Between Belonging and Erasure: A Grounded Theory of Transgender and Non-Binary Nurses’ Experiences

Introduction:
Nursing, as both a profession and an academic discipline, has traditionally been organized around binary and cisnormative understandings of gender. Within this context, transgender and non-binary (TNB) individuals remain marginalized, often encountering barriers that constrain their ability to fully participate and thrive in educational and workplace settings. Examining these experiences is critical to advancing equity in nursing and to building more inclusive systems of care and learning.

Goals and Methods:
The purpose of this study was to examine how TNB nurses and nursing students experience identity expression, authenticity, and safety in their professional and academic environments. A constructivist grounded theory design was employed. Data were gathered through in-depth interviews with 16 TNB practicing nurses and 9 students from across Canada. Analysis involved iterative coding and constant comparison, enabling the development of a theoretical model that illustrates the complex ways institutional structures, interpersonal interactions, and individual strategies intersect.

Results:
Analysis revealed that participants constantly weighed the benefits and risks of visibility, often modifying or concealing aspects of their identities to navigate professional expectations. Barriers were identified at multiple levels, including restrictive documentation systems, binary-oriented curricula, and recurring experiences of misgendering and marginalization. Yet participants also described strategies of resilience, such as peer solidarity, advocacy efforts, and the creation of affirming networks, which enabled them to assert agency and foster more supportive environments.

Conclusions:
Findings underscore how systemic cisnormativity within nursing perpetuates exclusion and undermines belonging for TNB individuals. Addressing these challenges requires institutional change, including curricular revision, policy reform, and leadership initiatives that create safer and more affirming spaces. The theoretical model generated through this study provides a foundation for guiding nursing education, research, and practice toward dismantling structural barriers and supporting gender diversity