Nurses' uncertainty in gender-affirming care

Background: Despite established standards for gender-affirming care (GAC), transgender and gender diverse (TGD) individuals continue to experience health care disparities. Nurses play a critical role in delivering affirming care, but organizational systems and leadership practices may influence care consistency. Purpose: To explore clinical nurses' perceptions and beliefs regarding the provision of GAC and to examine how organizational policies, leadership practices, and clinical systems influence nurses' ability to deliver GAC to TGD clients. Methods: A qualitative descriptive study was conducted using semistructured interviews with 22 clinical nurses from a region of the US. Data were analyzed using thematic analysis. Results: Three themes were identified: Uncertainty about Gender-Affirming Care, Fear of Offending, and Inconsistencies in Organizational Support for Gender-Affirming Care. Nurses described uncertainty related to initial interactions and care decisions, concern about unintentional harm through miscommunication, and variability in care practices across organizational contexts. Inconsistent leadership support, unclear policy enforcement, and limitations within electronic health records contributed to these challenges. Conclusions: Nursing leadership and organizational systems play a central role in shaping nurses' ability to deliver GAC. Addressing policy clarity, documentation practices, and leadership accountability may reduce uncertainty and improve equity in care for TGD populations.