It is the position of the National Association of School Nurses (NASN) that, in order to provide culturally competent care, school staff and communities should institute affirming policies that support lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth. These include bullying, health risk behaviors, and rejection from family and friends. Such challenges can cause adverse mental and physical health effects such as depression and suicidal ideation. Registered professional nurses (hereinafter referred to as school nurses) are uniquely positioned to help LGBTQ youth by creating LGBTQ-affirming spaces, guiding youth towards resources, advocating for school-wide protections, and assuring youth that their identities and feelings are normal and appropriate.
BACKGROUND AND RATIONALE
NASN supports comprehensive care, guided by the principles of cultural humility, in safe, inclusive, and affirming school environments for LGBTQ youth.
- In addition to increased psychological health risks from bullying, LGBTQ students also experience health disparities, such as physical violence; forced sexual encounters; and rates of alcohol, tobacco and other drug use that are nearly twice the rates of heterosexual peers (Kann et al., 2018).
- LGBTQ youth who do not have affirming parents or guardians are more likely to experience homelessness and associated risk factors than their peers (Guletkin et al., 2019).
- Safe and supportive school environments are accomplished when all school staff are familiar with current LGBTQ best practices and terminology, including use of appropriate pronouns and addressing myths and misconceptions which can contribute to inequities and violence. School staff should use gender-inclusive, non-heteronormative language (GLSEN, 2016).
- Barring an explicit legal obligation, school nurses should respect confidentiality and not disclose a student’s sexual orientation or gender identity to others, including parents or guardians, without permission from the student (Human Rights Campaign, 2019).
- School nurses should assess LGBTQ students carefully for signs and symptoms related to bullying, violence, and family rejection, such as frequent somatic complaints, recurrent absence from school, poor academic achievement, and signs and symptoms of depression, self-harm, and disordered eating (Hooker, 2019).
- Recognizing the substantial risk for depression in this population due to rejection and stigma, school nurses should provide education for students on depression prevention strategies such as stress management, regular exercise, and finding social support (Perron et al., 2017).
- School nurses should facilitate access to supportive medical and psychological sources of care for students who need referrals, as well as to local resources such as the nearest LGBTQ community center (Willging et al., 2016).
- School nurses should evaluate health education curricula for medical accuracy, inclusivity, and diversity to reduce risk behaviors and to support positive sexual health outcomes among teens, such as reducing teen pregnancy, sexually-transmitted infection rates, and sexual violence (GLSEN, 2016).
- School nurses advocate for policies which ensure equitable access to school facilities and activities, as well as policies which promote safety for students who identify as transgender or gender-expansive (Wernick et al., 2017).
- School nurses work with school staff, students, and families, when appropriate, to create a clear policy and plan for any students experiencing suicidal ideation with a focus on at-risk student populations, including LGBTQ students (Perron et al., 2017).
- To increase the likelihood that LGBTQ students will feel safe and seek out the support they need, school nurses should display a visible sign of LGBTQ inclusion, such as a pride flag, safe space sticker, or poster in the health office (Human Rights Campaign, 2019).
- In one survey, 42.8 % of students identifying as LGBTQ had seriously considered suicide in the past year. Schools with affirming policies for LGBTQ students are associated with lower rates of suicidal ideation, alcohol and other drug use, and poor school achievement in this population (Demissie et al., 2018).
In order to reduce these health disparities and to provide comprehensive care, school nurses should collaborate with educational teams to create welcoming, healthier, and thus safer environments for all students, while addressing stigma, discrimination, and marginalization of LGBTQ students.
Demissie, Z., Rasberry, C. N., Steiner, R. J., Brener, N., & McManus, T. (2018). Trends in secondary schools' practices to support lesbian, gay, bisexual, transgender, and questioning students, 2008-2014. American journal of public health, 108(4), 557–564. https://doi.org/10.2105/AJPH.2017.304296
Gultekin, L. E., Brush, B. L., Ginier, E., Cordom, A., & Dowdell, E. B. (2020). Health risks and outcomes of homelessness in school-age children and youth: A scoping review of the literature. Journal of School Nursing, 36(1), 10–18. https://doi.org/10.1177/1942602X16689263
Hooker, A. L. (2019). Nurses can curb LGBTQ bullying in schools. Nursing, 49(5), 64–65.
Kann, L., McManus, T., Harris, W.A., et al. Youth risk behavior surveillance — United States, 2017. MMWR Surveillance Summary 2018;67(No. SS-8):1–114. http://dx.doi.org/10.15585/mmwr.ss6708al
Perron, T., Kartoz, C., & Himelfarb, C. (2017). LGBTQ Part 2. NASN School Nurse, 32(2), 116–121. https://doi.org/10.1177/1942602X16689263
Wernick, L., Kulick, A., & Chin, M. (2017). Gender identity disparities in bathroom safety and wellbeing among high school students.Journal of Youth & Adolescence, 46(5), 917–930. https://doi.org/10.1007/s10964-017-0652-1
Willging, C. E., Green, A. E., & Ramos, M. M. (2016). Implementing school nursing strategies to reduce LGBTQ
adolescent suicide: a randomized cluster trial study. Implementation Science (11), 1–11. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0507-2#Tab
Acknowledgment of Authors:
Christine Amidon, BSN, RN, NCSN
Lynne P. Meadows, MSN, BSN, RN
Janet Thornton, MSN-Ed, RN
Camille Wheeler, MA, BSN, RN
Tina D. Miller, MA, BSN, RN, NCSN
Consulting Content Experts
Tracy Perron, PhD, RN, CNE, CSN
Vincent Pompei, EdD
Tonda L. Hughes, PhD, RN, FAAN
Revised: June 2003; January 2012; January 2016, January 2021
(Formerly titled “Sexual Orientation and Gender Identity/Expression [Sexual Minority Students]: School Nurse Practice).
Suggested citation: National Association of School Nurses. (2021). LGBTQ Students [Position Statement]. Silver Spring, MD: Author.
“To optimize student health, safety and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day”
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.