Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Cloton. We've talked a lot about diversity, equity, and inclusion on this podcast, but one area that can get overlooked is how LGBTQ plus issues intersect with health equity. These issues can be hard to surface at first, but they have a real impact on patient outcomes. Similarly, on the employee side of things, LGBTQ plus competence for leadership can improve staff retention and unit morale. And with that in mind, our guest today is Dr. Shannon Whittington, DNP MSN RNCCM. Her pronouns are she, her. She is a nurse consultant and LGBTQ certified expert who helps educate healthcare organizations to better understand their patients and employees. Welcome Shannon. Thank you so much for joining us today. I am delighted to be here, Charlene. Thank you. We're so happy to have you here as well. And there's a lot to talk about on this topic. So I want to dive right in. And to kick things off, actually, could you first explain what LGBTQ stands for and share how your journey has led you to advance LGBTQ inclusive patient-centered care?

Okay, well, that that's I I love to start off with that because that's like LGBTQ plus 101, right? With all the letters. And they can keep going on and on. And uh my mom said to me one time, Well, how would you talk if you didn't have the alphabet? And I said, Well, mother, I really don't know. But uh generally uh L is for lesbian, which are two women who are romantically attracted to each other, which I identify as a lesbian. Uh G is for gay, generally two guys who are attracted to each other, although you know, a lot of women call themselves gay. I do too as well, like because at some point L was like derogatory, lesbian was derogatory, right? So then I was just saying gay, but it's come back in vogue again, you know. So I'm using it again. Uh when I found out my 20-year-old intern was using it, I was like, oh, I can say that now. She's like, yeah, it's cool. I was like, well, I definitely want to be cool. So, and then you have B for bisexual, which means that this person can be attracted to men or women or other genders. And that last part, I I really didn't know. One of my good friends, you know, she's by, and sometimes she's with a girl, sometimes she's with a guy, and she tells me, oh, but you know, if I met a trans person, I would be, you know, into them. If I'm into them, I'm into them. And I was like, oh, I thought it was just boy or girl. And not these days. Okay. Uh, so then we have the T for transgender, stands for transgender. And that are that those are individuals who uh do not agree with their assigned anatomy at birth. Right. So uh that's that. Okay, LGBTQ, Q is queer. This can be people who are questioning their orientation, and it can also be an umbrella term that covers all. So probably on the podcast, you're gonna hear me say queer community a lot. Uh, this is a word that is no longer pejorative as well. So uh, but it depends on the generation. Like if you ask a senior citizen or or mention the word queer, they're probably gonna have a horror story to tell you about being made fun of and called queer. But it's been reclaimed. And one thing that we have to know about this is that you know, the the language is is evolving and it's linguistically fluid. So every three to five years, what wasn't cool is cool, and what is cool ain't cool, and who knows what cool is, you know. So that's pretty much the then you it can keep going, IA, you know, intersex. Uh there's over 200 intersex conditions, and these are individuals who have uh undefined body parts, or uh, I'm talking about below the waist here, or um one more developed than the other. That's a whole other thing. A for asexual people don't have a romantic attraction to anyone, but it can just keep going. I mean, I'm glad the alphabet has 26 letters. Is that right? 26 letters? It's been a while since I counted them. But I think so. Yeah, I think so. So, but and then the second part of your question was how did I get into this work? Is that is that right? Yes, yes. Okay, okay, so uh I never uh expected to be the gay poster lesbian child uh person on LinkedIn. I had been on it for years when it was just a resume site and uh in the closet, like a lot of other people. And one day I posted something, and I don't know, I just kind of casually mentioned it, you know, Charlene, just kind of like a little quick thing. And that got more engagement than all my other stuff because I'd gotten certified as a John Maxwell speaker, and I was, you know, sticking my chest out about that, and love the DNA of that organization. But when I started talking about this particular thing, it started to resonate with people, and I was like, can I really have the nerve? Because that's what it took to go public with outing myself on such a large platform, and I did, very scary time, right? Got a lot of cringe in my DMs, but overall, um, it's I mean, I speak all over the country, and most of the people find me on LinkedIn. So it turned out to be good, and you're always gonna have some duds, and you just gotta not pay attention to them.

