When to draw the line on religious and cultural accomodation?

[Inspired By Silence]

Should I ever come across a female patient who would prefer a female nurse insert her foley catheter, I will comply with a smile on my face and ask the nicest female nurse on my floor to assist this woman. Should a Muslim male prefer no male nurses (or doctors) be in the room while his wife gives birth, I'll make sure his wishes are respected and carried out and will personally round up the males and escort them to another more tolerant soon to be father.

But should I come across a woman who grew up in the pre civil rights era who does not want to be treated by a Mexican American male nurse, how do I respond?

[BluegrassRN]

I feel you should accommodate when you can. Honestly, if they don't want to be taken care of by someone of a different race, then the nurse probably doesn't want to take care of them, either. Whether it's cultural, religious, or even hate-based, reasonable or completely unreasonable, if someone's not going to get along, as a charge nurse I'm going to try to change the assignment. Maybe I shouldn't, so I could teach that pt a lesson--that the Mexican-American nurse is a great nurse--but honestly, I'm not there to teach them that lesson. And maybe they wouldn't learn it. Likely my nurse would have to put up with a bunch of crap all shift, and I'm not putting her through that.

So, I accommodate when I can. We have a few frequent fliers who don't like women, one who doesn't like men, and one who doesn't trust anyone except African American nurses. I try to match them with someone who will work best with them...if I can't, I make sure to give them to a nurse who is uebercompetent and ueberconfident. I don't need a sweet, new nurse's self confidence killed by a bitter, horrible pt.

[jessiern, BSN, RN]

I feel you should accommodate when you can. Honestly, if they don't want to be taken care of by someone of a different race, then the nurse probably doesn't want to take care of them, either. Whether it's cultural, religious, or even hate-based, reasonable or completely unreasonable, if someone's not going to get along, as a charge nurse I'm going to try to change the assignment. Maybe I shouldn't, so I could teach that pt a lesson--that the Mexican-American nurse is a great nurse--but honestly, I'm not there to teach them that lesson. And maybe they wouldn't learn it. Likely my nurse would have to put up with a bunch of crap all shift, and I'm not putting her through that.

So, I accommodate when I can. We have a few frequent fliers who don't like women, one who doesn't like men, and one who doesn't trust anyone except African American nurses. I try to match them with someone who will work best with them...if I can't, I make sure to give them to a nurse who is uebercompetent and ueberconfident. I don't need a sweet, new nurse's self confidence killed by a bitter, horrible pt.

I agree. It is easier for all involved if the charge nurse will swap the assignment. I work in a mostly black community, but almost the entire nursing staff consists of white female nurses. Caring for an individual who hates you just because of our skin is difficult, and you will never please them. You can't "teach them a lesson" they aren't open to receive.

[llg, PhD, RN]

Great question.

I agree with trying to accommodate the patient as much as possible in these types of situations. It's not just to please the patient -- but also to protect the nurse. If a patient is forced to receive care by a nurse who is not acceptable to her/him (for whatever reason) ... they are more likely to find fault, complain to the management about little insignificant things, file a lawsuit over any mistakes, etc.

Assigning that "unwanted" nurse to that patient places the nurse at great risk for harassment by the patient. The nurse can be hurt by the patients complaints/law suits, etc. and I don't want to hurt the nurse in that way.

Sometimes, it's best to avoid bad situations rather than to take them on in a risky way. For the nurse involved ... I recommend being gracious and hope that the patient's exposure to you (no matter how how brief) will help that patient see you in a positive light that might grow more favorable in time. Perhaps as she sees other patients accepting your care and staff members interacting with you in a positive way, she will begin to have just a little bit of doubt about her prejudices ... that might lead to some insight and growth over the long run.

[belgarion]

But should I come across a woman who grew up in the pre civil rights era who does not want to be treated by a Mexican American male nurse, how do I respond?

The knee-jerk "official, facility approved" response would probably be something to the effect that "all of our nurses are very qualified and competent. We cannot make assignments based on race, creed or sex".

Reality. The 87 year old woman who grows up having a certan set of beliefs drilled into her skull on a daily basis is not going to change because of a 10 second lecture. No matter how wrong her line of thinking is, trying to change it at this point is not going to help anybody. I know because that 87 year old woman was my grandmother about 25 years ago.

IMO, it is probably in the best interest of the patient and the nurses to try and accomodate the patient's wishes as much as POSSIBLE. It is certainly not fair to the nurse to be assigned to a patient who thinks he is some lower form of life. Of course, depending on the makeup of the staff, this is not always possible, especially in LTC.

