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It’s all in a Pronoun

It’s pride month, so now’s a great time to talk about how being a nurse puts you at an advantage because you have an opportunity to meet a variety of awesome people every day.
Gender is a tricky subject. It wasn’t long ago we had male and female options with no grey area in between. Today, many parts of the world have recognized a need to give sensitive gender discussions a try and maybe even a different pronoun.

Let’s start with the basics.

Before you start using pronouns correctly, it’s important to understand the basis behind them. You are likely familiar with the concept of cisgender, even if you have never used the term. This means you identify as the same sex you were assigned a birth. So if you were born with female genitalia and assigned the female gender at birth, you also feel emotionally connected to this gender.
If you do not identify with the gender you were assigned at birth, you may identify as transgender. Genitalia does not equate to gender; therefore, transgender males or females identify their gender, regardless of their genitalia.
Some people don’t identify with male vs. female characteristics at all. These people may identify as genderqueer, non-binary, gender fluid, or gender non-conforming. They may express their gender as either male or female, or both at the same time. Sometimes this shifts to one or the other on certain days or sometimes not at all.
It’s important to note that gender identity has nothing to do with sexuality. A heterosexual male may choose to identify as female or male, or a homosexual female may choose to identify as non-binary.

What can I do?

With all those options, it can be hard to know how to address your patients. First and foremost, ask! Many EHRs, including EPIC, one of the largest EHRs in the country, actually have the ability to note pronouns and preferred names. If you aren’t sure how to get started, a good tip is introducing yourself using your pronouns. Something like, “Hi, my name is Bethany, I’m going to be your nurse today; my pronouns are she/her/hers.”
You can bet now that your patient understands you will be accepting of their gender orientation, they will speak up and let you know if they use a different pronoun than the standard gender-assigned ones. You should also ask the patient if they have a different name they prefer to be called. If your patient has a preferred name that doesn’t match their gender, it may be hurtful for you to call them by their given name.
This is challenging in healthcare because their legal name will be on their armband and will be used hundreds of times during their visit. Not calling a person by their preferred name or pronoun can be demeaning or make them feel invalidated. Educate the patient on the need for armband confirmation but use their preferred pronouns or name whenever possible during your care. This shows you are open to their preferences and respect their decisions.
You likely won’t know the patient prefers a different pronoun unless you ask the question. Common pronouns include he/she/they and newer non-gendered options like ze/xe or per. Ask the correct spelling, and if you aren’t sure about how to use the pronoun in certain contexts, research or ask. Here’s an example of using “they” instead of him/her, “They are such an awesome friend; they always go above and beyond to help me when I don’t know how to use pronouns. If you aren’t sure, they are a great resource.”
If the person you are asking acts confused, it’s likely safe to assume they prefer the standard pronouns. If you make a mistake, apologize sincerely and move on. There is no need to overdo it. Your patient will feel a lot more respect from you if you acknowledge your mistake and fix it in future communications.

Nurses are awesome.

It can seem daunting to get started, but once you open the door to recognizing your patient as a whole person, you can begin therapeutic communication. Many of these patients feel disadvantaged by the healthcare system, so they avoid seeking care. As a nurse, you know how to care for people without passing judgment, but sometimes you and your colleagues need a little reminder that empathy goes a long way. Don’t be afraid to stress the importance and normalcy of alternative names or pronouns in your report and your colleague interactions.
A two or three-letter pronoun can make a huge difference in building a trusting relationship with your patient. Stay open-minded and start the conversation. If you want more information, GLAAD has some great articles to get you started.
If you aren’t sure why it is so important, consider thinking of yourself as an alternative gender for a day. Once you are paying attention to pronouns, how often are you “incorrectly” labeled? How frustrated would you be if you truly identified as a different gender? You don’t have to say your plans out loud or correct the pronouns; just keep a mental count.
No matter how you feel about your patient’s gender or sexual orientation, you have a chance to treat them with respect and understanding. Nurses are great patient advocates; how can you support your patient today?
Amanda Ernst, DNP, RN, CEN

Amanda Ernst, DNP, RN, CEN


Amanda is an ER nurse with 10 years of healthcare experience. She currently works as a nurse educator and as an adjunct professor for several schools. She also works as a freelance healthcare writer in her spare time. Amanda thinks the greatest thing about nursing is the endless possibilities and opportunities to learn. What have you learned today?


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