In 2019, an interprofessional team collaborated to prepare for the first gender affirmation surgery at Cooperman Barnabas Medical Center in Livingston, New Jersey. Nursing professional development (NPD) practitioners who covered the operating room, post-anesthesia recovery, and admitting post-op units, prepared the nursing and ancillary staff with education alongside the surgical team. During the COVID-19 pandemic, elective surgeries were temporarily on hold as the hospital was severely impacted by COVID census, even transforming the OR into an inpatient care area. With the return to the new norm, gender-affirming post-op patients were cared for by new staff, including Minerva Layug, MSN, RN, PCCN, an NPD practitioner assigned to the surgical stepdown unit that now cares for this patient population.

In order to prepare herself and the staff, she educated herself on the procedures and care for chest masculinization, chest feminization, phalloplasty, and vaginoplasty. She incorporated the NPD standards of practice: 1) Assessment, 2) Diagnosis, 4) Planning, 5) Implementation, 6) Evaluation, 7) Ethics, 8) Advocacy, 9) Respectful and Equitable Practice, 10) Communication, 11) Collaboration 13) Education, and 17) Resource Stewardship to educate and competency the staff. Minerva worked with the physician assistants to create coursework that was then included in the unit’s Advanced Stepdown Course for all new hires.

“Clinically, I had no experience caring for this patient population,” Minerva said. “Collaborative work became essential in order to ensure proper training and courses were provided to the current and incoming staff.”

In the healthcare setting, she explained, “changes are inevitable, which emphasizes the need to be able to adapt and readjust, shift, and refocus priorities.”

Promoting Inclusivity and Respect

According to a 2015 study from the National Center for Transgender Equality, 33% of transgender patients who saw a healthcare provider in the last year reported having at least one negative experience related to their gender identity.

“There are still so many barriers to care specifically in this population,” Minerva said. “Some patients have chosen not to see a doctor because of fear of being mistreated as a transgender person.”

To break down these barriers, Minerva aims to provide training that highlights a culture of inclusivity and respect for all people, especially when it comes to caring for transgender patients. She collaborated with the hospital’s director of diversity and inclusion when developing the content to increase awareness across the entire team.

Providing Education on Care

The two-day Advanced Stepdown Course showcases 12 content experts from a variety of disciplines, including physicians and surgeons, physician assistants, advanced nurse practitioners, and respiratory therapists. The topics incorporate body systems reflective of the most common diagnosis for admitted patients. The in-person course begins with a pre-test, continues with education using a variety of instructional modalities for engagement, and ends with a post-test. 

She shared: “I designed a portion that includes a competitive game requiring groups to answer set questions from different stations. Each station is designed to gradually increase in difficulty while testing the knowledge gained from the course itself, requiring knowledge recall, and then application.” Related to gender-affirming surgery, there is a focus on participants' demonstration of sensitivity by using their personal pronouns and addressing the patient based on patient-centered preference.

The course design has resulted in positive evaluations. She explained: “The fresh graduates and newly hired RNs appreciate the intimate setting of being in a classroom and learning from the interdisciplinary healthcare team. It allows them to ask questions, clarify the purpose behind the initiatives, and engage in discussions and case studies.”

A Personal Connection

A patient family advisory council (PFAC) is a group of patients and support persons, clinicians, and administrators who work together to improve the quality of care and patient experience. Cooperman Barnabas has an active Transgender PFAC that meets regularly. Minerva sits on the council representing nursing and nursing professional development initiatives. Recent work from the PFAC members includes inviting patients who have undergone transition surgeries to join a meeting and discuss their experience and add any suggestions on how to promote inclusivity and provide awareness to the community. The most current focus is to increase networking opportunities. 

Working to support people as they transition is particularly meaningful to Minerva.

“As a member of the LGBTQ [lesbian, gay, bisexual, transgender, and queer] community, it is important for me to always embody and foster a culture of acceptance and a sense of belonging,” she said. “The world we live in already emanates many challenges, and healthcare should not be one of them.”