Yeah, and I think that's such an important message because you know, LinkedIn is a huge platform. There's so many different voices, so many different audiences, so many different narrators and people who read posts. Actually, LinkedIn has some of the best outreach for posts when it comes to things that you have out there, and a lot of people read those posts. So very inspiring that you were able to share your insights and your expertise and experience on the platform, and it was well received in that way because I think that that speaks volumes to uh each of us who might want to share our voices on the platform. So so thank you for sharing that journey. Absolutely. And you know, speaking more from your experience, where do LGBTQ issues most commonly surface in healthcare settings in particular?

Well, uh, what's that movie you had me at? Hello? Oh no, you're maybe too young for that.

There's a movie that says I'm not that great with movies, I'm sorry. But there's a line that says, You had me at hello. It's at hello, where a lot of the problems surface. And I think the reason why that is, is because in in many cases, I'm not gonna say most cases, because some of us are doing really good across the country, right? But a lot of us aren't. And in many cases, the hello is what is where the problem is because we we don't have any uh way to identify this population. We're not asking soji data, sexual orientation, gender identity data. So we we are just treating these clients like everybody else, and we say, well, we treat everybody the same. Well, honey, there's the problem right there. Because if you don't get us at hello, we're gonna tell everybody, right? We're gonna spread the good. Hey, this this doctor is really affirming I had a wonderful experience, you can feel safe there. And we're gonna tell our friends, but we're also gonna tell our friends, honey, don't step foot in that place. They don't like gay people. You know, I had the most painful pelvic I've ever had because I told my GYN I was gay. So it's a hello.

Mm-hmm. And that is so interesting because when you aren't able to see the issues from the start, or if you're not able to have the conversations and have the ability to share things from the beginning, it really sets the tone for the rest of the care that the patients receive. And I it makes me think about underserved populations too, because a lot of the time they are more vulnerable and they may face more invisible issues. And so when we think about underserved populations and these invisible issues that they're that are hard to tell immediately and to see and recognize, you know, especially related to race and gender, what are some of those examples of problems that nurse leaders may not recognize as being LGBTQ plus related, but actually are? Like what are some of these invisible issues?

Well, I think one of the big issues is that nearly 50% of us hide in the workplace. So you are not allowed to be your authentic self. So I'm sitting next to someone that has a picture of her heterosexual relationship, right, with her husband on her desk. Can I dare put a picture of me and my wife on my desk? Um, I don't know. Is it safe for me to do that? Am I going to be treated differently because of that? And in many cases, that is, in fact, the case. So we're really scoping out the environment of where we are for safety first, you know, psychological safety, physical safety. You know, I was in the closet at every single hospital I worked at, including the organization I work at now. No one knew. You know, I I you know, at the other organizations I was too ashamed, right? And then at this one, it just didn't really come up until I got outed. And once you're out it, you could never go back in, whether it's true or not. And I just had to embrace, okay, now everybody knows. You know, and I'm super, super feminine. Y'all can't see me through the screen, right? But you know, I've got long hair, I wear makeup, and you know, cute little outfits trying to look good. And maybe I don't present as that, right? But that's that's the biggest issue I see. One of the biggest issues, yeah.

So oftentimes a lot of these issues can remain invisible and stay invisible for the some of the reasons that you already referred to, but are there any other reasons why these issues can stay invisible until there's a complaint or an incident or even problems with staff turnover?

Yeah, that's very interesting because that's usually when my phone rings when there's a complaint or something happened, somebody said something they shouldn't have said, or did something they shouldn't have did. You know, and then they're calling me. And I and I always think, you know, a lot of this could have been prevented if you had some simple education around it. And you know, I've even had organized say, well, we don't have gay people here. Okay, you got 50 or more employees, yes, then you have gay people there. You may not know it, okay, but you do. So I think a lot of times it's just about the safety of the individual, like, and and how is that going to affect them as an employee? Like uh at one organization I worked at, uh, after after you know, uh my boss found out. I went from being her favorite manager, top performing manager, I would say like her top three managers. She put me on every uh, you know, thing that was coming down the pipe. You know, she always had me on all these different types of whatever you call them, you know. And um it changed overnight, like all these projects, you know, she would always want me to do these special projects. I was always the one to do it, and all of that changed. And I was like, oh my god, I got a homophobic boss. And I I I couldn't believe it, and then I could believe it, but it was just so freaking obvious, you know. And then she proceeded to like try and sabotage my career, and I was like, I couldn't believe it because I was like, oh my gosh, I've worked here so long, we've worked together for so long. Like, what's different? You know, and I didn't feel like backlash or anything different in the around my my co-workers, you know, some people cared, some people didn't care. You know, it's New York, people really don't care, you know, in general. Like in California, you know, it's kind of like a Mecca of us. Um, but some people did. And she was one of them.

