California Requires Gender Pronouns

[DaveICURN]

Please re-assign if more suited in another thread. Thank you.

This Law, link below, was ratified in California. This law, as it appears to me, is an opening for many issues in a LTAC scenario. To Quote:

"The bill would require a violation of these provisions to be treated as a violation under the Long-Term Care, Health, Safety, and Security Act of 1973, the California Residential Care Facilities for the Elderly Act, or specified provisions providing for the licensure and regulation of health facilities, which may include the imposition of civil penalties. By expanding the definition of existing crimes, the bill would impose a state-mandated local program."

And,

"According to "Stories from the Field: LGBT Older Adults in Long-Term Care Facilities," a 2011 study published by the National Senior Citizens Law Center, these issues have gone unaddressed. In that study, 43 percent of respondents reported personally witnessing or experiencing instances of mistreatment of LGBT seniors in a long-term care facility, including all of the following: being refused admission or readmission, being abruptly discharged, verbal or physical harassment from staff, staff refusal to accept medical power of attorney from the resident's spouse or partner, discriminatory restrictions on visitation, and staff refusal to refer to a transgender resident by his or her preferred name or pronoun."

One of my concerns are the Patient identifiers we use before any medication or procedure. Say the Pt is giving a name as "Amy" but his/her name is "Andy" on the hospital band. Would this be considered a medication error? Are we then to perform HCG tests on all Pt. who identify as Female? Will insurance not want to pay us for using the incorrect pronouns in the nurse's notes? I'm worried about how far this rabbit hole will go.

I in my personal career use terms such as "Gal", "Bud", and "Bubby" (for children). I understand that these even are frowned on in the clinical setting, however I find that it increases the sense of moral with the Pt and Pt family when using this nomenclature.

I am interested to read all views, but am especially interested if nurses have seen this in action yet.

God Speed,

-David

Law text: Bill Text - SB-219 Long-term care facilities: rights of residents.

[herring_RN, ASN, BSN]

First this law is for long term residential care, NOT an LTAC.

Long-term acute care hospitals (LTACs) are defined by the Centers for Medicare and Medicaid Services as providing care to patients with medically complex conditions requiring an average length of stay greater than 25 days. LTACs must meet the same requirements as general acute-care hospitals. They often provide care for patients requiring mechanical ventilation, IV medications, and other acute care. The California safe staffing ratios must be met.

View Document - California Code of Regulations

The new law, SB 219 protects LGBT seniors from discrimination in long-term care facilities, such as a facility refusing to use a resident's preferred name or pronoun, denying admission to a long-term care facility, transferring a resident within a facility or to another facility based on anti-LGBT attitudes of other residents, or evicting or involuntarily discharging a resident from a facility, on the basis of a person's actual or perceived sexual orientation, gender, gender identity, gender expression, or HIV status. In addition, the bill requires that all long-term care facilities post a notice regarding this form of discrimination where its current non-discrimination policy is posted.

When LGBTI seniors need skilled nursing care they often go back into the closet. People should know they will be cared for with dignity.

Senate Passes Senator Wiener's LGBT Seniors Bill of Rights for Long-Term Care Facilities | Senator Scott Wiener

Bill Text - SB-219 Long-term care facilities: rights of residents.

[DaveICURN]

You suggest that I would not care for them in a adequate manner. This is far from the truth. In would render them the same care are anyone else. What i wonder is why have law makers been pressured to write laws to force people to agree with someone's perception.

Would it be wrong of me as a health care provider to encourage a Pt who may be experiencing Gender Dysphoria to speak with a counciler before serious life decision? At what point am I no longer allowed to express my logical reason for fear of hurting feelings?

[Ruby Vee, BSN]

These are biological females. I stayed clearly that a biological male cannot have a child. I'm not trying to start a slippery slope situation, but it amazes me how much healthcare professionals can focus More on a person's perceived gender than their biological one.

Actually, you said: "I agree with what you are all saying, except about a man getting pregnant. That's silly and biologically impossible."

That statement does not allow for a biological female presenting as male. It also seems to be rather judgmental and intolerant, not only of transgendered individuals but of those healthcare professionals who focus on an individual's perceived gender. Seems to me that you're more interested in stirring the pot than in seeking information or opposing viewpoints.

[Ruby Vee, BSN]

You suggest that I would not care for them in a adequate manner. This is far from the truth. In would render them the same care are anyone else. What i wonder is why have law makers been pressured to write laws to force people to agree with someone's perception.

Would it be wrong of me as a health care provider to encourage a Pt who may be experiencing Gender Dysphoria to speak with a counciler before serious life decision? At what point am I no longer allowed to express my logical reason for fear of hurting feelings?

I suspect you've already passed that point on this thread. Best wishes.

[bagladyrn, RN]

You suggest that I would not care for them in a adequate manner. This is far from the truth. In would render them the same care are anyone else. What i wonder is why have law makers been pressured to write laws to force people to agree with someone's perception.

