Young female patients

[corbinRN]

I work with a pediatric sedation team in the hospital as a care partner (it's like an ANA) and today I had a 15 year old female. I had to place ECGs on her, but I just kind of handed to a female nurse to do it. If the female nurse wasn't there to do it, should I have done it, or what should I have done? I want to be sensitive to the pt and realizing that I'm a 21 year old man, it might be embarrassing and awkward for the 15 year old woman.

[AirforceRN, RN]

It's all about keeping the pt comfortable and respecting her wishes. It's not really a sex issue, it's pretty much just a comfort issue: for me and my license, and the girl.

I somewhat disagree with this. I would say its all about health care. If a female wasn't available or if the situation was an emergency, you would have just placed the leads right? Working in a Children's hospital you are going to encounter a lot of situations where adolescent females are going to be undergoing procedures and you are going to have to help. I think you did the right thing but when push comes to shove, the girl needed an ECG and you were the one appointed to place the leads. You have to do what you have to do. Learning tricks like placing a blanket over the breasts to cover them while placing the leads, inviting Mom to come in to the room and explaining exactly what you are doing and where the leads have to go will help.

Of course pt comfort is a consideration but I don't think its #1 in this situation

[sharkdiver]

Again all of you are turning this into a sex issue, it is not one. This a a pt issue.

My nursing instructors, who are all female by the way. Agree that there will be no discrimination against male students in OB or other classes, and that pt's do not have the right to descriminate againt male nurses, or they will get no student nurses period.

I hate to say it again, but all of you are promoting that males are perverts and unprofessional in the work place, because we see sex first or our pt's do.

And "getting no student nurses period" is supposed to scare them into submission? If someone ever said that to me I'd laugh in their face - then tell them to get the heck away from me and don't come back. I'd wager that the vast majority of patients could care less whether they get to be practiced on by a student nurse or not. In fact, many, if not the majority, would probably prefer not.

I hate to burst your bubble, but a patient has the absolute right to refuse care by any provider for any reason they choose, including the sex of the provider. Even though minor's rights are somewhat more limited in some circumstances, if little Susie says she doesn't want a male looking at or touching her breasts but wants a female instead, it's very doubtful that any mom or dad would override that except in an immediately life threatening situation.

Not only can the patient refuse a provider based on their sex, but in some cases a health care facility can legally discriminate in hiring based on sex. It's called a BFOQ exemption to EEOC and it's legality under certain circumstances has been upheld by the courts.

It also doesn't matter how upright you think your character is, if you perform a procedure on a female involving an intimate area without a female witness and she complains that you did something inappropriate, the burden of proof will be on you - doubly so if she is a minor.

What people here are saying is be smart, be safe and be considerate of the patient's wishes.

[SuesquatchRN, BSN, RN]

I somewhat disagree with this. I would say its all about health care. If a female wasn't available or if the situation was an emergency, you would have just placed the leads right? Working in a Children's hospital you are going to encounter a lot of situations where adolescent females are going to be undergoing procedures and you are going to have to help. I think you did the right thing but when push comes to shove, the girl needed an ECG and you were the one appointed to place the leads. You have to do what you have to do. Learning tricks like placing a blanket over the breasts to cover them while placing the leads, inviting Mom to come in to the room and explaining exactly what you are doing and where the leads have to go will help.

Of course pt comfort is a consideration but I don't think its #1 in this situation

But he wasn't in an immediately emergent situation. Of course when it comes down to it it's all about saving the life.

And you suggested having Mom come in - same difference. It's providing a female to be there to enhance the patient's comfort.

[bradons]

In obs clinical I had to do physical exams on females clients both before and after giving birth. I would explain to the client what I was going to do and if they felt uncomfortable with me as a male doing it to speak up. They had no problem with it and welcomed it. If your professional about it and explain the procedure there should be no problem.

[vashtee, RN]

I have a 15 year old daughter, and sorry, but I wouldn't allow any male to do anything to her without a female (preferably me) present except in a life-or-death emergency. I care more about her right to privacy than anything else. Placing leads on the chest isn't rocket science. You can simply tell a 15 year old where to place them for themselves if they are conscious.

[nursinguy]

And "getting no student nurses period" is supposed to scare them into submission? If someone ever said that to me I'd laugh in their face - then tell them to get the heck away from me and don't come back. I'd wager that the vast majority of patients could care less whether they get to be practiced on by a student nurse or not. In fact, many, if not the majority, would probably prefer not.

This is a UC med center, so you are wrong, they get seen by residents and student all day long.

I hate to burst your bubble, but a patient has the absolute right to refuse care by any provider for any reason they choose, including the sex of the provider. Even though minor's rights are somewhat more limited in some circumstances, if little Susie says she doesn't want a male looking at or touching her breasts but wants a female instead, it's very doubtful that any mom or dad would override that except in an immediately life threatening situation.

Not only can the patient refuse a provider based on their sex, but in some cases a health care facility can legally discriminate in hiring based on sex. It's called a BFOQ exemption to EEOC and it's legality under certain circumstances has been upheld by the courts.

It also doesn't matter how upright you think your character is, if you perform a procedure on a female involving an intimate area without a female witness and she complains that you did something inappropriate, the burden of proof will be on you - doubly so if she is a minor.

What people here are saying is be smart, be safe and be considerate of the patient's wishes.

Thats like saying they have the right to refuse a nurse based on race. There is not a differance. What you are claiming is that discrimination is o.k and legal.

The burden of proof is on the accuser.