And you know, with her being in the leadership position too, I mean, her uh her behaviors, her decisions, if she changes that because of that, that could be really detrimental. I mean, it was really detrimental to you as a staff member. And I'm sure you're not alone too with others who have similar experiences with healthcare leaders reacting in the same way.

Yeah, I'm not alone because they they DM me on LinkedIn telling me about it. And I still can't believe, I can and I can't believe that it's still happening, you know, but it is. So I think I think organizations and particularly like healthcare leaders really need to have a no tolerance, right, for this population and an enforced no tolerance, you know, not a check the box no tolerance, but it needs to be enforced. Whereas if someone misgenders you or you know, you've changed your name and you want to be called Sam now, and uh things like that, you know, little comments and stuff, there should be some, you know, ramifications for that that should be enforced. And I think when organizations start to do that, and that spreads throughout the culture, people realize, hey, I can't say this. I can't do this. Um, I'm probably gonna get in trouble if I do, because it's going to be enforced.

Right. And a lot of the times when it comes to leadership, a lot of the skills that we learn, they are considered competencies, right? There's different competencies for doing different skills, and there could even be a competence for LGBTQ plus competence and learning more about how to appropriately, you know, support staff who are who identify as LGBTQ plus. And I want you to share more what do we mean by competence with our LGBTQ plus community, and how can this lack of competence affect all of us in terms of affecting patient trust and disclosure and health outcomes? What does that look like?

It's appreciating and understanding the differences, the nuances, the social determinants of health, the healthcare disparities that this population faces. And I think taking those into consideration, we can become more competent to provide affirming care. Whereas we are looking at the entire person, right? Um, who they are, how they identify, what their pronouns are, respecting their privacy, right? They're they're maybe they're not, maybe they're trans and they're stealth, right? Which means that they're passing, respecting that privacy, um, just understanding everything that's involved with that. So we're taking all of those things into consideration when we're talking to them, when they're employed with us, or when we are giving providing care to them. And that's what I really help organizations do is like standardize those practices so that, you know, once the hello happens, you know, the next that comes is it's it's it's smooth sailing. If you get it right at hello.

Right. And so the hello, you know, that really symbolizes for the patient's journey and and for the staff too. It's like the first encounter with the organization. And if we're speaking about the patient, that could be in the admission process, right? If they're in the inpatient setting, in the ED, it could be in the outpatient setting with the provider. And then there's also other moments of the patient's journey too, just like when they do uh meet with a clinician, when they're having an assessment, when they're about to be discharged or leave the healthcare facility, there's all these critical points in the journey where leaders can play and should pay closer attention, just like the hello, as you mentioned. So, for these specific moments, these key points of the patient's care, what can leaders do in these moments to make sure that the patients feel that safety or feel that they can really trust the organization to share this important information and to receive the best outcomes?