Would it be wrong of me as a health care provider to encourage a Pt who may be experiencing Gender Dysphoria to speak with a counciler before serious life decision? At what point am I no longer allowed to express my logical reason for fear of hurting feelings?

And this sort of attitude among health care providers is exactly why this law is necessary.

Why would you think that your personal opinion as to someone else's gender identity is relevant or needs to be considered?

[elkpark]

You suggest that I would not care for them in a adequate manner. This is far from the truth. In would render them the same care are anyone else. What i wonder is why have law makers been pressured to write laws to force people to agree with someone's perception.

Would it be wrong of me as a health care provider to encourage a Pt who may be experiencing Gender Dysphoria to speak with a counciler before serious life decision? At what point am I no longer allowed to express my logical reason for fear of hurting feelings?

What "serious life decisions" are you so worried about? And what psychiatric credentials do you hold that qualify you to diagnosis syndromes like "gender dysphoria"? (Which refers, BTW, to feelings of anxiety and depression related to having the physical, biological characteristics of one gender and feeling strongly that you are the other gender. People who have transitioned, and are living as the gender with which they are comfortable, are no longer experiencing "gender dysphoria." They've solved that problem. Now they just have to deal with people like you. )

[klone, MSN, RN]

Nevermind. Everyone else has expressed it better than I>

[herring_RN, ASN, BSN]

I thank you all for the reply. I'll hit on the most important first. Yes, I am a new poster. I am a 1 year licenced nurse and rarely post to social media. I felt this issue was part of a larger issue as I will explain next.

I agree with what you are all saying, except about a man getting pregnant. That's silly and biologically impossible. For these reasons I ask:

If this is such a easy to solve, not a big deal, just talk to your Pt. thing then why do we need to place laws demanding these requests be upheld? Why do we need to allow people the option to sue based on their preferences. I find it an unreasonable action for the state to strong arm this issue.

Are you an RN working in an intensive care unit?

[hppygr8ful, ASN, RN, EMT-I]

Politics aside though I don't really know how to discuss this issue without politics coming in somewhere - Those of us who live and work in the great state of California are quite used to have the state's boot pressed up against the back of our necks. Outside of New York California is the most litigious states in the country and someone is always suing someone for something. The fact that someone can sue a LATC for just about anything done by staff is pretty scary. I have always carried a large malpractice insurance policy. Not because I am a bad nurse but because I have no intention of losing everything I have worked for because of lawyers fees in a lawsuit.

I am a psych nurse and work with many patients in the LGBTQ community. In my opinion next to the homeless mentally ill they are the 2nd most underserved group pf people in the United States. On top of that I work with adolescents. When we do intake assessments we ask first what is your gender? If they say they are female or male doesn't matter they all receive the same advice which is the next question "Is there any chance you might be pregnant?" If so we do a pregnancy test. We also by law have to do a body check for injuries so we know pretty quickly what their biological sex is. If a patient who is very clearly a male physiologically tells me he might be pregnant I will gladly give him a pregnancy test. All biologically female patient's of child bearing age are pregnancy tested regardless of how they identify themselves. This is to protect the patient and any fetus.

As to how the patient prefers to be addressed I leave it to them. "A simple "What would you like me to call you?" usually suffices. I recently had a transitioning patient who wanted to be referred to by a gender specific name as well as a gender specific pronoun. I told this person that I would do everything to try to make sure those wishes were honored. As a group we got it right most of the time that patient was with us and if we forgot it wasn't because we were being insensitive.

Hppy

[DaveICURN]

Because their personal opinions about their gender identity is now threatened my lively hood. If some one can report me on the basis of not using their given name/pronoun on any given day and have a full board and civil infarction brought against me then I am concerned.

Its heinous to think that i can lose my hard won licence because I didn't call my Pt Xim or Xir.

[DaveICURN]

Thank you for the well thought reply. I assumed as much from the state of California, but had no first hand experience myself.

I applaud all mental health nurses for their much needed service. I worked as a mental health tech in a lockdown psych hospital as i obtained my licence and I had many wonderful experiences with Pt. I also had experiences with riots from our adolescence children. Its truly a mixed bag. I feel you all are doing a great service for the community.

I feel this would be the norm in most health care settings as this issue arose in area. Its not that I would be willfully malicious to the Pt., I'm concerned for the one over zealous Pt who is litigation happy. This just feels to give those who are sue happy a way to abuse a system for some of the fringe groups of a society.

[NunNurseCat]

I read the entire bill and it doesn't state we must alter the health care we'd provide. Clinical judgement is preserved.

Rather it says says we will respect an individual's perceived or actual gender identity, expression, sexual orientation or HIV status. We will respect their wish to be addressed a certain way, to dress or look a certain way, and to be treated as they identify. We will not allow any information of their LGBT status to justify discrimination, absuse, neglect ,or harassment.

That sounds like something a decent person would just do automatically.

Reading between the lines of the OP's words I can't help noticing some passive aggressive tendencies and maybe a lil' bit of incredulity toward the idea of someones gender identity not matching their biological sex.

Bottom line is we don't have to get it, we just have to respect it.