Unsafe Spaces

“I am constantly misgendered at work by my colleagues. I am open about being nonbinary and have let everyone know my pronouns are they/them but it’s exhausting to constantly be correcting folks.”

- T2SGD survey respondent

Advancing the health, safety, social and economic well-being of nurses is BCNU’s highest priority. Fighting for equality and social justice for nurses from all walks of life has been woven into the union’s fabric from its inception, and it has fought many battles to make nursing safer and more inclusive. But in 2021, with rising anti-trans rhetoric and increasing calls for laws that harm trans people, the LGBTQ caucus realized that BCNU needed to do more to protect transgender, Two-Spirit, and gender diverse (T2SGD) nurses.

 

“Transphobia and homophobia have always been a problem in the workplace,” notes Lindsay Manning, a full-time BCNU steward with a diversity, equity, and inclusion (DEI) focus.

“In the first year of the pandemic, reports of transphobia started to emerge much more frequently, and the reports were much more severe,” says Manning, who points to the increased use of personal protective equipment during COVID-19 as a possible reason for the increase in misgendering. This equipment often covers faces, ID badges and nametags.

Manning is also a member of the BCNU LGBTQ caucus. She says that, as incidents of bullying, harassment and discrimination continued to surface at an alarming rate, she and her caucus colleagues realized that managers were not equipped to handle T2SGD nurses’ complaints. Nurses seeking help described major inadequacies in reporting processes, Manning recalls, and told her that managers responsible for investigating complaints were sometimes part of the problem.

“When T2SGD members came forward with complaints, they often needed to do a lot of work to educate management and even the steward teams,” she says. “When someone is traumatized by an experience, having to explain why it’s traumatic compounds the problem.”

“It was clear that we needed to start from the ground up,” says Manning. “We knew that T2SGD nurses needed to be heard.”

In addition to assessing the impacts of transphobia in nursing, the LGBTQ caucus sought more information about T2SGD nurses’ resiliency. This information, the caucus hoped, could inform how cisgender nurses, stewards, BCNU elected representatives, and other allies could build on these strengths to better support T2SGD nurses.

Then, in 2022, BCNU commissioned TransFocus, a consulting firm that helps organizations develop more inclusive workplaces for gender diverse individuals, to conduct a survey on gender diversity in the nursing profession. More than 600 members from across the province participated in the survey, with T2SGD and cisgender respondents sharing their experiences.

The survey report revealed concerning data on the prevalence of transphobia in health care. But it also outlined the ways BCNU can promote more inclusive and safer workplaces that will enable T2SGD members to participate fully at work – and in their union.

TROUBLING TRENDS FOR T2SGD NURSES

The survey responses paint a concerning picture. Eighty-one percent of T2SGD-identifying survey participants report directly experiencing workplace discrimination based on their gender status and share specific examples.

“I have had supervisors, managers and colleagues intentionally misgender me and refuse to use my chosen name,” one respondent shared. “I have worked at sites with only gendered washrooms and been told by my employer to ‘just pick one.’ ”

The impacts of these experiences include increased anxiety and depression – resulting in more time off work, and reduced productivity. Many T2SGD nurses considered leaving the profession. For members who are Black, Indigenous and people of colour, the outcomes are even more severe, with more than 50 percent of respondents considering leaving nursing altogether.

The survey identifies a dire need to make members feel safer when reporting incidents of discrimination, and to create more trans-inclusivity in health-care settings. Survey participants describe facing several barriers to reporting discrimination, including worries about outing themselves to their employer, not knowing how to report discrimination, and having managers dismiss their concerns or not take them seriously. They also note that many health-care professionals lack education, and those that have education often don’t retain knowledge about gender diversity.

Finally, the report points to major structural issues in workplaces. Some lack inclusive bathrooms and changerooms – leading to gender policing and harassment. Workplaces often have onerous processes around using a chosen name change and correct personal pronouns. Many respondents report that gendered job responsibilities persist in the profession, such as the assigning of patient lifts to masculine-presenting nurses only.

BUILDING INCLUSIVITY INTO THE FABRIC OF BCNU

The survey results also inform 12 key actions (see sidebar) that BCNU can take to better advocate for safer and more inclusive workplaces while building a stronger culture of inclusivity within the union.

The report recommends providing staff and members with education on gender diversity, building peer-to-peer support networks, including networks for Two-Spirit Elders, and creating anonymous feedback systems to support T2SGD and gender-questioning members’ safety.

“We really can make more inclusive workplaces for everyone. As a self-regulating profession, nurses are uniquely positioned to be at the forefront of this work.”

- steward Lindsay Manning

While the report suggests there is much work to do, BCNU has been working to build trans-inclusivity into the organization and into the profession.

The union successfully advocated for more T2SGD-inclusive contract language in the last round of Nurses’ Bargaining Association negotiations. The 2022–2025 NBA Provincial Collective Agreement now grants up to eight weeks of paid leave for gender affirming medical procedures and uses improved language around parental leave to reflect gender-diverse parents. Employers are now required to provide single-occupancy bathrooms and changerooms for employees of any gender expression or identity. Critically, the contract explicitly states that deadnaming (using a former name), misgendering (referring to someone using a word or pronoun that does not reflect that person’s gender), and doxxing (harassing people by sharing their address, medical information, or photos) are forms of gender-based discrimination.

In addition to its advocacy in bargaining, the union has created four steward positions with a DEI focus to ensure that members experiencing discrimination receive help through an anti-discrimination lens (Manning is one of those stewards).

There is a long road ahead to fostering safety and inclusion into the BCNU, but Manning feels optimistic the union can accomplish this goal.

“We really can make more inclusive workplaces for everyone. As a self-regulating profession, nurses are uniquely positioned to be at the forefront of this work,” she says.

“Our professional and practice standards require us to self-reflect, challenge our own privileges and biases, and advocate to change the structures, policies, practices, and behaviours that perpetuate discrimination. The foundation is already there for us to be able to do this work, we just need to dedicate the resources needed for this kind of advocacy.” •

UPDATE (Summer 2024)