Before pursuing her master’s degree in public health at Simmons, Ellie Spoering ’25 had 16 years of experience as a registered nurse. Working at a hospital in Colorado, where high-risk sports are popular, she frequently saw patients with traumatic brain injuries. However, over time, she noticed a pattern.
“A disproportionate number of those patients had one or more marginalized identities,” she recalled. “I started asking those questions: why aren’t these injuries spread more equitably across the population? That’s what got me thinking about public health, and that’s what brought me to Simmons.”
Spoering was attracted to the online master’s degree because of its basis in health equity across population outcomes, all driven by anti-racist principles. As a transgender woman and a nurse, Spoering has a unique perspective on the challenges faced by both transgender patients and the nurses who have received little guidance on how to approach their treatment.
Gender-Affirming Care for Trans Patients
“There is an experience universal to all trans people. We call it transgender broken arm syndrome,” says Spoering. “It’s when a trans person goes to the doctor for something totally unrelated to their identity, only to have their symptoms attributed to their identity or transition.”
Many trans people have experienced trauma in a healthcare setting. According to the 2022 US Trans Survey (the largest such survey of trans people worldwide, with over 84,000 respondents) 48% of respondents reported having had a negative interaction with a healthcare provider, from misgendering to physical abuse.
“Those negative experiences aren’t inconsequential to health status,” says Spoering. “Trans people have a mortality rate five times higher than cis gender individuals.” This increased rate isn’t solely attributed to health issues one may consider an LGBTQIA+ population at greater risk for, such as HIV, substance use, or suicide. There is also a greater risk of cancer and heart disease, and no evidence to imply that transition medications are responsible for the difference.
“These are preventable illnesses,” says Spoering. “Because of those negative experiences, trans people are more likely not to see a primary care physician, and not seek specialist care during an illness.”
Given her work as a nurse, Spoering saw this as an area where she could have an impact. For her final project in “Health Equity Change Project (HECP)” (MHEO 495), Spoering developed a virtual training for nurses on providing gender-affirming care.
“Nurses don’t receive any specialized education in transgender care,” she notes. “In pre-licensure programs, there is less than two hours [spent on] LGBTQ health, in general, and I’m not sure how much of that two hours is spent on trans health.”
In Spoering’s experience, she’s heard from both communities about how nurses often struggle to care for trans people. “I’ve heard nurses say that they don’t know how to talk to a trans person. I’m often the first trans person that a lot of medical professionals have spoken to. Trauma-informed care comes down to talking to patients and listening. [Active listening] is something that we don’t teach enough.”
Further, Spoering can understand the plight of clinicians. “We see ourselves as the experts in the room, but the patient is the expert of their own experience,” she says. “You may not agree, you may have a different opinion, but you can’t discount their own experience and life.”
The result of her project is a Foundations of Gender Affirming Care for Nurses, a series of videos, workbooks, and additional resources to support nurses in their work. While the organization that originally supported this project is unable to publish it due to a loss in funding, the materials are still available on the Simmons website. In addition, Spoering recommends the Non-Discrimination & Staff Training resources provided by Human Rights Campaign in collaboration with Fenway Health.
The Shift from Bedside Nursing to Public Health
Reflecting on her education at Simmons, Spoering can see how it provided a mindset shift valuable to her current work in health process and improvement. “Health care safety and quality work can get very granular into individual cases,” she said. “We’re really focused on the trees. Simmons helped me see the forest: the bigger social conditions that create inequitable health outcomes.”
Her public health education taught her to broaden her view, looking at genetics and health behaviors, as well as patients by zip code and what field they work in, what racial and ethnic identities they hold, and what access to primary care they may have, or lack.
“We don’t focus on [these issues] as a clinician because we can’t control it,” she notes. “As a nurse, I would ask about a patient’s personal choices and past. Now I look at their community and its past.” As an example, Spoering refers to “Epidemiology” (MHEO 415), where they studied how a history of redlining impacted COVID–19 mortality rates in certain communities.
She’s also interested in community partnerships, looking for local organizations to support process improvement plans to improve the system in an equitable manner, across populations. “Simmons does such a great job looking at that big picture that you don’t get as a nurse or a physician.”
Immersion Experiences at Simmons
Those principles are also central to the two immersion experiences required by the program, “Immersion: Racism, Health & Equity” (MHEO 430) and “Immersion: Arizona” (MHEO 461). The latter, which took place in Patagonia, Arizona, 18 miles from the US–Mexico border, was of particular importance.
“It is one of those experiences that I will remember for my whole life,” said Spoering. “We learned an incredible amount about migrant health and the health crisis at our border. It also showed us how public health can be weaponized against marginalized communities.”
However, the most memorable part of the trip was connecting with other Simmons students. This cohort included others, like Spoering, with well-established careers, but the majority of the students were in their 20s, pursuing their master’s degrees not long after their undergraduate studies.
“It was incredibly inspiring to see this group of future leaders who were really passionate about health equity, changing systems, and focusing on historically underserved communities,” she says. “Public health students have a [unique] mindset: they see a problem and want to be a part of the solution.”
The public health mindset has also enabled a more expansive view of her work. “Public health is everywhere. You can make ties between public art and public health, between trees and public health.” For her part, Spoering has begun volunteering to plant trees in her local area in Denver, Colorado. “It’s fun to be outside and plant trees, and it’s public health work, too. Soak up as much [experience] as you can. It will add to your expertise in ways you might not expect.”