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.

[Zyprexa]

Welcome to California! Where misgendering someone is a crime but knowingly spreading HIV is perfectly legal!!!!

*I have had many transgender patients as a psych nurse, and I have always respected what name/gender pronouns they prefer to be called by. In my nursing notes, I use gender neutral terms to refer to the patient (whether they are trans or not), such as "the patient requested and received Ativan 1mg PRN." However, unless they have legally changed their name/gender, I'll document according to the name/gender in the chart if I absolutely have to, as my nursing notes are part of a legal document. Hope this helps, I don't live in CA though, where enough snowflakes melt every day to fix the drought problem.

[klone, MSN, RN]

OFFS.

[herring_RN, ASN, BSN]

More than 40 years ago I was a CNA when I cared for my first transgender patient. She was in traction for a fractured hip with surgery scheduled for the morning. I helped her with a bedpan before finding out she had been born a boy. (At that time we aides answered call lights while the RNs took report.

Later in the CNA report the RN told me she was transgender. Her "sister" stayed with her. Her adult children visited.

The H&P stated she had been a man in the British army during WWII. He was married with two kids.

When he figured out why he felt so out of place he told his wife. Because they had a successful business he could afford to have treatments and surgery in Sweden.

The lady with him had once been his wife. When they came to the USA they lived as sisters. He had been his kids father and now was introduced as their aunt. They were very pleasant people thankful for the care she received.

If not for the chart I wouldn't have known.

When I first introduced myself I called her "Mrs. *****. She told me she was like Rene Richards and had been a man. She asked me to call her by her first female name.

This new law is for nursing homes. It was passed because people were discriminated against in their HOME.

... 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.

Eighty-one percent of respondents believed that other residents would discriminate against an LGBT elder in a long-term care facility, 89 percent of respondents believed that staff would discriminate against an LGBT elder in a long-term care facility, and 53 percent believed that staff discrimination would rise to the level of abuse or neglect. Though this was a national report, it included instances of severe discrimination within California.

Even more recently, in 2013, the San Francisco LGBT Aging Policy Task Force commissioned a report by Professor Karen Fredriksen-Goldsen of the University of Washington, "Addressing the Needs of LGBT Older Adults in San Francisco: Recommendations for the Future," based on information collected from over 600 LGBT seniors residing in San Francisco, including nearly 140 LGBT seniors of color.

This report found that nearly 60 percent of the study participants lived alone, and of the 15 percent of the study participants who had children, 60 percent reported that these children would not be available to assist them.

Many reported poor physical and mental health with nearly one-third of all respondents reported poor general health, close to one-half reported having one or more disabilities, and one-third of male participants reported that they were living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).

These results indicate that, as compared to seniors in San Francisco generally, LGBT seniors have a heightened need for care, but often lack family support networks available to non-LGBT seniors.

Further, LGBT seniors' fear of accessing services is justified.

Nearly one-half of the participants in the San Francisco study reported experiencing discrimination in the prior 12 months because of their sexual orientation or gender identity.

While state and local laws already prohibit discrimination in public accommodations on the basis of actual or perceived sexual orientation, gender identity, gender expression, and HIV status, the promise of these laws has not yet been fully actualized in long-term care facilities.

The purpose of this act is to accelerate the process of freeing LGBT residents and patients from discrimination, both by specifying prohibited discriminatory acts in the long-term care setting and by providing additional information and remedies to ensure that LGBT residents know their rights and have the means to vindicate them.

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

[jdub6]

I can maybe see a little where OP is coming from (giving benefit of doubt). In the ED at times it can be confusing at times as we resister people by their preferred name/gender and it can be difficult to know when we need an hcg or when to set up for a pelvic for that low abd pain.

I wonder if there is a sensitive way to note biological status (whether a uterus is present, or testes, ovaries, etc). It's that much harder since people can have different degrees of surgical change. ultimately I guess we need to just ask the patient which parts are there-and there should be a way to alert staff in the medical record that the male patient meets hcg prior to radiology in the ED etc.

[Accolay]

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

Yep.

In the end, I don't really care despite how many hypotheticals materialize. I don't really see how this law would affect the care I provide.

I will say in one google search about this law, the first eight results I received were from right wing internet sites.

Apparently this law is the sign of the apocalypse.

Better stock up on canned soup.

[herring_RN, ASN, BSN]

I can maybe see a little where OP is coming from (giving benefit of doubt). In the ED at times it can be confusing at times as we resister people by their preferred name/gender and it can be difficult to know when we need an hcg or when to set up for a pelvic for that low abd pain.