I love this question because you know, when I'm doing my talks, one of the questions that I ask organizations is how does LGBTQ look in your organization? And and I will say to them, in many cases, it looks like this. And I forward the slide to a blank screen. And inevitably, the person that is arranging the conference, the event planner, whoever's going over everything, they said, You've got a blank screen in your presentation, Dr. Whittington. Would you like for me to remove it? Is that an error? And I'm like, Nope, not an error, because that is how it looks in many organizations. We are looking for signage that says, Hey, you are welcome here. You can be yourself here. And what does that look like? Well, the pride flag. Okay, we see the pride flag, honey. That's like a welcome mat for us. All right. I know that I can go into this hospital setting, this outpatient, I can go and apply for a job here and not pretend like uh uh my wife is my sister if I'm receiving healthcare. Okay. Or if I'm applying for a job and I see that, I'm like, I can be myself here and I can feel safe here. Now, word to the wise, though. It's not a check the box thing, right? This is iterative education, y'all. Like it's not a one and done, honey. You know, you have to keep, and especially like for the older generation, baby boomers. I ain't calling y'all old, but you know what I'm talking about. Like, we didn't say anything about pro what do you mean? That's a girl, that's a boy, that's a he, that's a her. That's it. Non-binary, what the heck does that mean? Like, I didn't know what that meant back in the day. Uh, I didn't even know like transgender issues, you know, I had no idea. But if we see on on the hello again, I'm I'm filling out the application to to work for the ACNL. All right. And there's identifying applications, identifying information on there. How do you identify? And all I see is male or female, and that's it. Well, then that tells me right there a lot about the ACNL. Okay, because there's no category for many of us who identify beyond the the the binary spectrum of male and female, right? So we we we we we have to get comfortable. We gotta normalize, you know, respecting people's pronouns, respecting people's chosen names, whereas and respecting the they them pronoun for one person that's driving some people crazy these days, right? And that way we can have better cohesion. You know, Forbes says that organizations who have a diverse workforce make better decisions. I think it was like 78% of the time. Right. Now, I don't know about you, but I would love to make better decisions 78% of the time. All right. And what we have found is that it cost organizations a lot of money when they mess this up. Right. From lawsuits to turnover to morale to uh satisfaction, uh you know, uh employee satisfaction, client satisfaction, it cost a lot. And I think a lot of times we just don't realize that. And and what I want to say to your audience is that we are everywhere, okay? 20 million strong in the U.S. alone. And and and my mom says, you know, there sure don't seem to be no shortage of y'all. And there isn't. And it's not like all of a sudden, whoa, where's all these gay people come from? We're just slowly starting to feel more comfortable to even tell you who we are. Because it hasn't always been safe, you know. Honestly, like, you know, I told you, Charlene, I speak all over the country, right? And I do my videos. Hey, I'm here at the so and so conference for I was at the American Nurses, American Nephrology Nurses Association, somewhere, I can't remember where. And I was doing my video. This is where I am. I'm speaking about blah blah blah blah blah for the renal failure patient. Do you think I posted that while I was there? Heck no. I don't feel that safe. Right. I don't know who's listening, who's in the elevator. I don't, I don't want to get jumped. Right. So I post it after I leave. Like I never post where I am until I'm on the plane going to the next place. Because I still have to be cautious of my own safety. You know, and as much as I talk about this, and I'm so glad that the ACNL is discussing this today because it ain't popular right now. You know, us queer folks are under attack right now. And if and yes, unless you've been living under a rock, honey, you know that. All right. It's just not popular to be queer. Certainly isn't popular to be trans. And yes, you can say trans for short. So I even feel like, and it sure ain't popular to say D-E-I. Oh Lord, you know, get yourself in trouble, right? But here we are, and we are here, and we still need that care, you know, and leaders really need to know and understand that we are here and we will perform our best if we feel comfortable in the environment that we're in.

And you brought up a lot of um great, you know, you brought up a lot of great nuggets too, because there are some important uh important notes I want to reiterate. And the first is that there is a really big need for psychological safety, even for physical safety, for all levels of safety when it comes to patients and staff who are in the LGBTQ plus community. And there is a real risk for a department, for an organization when those practices are not implemented in the workplace in these environments. And, you know, for those who are listening who maybe maybe they are in a hospital where they don't have a signage, or maybe they don't have the questionnaires with all the different options for gender identity, what are a few of these high-impact actions that leaders can take to, you know, reduce the risk, improve these outcomes for the community? Uh, what can nurse leaders do if they want to support more of, you know, diversity, equity, inclusion, anti-racism, and accessibility?

That's a really good question. You know, um, there was a study done by Liam in 2017 that said that the average nurse gets about 2.12 hours of education in LGBT, anything. Right. Now I get nurses from Ivy League to No League, okay. And I asked them, hey, I just asked one yesterday, did you have any, you know, any education around this? You know what the answer is 99% of the time? No.

Right.

