At the end of January, a 15-year-old transgender teen in Texas was told his hormone therapy would be discontinued immediately. His nurse, eyes filled with tears of frustration, could only say, "I'm sorry, my hands are tied." This is the chilling reality LGBTQIA+ patients of all ages now face under President Donald Trump's second administration, where new policies have swiftly threatened access to essential gender-affirming care and a variety of other health-related services. Executive orders, such as "Protecting Children from Chemical and Surgical Mutilation," have federally prohibited gender-affirming care for patients under 19, overriding state laws and defunding hospitals that provide these services. While politicians debate ideology, nurses are left confronting the devastating human cost of these policies.
This EO sent shockwaves through health care institutions nationwide. Major hospitals in New York, Los Angeles, and Washington, D.C. abruptly canceled transition-related appointments for minors, fearing federal retaliation. These discriminatory policies are not based on research or evidence-based care, and have left thousands of transgender and nonbinary youth stranded, without continuity of care, and at increased risk of anxiety, depression, and suicide. This has created a climate of fear not just for patients but also for providers. Nurses and doctors who once provided compassionate, empowering care are now being forced to choose between their ethics and employment. Many fear professional censure, legal action, or even the loss of our licenses for simply following protocols and guidelines set by respected organizations like the American Academy of Pediatrics and the American Medical Association.
This EO is just the beginning of the impact of our current political climate on LGBTQIA+ health and well-being. Stigma, discrimination, and outright hatred will continue to impact health and healthcare across the entire lifespan and a wide range of health processes and conditions. The disproportionate impact of violence, hatred, and discrimination means that LGBTQIA+ patients are less likely to access care, less likely to receive equitable care, and less likely to have excellent health outcomes after care.
What is the ethical implication for nurses? Nursing is founded on principles of autonomy, beneficence, and justice. But what happens when federal policies directly contradict these ethical standards? Historically, nurses have played a critical role in advancing LGBTQIA+ health equity. From supporting patients during the HIV/AIDS epidemic to advocating for inclusive health care policies, nurses have always been at the frontlines of patient-centered care. Today, the need for nurse advocacy is greater than ever.
Restrictive laws like the recent EO not only harm patients but also undermine the trust that is central to nursing. LGBTQIA+ youth already face disproportionately high rates of discrimination in healthcare settings. Adding legal barriers to essential medical services further exacerbates their distress and erodes confidence in the health care system.
Nurses are facing an increasingly harsh reality under these policies. In hospitals and clinics across the country, administrators – fearful of losing federal funding – are implementing restrictive internal rules that prevent nurses from providing gender-affirming care, even in an advisory or supportive role. Those who dare to advocate for their LGBTQIA+ patients risk disciplinary action, job loss, or even legal consequences. This hostile environment is leaving many nurses grappling with profound moral distress, forced to stand by as patients are denied the life-saving care they so desperately need. The very principles that guide the nursing profession – compassion, advocacy, and ethical care – are now being threatened, putting both providers and patients in an untenable position.
The question is: Will nurses remain silent, or will we fight back? Nurses are not powerless in the face of these restrictive policies – there are concrete steps they can take to continue protecting LGBTQIA+ patients. In fact, not only are we powerful, but we are also obligated by our profession to speak up for our most vulnerable patients, clients, and families. Education itself is a form of resistance; by deepening their understanding of LGBTQIA+ health disparities, nurses can ensure that even in hostile environments, they provide informed, respectful care.
Advocacy must happen at every level, from joining professional organizations like the American Nurses Association to working with LGBTQIA+ health coalitions that fight back against harmful legislation. Even within federal constraints, nurses can create safe spaces through compassionate language, active listening, and connecting patients with trusted community resources. Beyond the bedside, nurses can take legislative action – testifying before lawmakers, joining advocacy campaigns, and supporting lawsuits that challenge these discriminatory policies. In a moment when LGBTQIA+ health is under siege, nurses must stand firm in their ethical commitment to equitable care for all.
We are at a turning point. If nurses do not take a stand now, the erosion of LGBTQIA+ health care will only accelerate. The next four years could see the dismantling of decades of progress in patient rights, and the most vulnerable among us will suffer first. Nursing is not, and has never been, about compliance with political ideology – it is about caring for patients with dignity, respect, and evidence-based practice. The question is not just whether we are willing to stand up for LGBTQIA+ patients but whether we are willing to defend the integrity of nursing itself.
The time to act is now. Our voices matter. Our advocacy matters. It's up to you.
Jan Oosting, Ph.D., RN-BC, is an associate professor of nursing at City University of New York (CUNY) School of Professional Studies. She identifies as a member of the LGBTQ community.
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