[sharkdiver]

This is a UC med center, so you are wrong, they get seen by residents and student all day long.

I didn't say that patients don't get seen by students, only that they could care less whether or not they "get a student" to practice on them, and that if the truth were known many, if not not the majority, would prefer not. The patients are doing the student a favor by allowing them to practice their skills on them, not the other way around. If a patient is not comfortable with having a student participate in their care for any reason, including the sex of the student, you simply say thank you and move on. It is wrong to attempt to coerce or intimidate a patient into accepting a student.

Thats like saying they have the right to refuse a nurse based on race. There is not a differance. What you are claiming is that discrimination is o.k and legal.

No, what I said was that under certain very limited circumstances, a health care facility can legally discriminate in hiring based on sex. It's not a claim, it's a fact. No they can't discriminate based on race, and I never said they could.

A patient on the other hand, has the absolute right to refuse care by any provider for any reason they choose. At this point the facility has three choices: attempt to accommodate theri request, discharge them if their condition permits, or transfer them to another facility.

The burden of proof is on the accuser.

If it comes down to "he said-she said" without a witness to back you up, guess who they're going to believe. I truly hope you never have to find this out the hard way....

[nursinguy]

I didn't say that patients don't get seen by students, only that they could care less whether or not they "get a student" to practice on them, and that if the truth were known many, if not not the majority, would prefer not. The patients are doing the student a favor by allowing them to practice their skills on them, not the other way around. If a patient is not comfortable with having a student participate in their care for any reason, including the sex of the student, you simply say thank you and move on. It is wrong to attempt to coerce or intimidate a patient into accepting a student.

No, what I said was that under certain very limited circumstances, a health care facility can legally discriminate in hiring based on sex. It's not a claim, it's a fact. No they can't discriminate based on race, and I never said they could.

A patient on the other hand, has the absolute right to refuse care by any provider for any reason they choose. At this point the facility has three choices: attempt to accommodate theri request, discharge them if their condition permits, or transfer them to another facility.

Race is just like sex, you are born with it and you can not choose. There is no diferance between a pt saying I don't want a male nurse or I don't want a black nurse. That is discrimination.

Both are discrimination and should be denied.

If it comes down to "he said-she said" without a witness to back you up, guess who they're going to believe. I truly hope you never have to find this out the hard way....

Last time I checked we are INNOCENT until proven guility in this country, I don't know what country you live in. It is not the other way around.

That statment is like saying Kobi Byrant was juilty because he was a black man accused by a white woman, thefore he must be guility because all black men are perverts and rapest right? Nope!

[canoehead, BSN, RN]

If it wasn't a 12 lead EKG you can easily put a lead below each midclavicular area, and one on each side of the belly, and the tracing is just as useable. I don't think this needs to be an issue if you can do the procedure without exposing the patient.

[red18]

I remember all my instructors in medic school talked about cya. On the ambulance, if I'm doing anything that exposes, I try to have another female present, and only expose what is absolutely nescessary. I know in the ems world that I grew up and currently work in, you are GUILTY until proven innocent.

-Red, EMT-P

[sharkdiver]

Race is just like sex, you are born with it and you can not choose. There is no diferance between a pt saying I don't want a male nurse or I don't want a black nurse. That is discrimination.

Both are discrimination and should be denied.

The original post of this thread had nothing to do with race, I don't understand why you keep trying to interject it into the discussion.

The information I have previously posted is factual - do the research and you will find that out.

You can not force care on a patient that has refused you as a provider, regardless of their reason. If you attempt to do so, you are committing a crime (assault and/or battery, depending of the state's specific statute) that can result in your arrest and imprisonment.

Last time I checked we are INNOCENT until proven guility in this country, I don't know what country you live in. It is not the other way around.

That's true, but the reality of of a sexual assault/abuse case, especially where a minor is involved, is that when it comes down to a "he said-she said" situation, unless you can provide a credible witness to the contrary or prove you had no access or opportunity to commit the alleged abuse, the overwhelming odds are that the judge or jury will believe the victim.

That statment is like saying Kobi Byrant was juilty because he was a black man accused by a white woman, thefore he must be guility because all black men are perverts and rapest right? Nope!

Not even comparable to the discussion at hand. And again, I don't understand why you insist on interjecting race into the discussion.

(As an aside, the rape charges against Kobe Bryant were dropped after the victim told prosecutors she didn't want to proceed, shortly after which she received a large financial settlement from Bryant.)

Part of a nurse's responsibility as a patient advocate is to respect the patient's autonomy while helping them be as comfortable as possible through the procedure or treatment process. Attempting to accommodate a patients discomfort with care involving exposure of intimate areas to caregiver of opposite sex isn't that hard to do, especially for female patients. It should also be done for male patients if they request, but that can be a little more difficult due to the predominance of females in the nursing profession. The bottom line is that the patient's wishes trump provider ego every time, and attempting to browbeat or coerce them into accepting care by a provider they are not comfortable with is unethical.

[groovy jeff, RN]

Lots of good posts here!! All the points about pt comfort level and privacy are valid points.

However, in my eyes, the biggest issue isn't about ones character, integrity or discrimination, it is about the accusation. Once you have been tagged, true or not, your tagged. Even if it is proven wrong, you still have the tag. You can be the greatest nurse ever but you will still have the tag. What if your accused again even though it isn't so? It would not be pretty. It is just like a nurse in a 12 step program; she might be clean for years but when there is a narcotic missing, guess who they go to first.

Just protect yourself and your license; don't take it as a personal attack on your integrity.