Gender self-identification and the Royal College of Nursing
Introduction
It has been reported that the Royal College of Nursing (RCN) has ‘refused to represent’ Sandie Peggie, the nurse currently pursuing a harassment claim against her employer, NHS Fife, after she encountered a male doctor in the female changing room at work.
This blog considers advice and guidance provided by the RCN to its members on the issue of sex and gender, both on how they are expected to behave in their roles and the care they are expected to give to patients who assert a transgender identity.
Peggie vs NHS Fife and Upton
The initial two-week hearing in this employment tribunal concluded on Friday 14 February. (The hearing will resume for 11 days in July.) Since then it has been reported that Ms Peggie is subject to a separate disciplinary process for ‘misgendering’ the trans-identified male doctor whose presence in a female changing room she is challenging in the tribunal. A hearing initially scheduled for today (21 February) has been rescheduled to a later date, according to reports.
The RCN and its role
The RCN is the UK’s largest nursing union. Its 2023 annual report [archived] states that it has more than half a million members, the vast majority of whom are female. The 2021 RCN Employment Survey [archived] found that 89% of respondents were female, 10% were male and 1% identified as ‘non binary’.
RCN publication [archived] ‘On the case: Advice, support and representation from the RCN A guide for members’ (2021) states:
“It is your right to receive our support, guidance or representation regardless of your ethnic or national origins, religion or belief, sex or sexual orientation, gender reassignment, disability, marital status or civil partnership, age, pregnancy or any complaint you may have previously made about the RCN itself. If, after careful consideration, we find that we are unable to provide advice or representation, we will give you a clear and detailed explanation as to why we have taken this decision.”
As well as being a trade union, the RCN is also a professional body, providing guidance and advice to its members on professional standards for nursing care.
The RCN on Equality, Diversity and Inclusion
Following the launch of its equity, diversity and inclusion strategy [archived] earlier in the year, in December 2024, the RCN published a toolkit entitled ‘Let’s talk inclusion’ [archived]. The press release [archived] announcing the launch of the toolkit stated that it “offers members ideas for starting conversations around equity, diversity and inclusion” and that “It has been developed to help people to better understand issues like microaggressions, psychological safety and allyship – as well as actions we can all take to promote equity, how to speak up and get help.”
Launching the guide, Wendy Irwin, RCN Diversity and Equalities Co-ordinator, said:
“Inclusion is about creating great workplaces that the whole of the nursing family can thrive in. We know that discriminatory language and behaviour causes widespread harm to everyone.”
The document sets out the different types of discrimination in the Equality Act 2010, and lists the nine protected characteristics, as well as anti-discrimination protections that apply exclusively in Northern Ireland.
It contains a section entitled ‘Using inclusive language’, which invites readers to ‘educate’ themselves on ‘current terminology’ and ‘be prepared to be challenged’.
Advice on interacting with colleagues
The section on the protected characteristic of sex under the Equality Act is titled ‘Gender/sex’ on the basis that ‘gender is the more inclusive term’. It goes on to state that: ‘All genders and sexes can experience discrimination and disadvantage because of their gender in and out of the workplace.’
The section on the protected characteristic of gender reassignment in the Equality Act refers to a scenario where a member of staff is using the ‘wrong pronouns’ for a colleague. The advice given for dealing with such a scenario is to offer the member of staff a ‘supportive space…to try and change this’.
Diversity training materials for RCN employees in use in 2019 cited objections to a trans-identified male using the female toilets at work as a failure to treat the individual with dignity and respect.
The same training materials claimed that the protected characteristic of sex in the Equality Act 2010 includes ‘people who identify as non-binary or gender fluid’.
An update [archived] on the RCN website in December 2020 referred to an employment tribunal ruling (Taylor v Jaguar Land Rover) claiming that the decision in this case “determined that the protected characteristic of gender reassignment includes those who identify as non-binary or gender fluid”.
The then RCN Head of Legal (Employment) Joanne Galbraith-Marten is quoted as saying:
“This is an important decision for members as it represents a widening of the protection afforded by the Equality Act and, given that gender is a spectrum that continues to develop, these types of complaints may become more prevalent. This will be of assistance to RCN reps who are representing those who identify as non-binary or gender fluid in the workplace and should form part of the framework of any staff side discussions on diversity and inclusion.”
As noted by human rights campaign organisation Sex Matters:
“This is a first instance employment tribunal case, so doesn’t create a legally binding precedent.”
Employment lawyers Anya Palmer and Monica Kurnatowska wrote:
“While some reports suggest the tribunal found gender to be a ‘spectrum’, in our view, that is a misreading of the case.”
Following the 2021 Employment Appeal Tribunal ruling in the case of Forstater v CGD Europe and others, the RCN acknowledged that so-called ‘gender critical’ views were protected under the Equality Act 2010.
Patient care
In relation to patients, the RCN has now produced three editions of ‘Fair care for trans and non binary people’. The RCN website notes [archived] that this guidance is currently under review.
The current version [archived] of the guidance, published in November 2020, cites the 2016 House of Commons Women and Equalities Select Committee Transgender Equality report, which stated that:
“Trans people encounter significant problems in using general NHS services, due to the attitude of some clinicians and other staff who lack knowledge and understanding — and in some cases are prejudiced. The NHS is failing to ensure zero tolerance of transphobic behaviour.”
The guidance advises RCN members that:
“…if you are unsure about how to address a person you are supporting or caring for, begin by introducing yourself with your name and pronouns [see glossary]. You can then, politely and discreetly, ask the person for their name and pronouns.”
Under the section entitled ‘Psychological Support’, it states that:
“Nurses and health care support workers have a powerful role to play in affirming the true gender identity of trans and non-binary people. This can be demonstrated by using pronouns of the patient’s choosing when referring to them.”
Under the section entitled ‘Accommodation and environment’, it states that:
“Where trans and non-binary patients are cared for in an inpatient setting, care should be taken to meet their needs for privacy and dignity whilst an inpatient. Patient placement should be based on both asking the patient for their preference, and on gender presentation.”
Similar advice is given for children:
“Where segregation is needed, then this should be in accordance with the dress, preferred name/and or stated gender identity of the child or young person.”
Magazine articles hosted on the RCN website have also carried advice for members taking care of trans-identified patients.
“Certain health care settings are currently gendered. ‘Those who identify as female should not be placed on an all-male ward,’ says Liz.” (July 2022) [archived]
“In nursing, there’s a lack of education around what it means to be transgender. There might be ad hoc things around pride month and LGBTQ+ history month, but no mandatory education or training. I put together training to improve education and awareness in my workplace, emphasising the importance of getting pronouns right.” (May 2022) [archived]
Guidance co-authored by the RCN and Public Health England in 2015 (‘Preventing suicide among trans young people: A toolkit for nurses’) states:
“Regardless of how an individual presents, you should always refer to the trans person with the names and pronouns they prefer.”
Conclusion
A consistent theme emerges from the advice that the RCN gives to its members regarding the way in which they should deal with trans-identified colleagues and patients. Like many other institutions, the RCN promotes gender self-identification principles, with little to no apparent consideration of their impact on female members, patients, or their colleagues at work.
Declaration of interest
MBM co-founder Lisa Mackenzie was an employee of the RCN from 2017-19. She was investigated by her managers in the summer of 2019 for her co-authorship of an article in peer-reviewed journal Scottish Affairs regarding the uncritical adoption of gender self-identification principles by two Scottish public bodies, to the detriment of women’s sex-based rights. Lisa eventually resigned from the RCN in September 2019.
Note: archived links added on 23 July 2025