Cultural diversity help

Ruby Vee, BSN · Mar 20, 2011

it's probably a good thing that i'm not in managment. i'd be inclined to say "we don't have a female physician on call right now. dr. imanass can see you, and we'll make sure we have a female employee in the room while he examines you -- or the male relative of your choosing -- or you can refuse our care. there's another hospital ten miles down the road -- maybe they have a female physician on call."

OBnurse3 · Mar 20, 2011

Which was my initial (and HONEST) feeling, but unfortunately, the boss-lady wants me to do "some looking" and get "some ideas of how other facilities handle this". yadda-yadda:banghead:

flashpoint · Mar 20, 2011

What other options are there? The hospital can't pull a female doctor out of thin air, can they? What did people do before there were female doctors? All you can do is make sure there is a female present as needed or offer to transfer to a facility with a female doctor present.

Chin up · Mar 20, 2011

I will only use female doctors, purely personal preference, I think they are superior in every way. I only make appointments with my own specialist, so this has never been a problem for me. However, if an emergency arose and Dr Joe was the only doctor around, of course, I would have to comply.

Your hospital either needs to hire more women MD or MW if they are going to serve their community well. They can't expect staff to do it. Or, they can make arrangements with another hospital in the area. America is diverse and many cultures reject, male or female, depending on the sex of the individual and cultural persuasion. If your institution wants to stay competitive, they must address this. This is not a nursing issue. You should not be put in positions in which you have no power to rectify. Peace!

klone, MSN, RN · Mar 20, 2011

The only time I've encountered such a situation is where I work now, where we see a large population of people from other ethnicities, such as Muslim cultures, where the women refuse any male care givers. Luckily, we work in a teaching hospital where there are always a bajillion residents around, and 80% of them are women.

psu_213, BSN, RN · Mar 20, 2011

I have a friend who is currenly pregnant. Her OB suggested that she, over the course of her pregnancy, see all the OBs in the group, because there is no way to know when she will deliver and who will be on call. (I know that does not really help you...just wanted to share)

As for your situation, this is a hospital admistration problem, not a nursing problem. If the hospital chooses to employ just one female OB, this is a risk they run, and an issue they need to deal with. Otherwise, I'm not sure there is a whole lot you can do in the short-term.

NPinWCH · Mar 20, 2011

I don't have an answer, but wanted to point out that the OP states this is a small hospital. Most small hospitals don't have OB/GYNs "on staff". These providers apply for privileges to care for patient's there. Sure, they can try to recruit more docs, but it's not easy for small hospitals to do so, especially for a specialist like OB with its large malpractice costs.

For the longest time we didn't have ANY female OB providers, but then the patients seeing those docs KNEW that. Eventually, we had 1. Even the docs in a group made sure their patients knew that it was possible that they wouldn't deliver with "their" doctor since call rotated on the weekend.

So to the OP: are these patients walk ins or patients without prenatal care?

If they aren't then the female provider they are seeing during their pregnancy should tell them up front that it's possible a male may be delivering their baby. If that's not acceptable to the patient at the first prenatal visit, then they should find a different provider/hospital to deliver at.

I also agree that this isn't a nursing issue. You can do nothing about this. That being said, no one can touch the patient against their wishes. If the patient is screaming, "Don't touch me, get away from me", and you touch the patient you COULD be held liable for battery. This puts you in a sticky situation when there is risk for harm to mom or baby...

Whispera, MSN, RN · Mar 20, 2011

Patients have the right to refuse being cared for by anyone they choose to refuse. In the case where it's a religious or cultural rule, they don't have the option of accepting who is available at your facility. It would make their stay and care stressful to them and maybe even be a sin or at least a big personal transgression. They have the right to refuse and your facility (not you) needs to find someone who fits what they need, or find another place they can be transferred to. Patients come to a hospital assuming their needs will be met. It's not their fault they can't accept what's available, when it's a cultural or religious rule. Since they are in our care, it's up to us to find what works for them in such situations.

OBnurse3 · Mar 20, 2011

I appreciate all your responses. I agree that it is an administration problem, and they are working to recruit more femal OBs. However, what am I supposed to do when a pt presents in active labor and refuses a male physician and that is all I have to offer? I can't transfer an actively laboring woman, I can't send the doc in the room and I can NOT legally deliver this baby on purpose!!! (We all know precips happen) So is it possibe to hand them an AMA form and tell to get on down the road????

As for PNC, our docs are covering this THOUROUGHLY in the pre-natal visits, to the point of having the pt and husband sign a paper that states thy understand that a male might be the doc on-call and they will allow him to deliver, if they don't sign it, they must transfer care to an all female practice elswhere. The problem is they are siging these, but when the time comes, they refuse our male docs!!!

Let's face it, while it is an administration problem, if she refuses our male docs, and I can't transfer her, what are my options?? The only things I can think of are: make her sign the AMA form, or let her deliver into the bed unattended. But then what liabilities are open for there (failure to rescue) as it pertains to baby??? I know there is no "right" answer, but I just wanted to bounce this off other nurses and see if there is a possibility I am NOT thinking of

klone, MSN, RN · Mar 20, 2011

Why can't you transfer her?

We transfer laboring women all the time, where I used to work (small community hospital that couldn't take high-risk women, and if they came in, they'd get transferred to a hospital 80 miles away).

It seems to me that transfer is the only option if she refuses the care of the only OB who's on at that time.

OBnurse3 · Mar 20, 2011

Why can't you transfer her?
It seems to me that transfer is the only option if she refuses the care of the only OB who's on at that time.

One word: EMTALA