For many years, nurses were seen as doctor’s ‘handmaidens’. Their education was heavily focused on technical skills and their duties were task-based. Today, nurses are better educated, with a focus on coordinating patient care and the use of critical-thinking skills. They care for patients with complicated diagnoses who may spend little time in the hospital but who still require highly technological care. Physician and nursing shortages, an aging population, health-care reform, new-age problems and the expanding role of technology requires that nurses take on new roles. An example of these roles is caring for Transyouth.

The waiting list of young people wanting to get help at the Center for Transyouth Health and Development in Los Angeles usually runs at over 100 people long. These children, teens and young adults come from everywhere to seek support for the issues they are processing.

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Bianca Salvetti works at a center that is located at the Children’s Hospital, Los Angeles. Salvetti coordinates and implements HIV clinical research and medical care activities within the Risk Reduction Program. She also provides primary care to teens and young adults, as well as specialty care to transgender youth and young adults living with HIV.

“I like being part of the team that helps them get to that place of being who they are,” says Bianca Salvetti, pediatric nurse practitioner and HIV and transgender health specialist.

Salvetti started at the Children’s Hospitals in the pediatric ICU and stayed there for seven years before becoming a pediatric nurse practitioner in 2012.

Her interest in trans youth was sparked during her own nurse practitioner training when she shadowed a nurse practitioner who worked with homeless youth.

“Something about that drew me in. You worked with young people, and it was more laid back, not so formal. It was just a conversation, and I liked that,” Salvetti adds.

When the job opened up in the Transyouth clinic, she knew she had to apply.

In terms of what her job entails, she handles the HIV clinical research and medical care coordination. But she also began seeing her own patients about four years ago.

“I’m adding five to six patients per week. I’m not their medical nurse care manager, but I make sure they have answers to their medical questions,” she says.

She also sees them for other reasons like rashes and provides hormone self-injection teaching and medical care to transgender and gender non-conforming patients.

Why such a long waiting list, one asks?

“It’s a mix of a lot of things such as the television shows that feature a transgender person and Bruce Jenner. It’s more out in the media than ever before, and people are writing books about it all the time,” she says. Social media also plays a large part.

She believes more young people might have had feelings for a long time. They wondered what it is called, and perhaps felt something but don’t know how to articulate it to their families or medical caregivers.

“Some of the kids we see are very tech savvy, and they want to pursue medical treatments to change themselves,” Salvetti says.

According to a study by The Williams Institute at UCLA, it is estimated that 1.4 million Americans identify themselves as transgender with 218,000 of them living in California.

Children’s Hospital Los Angeles provides hormone treatments, puberty blockers, implants with outpatient surgery, counseling and more. The hospital doesn’t have anyone yet to do gender confirmation surgeries.

Most of the trans youth males want a removal of breast tissues.

“Luckily in California, a law says that any sort of medical treatment for transgender-identified that the cost is covered. We are lucky that most of our patients can access surgical procedures if they want to,” she says.

“When they first come in, many of them feel no one really understands them,” she says. “A lot of what they will have to deal with is a challenge. They don’t see the happiness at the end of the tunnel. They have to overcome obstacles with their parents, insurance companies and within themselves,” she says.

“After we get through all of that, I tell them that they will be able to breathe easier,” Salvetti says. “I do a lot of hormone shot technique teaching. I give them that education and the skills. Their bodies align with how they feel, and I see them come back in a month and they look different. They begin to love how things are going.”

She sees parents come in and use the wrong pronoun to describe their own child. The language can be a tricky part of it all, Salvetti says.

“They visually look like one gender. They may present a look of masculinity, but they want you to call them her or she,” she adds.

There is one case that stands out in Salvett’s memory:

“I have one transgender boy that I think about because he was very persistent, insistent and consistent with identifying as male, but his parents were never supportive,” she says.

The parents finally agreed to their child starting testosterone, but the parents were never engaged in care.

After about one year of hormone therapy, the parents wanted to go to a family reunion, but they would not let him present male or use a male name/pronoun. So, he had to decide if would see his family or present as himself. He ended up choosing to dress like a girl, so he could go to the family reunion.

When he returned, he told his therapist that he was going to continue dressing female and live life as a female because it was easier for the family.

“I never heard from him again, and I wonder if he is still living his life for his family or for himself,” Salvetti adds.

According to Salvetti the jobs can be limited, and it is not a route for everyone to pursue.

However, Salvetti adds that there are more trans programs opening up which opens up more opportunities for nurses and medical providers. This is most likely largely due to the visibility of trans and gender non-conforming folks on TV and social media.

She also believes that young people are pushing for more acceptance and medical care access.

“My plan is to stick with this job. But the hard part is if I ever decided to move from Los Angeles, it would be limited where I could go,” she says. “I’m from Oklahoma originally. My thoughts are that maybe I could buy a house there. But I’m sure the jobs for my skills don’t exist there yet.”

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