In 2008, my partner gave birth to our son, Sebastian, in a mid-sized Midwestern hospital after multiple expensive rounds of artificial insemination. Her labor began 6 weeks early, and due to a sudden and dangerous spike in blood pressure paired with fetal heart rate deceleration, she required an emergency C-section. Thankfully, they both made it through, but what followed in the postpartum setting revealed how deeply unprepared the healthcare team was to care for a lesbian family.

The nurses seemed visibly confused and uncomfortable interacting with us. When I introduced myself as her partner, I was repeatedly asked if I was her “sister.” During shift changes, my presence and role weren’t communicated, forcing me to reintroduce and re-explain myself to every new nurse. I was emotionally exhausted and angry. Our newborn had to remain in the nursery in an incubator. My two school-aged daughters weren’t allowed to visit their baby brother. The staff said they weren’t “family,” even though they were part of the same household. The girls were heartbroken, left staring at their brother through the glass window, confused and excluded.

This experience happened shortly before I entered nursing school. At the time, I was far less assertive than I am now. I didn’t know how to speak up for myself, and I worried that complaining could jeopardize my ability to stay close to my partner and our baby during his hospital stay. Looking back, I wish I had voiced my concerns or even told our OB-GYN—someone who likely would have advocated for us. But I was in shock. This was 2008, not 1968. And yet, we were treated like outsiders.

That week in the hospital, which should have been joyful, was marred by repeated acts of exclusion and erasure. It was a defining moment for me. When I became a nurse, I promised myself that no other family would be made to feel the way we were made to feel.

That’s why I now offer a presentation titled “All Patients Mean ALL Patients: What You Need to Know to Care for LGBTQ+ Patients.” I give it to fellow nurses, nursing students, and medical students, especially during June, when Pride Month is celebrated. People sometimes say, “But we have Google and ChatGPT now—why don’t people just educate themselves?” The truth is, having access to information doesn’t guarantee people will seek it out. Even when they do, they may run into misinformation, conflicting sources, or material that lacks context. Plus, it’s easy to underestimate how difficult it is to learn about marginalized identities when those topics are still treated as taboo or “extra.”

As nurses, we must rise above personal discomfort or unfamiliarity. Regardless of personal or religious beliefs, our professional responsibility is to treat all patients with compassion and respect. We take oaths to do no harm. That means LGBTQ+ patients, too.

Unfortunately, the education many nurses receive on LGBTQ+ care is inconsistent. Research shows that both nursing and medical students in the United States receive limited instruction on caring for lesbian, gay, bisexual, transgender, and queer patients. Although efforts are underway to improve this, significant gaps remain in both content and quality of instruction.

This means that many healthcare professionals must seek out training independently. But why should we? Nurses love a good rationale. Let’s look at Provision 9.4 of the newly updated 2025 Code of Ethics for Nurses: “Nurses must condemn all forms of oppression and demonstrate intentional efforts to reflect and act upon social justice issues that influence health outcomes and healthcare equity.” And “Nurses must advocate for more inclusive and equitable approaches in healthcare.”

If that’s not enough motivation, consider this: a 2024 Gallup poll found that 9.3% of U.S. adults now identify as LGBTQ+. That’s up from just 3.5% in 2012. Based on the U.S. Census Bureau’s January 2025 adult population estimate of 263 million, that translates to approximately 24.5 million American adults who identify as LGBTQ+. These individuals will need healthcare, preventive care, mental health support, reproductive care, chronic disease management, and more. They deserve clinicians who can offer competent, respectful, and affirming care.

To do that, healthcare workers must understand basic terms around sexuality and gender. The World Health Organization defines sexuality is “a central aspect of being human that encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction.” It includes:

• Sexual identity: The labels individuals use to describe themselves as sexual beings.
• Sexual expression: How people demonstrate their sexuality through behavior or relationships.
• Sexual orientation: A person’s emotional, romantic, or sexual attraction to others (to people of the same gender [gay or lesbian], different gender [heterosexual], both genders [bisexual], all genders [pansexual], or none/not at all [asexual]).

