Accomadating patients racist request?

[remotefuse]

Does your facility have a policy in regards to handling patients request made with regards to race? We recently had a family of "proud white supremacists" who tried to refuse care from any non white staff. One of our charge nurses tried to accommodate this request while making assignments, while a different charge nurse refused to use race in making the next assignment. The doctors eventually discharged them because they just refused EVERYTHING offered for 3 days and kept wanting to change doctors until they got a white doctor.

Our hospital does not have a set policy on these types of requests. Just the generic equal opportunity employer statement given to staff at orientation. However, a nurse manager did recommend "just try to accommodate them to keep them quiet".

[Alex_RN, BSN]

Have only seen this in little old white ladies and men with dementia.

My elderly non-white parent used to be discreetly racist in public and very vocal in private, common for their age and culture. Once dementia set in, they forgot their lifelong grudges and prejudices, was relaxed for the first time, and able to enjoy life in a different way than before.

[nursinglove30]

Lol racism in 2018 is so pathe tic (excuse my French) on so many levels. People don't understand that in today's world with globalization, everything you own, eat, ect... had a minority's involvement. Yes you will refuse care from a black person but the food you eat there, sheets you sleep on, medication you take was probably prepared by a black person. Can you refuse that? Until hospitals stand together to enact a common policy (highly doubts due to $), I am sure this will continue. Also I disagree that requesting same sex caregiver equals racial caregiver preference.

[LovingLife123]

I'm very confused about this. Was it the patient or the family? You don't mention the patient at all, just their family.

And this is where the family is under the impression they have all the power. I'd escalate the situation until management escorted their butts off the premises and told they would be charged with trespassing for coming back onto the property.

The patient can then either transfer to another hospital or sign out AMA. They can be another facility's problem.

If they are disruptive, call security.

Things need to change where families think they have all the power over us. They don't run the show in the hospital. We do.

[Neats, BSN]

As an Administrator I have tried to accommodate people and meet them where they are. I live in Idaho and northern Idaho is the white supremacy capitol, no kidding if you even look different just keep driving so you do not get hurt. When I have to go up there I tuck my Jewish Cross inside my shirt and hope I get out of that area. Now in all fairness it has changed over the years and seems to be getting better for people or is it because they are being called out for their behavior?

If a patient (and I have had plenty working with geriatrics) tell me they have never had "that kind" of person take care of me and never will....I try to reassign but I always ask the staff member if this is OK or are they willing to provide cares with another staff member (a witness). Some say just reassign but some say I have no problem taking care of people...end of story.

Here are two examples of what I have seen:

An elderly lady who lived in the bread basket USA but spent most of their lives in the southern states brought to SNF. The area in the mid west had many immigrants who worked at this facility and this resident wanted only what appear to be Caucasian people to work with her. I asked the staff how they wanted to handle it. All...all agreed they would have no problem taking care of this resident. I spoke with the patient and informed her that at this facility we give great cares to anyone who is admitted....period. If you have an issue with this you can ask to be transferred to another facility because we cannot accommodate your request for specific staff members based on culture. I required another staff member (just to protect staff) and this is what they did. By day 60 this lady broke down and cried saying how bad she feels about growing up in the South, how bad she feels about thinking the way she did. She was ashamed of how she acted at first but she also swallowed her pride and thanked everyone for teaching her a lesson she will never forget. It all came from humble hearts that wanted to care for another.

My other case was a black man who did not want anyone other than black staff to take care of him. I did the same thing. He checked himself out after 2 days, wrote a letter to corporate who in turn gave our facility a huge pizza party (being the passive aggressive nurse I can be I sent an invitation to this gentleman for our pizza party) letter came back undeliverable. (I sent all paper work to state ombudsman)

Lastly there are cases where I would consider specific staff based on the patient history. You cannot expect people to change just because they are facing a healthcare scare (think about all the cancer patients who continue to smoke) I can make it uncomfortable for them to want to leave based on boundaries.

[cyc0sys]

I work long term care/ rehab in the south. There is plenty of closet racism on both sides. I've had more than one old white demented betty, with no filter, drop the "n" word on my aides. One the flip side, I've have the same number of old black demented betties refusing care and cursing me out of the room for being a "blue eyed white devil".

I'm quick to inform the patient and family that type of language and behavior is unacceptable. Administration is quick to reassign the aides to avoid staff abuse complaints to corporate. Reassigning aide often comes across as another form of preferential treatment and does very little to change the reality of the situation on the floor.

Ultimately, the patient suffers from their own behaviors. They either figure it out or go without. If your beliefs are outside of what is socially acceptable and civil, you get what's coming to you. I don't have time to play the political correctness game.

[TriciaJ, RN]

Our policy is to send them out the damn door. Many healthcare facilities have been sued for "accommodating" racist requests from patients. We are fortunate that we have doctors who don't put up with that BS, they will discharge faster than you can blink an eye.

THIS is what needs to happen. And I completely agree with JKL that management needs to have and enforce a strict policy about this. It is the ultimate in poor leadership to let charge and staff nurses deal with this on an ad hoc basis.

