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LGBTQ Savvy: Law, Policy, and Diversity
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Tiffany A. Ewton discusses LGBTQ Savvy: Law, Policy, and Diversity at ONS Congress 2017. For the ability to view on your mobile phone please visit us at

This transcript is software driven, please understand there may be errors.  Should any inaccuracies or omissions be found, please notify for correction.

Hello there. My name is Tiffany Ewton. I'm a physician assistant in Houston, Texas with the University of Texas Health Science Center. Today I'm going to be talking about workplace diversity in healthcare, specifically how it relates to our LGBTQ colleagues. This is a two part presentation. I encourage you to follow up this presentation with Dr. Caroline Dorsen's presentation from NYU.

I'll provide a general overall of our nondiscrimination laws. I'll do a quick review of our professional organization policy statements on diversity and nondiscrimination. I'll quickly highlight the environment for what it's like to come out with an LGBTQ status, and then finally we'll go over some recommendations and guidelines.

So quickly, a quick legal overview. There is to date zero federal legislation that includes sexual orientation or gender identity, aside from hate crimes. To date, we're approaching about 200 bills that have been introduced since 1974 as amendments to the Civil Rights Act, either as standalone bills or as comprehensive bills in some or all of these areas. We do have the Equal Employment Opportunity office which is a federal agency, and two years ago they decided that sexual orientation discrimination could be covered under discrimination on the basis of sex, so that is currently the only option at the federal level.

So with the lack of federal legislation, we're left really with the patchwork of policy at the state and local levels. But to date, there are still 16 states without a mandate to include sexual orientation or gender identity. Fortunately you can live in a city. We have now over 200 cities that do cover both of these demographics for all of their employees, both their city and private employees. And also you can potentially work and live in a state as I do. I live and work in Texas. It does not have a mandate, but you could be a state employee and still have protection because that institution could include these demographics. So my institution does, so I am protected in that way.

This is a U.S. map that includes a review of the employment laws regarding orientation and gender identity. There are 20 states and DC that include both sexual orientation and gender identity. New Hampshire and Wisconsin only include sexual orientation, and then only 11 states have these protections for only their state or public employees.

So in the last 10 to 20 years, our professional health organizations have really expanded their definitions of nondiscrimination and included these demographics starting in 1993 with the American Medical Association, and then as you can see, in 1998, the ANA really broadened their definition stating, "We need to have diversity in the processes of delivery in the education and practice of nurses," and then what we're talking about today, "We must employ nurses from culturally or otherwise diverse backgrounds at the national and local levels." So I think these are really powerful statements. They're a great reminder of how important our governing bodies think diversity is, and I think they're calls to action for us to be more proactive about being diverse.

In the last 10 to 20 years, we haven't really had a lot of research on what health workers think about LGBT health workers, but we have had, has represented more or less a negative attitude, starting with really a landmark study of nurse educators, in which 17% thought lesbianism was a disease and lesbians were molesters. Eight percent thought lesbians were not fit to be nurses. Over the years, this has changed. There is a more positive attitude in the few studies we have now more recently.

But two years ago, the largest survey of LGBT workers was conducted, and have of them were not out at work and less than half felt comfortable talking about their lives or relationships. So why is that, especially with more positive attitude or greater media attention and a seemingly better attitude towards LGBT people.

Well part of that was because of just conversations they heard every day at work. Half or more heard anti-LGBT jokes or comments, many hearing them from their own supervisors, and one in four workers saying that their co-workers just seemed uncomfortable around them.

When asked more specific reasons or to rank their reasons, these respondents felt that their bosses or co-workers would think that they were being unprofessional. They were afraid that their co-workers would think that they were attractive to them. They were afraid of losing already positive established connections with their co-workers. They were afraid of being stereotyped. They were afraid of making others uncomfortable. 

And then finally, they thought that it was simply nobody's business. But this response was statistically related to those that had actually experienced some type of harassment at work or been the brunt of an LGBT joke or actually lost their job.

This study gets more interesting when asked what non-LGBT workers, so heterosexual, cisgender workers thought about gay and trans people. And the overwhelming majority, 80%, thought that they should not have to hide who they are at work. But when asked more specific questions, more than 70% thought that it was unprofessional talk about orientation and identity, and less than half felt comfortable hearing their LGBT co-workers talk about their lives.

I think this really brings up two important points. First that how can you be out or not hiding without talking about these things. And secondly, there may be a lack of awareness among straight or cisgendered people that when you come to work and you talk about your kids and your wife or your boyfriend and girlfriend, that you are implicitly talking about gender identity and orientation. And especially when both of these groups felt that the three most common conversations at work was first their social lives - what they did over the weekend, secondly their children, and third dating and relationships. So yes, you come to work. You talk about the job, you talk about movies and celebrities. But it is inevitable that you'll be having these conversations at work that you'll be talking about your lives, and especially the longer you are at work. So there just seems to be maybe a double standard on who can have these conversations without repercussions.

There is a real physical and mental impact on workers who try to hide an LGBT status. You can see many of this here. Many feel distracted. People will lie about their life. There are higher rates of depression. They will avoid people at work. They will avoid work events or they just won't go to work at all. There are increased rates of fatigue and stress, and then many will job hop or constantly be looking for another job. So we need to appreciate there's a real productivity issue here and a workforce or labor force issue here or consequence even.

So finally, what can we do, which would be looking for at our institutions? What can we advocate for? First and foremost, we need to have orientation and gender identity in our nondiscrimination policy at work. Furthermore, that policy needs to be well known, easily accessible, distributed. For example, that can be an annual mass email sent out by HR. We need to feel confident and know how to report harassment. The insurance companies that we use for employees need to not discriminate on the basis of orientation or gender identity. Ideally, we have coverage for transgender workers, and that should include hormone treatment and surgical treatment. We need to have a gay-friendly resource group if our institution is large enough.

And then finally and more specifically to our trans applicants and workers, whenever we are hiring people, we need to have just a simple line of asking what their preferred name and pronoun is, maybe having a box that says MTF or FTM in addition to the M and F. Ideally our HR department has guidelines already in place that our departments can use if somebody decides to transition at work. And then finally, if you're at work and you suspect a new hire, a student, a colleague might be transitioning, just simply ask their preferred pronouns.

So that's everything I have for you today. I appreciate your time, and again I encourage you to follow up with Dr. Dorsen's lecture and presentation. Thank you.