Sexuality is about attraction and relationships and is a key part of a person’s identity. Gender, on the other hand, is defined by the Centers for Disease Control and Prevention as “the cultural roles, behaviors, activities, and attributes expected of people based on their sex.” Gender identity is one’s personal sense of being male, female, both, neither, or something else entirely.

Here are some foundational terms:

• Cisgender: A person whose gender identity aligns with the sex they were assigned at birth.
• Transgender: A person whose gender identity does not align with their sex assigned at birth.
• Non-binary: Someone whose gender identity doesn’t fit within the traditional categories of “male” or “female.”
• Gender expression: How individuals express their gender through clothing, behavior, hairstyle, voice, etc.

According to the Williams Institute, about 0.6% of U.S. adults and 1.4% of youth between the ages of 13 and 17 identify as transgender. It’s crucial for healthcare professionals to understand that gender is different from biological sex, which involves chromosomes, anatomy, and hormones. There’s also growing visibility for intersex individuals, whose biological sex characteristics don’t fit typical definitions of male or female. The documentary Every Body explores the lives and identities of intersex people and is a powerful educational resource.

Key differences between sexuality and gender

• Focus: Sexuality is about attraction and relationships; gender is about identity and expression.
• Independence: Gender identity does not determine sexual orientation, and vice versa.
• Spectrum: Both sexuality and gender exist on broad spectrums.

So, how does this apply to patient care? As nurses and clinicians, we must respect diverse sexual orientations and gender identities to provide individualized, culturally sensitive care. That starts with not making assumptions. Don’t assume a patient’s gender identity or sexual orientation based on appearance or partner. Ask open-ended questions like, “What pronouns should I use when referring to you?” or “How would you like to be addressed?” These small steps go a long way in making LGBTQ+ patients feel seen, safe, and respected. This knowledge isn’t as widespread in our profession as it should be. But each of us can work to change that by staying informed, sharing what we learn, and creating inclusive spaces where allpatients feel cared for.

Because, truly, “all patients” means ALL patients.

Daphne Scott-Henderson, MS, BSN, RN-BC, CPHQ is Director of Health Equity Informatitcs at University of Rochester.

References

American Nurses Association. Code of Ethics for Nurses. American Nurses Publishing; 2025.

Burnham KD, Lady SD, Martin C. Awareness of LGBTQ+ health disparities: a survey study of complementary integrative health providers. J Chiropr Educ. 2023;37(2).

Centers for Disease Control and Prevention. Social determinants of health. https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html. Published 2024. Accessed June 13, 2025.

Centers for Disease Control and Prevention. Terminology. https://www.cdc.gov/healthy-youth/lgbtq-youth/terminology.html. Published 2022. Accessed June 13, 2025.

Flores AR, Herman JL, Brown TNT. How Many Adults and Youth Identify as Transgender in the United States? Williams Institute, UCLA School of Law; 2022. https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/. Accessed June 13, 2025.

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al. The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity. National Academies Press (US); 2021. https://www.ncbi.nlm.nih.gov/books/NBK573898/. Accessed June 13, 2025.

National Institutes of Health. Sex, gender, and sexuality. https://www.nih.gov/nih-style-guide/sex-gender-sexuality. Published 2024. Accessed June 13, 2025.

Sherman ADF, Smith SK, Moore SE, et al. Nursing pre-licensure and graduate education for LGBTQ health: a systematic review. Nurs Outlook. 2023;71(2):101907. doi:10.1016/j.outlook.2022.12.003

Streed CG, Michals A, Quinn E, et al. Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011. BMC Med Educ. 2024;24:482. doi:10.1186/s12909-024-05469-0

World Health Organization. Defining sexual health. https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health. Accessed June 4, 2025.