[Night__Owl, BSN, RN]

When the little old folks with late stage Alzheimers get bent out of shape about a staff member of X race, we try to accommodate it. At that point, it's too late to change the mental process. It's going to make all our lives easier to try and keep this person comfortable, even if it's a bad situation.

If it was an A&O person, I would go straight to my nurse manager and hopefully risk management. I'll do whatever they tell me so long as it isn't blatantly wrong, because then I'm not going out on my own limb making decisions, I'm acting under the direction of a superior. I would also make sure that I had a "buddy" every time I went in the room. Or at least door and curtain open so someone could watch at the nurse's station.

[peachtreednurse, RN]

Anyone with as rigid a viewpoint should have already had all their hoods in a row and checked in to some backward thinking cinder blocked built building or bunker.

[amzyRN]

There's never a time to accommodate that. People need to be able to accept the help offered by the staff that's available. If they want to hire private duty doctors and nurses of their preferred color preferences that's fine, but in a hospital cannot make those demands. I've never worked in the South but did work in a conservative area in the Midwest where there were a few racist and homophobic patients, who made inappropriate comments and requests, and their requests quickly dismissed and they were informed our hospital does not accommodate that kind of preference. My manager was very nice and respectful and the hospital was concerned about HCAPS like every other hospital in the country, but racism and discrimination was not tolerated or viewed as acceptable under any circumstance. I was impressed by that, that even in a majority white, Christian and conservative community they took a stand against bigotry. I expected that there may be more tolerance for this kind of thing and I was wrong. In fact, I have found that hospitals in California (I've worked in many) were more tolerant of crap from patients than the midwest.

There's no reason in this day and age that bigotry in any form needs to be tolerated. It's time to educate and help people overcome that. It's a perfect opportunity to educate people.

[CBlover, BSN, RN]

I hate that we even have such fools in this country to demand what freaking color skin takes care of them. Shameful.

[trytounderstand]

A patient requesting same sex caregiver should be observed and if possible accommodated. The patient may have had a terrible experience that causes them to request the accommodation or it be due to religious beliefs or any number of things which could affect whether they refuse care. At the very least their reasoning should be listened too and if possible accommodated.

But to turn away a helping hand because it is not the same color is silly. I do believe if there is an issue it should be addressed by management and the staff should be made aware of why this would be accommodated before it becomes an issue with any staff member. If the hospital or administration believes it is in the best interest of staff to prevent a possible complaint that could result in issues for a staff member, the staff member should be protected. If the request cannot be accommodated then the patient/family need to be made aware that there is not a possibility of accommodating them and once the patient is stable and able to be transferred sent on to another hospital. Of course if family/patient are becoming disrespectful or threatening security should be called in to protect the staff member and someone should always be present to prevent a possibility of drummed up complaint until the situation can be remedied.

There is always going to be the possibility of personalities clashing and no one will be comfortable. If I were a patient I would appreciate the option to ask for a different nurse or doctor or to request another physician for a second opinion without offense being taken. The same goes for the nurse or doctor who has run into a patient that their personalities clash and to remedy the situation a change will have to be made. There is nothing wrong in the professional asking for someone else to step in and deal with the situation rather than to have upset patient and upset staff member. Why should anyone have to deal with a situation that may only end in complaints from both sides and possibly a sick, confuse patient refusing reasonable care.

[amzyRN]

A patient requesting same sex caregiver should be observed and if possible accommodated. The patient may have had a terrible experience that causes them to request the accommodation or it be due to religious beliefs or any number of things which could affect whether they refuse care. At the very least their reasoning should be listened too and if possible accommodated.

But to turn away a helping hand because it is not the same color is silly. I do believe if there is an issue it should be addressed by management and the staff should be made aware of why this would be accommodated before it becomes an issue with any staff member. If the hospital or administration believes it is in the best interest of staff to prevent a possible complaint that could result in issues for a staff member, the staff member should be protected. If the request cannot be accommodated then the patient/family need to be made aware that there is not a possibility of accommodating them and once the patient is stable and able to be transferred sent on to another hospital. Of course if family/patient are becoming disrespectful or threatening security should be called in to protect the staff member and someone should always be present to prevent a possibility of drummed up complaint until the situation can be remedied.

There is always going to be the possibility of personalities clashing and no one will be comfortable. If I were a patient I would appreciate the option to ask for a different nurse or doctor or to request another physician for a second opinion without offense being taken. The same goes for the nurse or doctor who has run into a patient that their personalities clash and to remedy the situation a change will have to be made. There is nothing wrong in the professional asking for someone else to step in and deal with the situation rather than to have upset patient and upset staff member. Why should anyone have to deal with a situation that may only end in complaints from both sides and possibly a sick, confuse patient refusing reasonable care.

You are certainly entitled to your opinion but I disagree with you. Sometimes we have accomodated gender requests when placing a Foley catheter or clean ups, but anything beyond that is unreasonable. Just because a health care provider has different genitalia from the patient doesn't mean they can't proide compassionate care.

Patients are entitled to safe and respectful care but that does not mean that they have the right to change caregivers based on gender or racial preferences. They also don't have the right to switch providers due to a personality clash. What patients deserve is competent providers who will act in their best interest and advocate for their health. Racial, gender/sex characteristics have nothing to do with the ability to do that.