Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care

Background: The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals - in particular nurses - towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people. Methods: We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2022. We focus on differences between three subsets of participant: (1) nonhealthcare professionals (N = 177,810), (2) non-nursing healthcare professionals (N = 22,443) and (3) nursing healthcare professionals (N = 11,996). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics. Results: We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals - but in particular nurses - conflate sex and gender identity. Conclusion: Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students.