As health care evolves to meet the needs of diverse communities, one issue often remains neglected: true inclusivity for LGBTQ+ patients and staff. As an LGBTQ+ health care provider and researcher, I have dedicated my career to understanding and addressing the challenges faced by LGBTQ+ individuals in health care settings. In my recent research, my colleagues and I set out to explore this by speaking with nurse leaders from across the U.S.—the majority of whom were C-suite executives—nurse leaders occupying the highest levels of health care administration, such as Chief Nursing Officers or Chief Nurse Executives. Their insights reveal eye-opening truths about what inclusivity truly means in health care.

Our study found that while inclusivity might seem straightforward, many health care institutions still struggle to fully integrate supportive practices and policies. These nurse leaders, responsible for overseeing vast teams and shaping health care environments, spoke passionately about the importance of fostering truly inclusive practices.

As one leader shared, “When you think about health care delivery, humanity is at the core of it. You have to set aside your biases. … It’s all about serving humanity and meeting human needs, so you have to see past any of the things that make us different to see the core of things that make us all the same.” Inclusivity in health care settings can manifest in many ways, but the focus should always remain on “meeting human needs.”

Inclusion Requires Active Leadership Engagement

Creating a truly inclusive environment is not accidental—it requires intentional policies, strong leadership engagement, and a willingness to address uncomfortable topics. The leaders I spoke with emphasized the importance of an open culture where staff feel comfortable discussing LGBTQ+ issues, biases, and even their discomforts. “It’s important for leaders to be comfortable talking about LGBTQ+ issues … to create a dialogue that keeps these issues alive and well,” one nurse leader noted. However, in many institutions this level of openness is still rare, and inclusivity efforts often remain siloed or surface-level.

These leaders also stressed that inclusive policies aren’t just “nice-to-haves”; they need to be embedded in organizational strategies. One Chief Nurse Executive made LGBTQ+ inclusion a priority during strategic planning, and explained, “It’s an important way to demonstrate that inclusivity matters to the whole health system and to the community.” When inclusivity becomes a core value rather than a checkbox, it sends a powerful signal to both staff and patients that they are truly supported.

Magnet Hospitals: An Intervention for Inclusive Health Care

The theme of proactive, embedded inclusivity extends to organizational recognition. Another study I recently led found that hospitals with Magnet status—those recognized for nursing excellence and strong patient outcomes—are also among the best for LGBTQ+ inclusivity. Magnet hospitals outperformed non-Magnet hospitals on the Healthcare Equality Index (HEI), a national measure of LGBTQ+ inclusion efforts. However, it is important to note that, due to the cross-sectional nature of this study, while the association is clear, causality cannot be definitively established. Magnet designation reflects not only clinical excellence but also a commitment to inclusive, patient-centered care. This finding highlights the critical role of regulatory and accreditation bodies in advancing LGBTQ+ inclusion in health care through clearer, more specific criteria.

Inclusivity Goes Beyond Policies to Real Actions

Our research revealed that inclusivity requires action, not just policy statements. For example, adapting electronic health record systems to capture sexual orientation and gender identity (SOGI) data is an effective step. Yet, even this seemingly straightforward measure can be fraught with challenges. As one Chief Nursing Officer explained, “When you’re collecting SOGI data, people are like, ‘What do you do with that information?’” This response underscores the need for thoughtful and respectful data collection practices to build trust and ensure LGBTQ+ patients feel safe sharing their identities.

Representation Matters for Patients and Staff

Inclusive practices aren’t just about patient interactions, they’re about creating supportive environments for LGBTQ+ staff. Many nurse leaders advocated for greater diversity in leadership and staffing. “Representation is really important because without it, you can’t gain the perspective that you can only truly understand by being a member of that population,” a Chief Nursing Officer shared. When health care leaders reflect the communities they serve, it fosters more empathetic and informed care. For organizations unable to achieve immediate diversity in leadership, engaging with LGBTQ+ employees and participating in training can help bridge this gap.

Why Inclusivity Matters Now More Than Ever

For many LGBTQ+ individuals, health care remains a space of discomfort, even fear. One nurse leader remarked, “It’s about dedicating time and attention to making sure that our policies are not excluding [LGBTQ+ individuals] from our services.” Until LGBTQ+ patients and staff feel fully included, health care falls short of its mission to care for all.

Given the arrival of a new president’s administration signaling its hostility toward these practices—particularly for transgender and gender-diverse populations—and the significant rise in state bills attacking LGBTQ+ health care; inclusivity in health systems is more critical than ever.

A Chief Nurse Executive from a health system in a state that attempted to pass a law banning transgender health care emphasized, “If not us, who? We can’t just close the door and not provide the services; these services are part of health and human services. We must learn and educate ourselves, so that we can learn how to navigate and exist within whatever the current policy, laws, and rules are.” The voices of nurse leaders and evidence-based interventions can provide a real, actionable roadmap for meaningful change in health care inclusivity. This is not just an ethical imperative; it’s essential for high-quality, patient-centered care. If we are to achieve health care that truly serves everyone, we must embed inclusivity in our policies, leadership, and everyday practices.

The views expressed in this article are solely those of the author and do not necessarily reflect the views of CHOPR or the University of Pennsylvania School of Nursing.

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The study, “Nurse Leaders’ Recommendations for Implementing LGBTQ+ Inclusive Practices in Health Systems: A Qualitative Descriptive Study,” was published in December 2024, in the International Journal of Nursing Studies Advances. Authors include Hyunmin Yu, April Ancheta, Dalmacio Dennis Flores, Stephen Bonett, Steven Meanley, Seul Ki Choi, and José A. Bauermeister.

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The study, “The Relationship Between a Hospital’s Magnet Status and LGBTQ+ Inclusivity in Policies and Practices in U.S. Hospitals,” was published on October 23, 2024 in Research in Nursing & Health. Authors include Hyunmin Yu, Stephen Bonett, Dalmacio Dennis Flores, Steven Meanley, Seul Ki Choi, Tari Hanneman, and José A. Bauermeister.

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