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Clinical Competence of Nurses in Caring for LGBT Patients: A National Cross-Sectional Study
Stanisław Manulik1, Raúl Juárez-Vela2,3, Christopher S Lee1,4
1Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland.
Aim:
To assess LGBT-related clinical competence among nurses and identify sociodemographic and occupational factors associated with overall competence and its domains of clinical preparedness, attitudes, and knowledge.
Design:
Nationwide cross-sectional study.
Methods:
A nationwide online cross-sectional study was conducted between January and May 2026 among 861 registered nurses. Participants completed the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) and a questionnaire assessing sociodemographic and occupational characteristics. Descriptive statistics and univariable and multivariable linear regressions identified factors associated with overall and domain-specific LGBT-related clinical competence.
Reporting Method:
This study followed the STROBE Statement.
Results:
The mean overall LGBT-DOCSS score was 4.10 ± 0.53 on a 1-7 scale, with higher scores indicating greater competence. Nurses reported the highest average scores for attitudes (5.78 ± 0.86) and the lowest for clinical preparedness (2.48 ± 0.79). Rural residence was consistently associated with lower overall LGBT-related clinical competence and lower competence across all three domains. Master's degree education was associated with higher overall competence and greater clinical preparedness. Nurses born in 1965-1994 reported lower clinical preparedness than those born in 1946-1964, whereas Generation Z nurses demonstrated higher knowledge. Working more than 200 h per month was associated with lower knowledge.
Conclusion:
Although nurses reported generally positive attitudes towards LGBT patients, important gaps in clinical preparedness and knowledge remain. Rural residence emerged as the strongest and most consistent predictor of lower LGBT-related clinical competence.
Implications For The Profession And/Or Patient Care:
Undergraduate nursing education and continuing professional development should strengthen LGBT health content, with particular emphasis on practical clinical skills and targeted educational support for nurses working in rural settings.
Impact:
The findings identify modifiable factors associated with LGBT-related clinical competence among nurses and provide evidence to guide nursing education, continuing professional development, and workforce strategies that promote equitable, culturally competent care for LGBT patients worldwide.