The Great Double Standard?

BillEDRN · Oct 9, 2007

again i beg to differ...
if it was your grandmother who was too embarressed to have a male do personal care or your grandfather .. . would you force a nurse on them who made them uncomfortable?? patients in hospital feel threatened and vunerable... why would you add to those feelings by riding rough shod over their feelings??
this is, as Leslie says, an emotional response and something a lot of our older patients feel. it is about respect.
or is care in the states so different to care here in the UK?

I don't know about the state of nursing care in the UK, except to say that lots of your nurses are coming here to practice and not many US nurses are flocking to the UK. So, take that observation for what it's worth.

However, to answer your question, my grandparents are deceased, but my elderly mother recently was diagnosed with breast CA and had to undergo multiple procedures and ultimately surgery. At one point, she had to have a male tech administer dye for for a radiology study. The dye was injected into her breast to map migration to her lymph nodes. Initially, she was hesitant to have this performed by a male. So, I talked to her about this concern. After a short time, she realized her fears were unfounded and that a male could be as caring, gentle (considering the procedure), empathetic, professional and competent as a female. Moreover, she made the realization that placing limitations on someone for reasons of sex is rarely, if ever justified. Just as she hoped that no such limitations would be arbitraily placed on her daughter's professional endeavours because of her gender, none should be placed on someone else's son.

So, my response to irrational and unfounded fear/concern/modesty is one of education and logic. I know this may run counter to the current drivel espoused by many of the nurse educators, but I for one prefer to educate people as opposed to perpetuate unhealthy stereotypes, discrimination and fear.

TDub, MSN, EdD · Oct 10, 2007

i moreover, she made the realization that placing limitations on someone for reasons of sex is rarely, if ever justified. just as she hoped that no such limitations would be arbitraily placed on her daughter's professional endeavours because of her gender, none should be placed on someone else's son.
so, my response to irrational and unfounded fear/concern/modesty is one of education and logic. i know this may run counter to the current drivel espoused by many of the nurse educators, but i for one prefer to educate people as opposed to perpetuate unhealthy stereotypes, discrimination and fear.

are you actually saying that someone's fear is irrational? unfounded? you're going to educate the patient who perpetuates unhealthy streotypes? espousing patient choice is drivel? i agree limitations shouldn't be arbitrary. i hardly think being raped, tortured or molested creates irrational fear. or that the patient who is terrified of men because of this is being arbitrary or unjustified in requesting a female nurse.

have you any idea of the terror or the flashback that happens when you are alone in a room with a strange man, on your back, with one layer of cloth over your naked body while he's looming over you, something sharp in his hand? you wonder if you can scream loud enough so someone will hear, can you get away or will you be frozen like the last time?

i have had more than one patient so traumatized by a gang rape she couldn't lie on her back and spread her leg to deliver her baby. she had to deliver on her hands and knees, which was ok, thank god. what if she'd had to have a csection? flat on her back, arms and legs tied down, she would have lost her mind in a psychotic breakdown.

i've had refugee patients tortured in prisons in dictatorships who are frozen in fear when they see a man with a mustache or something else that reminds them of their captor.

do you think muslim and orthodox jewish women should be re-educated with logic so they can see how wrong their beliefs are? have you no empathy or mercy at all?

i was molested for 9 years over 40 years ago and my heart still skips a beat if i'm in bed and i see a male silhouette in the doorway. the door has to be locked for me to feel safe in my own bedroom.

i can't have a man i don't trust take care of me. there are a few i trust. if it was life or death and i had no choice about the gender of my nurse, i would grit my teeth and go to therapy later. but i think i am or any other patient is completely justified in asking for whatever nurse will help them keep their sanity.

i am ashamed of you. i read in your posts self righteousness and anger over the fact a patient doesn't want you. it's not personal, bill. it's not about you. it's about the patient and what ever will help. we are afraid, bill. do you get that? no 10 minutes of logic, re-education or gentle explanation is going to cut it because we are talking about real, primal-oh-god-oh-god-he's-going-to-rape-me-and-kill-me-terror.

if a male patient wants a male nurse, fine. if a white patient wants a white nurse, great. i don't know what their issues are and in the moment is not the time to address them. i just want them to feel cared for and safe. i would hope we were big enough so that if the only way to help someone was to step aside, we would do so. i pray the next time i'm in hospital, i don't have a nurse this intent on his own agenda and proving his point at the expense of my mental well being.

i can only think that perhaps you didn't realize this is what we were talking about when we said we'd rather have a female nurse. it's not worrying over if the cute tech might catch a flash of your heinie, it's reliving the sickening flat feeling in your chest of a rape, remembering the sharp repetitive pain over and over again with each thrust in your lady parts or your orifice; so sore for days, how much you bled or how badly you were beaten.

