A Nurse First

Living your truth

• Sigma Nursing • Season 4 • Episode 5

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Katie Foster believes authenticity in healthcare goes beyond personal identity; it is about embodying professionalism, empathy, and dedication to patient well-being. When she reconnected with a patient who didn't recognize her after her transition, Katie was fervently hopeful that her belief would manifest in reality.

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When I made the decision that I was going to transition a couple years ago, I spent a good eight months trying to plot everything out and figuring out how I was going to go about it. I did not want to be a distracting event for my employers, my teammates. I wanted to make sure I had all of my stuff together in terms of what my plan was. I did not want any disruptions. I did not want to just show up one day and be the event. I wanted to continue to be a professional. That means my primary duty is patient care. Who I am, that's part of me, but I want to be known for being a caring professional, not just a transgender health care provider. The fact that I am transgender is tangential to everything else. I still have to do my job and do it well. Welcome to A Nurse First. This is Katie Foster telling her own A Nurse First story. I have a doctorate from University of South Alabama as well as my master's in nursing from the University of South Alabama. I've been an emergency nurse practitioner since 2016 when I graduated. I'm board certified as a family nurse practitioner, adult geriatric acute care nurse practitioner, and emergency nurse practitioner. I currently work at a small critical access hospital in rural Wyoming, Crook County Medical Services District, and there I provide emergency care to all patients that come in when I am on duty. If we all did everything we're supposed to do and we didn't make any mistakes in life, we'd go through life without needing any health care. But sometimes things just don't work out that way and people show up in your ER and they wouldn't care. And that's where in emergency nursing, you can provide that. You serve as their advocate. You serve there. You're right there in the middle of the circle with them, helping them get what they need. You know, you're making a difference in their life and you can see that tangible difference during that visit, no matter whether it's a simple thing or maybe it's a lot more complex. You know, the reality of it is, is that Again, people have no idea who you are when they come to that ER. They just want you to take care of them. Now, it is interesting. Some of the people in the town where I'm at, they know that I'm transgender. Some of them do not. Some of them remember me from what I appeared as when I first went to that town and have no idea that it's me now. In her role in Wyoming, Katie cared for several long-term COVID-19 patients and their families. One in particular spent significant time with Katie before her transition. And when he returned to her care many months later, Katie's thoughts raced. Would he recognize her? Should she tell him? we have a swing bed rehab component and we have this gentleman there. He was, um, not that old, but he had long COVID and he had a lot of the complications. So I started taking care of him last year before I had made a lot of transitional changes and, uh, took good care of him. We finally got him to the point where he could go home and, uh, didn't see him for five or six months. And in the interim, I had a number of things, surgeries and so forth, and continued to lose a lot of weight. And my appearance had changed dramatically from what it used to be till today. And he came in and he had a laceration to his hand. And I walked in and I said, hey, how can I help you today? And I introduced myself. My name had changed. And I just went ahead and started taking care of him. I had cleaned up his laceration, sutured it and so forth. He was very happy with the procedure. And then I went over his discharge instructions and I went out and I typed them up and I gave them to the nurse to go in to review. And the nurse goes in and she starts talking to the patient and the patient says, is so and so here? I haven't seen them in a while. And she went, that was him. And actually, no, she said, that was her. And he goes, her? And she said, yeah, that used to be so-and-so. And the look on his face, he was just totally stunned. He and his wife were just totally stunned. So I went in and I talked to him for a little bit. He had no problem with it. He didn't. Neither did his wife. They don't care that I'm transitioning as much as they care whether I gave them good care. That's the bottom line. And, you know, there have been people that have asked me. I remember this one woman, she was 84 years old. She said to me, are you one of them transgender people? And I went, well, if you must know, yes. And she said, OK. I was just wondering. You're taking good care of me. I don't care. That was the extent of our conversation. At the end of the day, you're going to be better off because you were genuine. You are your authentic self. You're not having to hide anything. You don't have to lie about anything. You don't have to make anything up. There's a whole great world out there if you just open up and you're yourself. You are who you are. Be proud of it. You recently received the World Professional Association for Transgender Health Certification. Why was it important to you to obtain this certification? What insights can you provide to our nurses from this training? You know, I've been trained since I was four or five years old. I've seen this from a child's perspective all the way through to an adult. I can't say that I had any idea where to get care over the years. And as I explored more of this, it became apparent to me that We needed more health care providers that could provide compassionate care, knowledgeable care. You can't just read a couple of protocols and just go winging it in a clinic. My career has been based on learning and then applying that education to the clinical setting. As a DNP-level provider, I want to provide the best evidence of care that I can provide. By going for the WPATH certification, it affords me that opportunity to not only educate myself, but also learn from other key professionals that are part of the entire team that a transgender individual needs. Consequently, I felt I should get the certification so that if I run into either a transgender emergency department patient or I wound up eventually providing care in a clinic to a transgender population, I could do so effectively, compassionately, and with the proper knowledge. Let's face it, not every patient in the country has good access. I've seen patients in urban settings. Prior to moving out to Wyoming, I worked in a suburban ER in North Carolina. And in that suburban emergency department, we would see individuals coming in that were clearly in distress. Some were transgender, but they lacked all the resources to get appropriate care. And they were engaged in high-risk behaviors, whether it be engaging in high-risk sexual activities or obtaining black market medications or taking bio-identical medications. This put their lives at risk. And some of this was tangential to their emergency visit. But in asking them what their pronouns are, by asking them what's their preferred name, these are all things that provide appropriate care. And they'll open up to you when you do that. I think nursing is ahead of the other groups at this point. You know, I think that the Emergency Nurses Association, which I've been a member now for over 25 years, they have a diversity, equality, and inclusivity committee. They produced a document for taking care of everybody. who presents, who is LGBTQ+, and it's a wonderful document. They have wonderful protocols. It explains pronouns. It explains why it's important. It explains sexual orientation versus gender ID. I was blown away when I saw the quality of the product that they put out. It's a, I think it's close to 200 pages of well-referenced material that represents the best evidence across the country that times are changing in nursing in general. And that's going to have a positive effect on healthcare. Nursing's an incredibly rewarding career if you give it a chance. Is it hard? Absolutely. Do you have to deal with a lot of different situations regardless of your walk in life? Yes, you do. And some days it's thankless, but a lot of times there's a lot of thanks there if you just open your eyes up and look at the wonderment of helping somebody. You know, and I think back to one of the things that Dorothy Oram said, and she was one of the grand masters of nursing, one of the grand theorists. And somebody asked her once, What's so important about the nursing profession? What is your theory?" She said, nursing exists when people lose the ability to take care of themselves. That was the crux of what she said. And I thought to myself, that's so very true. We intervene to help people get back to a point where they can take care of themselves. I love nursing. I love my emergency care environment. But I also like to think that at the end of the day, I'm a human being. I'm more than just the fact that I transitioned. I have a lot of caring to give and I have a platform to do that. And that's what it's really about. Thank you for listening to A Nurse First from Sigma. If you loved this episode, do us a favor and subscribe, rate, and leave us a review. It is very much appreciated. For more information about A Nurse First and Sigma, visit sigmanursing.org. Until next time.