Visiting the emergency room can be a harrowing experience for a patient on its own, let alone if the hospital's staff are pointing at you and making a spectacle.

Such was the case for "Brandon James," a transgender man who visited one ED in southeast America a few years ago, expecting the same level of service as any other patient. Instead, he was treated like a "freak show at the circus" by hospital staff when the female marker on his driver's license and medical record did not match up with his masculine appearance and preference to go by male pronouns.

The story, highlighted in an article published Monday by the Journal of Emergency Nursing, explores some of the steps that nursing leadership can take to improve care for such individuals. Authors point to one recent study, which found that about 19 percent of transgender patients reported having been refused care because of their gender status, and 28 percent said they experienced harassment in a medical setting.

"Unfortunately, this is fairly common," says Ethan Cicero, R.N., a co-author of the article and doctoral student at the Duke University School of Nursing. "From a nursing perspective, those are very alarming numbers to learn about, so that's why we wanted to look a little more closely into this community's health care experiences."

Upon Brandon's arrival at the ED with an elevated blood pressure and severe anxiety, the confused check-in staff member left briefly to go grab three or four more employees. The group proceeded to make a spectacle of Brandon — a pseudonym to protect his identify — pointing and saying things like "No, that's really a girl." Following check-in and several hours of waiting, a second staff member furthered the patient's discomfort by repeatedly referring to him as "Ms. James" or the female pronoun, despite his objections.

He ended up leaving without seeing a doctor and planned to never visit that facility again. About 28 percent of transgender patients surveyed say they have postponed medical care because of discrimination. "It definitely makes me wary of going to an emergency room again. I refuse to go to that specific place," Brandon is quoted in the piece.

The article offers several resources for hospitals to help strengthen the care they provide to transgender patients, including the Fenway Institute's National LGBT Health Education Center, and this report produced by the Joint Commission in 2011. Authors also suggest several simple steps nursing leaders might take with their staffs to improve patient care:

  • Develop policies and protocols to accommodate transgender patients within facilities.
  • Establish trans-inclusive spaces within hospitals.
  • Update demographic forms and electronic health records to recognize transgender identities.
  • Educate all staff members on appropriate communication with transgender patients.

"Harm must not be inflicted by providers' misunderstandings or even biases about gender expressions or identities," authors conclude. "Health disparities experienced by transgender people is an example [of] one of the many breakdowns in the U.S. health care system. Nursing, however is capable of creating the change needed to provide equitable care to all persons, including members of the transgender community."