knowing your dad's "friend" was coming through your bedroom door any minute now to "tuck you in" for 45 minutes and what he was going to do to you and make you do to him, holding his dirty hand over your 10 year old mouth the whole time.

after the rapist cut through the screen and got in your room, you remember all the evil nasty things he said as he forced your head down and how you though you'd choke when his member cut off your air. how he'd mock your tears and pleas and laugh after he'd slap you hard enough to make your nose bleed.

waking up in the bathroom of the frat house the morning after a big party and realizing your panties are gone, your top is on inside out and your bra is fastened wrong. you feel really sloppy between your legs and sore, very sore. your breasts are bruised and you can't find your purse and all the guys there are smirking at you and all you want to do is disappear off the face of the earth.

trying to hide the bruises you boyfriend planted on your face last night. too bad you can't hide the ones on your thighs with make up. last night was the first time he forced you and you have a feeling it won't be the last.

remembering how scared you were shoved down in the back seat under a scratchy smelly blanket while he drove around town telling you how he was going to kill you and then take your keys and go back and kill your 11 and 13 year old daughters but first he'd have a little fun with them first. how that gave you the courage to jump out of the moving car, stark naked, hands tied behind your back, running through the streets and begging the astonished people in traffic to help me! help me! a good guy leapt out of his car and wrapped you in a blanket and called the cops. your girls were safe, but you couldn't live in that apt anymore.

it's not about you; it's about them. have compassion, for god's sake. allow us our own opinions and feelings.

and every single one of these situations has been experienced by somone i know.

nursemike, ASN, RN · Oct 10, 2007

Are you actually saying that someone's fear is irrational? Unfounded? I agree limitations shouldn't be arbitrary. I hardly think being raped, tortured or molested creates irrational fear. Or that the patient who is terrified of men because of this is being arbitrary or unjustified in requesting a female nurse.

At the risk of being argumentative--well, I suppose it's more than just the risk--I feel compelled to point out that the fears you describe are irrational. I don't mean to make light of them--I'm sure they are very real to the person who experiences them--but PTSD is a disorder, it isn't a reasonable perception of reality.

That said, I agree with your general point, that a patient's wishes should be accommodated. In instances such as you described, where a patient has been traumatized, I'd go so far as to say they must be accommodated. There's simply no way to provide adequate care to a patient who is terrified at the very sight of you, and it would, indeed, seem irresponsible to press the issue.

I do think, though, that most of the objections to discrimination are based on instances that are arbitrary, to a patient who just doesn't think men can be good nurses, or that nursing isn't "man's work." I think some may tend to include patient modesty among those arbitrary reasons. I don't. I've talked to co-workers who've said if they had to be hospitalized, they'd want it to be at a facility other than our own, to avoid embarassment. It makes me think, well, yes, it would feel a bit uncomfortable to have one of my friends start a foley on me. I think I would still tend toward wanting nurses I know and trust, but that's me, and I can see how others could feel differently.

I drew a distinction, earlier, between personal modesty and sexism or racism, but the more I think of it, I don't know that I'd feel all that good about caring for someone who objected to having me, even if their objections were completely arbitrary. If a patient told me, "I'd just feel more comfortable with a black nurse..." I'd be inclined to honor their wishes, and, frankly, I'd think they deserved the same accommodation if they'd be more comfortable with a white nurse. I don't say I would respect their opinions, but I wouldn't necessarily say show them the door, unless they were overtly hateful about it.

My own experience during my short career as a nurse has been far less dramatic than most of the instances that have been described, here.

I've cared for older ladies who had initial misgivings about having a male nurse, but who've given me a chance and been pleased with my care. I don't apologize for having more respect for someone like that than to someone who is just closed-minded and obstinate. I've cared for a few women who've had a history of abuse in one form or another who have been able to distinguish between me and their abusers--but then, I've been grateful to the nurse giving me report for alerting me to that history so I can take extra pains not to appear threatening. Still, I have to say that I've encountered the view that men shouldn't be nurses, or shouldn't work L&D, or whatever, enough to feel a little resentful of that sort of prejudice. I'm a second-year nurse. A lot of my female colleagues are more experienced, better nurses than I am, and I'm man enough to admit that. But I won't concede that even the very best of them care more than I do, and I fully intend to be as good as any of them, as soon as I can.