I wonder if there is a sensitive way to note biological status (whether a uterus is present, or testes, ovaries, etc). It's that much harder since people can have different degrees of surgical change. ultimately I guess we need to just ask the patient which parts are there-and there should be a way to alert staff in the medical record that the male patient meets hcg prior to radiology in the ED etc.

The new law only applies to residents of a skilled nursing facility.

I think the chart would use the patient/resident's legal name.

Unless they are a celebrity or well known the legal name if used.

We nurses and other staff call the persons how they wish to be addressed.

I cared for a pleasant man in his ninties. He said, "Don't call me Mister *****. That is my father.

We all fondly remember a patient who wanted to be called, "Big John."

Often people like to be called, Buddy or Bud, Carrot Top, speedy, or Blondie.

Then the common Pat, Patty, or Patsy for Patricia, Chuck, Chaz, or Charlie for Charles.

I think that in general the admitting physician would document their patients conditions ans history.

I have cared for intersex people whose chart didn't mention it. One example was a married grandmother whose privy parts looked like the member of a two year old boy.

It was noticed during her bath.

When I asked her doctor about it he said. "It is normal for her and not unhealthy."

I called her Mrs. *****.

What is intersex? | Intersex Society of North America

[FolksBtrippin, BSN, RN]

I work in child/adolescent psych where there are many transgendered patients. It would be helpful to me to be able to update the MAK system to show the preferred name. We currently can't do that. I would not like to wait for a med error to change this.

Updating mak would eliminate any legitimate argument against using the preferred name.

[RNNPICU, BSN, RN]

I could see where there might be some confusion and putting a patient at risk for a medication error. If the given name for a patient is John Boy and has male body parts, but John Boy believes she is Jane Boy, and calls herself Jane. A nurse goes to give a medication, the medications are labeled as John Boy. If you ask a patient their name and they say Jane Boy, there has to be a way to help keep these patients safe, especially if they are under 18 and cannot legally change their name. Some name bands have M/F on them as well. Also, if a transgender patient under 18 is still wavering between genders (I have known someone who this was happening to), it can cause confusion to a health care provider. Care is still given the same but for administering medications there should be a way to safely abide by the 5 rights, (right patient - names must match up.) If a patients says my name is Jane Boy, but armband, medication label, chart say John Boy you have to stop, and reassess. I do not know enough about transgender to determine how to tackle the problem if there are name issues, esepcially if the armband has M/F and the patient states the opposite of what is on the armband.

I realize it is being aware, but there should be safeguards in place to prevent potential medication errors. The system just needs to have safe guards.

[hppygr8ful, ASN, RN, EMT-I]

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.

I suggest that you go to your BON website and look at the kind of things they take licenses away for. Anyone can report anything to the BON but I highly doubt one would lose their licenses over failing to use a gender specific pronoun even if that failure was maliciously motivated. Licenses are mostly disciplined or lost due to substance abuse issues and crimes/acts of moral turpitude.

Hppy

[Kooky Korky, BSN, RN]

This exactly. As Elkpark said, it's attitudes such as yours that necessitate this law.

So here's a guy who comes here asking a simple, honest question and he's getting a lambasting from you and elkpark.

Is it just human nature to fight over every thing?

OP, I'm sorry your motives were suspected. I hope you stick around and can get some answers.

I agree with you that no law would be necessary if there weren't the possibility for trouble to happen. What a mess human nature is.

How dare anyone have an opinion or experience different than anyone else here?

[Kooky Korky, BSN, RN]

Hmmm, brand new member, first post. Is there some agenda here we should know about?

Seems to me that the scenario of an individual who is legally "Andy" but goes by "Amy" would not be that big a deal to sort out with staff, particularly in a long-term care setting, where all the staff become familiar with all the residents (might be a bigger problem in acute care, where staff and clients are coming and going all the time). Since when is identifying individuals by the name they prefer to use heading down a "rabbit hole"?

At one time, you were new here, too. Is that a crime?

What agenda are you concerned he might have?

[LibraSunCNM, BSN, MSN, CNM]

So here's a guy who comes here asking a simple, honest question and he's getting a lambasting from you and elkpark.

Is it just human nature to fight over every thing?

OP, I'm sorry your motives were suspected. I hope you stick around and can get some answers.

I agree with you that no law would be necessary if there weren't the possibility for trouble to happen. What a mess human nature is.

How dare anyone have an opinion or experience different than anyone else here?

How is he getting lambasted? People are trying to explain what the law actually means, who it would affect, and why it might be necessary, but the OP is the one being aggressively negative about it and unwilling to consider other points of view.