Clinical Competence of Nurses in Caring for LGBT Patients: A National Cross-Sectional Study.

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.