6% of US population identifies as LGBT, a slight increase from the 2017 estimate of 4.7%, with younger generation more likely to identify as LGBTQ than older generations. In the last decade, there has been a general consensus that Americans are increasingly more supportive of LGBTQ rights. In spite of this, workplace inclusion issues affecting LGBTQ workers such as incivility, bullying, and discrimination remain an ongoing challenge.
The progress in LGBTQ rights remains uneven from a global perspective, too. A 2019 report by the International Lesbian, Gay, Bisexual, Trans, and Intersex Association (ILGA) indicated that 70 countries still criminalize consensual same-sex sexual acts between adults.
As an ally, I’ve centered some of my research around fostering inclusivity through the lens of education, research, and social policy. I know nurses can lead the way by advocating for and implementing inclusive workplaces!
Out and about in the workplace: Why it is important?
The impetus to cultivate a climate of inclusivity is both common sense and regulatory. It isn’t difficult to imagine that a noninclusive environment is bad for any business. But in nursing specifically, being closeted at work negatively impacts staff and patients. Minority stress experienced by LGBTQ nurses resulting from a hostile, homophobic work environment can lead to work dissatisfaction, burnout, increased turnover, and can make it difficult for LGBTQ staff members to be authentic at work.
Subordination of low status groups not only harms minority groups, but also majority groups. An inclusive workplace fosters safety for employees and allows workers to be more productive by using less energy in masking their identity. Patients and staff can both agree that the essence of caring comes from bringing our authentic selves to the nurse-patient relationship.
Considerations and mandates for inclusion
In designing policies and programs to address LGBTQ inclusive workplaces, stakeholders can use the five Standards of Conduct supported by The United Nations Human Rights Office as building blocks.
Companies and institutions are admonished to:
- Respect all human rights.
- Eliminate all aspects employment discrimination.
- Provide a positive affirmative work environment.
- Prevent other human rights violations in the marketplace and businesses.
- Encourage businesses to contribute to stopping human rights abuses in the community.
Title VII of the Civil Rights Act of 1964 is a US federal law that protects employees against discrimination based on certain characteristics such as race, color, national origin, sex, and religion. Existing sex discrimination provisions protect LGBTQ job applicants and employees against employment bias. On 16 June 2021, the US Education Department announced that Title IX protects LGBTQ students. Title IX of the Education Amendments Act of 1972 is a federal law that states: "No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance."
The International Labor Organization, a United Nations agency mandates that LGBTQ workers have the right to be free from discrimination at work. During accreditation surveys, the Joint Commission may also assess how the institution addresses workplace inclusivity.
How LGBTQ-inclusive is your workplace?
The annual Healthcare Equality Index (HEI) report published by the Human Rights Campaign is the national LGBTQ benchmarking tool that evaluates healthcare facilities' policies and practices related to equity and inclusion of their LGBTQ patients, visitors, and employees. In 2020, a total of 765 healthcare facilities participated in the survey related to these four criteria:
- Non-discrimination and staff training
- Patient services and support
- Employee benefits and policies
- Patient and community engagement
I encourage you to use the Human Rights Campaign website to check how your facility meets these criteria.
Having a diverse workforce is a great step towards inclusion, but teams need to have tools to create an inclusive workplace. One of the first steps in creating an LGBTQ safe workplace is by shifting the culture. Cultures shift through:
- Policy changes such as non-discrimination policies
- Zero tolerance for incivility and bullying
- Ensuring the mission and vision reflect inclusivity
- Expanding benefits to spouses regardless of gender
Strength and maintenance of an inclusive workplace is demonstrated by leaders ensuring policy matches practice, though. The participation of key personnel in events such as diversity workshops, pride marches, and community service events are behaviors that inspire an inclusive atmosphere.
Employee LGBTQ resource groups can be organized to provide mentorship, roles models, career guidance, and support. Regular mandatory educational activities about diversity, inclusion, and equity for all team members is fundamental to sustaining cultural competence across all levels of care, too.
The preferred future
The healthcare industry and nursing, in particular, still has work to do to make inclusive workplaces an everyday reality.
Healthcare is a business enterprise, and inclusivity in the workplace that honors LGBTQ diversity is good for business and better for the patients. It is my hope that the nursing profession will become a leader in advocating for inclusive workplaces. To combat what experts consider as parallel epidemics confronting the global community, COVID-19 and healthcare inequities, all healthcare stakeholders are admonished to have the moral courage to address healthcare injustice affecting not just LGBTQ persons, but all vulnerable populations.
Fidelindo Lim, DNP, CCRN, is a clinical associate professor at New York University Meyers College of Nursing in New York City, New York, USA. He is a member of Sigma’s Upsilon Chapter.