Unless they took an elective or you know, something like that. So it starts with education. You know, you got to educate your staff. We ain't going nowhere, y'all. I don't care how much we're trying to be we are being oppressed at this moment. I'm not, can I go back in the closet? I've got almost 40,000 followers on LinkedIn. Do you think I can go back in the closet? No, I can't. You know, we're not gonna go anywhere, right? But if you allow us to be who we are, we are often very eager to help you achieve a culture of acceptance, of tolerance, of understanding, you know. It it's for all levels, for everything, all the isms that you just mentioned. You know, you you think about like, oh, this person, this, that, and the third. No, we're really everyone's just trying to be the best expression of themselves. That's what I think. That's what Oprah says. You know, everyone's trying to be the best expression. That's all I want to do. I don't want anything different than you, Charlene. I don't want to make more money than you because I'm gay. I mean, I do want to make more money than you, but not because I'm gay. You know, what's that got to do with it? But I don't want to make less than you because I'm gay. You understand? Like, I don't want to be passed over for a promotion that I'm more than qualified for because I'm gay. Right? But that's that's the reality of it. I think it's less than 2% of C-level positions, C-suite level positions, are occupied by us. You know, is that in healthcare organizations or just in organizations in general. Now, you mean to tell me that's all the gay people leaders, that's all there is, is only 2%? I really doubt it. Heck fire. I I got my doctorate. You know, I got enough letters to spell people's name after my name, right? But I I mean, I just think organizations need to wake up, y'all. We are everywhere. We're in your communities, we're in your schools, we're sitting on your tables getting an examination. We are providing care to you. We're doctors, nurses, therapists, social workers, aides. We're your Uber driver. And can I dare say we are in your churches? Yes, honey, we are, because many of us are believers. I am right. Okay, so we're everywhere. And you can't escape us, whether you want to or not.

That's the T. Okay. We ain't going nowhere. And you said it so beautifully because at the core of all of this, it's the ability to be your authentic self and show up as you are as a patient, as a staff member, as a human being in all of these spaces that exist in our communities, right? And obviously, healthcare organizations are part of that. And, you know, I want to talk about this for so much longer, but for today's conversation, we do have to wrap up. And I wanted to give you the opportunity to share any last uh words of wisdom for our audience who's listening. Maybe they are in the LGBTQ community, maybe they're a nurse leader who has uh LGBTQ staff or patients. What would you like to share for our audience just as final words of wisdom?

I would say take a look at your organization, right? And look around, look around on the website, look around in when you first walk in the lobby, just look around and see what is the representation of us there. And if you're drawing a blank screen, all right, you need some education around this, bring it up to your leader. You know, show some statistics of the number of gay people in your community because I don't care if you live behind God's back somewhere, we're there too. Okay, that's the main thing to do. And and the other thing is, you know, reach out to people like me who can help you, who can help your organization. Do you have many like wonderful uh DMs and emails I get after I've done a session with an organization or done a workshop with a with a hospital system or healthcare providers? Oh my gosh, they'll give me an example. Hey, this patient came in. You know, I I'll tell you an example. One time this nurse said to me, we had a transgender patient come in the ER and we drew sticks to see who would take care of him because nobody wanted to take care of him. That saddened me so bad. But after they got the information that they needed, because here's what my research showed when I was working on my doctorate project, right? Once clinicians, leaders in this in this sphere are exposed to the information, they tend to do very well. They tend to do very well. And for me, it's all about clinical transformation. I love speaking at companies, and and and someone comes in there and their body language is turned sideways and they're all twisted up because they don't want to be there. And at the end, they're like, wow, I had never thought about it like that. Like that brings me joy.

That's amazing. And Shannon, where can people find you or learn more about your work?

Whittington Consulting. All right, just look that up and on LinkedIn, Shannon Whittington, uh, a YouTube channel, Shannon Whittington. Just Google my name, honey. She there. I'm not the photographer, okay? It's Shannon Whittington. You'll see, you'll see the letters. It's not the only person named that. Thank it, I'm not. You know, yeah, I thought I was the only Shannon Whittington in the world, but I'm not.

Well, we're so glad that we were able to speak with you today and have you on our podcast, Shannon. And I just want to say thank you so much for being here and for sharing all of your expertise and experience with us.

Well, thank you, and thank you to the ACNL for recognizing the need to have this conversation. It says a lot about you and your organization. So I am delighted to have been here today, Shirlene.

Well, thank you so much, and we really appreciate you. And our guest today was Dr. Shannon Whittington, a nurse consultant and LGBTQ patient-centered care expert. We'd love to hear your feedback. Email us at socialmedia at acnl.org and connect with us on LinkedIn and Facebook at ACNLNurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.