LGBTQI and Psych Nursing

Sour Lemon · Apr 3, 2017

Question for those of you who are MSN Psych Nurses. To what degree do you have to deal with psych patients who are also dealing with LGBTQI issues? - compared to the general US population? Especially, how common are transgender patients?
When I was in nursing school doing my psych rotation at a state in-patient facility, it seemed as if every patient was dealing with issues of sexual mental health.

I've only worked in behavioral health for about a year. I can't think of any transgender patients that I've had. I've had gay/lesbian patients, but that's not what landed them on the unit. The only sexual type of issue that I encounter regularly are hyper-sexual patients. They're usually patients in a manic state who have poor boundaries and poor impulse control.

Here.I.Stand, BSN, RN · Apr 3, 2017

I'm not a psych nurse, but I know someone who works in chemical health facility for LGBT people.

Meriwhen, ASN, BSN, MSN, RN · Apr 3, 2017

I deal with a fair number of LGBT patients; then again, I'm in CA, where anything LGBT is nothing new :) I'd wager about 25-33% of my patients are LGBT. Sometimes being LGBT is part of their psychiatric issues; sometimes they're the furthest thing from it.

As far as transsexual patients, I'll encounter on average one such patient a month, in varying points of their transition.

The hardest part of dealing with transsexual patients is room assignment. We prefer to give them a single/their own room for their own safety. In a small locked unit where privacy can be hard to come by, the information about a patient' sexuality is bound to get out. And it's not the staff releasing the info, but the patient, either directly telling others that they are transsexual, or indirectly via their being overheard when they talk to friends/family/staff/on the phone. And it's not a HIPAA violation if the patient themselves disclose said information.

Or other patients will see a transsexual patient that is in the process of transitioning (e.g., patient identifies as a female but still appears to be a male at this point) and draw their own conclusions. Again, also not a HIPAA violation.

Unfortunately, other patients are not always comfortable or accepting of transitioning patents, hence the private room. For other LGBT patients, they can share rooms with non LGBT patients but we'd pay attention to who they are roomed with (e.g., we're not going to put a LGBT patient in with a known homophobic patient that has a tendency to be violent).

All of the bathrooms are either in the patients' rooms or are single units, so there are no restroom gender issues.

We will also refer to them as the gender they identify with and their preferred name, though the EMR may still reflect their birth gender and legal name. I'm not sure what the criteria is to change/enter the new gender and name as I don't register patients in the EMR; I think the change has to be official/legal before you can do it.

Meriwhen, ASN, BSN, MSN, RN · Apr 4, 2017

Also moving thread to the Psychiatric Nursing forum for more targeted responses.

msmoe16 · Apr 7, 2017

I work in a state psych hospital. I'd say the ratio of the LGBTQI population in my hospital is quite a bit higher than it is out in the real world.

oldpsychnurse · Apr 10, 2017

I'm not an MSN by any means but I've had my share LGBTQI patients. I'm not sure what you mean by LGBTQI "issues." Most of the ones I've had don't have issues with their sexuality. I'd say the ones who do are in the minority, as most have accepted who and what they are. I have had some who came in because they were having problems either with accepting it themselves or with those they love accepting their sexuality. As to the trans patients, overall I'd say they have more issues than any others. I've seen so many that had underlying psych issues and seemed to believe transitioning would cure all their problems. Obviously, IMO, they weren't stable enough to make that decision and I've worked with quite a few that were transitioning back to their original sex. I think trans patients should have a lot of psych evaluation done before any doctor agrees to perform that surgery.

wayemika · Apr 16, 2017

I know god is the trans patients in Florida can be the hardest to deal with at times as they often have mental health issues linked to assault, rape, family issues or alintation from family or at school. But if you take the time you can work with them like anyone elseí ½í¸Š

SwampCat, BSN · Apr 21, 2017

I'm not an MSN either, but at least once a month we get a kid on the floor that is here for one thing but the kid is also questioning their gender identity. The youngest I've seen dealing with this was 10. My floor does 5-12 years old.

Natkat, BSN, MSN, RN · Apr 23, 2017

The biggest issue I have dealing with LBGTQI patients is ignorance among the staff. I am new in the clinic I work in and the degree of homophobia is shocking. I listened to a conversation between two case managers. One said she thinks trans people are "just doing it for attention". Another one said "why can't boys just boys and girls just be girls?" I didn't speak up because I'm new and didn't want to get into an intense discussion just yet. I myself am a lesbian in a relationship with a butch-identified woman. I'm ready to have a conversation when the time is right. I may never come out to them, but I would like to have an enlightening discussion someday. It makes me feel bad for our patients that they have to deal with this level of ignorance.

wayemika · Apr 23, 2017

The biggest issue I have dealing with LBGTQI patients is ignorance among the staff. I am new in the clinic I work in and the degree of homophobia is shocking. I listened to a conversation between two case managers. One said she thinks trans people are "just doing it for attention". Another one said "why can't boys just boys and girls just be girls?" I didn't speak up because I'm new and didn't want to get into an intense discussion just yet. I myself am a lesbian in a relationship with a butch-identified woman. I'm ready to have a conversation when the time is right. I may never come out to them, but I would like to have an enlightening discussion someday. It makes me feel bad for our patients that they have to deal with this level of ignorance.

I'm sorry you have to work with people like that but they are in the health care field sadly. We have people like that who don't like to deal with LBGTQ+ people and have very negative things to say about them and to them. We even had staff members try to find an excuse to take off a pre op transgender persons undergarments to see if they still had a member and confined to refer to her with male pronouns and tease them. It's sad that nurses, therapist, psychiatrist can behave this way and they are supposed to be helping these people. Some will even tell them it's wrong or site religious reasons why it's wrong. Like that's really going to help a suicidal patient judging them and calling them names.

FolksBtrippin, BSN, RN · May 17, 2017

The biggest issue I have dealing with LBGTQI patients is ignorance among the staff. I am new in the clinic I work in and the degree of homophobia is shocking. I listened to a conversation between two case managers. One said she thinks trans people are "just doing it for attention". Another one said "why can't boys just boys and girls just be girls?" I didn't speak up because I'm new and didn't want to get into an intense discussion just yet. I myself am a lesbian in a relationship with a butch-identified woman. I'm ready to have a conversation when the time is right. I may never come out to them, but I would like to have an enlightening discussion someday. It makes me feel bad for our patients that they have to deal with this level of ignorance.

I am sorry you are witnessing this. I think when you are ready to speak up, you will be helping many patients.