Showing calm and competence can go a long way towards breaking down the barriers. I agree that it would not be a good idea to send a newly minted nurse into this situation. Send in someone with a few battle scars who knows how to keep his cool and deflect hateful coments.

We have to deal in reality. You leave "Fantasy Island General" behind the day you walk across the stage and get pinned.

[WalkieTalkie, RN]

We had a neo-Nazi on our floor once, and an African American nurse and I (gay) didn't want to take care of him, and I'm sure he wouldn't have wanted her as a nurse. To avoid conflict, we gave him one of the straightest, whitest men on our floor and things went without a hitch.

I think it's reasonable to accomodate people to an extent. After all, would you want to take the patient who disliked you for your skin color, sexuality, or other trait? Why have conflict if it can be avoided?

I once got "fired" from a frequent flier in the ER because she didn't like the way I looked. She would always come in for some kind of crotch rot and I would have to supervise the pelvic exams. As you can imagine, I was not very upset when I found out I didn't have to supervise her exams any more!

[s4twin]

by accommodating you make their behavior worst and continue their ignorance. the neo-nazi you assign the black or gay nurse, just maybe that the ignorant nazi met realize black/gay people aren't that bad. the old lady, give her the hispanic, we're not all "macho wife bitters". we live in a time that, that behavior/ignorance is not acceptable and doesn't have to be catered too. if they don't come back, even better.

[flightnurse2b, LPN]

sometimes you can accomodate their requests, other times you can't.

my facility tends to not accomodate them unless there is a huge problem with nurse/patient because of the demographics of our staff.

the majority of the nurses and aides on the floor i work on are african american, haitian, jamaican, philippino, chinese, portuguese or indian. if someone comes in and wants a white female nurse during the 7p-7a shift, they have to fight over me, cause i'm the only one.

hatred is deep rooted and not going to be changed by anyone but the person with the seed of it in their heart.. so lecturing them i suppose will make them angrier.... we don't have too much of a problem where i work because the community is so diverse, but every once in a while you get that patient who will complain about their nurse being from another country, having an accent or being darker than they'd like... and it's not usually well tolerated on my floor, meaning that they are told their behavior has to stop by administration.... but they don't often change assignments.

we've all pretty much learned how to deal with patients like this and have a good handle on the mute button when it comes to hateful comments.... consider the source, really... and kill them with kindness. by accomodating them, it makes it look like their behavior is acceptable....

[~Mi Vida Loca~RN, ASN, RN]

by accommodating you make their behavior worst and continue their ignorance. the neo-nazi you assign the black or gay nurse, just maybe that the ignorant nazi met realize black/gay people aren't that bad. the old lady, give her the hispanic, we're not all "macho wife bitters". we live in a time that, that behavior/ignorance is not acceptable and doesn't have to be catered too. if they don't come back, even better.

I have to disagree with this, it's not a nurses job to force someone to change their beliefs, however wrong we feel they are. People come to a hospital because they are sick (legitimate people coming in, not the habitual fakers) they need to heal, when they are sick, immunocompromised, stressed etc. etc. this is not the time to force them to deal with their prejudices. It will only stress them more, anger them more etc, which will delay healing and cause you to have to put up with them longer.

Are their feelings right? Are they racist or pregjudiced? It doesn't matter, they are paying to be taken care of and as nurses we are supposed to do what we can to give the best over all care for our patient and forcing them to be taken care of by people they do NOT want taking care of them, is not doing that.

Maybe not every single demand can be met nor should it. But something like this is a pretty big thing and can bring on some pretty big emotions to the patient and is not the battle that should be picked with them IMO

[elkpark]

My facility's system-wide, official policy is that we will accomodate people's religious/cultural beliefs/practices, but we will not accomodate personal prejudice.

[Inspired By Silence]

My facility's system-wide, official policy is that we will accomodate people's religious/cultural beliefs/practices, but we will not accomodate personal prejudice.

Do you not find it difficult to differentiate between cultural sensitivities, religious needs, and blatant prejudice?

[flightnurse2b, LPN]

Do you not find it difficult to differentiate between cultural sensitivities, religious needs, and blatant prejudice?

some women do not want a male nurse. some men do not want a male nurse. it has nothing to do with the nurse.

some cultures do not allow you to use their left hands for IV starts, sit with the sole of your foot facing them or put meat and milk on the same meal.. if you don't know these things and you do them, they may get offended.. but it has nothing to do with the nurse.

if someone doesn't like you because they are prejudice, they will make it about the nurse, personally.

believe me, you'll be able to figure it out.