am orienting to L&D and loving it! and our floor is hosting several students, including a few male students. i remembered that on this forum are at least two, probably more, male L&D nurses, and was wondering about something my preceptor said. she said that males "couldn't" be L&D nurses, in a practical sense, because they would not be able to perform vag exams on their patients without another person in the room.
now i know there is a helluva lot more to L&D nursing than vag exams, but was just wondering, for all you guys out there, do you perform the vag exams for your laboring moms? do you perform the exam if only you and the patient are in the room? do you perform the exam if the significant other is present but no other staff member? do you ask another nurse or tech to accompany you? do you ask a female nurse to perform the exam? just wondering. i'd like to point out to my preceptor that there are indeed males in L&D, but i just know she'd ask me about the logistics of it, and i don't know them!
thanks so much,
Sep 19, '05
Yeah this has come up a few times for me.
As far as I know, There is no Law saying that male nurses need an escort to do a vag exam and defiantly not a female escort. There is however an AMA guideline that says that every MD regardless of gender needs to have someone else (male or female) present in the room. It doesn't have to be another staff member but some choose to make it another staff member because a family member can misinterpret something or could lie. Female docs often ignore this, however the rule does apply to them too.
Any policy a hospital may have specifically about male docs or nurses is most likely not written and if it were would be discriminatory. However because so many female docs ignore it and most male docs follow it, people think that it only applies only to males.
Aside from the fact that this guideline has nothing to do with gender it also is an AMA guideline applying to doctors not nurses.
All that being said here is what I do.
Most of the time there is a family member around so it is a non-issue. When there isn't a family member around and sometimes even when there is I use my judgment weather or not I want to place my self at risk in doing the exam without someone else around. Now I wouldn't be at risk for breaking a rule because there is no rule but there is risk of the patient misinterpreting something or making something up. So if I get weird vibes, if I sense that the patient is uneasy, or if I feel that the patient is particularly vulnerable i.e. teen mom, developmentally disabled or doesn't speak English I grab a coworker to go in with me. Otherwise just like any other nurse I do the exam with no one in the room.
It is very rare mabey 2% of the time that I ask soemone to come along with me.
I don't routinely have an escort when a patient is alone for 2 reasons:
Usually by the time I'm doing a vag exam a level of trust has already been established, that or the situation calls for immediate action and I don't have time to think about possible allegations. Most patients are very at ease with me and aren't going to have a problem with no one else in the room. Some patients are very private and having even another female in the room would be much more uncomfortable then having just their nurse (yes even though I'm a man).
I choose to take on the risk of working L&D as a male and I see doing vag exams as a big part of that risk. I don't have another nurse follow me around because to do so would make me much less productive and would also mark me as different or as half a nurse.
Just think if you always had to have a coworker with you when doing exams or placing foleys. I would have to ask the question: "if I need another nurse with me then why doesn't she just do the exam and well why doesn't she just take the patient then?" and why don't I just go work in the ER where guys are supposed to work? And then I might as well sit in the back of the bus too.
The whole idea seems to imply that I can't be trusted and if that's the case then why am I even there.
Still I am very careful; I try to explain things clearly but not overerly so before I do them. I also always always do things the exact same way with every patient. I have them all get into the same position I say the exact same thing, every action is as though I'm following a script. I do this because if I ever come into question I will know exactly what I said and did and this way there is no room for accidental slip-ups like saying or doing something that can be misinterpreted.
I also have to wonder (and maybe this is due to lack of imagination) what I could possibly do (or be accused of) that could be seen as being more invasive then what we routinely do. You can't get much more invasive then a vag exam and that is part of the job.
I know that a female escort for male caregivers is the norm in many places but it isn't a law, some may argue that it is a good idea. In today's world the law sees differentiation in regards to gender the same as differentiation in regards to race or religion. So any rule or policy that is written specifically limiting the action of one gender or race is illegal and unconstitutional. Our society has not caught up with this ideal so a law requiring only female escorts for only male care providers sounds reasonable but it woulden't be legal.
I have occasionally worried that those who see males in L&D as wrong might try to make trouble by requiring this. If they ever did they would quickly find themselves in a staffing nightmare because to make a policy like this they would have to have escorts for all (not just male) nurses.
Still I have had a few issues with other nurses that insist that it is a rule and still some others that wonder why I would take such a risk. It is a risk but that risk is at the very core of what I do.
Last edit by Dayray on Sep 19, '05