Laura Kelly, PhD, an associate professor of nursing and director of the Psychiatric Mental Health Nurse Practitioner Program, has seen first-hand the obstacles transgender people face to accessing affirmative health care.
"Many clients come to me having purchased their hormones on the street," says Kelly.
Even if a trans or gender non-binary person has health coverage, not all insurers will pay for costs related to gender transition. Health care providers receive scant training on transgender care; Kelly estimates nurses get about an hour's worth of instruction on caring for LGBT patients in total. "Even if you're on the East or West Coast, the care for trans folks is lacking," she says.
In a 2017 poll, 31% of trans people reported not having regular access to health care, and 22% said they avoided doctors due to fear of discrimination.
Access to affirming health care can be a matter of life and death. Transgender people are at increased risk of suicide, while gender-affirming treatment sharply reduces this risk. Trans people may also need to undergo the preventive care required for their biological sex, for example prostate cancer screening for those born male.
To address the scarcity of clinicians trained to treat trans patients, Columbia Nursing is launching the first-ever Certificate in Professional Achievement in Transgender/Gender Non-Binary Health Care for Nurse Practitioners this September. The deadline for application is July 15.
The two-semester program includes three didactic courses and one clinical practicum, all offered online, with the goal of giving NPs the specialty knowledge and skills they need to provide quality care to trans people. Participants who aren't based in New York City can complete their practicum locally. "The goal is really to improve care where they're practicing now," Kelly says.
NPs who complete the program will learn to:
- Perform an appropriate, complete history and physical assessment of transgender patients.
- Describe primary care needs specific to transgender patients.
- Start and manage hormonal interventions for transgender patients and monitor side effects.
- Identify how transgender patients will be incorporated into current clinical practice.
- Make changes in clinical practice to create a more trans-inclusive environment.
Columbia Nursing's faculty practice, ColumbiaDoctors Primary Care Nurse Practitioner Group (NPG), has been a leader in incorporating culturally competent care for LGBT patients into practice. All staff are educated in LGBT health. The NPG's Washington Heights location, opened in 2016, was the first practice in Upper Manhattan to offer a full range of LGBT-specific services.
"There is a general gap in healthcare when it comes to transgender and gender non-binary (TGNB) patients. At the Nurse Practitioner Group, we fill that gap to foster the best health outcomes. As nurses, building relationships is the core of our practice and removing patient-provider barriers can be as simple as confirming pronouns, using chosen name, and using preferred or gender-neutral terminology when discussing anatomy," says Rakiyah Jones, DNP, an assistant professor and family nurse practitioner.
He added that the practice has developed a clinical team trained in the nuances of TGNB health care, eliminating patient burden so they can be active partners and participants throughout their health care journey.
The new Certificate for Professional Achievement aims to expand TGNB people's access to respectful, high-quality health care, no matter where they live, Kelly says. "This is a first step in increasing access to care for transgender clients."
