male L&D nurses and vag exams

  1. hallo,

    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,
    kori
    •  
  2. 8 Comments

  3. by   midwife2b
    Quote from lionkore
    hallo,

    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,
    kori
    One of the BEST RN's I ever precepted in L&D was male. He took care of his patients just like we all do, including vaginal exams and the occasional birth. Our patients loved him! One OB (male) had a problem with him and requested that a female chaperone be in the room when the nurse examined his patients, but that was the only real problem. He asked all the women if they wanted a chaperone and 99.9% said it wasn't necessary. Of course there were always family members in the room...
    He's married, has kids, and is now in service for our country... still birthing babies. In addition he was strong and could help us with heavier patients and fix our computers and furniture!!! I miss him and really wish he'd come back and work with us. He wants to be a midwife, and will hopefully start that program in a year or so.
  4. by   DIXONLPN
    I am proud to say that my daughter was born into the loving, caring hands of a MALE L&D nurse! He was awesome. We all loved him. He took excellent care of all his patients. Then five years later when I had my L&D rotation in nursing school he was my preceptor! And all the laboring moms loved him as much as I did!
  5. by   kmrmom42
    If the male MDs are required to have a female staffer in the room when they are doing exams then I guess you could require the same of a male nurse. If not then why would the nurse need one if the doc didn't? Doesn't make much sense to me.
  6. by   lionkore
    Quote from kmrmom42
    If the male MDs are required to have a female staffer in the room when they are doing exams then I guess you could require the same of a male nurse. If not then why would the nurse need one if the doc didn't? Doesn't make much sense to me.
    The male docs are required to have a staff person in the room, and we all happen to be female.

    Perhaps this is an Indiana thing. I wouldn't be surprised to learn that, yet again, my state is just a teeny tiny bit behind the times...
  7. by   Dayray
    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:

    1.
    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).

    2.
    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
  8. by   AlliBean
    I am a nursing student (female) and we started our rotation on L&D. The charge nurse who gave us the tour on our first day made a similar comment about male OB nurses. She told us about a previous male nurse who had to fight to stay on the unit b/c no one else (Nurses / staff) wanted him there
    b/c of that need for assistance/supervision while performing vag exams. I though that was ridiculous but I guess it does happen. I personally wouldn't mind having a male nurse, and my gyn is in fact a male. I think it should be ultimately up to the patient, however the male nurse should not be denied the opportunity to work as a L&D nurse or even more so forced out...

    AlliBean



    Quote from lionkore
    hallo,

    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,
    kori
  9. by   ClimbingNurse
    I have heard this debate time and again and I really don't get it. If you are going to require male nurses to be escorted while doing vaginal exams then do you require female nurses to be escorted when doing rectal temps or putting foleys into males.

    Would you make lesbian nurses have an escort for vaginal exams? What if the male L&D nurse was gay? Would he need an escort?

    Is that the idea anyway? That a male nurse might get something sexual out of doing a vaginal exam on a woman in labor? Hullo!?

    I work in an ED and we always try to have someone with us when we do something invasive for 2 reasons: Usually it helps to have someone to hand you stuff and it's just the smart thing to do (liability wise). But sometimes there's an emergency (hence the name of the department) and you end up doing these things alone. No big deal.

    I don't see why a patient couldn't claim I did something inappropriate when I was in the room by myself putting in an IV. What's to stop me from doing or saying something inappropriate while taking a blood pressure? What's to stop a Pt from saying I went into the room alone and sexually molested her/him even if I was NEVER alone in the room with him/her?
  10. by   lionkore
    Quote from Dayray
    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:

    1.
    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).

    2.
    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.
    Dayray, I really appreciate your responding to my question.

    I have put foleys in male patients before without an escort and it was never an issue. I have also put foleys in female patients before at the request of their male primary care nurse, who felt for one reason or another that the woman would not be comfortable with him doing the procedure. It is, and should be, about the patient and her/his comfort level.

    My own gynecologist is male, and certainly there are male nurses I would trust to examine me if I were in labor, and unfortunately there are female nurses I would not trust! but it is not a sexual issue, it is a matter of competence. again, unfortunately. :uhoh21:

    And now that I think on it, I have seen our female OB-GYN's grab a staff member for escort when they plan to do a vag exam or AROM. Makes me wonder if the requirement for a physician to have an escort arose when docs were pretty much all males?

    The point about assuming a sexual connotation to a health care act is an excellent. myself, I identify as bisexual. There is a huge, huge difference between the examinations that come with being a health care provider and any intimate contact between two friends/lovers. People who do not understand that should not be in health care, period.

    In any case, you have confirmed my suspicion that there is, in fact, nothing written or official that prevents a male nurse from working L&D, other than prejudice. or perhaps overestimating the importance of gender when it is in fact a non-issue.

    peace,
    kori

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