I'm truly sorry for those who've been victims of abuse. I don't minimize their pain, and in terms of raw instinct, their feelings of fear are quite understandable. Understandable, but not reasonable, because the reality is that men are just as capable of kindness, gentleness, and caring as women are. Some men are monsters. Some women are, too. Clearly, it will take more than "ten minutes of education," to correct the distorted views of those who've been traumatized, and decency demands giving them time and room to come to terms with their feelings, but those views are distorted, and coming to terms with them is a necessary step toward health. To argue that clinging to these distorted views is rational or healthy seems very nearly as cruel as to ignore their reality.

TDub, MSN, EdD · Oct 11, 2007

NurseMike, that is a superb post. You made the point much better than I because you brought out the difference between being scared and/or modest and then just being hateful. (And because I got a little, ok, a lot shrewish) I have found male nurses to be no different than female nurses to work with. Most of them are great and a teeny tiny minority are poops.

My first mentor more than 20 years ago was a man and he taught me more about being a good nurse than many of my professors. I also believe very strongly we need more men in nursing. We need good role models for boys in the caring professions. I always have to smile to myself when a dad is amazed at teh great job a male nurse does in labor and delivery. I think, "What did you think he was going to do? He is using his mind, heart and hands to be a nurse, not his member."

I was definitely overlooking the fact some people refuse care because they mistakenly believe a man couldn't do the job. In that case, I do agree with Bill that a little modeling or exploration of the issue might help. It may not, either and of course you wouldn't push it, but it's worth a try.

I hadn't considered it, but I guess the fear is understandable but not rational. It's still very hard to get over. I know perfectly well I am safe with the nurse, (safer than with any random guy off the street) but my body doesn't. My heart starts to pound, my mouth gets dry, I tremble and feel like I'm going to jump out of my skin. I've had plenty of therapy for it--I couldn't even go on a date until I'd been in therapy for a year. Then I had to undergo hypnosis to get pregnant: I was so afraid I'd get a male doctor, I couldn't have kids. I finally did the whole Victorian thing..."Close your eyes and think of England", although in my case it was "think of the baby". On the night I went into labor, I knew Dr. Dave was on. My hubby was panicked I'd deliver at home because I refused to go in until he was off call.

So, now on that note-how would you help calm down a p*ss-scared patient like me who couldn't think straight?

fins · Oct 11, 2007

I also believe very strongly we need more men in nursing. We need good role models for boys in the caring professions.

And here's the problem. As long as a double standard is allowed to endure based on gender, it's going to remain difficult to get men into nursing in any serious numbers, and men's careers are going to be affected. I personally would rather gouge my eyes out with a rusty spoon than work in L&D, but the fact that L&D is effectively closed to men IS still discrimination. Yeah, everyone knows about that one WONDERFUL male L&D nurse that they worked with for a couple of years. He's talked about with the same sort of condescending approval as the black athlete who is articulate. ("Bill/Joe/Bob was every bit as good as the other nurses. Who'd have thought!") But the fact remains that there are huge swaths of nursing that are essentially closed to men.

I was actively discouraged from pursuing a job in a neonatal ICU while I was in nursing school. It "wasn't for me," I "wasn't right for it." More than once, from more than one nurse, I heard that. From professors, in whose classes I was getting A's. From relatives who were nurses (including neonatal ICU nurses) who had never seen me in clinicals. Each and every time I would ask what it was about me, a husband, a father, and a nursing student with a 3.8 GPA that made me wrong for it, and it always boiled down to: I'm a man, and the parents prefer women nurses. It might not even be true, but nurse managers believe that it's true, and they act on that belief. So while accommodating the fears/desires/preferences/modesty/whatever of patients sounds unambiguously virtuous, keep in mind that it has actual detrimental career effects on men. To the point that I would actively discourage my son from becoming a nurse.

Of course, every cloud has its silver lining. One good thing about becoming a nurse - it has made me realize that women are every bit as sexist as men are, and are no less hesitant to discriminate when they have the power to do so. It makes me feel a lot better about my gender.

leslie :-D · Oct 11, 2007

:chuckle:chuckle:chuckle

leslie

nursemike, ASN, RN · Oct 11, 2007

So, now on that note-how would you help calm down a p*ss-scared patient like me who couldn't think straight?

Thanks, and that's a very good question. Honestly, I don't know how one could go about calming a deeply traumatized, panicked patient. I think you'd just about have to find them a nurse they could be more comfortable with. My own limited experience with abused patients probably doesn't apply fully. I know that I was careful to approach slowly, speak in a soothing tone of voice, explain everything I meant to do, and leave most of the personal care (baths, toileting) to the female aide. Then, too, I'm short, fat, and 51. Much as I might sometimes like to look more sexy and dangerous, I probably come across more as a dotty old uncle with a houseful of cats--which is fine, in a nursing environment, and probably keeps me out of a lot of trouble in singles bars.

