mentation of cultural changes at the
system level will require a collaborative effort between multidisciplinary
teams and community partnerships
to transform the VA environment
over time. The authors believe that
on this issue, external forces must
guide and lead changes within the
VA system in order to develop sustainable and trusting relationships
with transgender veterans.
The fourth solution is implementation of policies that “empower
patients or families in all aspects of
the health care process.” 42 Again,
the nurse leader is trained and prepared to advocate for a policy that
implements a Patient Bill of Rights
that explicitly guarantees health
care and prohibits discrimination of
gender-minority veterans. This
change would foster trust and
confidence from transgender individuals. A study found that 83% of
providers and 83% of lesbian, gay,
bisexual, and transgender veterans
believe that this policy change would
make the VHA environment more
welcoming. 48 Providing transgender-affirming materials and language on
standard forms also would eliminate
barriers, promote patient-centered
care, and empower transgender patients by creating an environment
that is more inclusive of everyone. 48
The nurse leader is well positioned
to implement the QSEN framework
to integrate research, practice, and
policy to create a more inclusive, pa-
tient-centered health care system for
transgender veterans. By using the
essential principles of doctoral educa-
tion for advanced nursing practice,
the nurse leader is prepared to advo-
cate for changing the organization at
the systems level. The nurse leader
also is equipped to direct the imple-
mentation of patient-centered trans-
gender care initiatives by ensuring
the integration of the nursing organi-
zation as a partner in strategic plan-
ning as well as the development of
The VHA Blueprint of Excellence
envisions organization and collaboration to promote new relationships
that serve and benefit veterans. The
DNP preparation allows the nurse
leader to demonstrate the ability to
collaborate with VHA stakeholders
and develop alliances within and
outside the organization by advocating for policy changes that will
be transformational in improving
health care delivery and patient
outcomes to vulnerable transgender veteran populations. The IOM
has tasked nurse executives with
creating a health care infrastructure
of doctorally prepared nurses to
provide patient care that is increasingly growing more complex. With
an increasing number of veterans
using services, VHA has prioritized
an expansion in the number of doctorally prepared nurses.55
As the largest integrated health
care system in the U.S., the VHA
provides an ideal setting for initiating these organizational changes
as a result of having developed an
integrated infrastructure to collect
evidence-based data at the regional
(network) and state facilities and
make comparisons with national
benchmarks. Therefore, changes are
less difficult to disseminate throughout the hierarchy of the VHA. Consequently, the VHA has been a leader
in the U.S. for equity in the health
care arena and provides a model for
international health care systems.
Finally, these changes address an
urgent need to reduce health disparities, morbidity, and mortality by improving quality care and health care
delivery to a vulnerable transgender
The authors report no actual or potential conflicts of interest with regard to
The opinions expressed herein are those
of the authors and do not necessarily
reflect those of Federal Practitioner,
Frontline Medical Communications
Inc., the U.S. Government, or any of its
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