Then, too, I work in neuro/neurosurg. One of my previously abused patients was a closed-head trauma, and another had an altered LOC r/t drugs. Caring for them wasn't a lot different than any other confused patient. In fact, at one point when I had to get the closed-head out of bed, she insisted on dancing with me for a couple of minutes, which was kind of a sweet, funny moment in a hectic night. (I believe she eventually recovered fully from her injuries,btw.) There were a couple of others with unfortunate histories who were AOX3, but the traumatic events were long past, so they weren't panicked over them. Dealing with them was just a matter of being gentle and preserving their modesty, which I would try to do even with a male patient, and avoiding any remarks that might be remotely flirtatious (I'm not above addressing an older lady as "Darlin' " once in awhile, if it seems welcome, but I wouldn't with someone who might have issues.)

But I'd think for anyone with PTSD (or any anxiety on that level) you'd have to have some psych intervention. People do learn to live with their fears and put them in manageable perspective. A lucky few seem to be able to "get over it" on their own, but I'd think a course of therapy would be more the norm. Actually, living their lives in fear is probably more the norm--we seem, as a society--to do far too little about our mental health. But even with our typical confused/agitated patients, you don't force them to confront their fears, and you aren't going to talk them out of them in a few minutes. I think of it as a sort of mental tai chi: you try to divert them from what's freaking them out by deflecting the energy, rather than opposing it. And, very applicable to this thread, you try to avoid freaking them out in the first place.

I've had a couple of female pts. reassigned to a female nurse. One I won't discuss in an open forum, since it wouldn't be appropriate. The other was a young woman with some psych problems and a possible history of abuse who told me "a black man" had come into her room and threatened her. I was skeptical, because the only black men on our floor were two doctors, neither of whom was on duty that night (and neither of whom could I remotely believe would do anything out of line) but I reported the claim to my CN, who talked to the pt and then switched my assignment with another, female nurse (to protect me).

More typical, though, is the case of a woman who "isn't sure" about having a male nurse, but will let you give her her meds and even do an assessment, as long as the aide does the really personal stuff (and it's not like I ever have a lot of time for the personal stuff, anyway.) More than a few, during the course of a night, decide they'd rather let me put them on the bedpan and clean them up afterwards than wait for the busy aide, and most, by morning, are all for male nurses. I really enjoy those little victories for "us guys," and I think we need to not be so quick to accommodate that those victories never occur.

teeituptom, BSN, RN · Oct 11, 2007

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So, now on that note-how would you help calm down a p*ss-scared patient like me who couldn't think straight?

My immediate thought is a lot of Valium is needed to calm you down

socalpca · Oct 11, 2007

I guess my point is regardless of the patients wishes, these female nurses are automatically assuming that we (for some reason?) should not be providing care. It really wouldn't be an issue if the patient said they would be more comfortable with a females care, which wouldn't bother me at all, at least I can understand that. I have a big problem just accepting an answer that is "well thats just the way it is" If all people accepted that as an answer, women wouldn't be able to vote, and african americans wouldn't have equal rights. I know these examples are extreme but I really hate this distinction that males can only do " ..." while females can do it all. What can be done to change this?

As a male RN, I do not get this impression in my practice. The only time that I defer a nursing task on a female patient is if the patient or family asks for a female to perform care. I will also say that this has only happened once in my 4 months on the floor. I know it will happen again, but I don't take it personally.

nursemike, ASN, RN · Oct 11, 2007

My immediate thought is a lot of Valium is needed to calm you down

I have no problem with the use of anxiolytics, where appropriate, and I have joked that I would like to be able to carry a dose of Ativan in my pocket at all times, just to intereact with the public--i.e., injecting them, not myself. I have no objection to using physical restraints, when necessary, either. But I tend to look on benzos in much the same way as restraints--a last resort, and a temporary "fix." I see a lot of confused and agitated patients, and it amazes me how often soft speech and reassurance can bring someone out of "fight or flight" mode.

TDub, MSN, EdD · Oct 12, 2007

My immediate thought is a lot of Valium is needed to calm you down

That would probably do it! But then you'd have a large, uncoordinated, sentimental nonweight-bearing patient with her arm slung around your neck, sobbing "I love you guys, you're the besht!".

nursemike, ASN, RN · Oct 12, 2007

That would probably do it! But then you'd have a large, uncoordinated, sentimental nonweight-bearing patient with her arm slung around your neck, sobbing "I love you guys, you're the besht!".

Are you sure you've never been one of my patients?