Legal analysis of race-based staffing at patient request

HouTx, BSN, MSN, EdD · Jun 23, 2016

Very interesting question - I can't wait to see the feedback.

How would it have impacted this case if there had been a Psych consult with a consequent physician directive to restrict the race/gender of care providers in order to prevent exacerbation of the patient's trauma? I don't have answer... just wondering.

As part of our cultural care philosophy & guidelines, my organization DOES honor gender-based requests to uphold religious or cultural traditions. We do NOT support discrimination preferences that are simply racist, ageist, homophobic, or misogynistic. We inform patients of this boundary. If any staff do not want to deal with that particular patient (because of the potential for abuse), we do everything we can to avoid assigning them to care for that particular toadstool.

KatieMI, BSN, MSN, RN · Jun 23, 2016

In all three places I was so far, that was daily and common practice, save for the sign on the door for most of the times.

Patients were, and are, granted whatever their whims might be, for a reason or not. I saw requests of "only obe gender" (taken so seriously that male physician had to run code on that cookie by yelling from the corridor), only certain skin color, "no immigrants", etc., all of that was happily granted in the name of the all-mighty Customer Satisfaction. In only one place (the one I still in, to make it clear) some boundaries might be eventually set, usually after the family "fires" like 1/3 staff or more. For honesty's sake, the same facility supports opposite behavior as well - staff, at least, may voice concerns about inappropriate behavior, and patient/family might be spoken with if that happens.

I actually saw nursing and ancillary staff being very happy about such rules, because nobody wants to deal with xenophobs/racists/etc., and it makes life somewhat easier if you do not have to deal with that sort of people for 12+ hours. I still wonder what should be done if the only one nurse able to do the task in a place is "the undesirable" one. I was in that position a few times by now and still do not understand how I hold myself from telling those "customers" everything I thought about their atrocious behavior as a nice response on their feeble thanks. But I was, and is, in the minority thinking that such requests must not be granted except, maybe, for some selected cases.

It looks like that patient in article was suffering from PTSD or something from this spectrum; if so, she should be provided with effective treatments, not put into bubble of a sort. How would her family prevent her from ever seeing another black male?

Here.I.Stand, BSN, RN · Jun 24, 2016

Is it equally discriminatory to assign nursing staff by gender either at the request of the patient or based upon patient need?

In most cases, I don't think so. Nearly all of the requests for same-gender caregivers are due to the pt's sense of modesty....be it cultural, religious, or personal. It's not due to the pt's disdain/hatred/distrust of people of the opposite gender. Generally those who demand no caregivers of certain ethnicities do have those ugly feelings.

KatieMI, BSN, MSN, RN · Jun 24, 2016

In most cases, I don't think so. Nearly all of the requests for same-gender caregivers are due to the pt's sense of modesty....be it cultural, religious, or personal. It's not due to the pt's disdain/hatred/distrust of people of the opposite gender. Generally those who demand no caregivers of certain ethnicities do have those ugly feelings.

I actually do not think that even race-preferred staffing for deeply demented LOL who happened to live 90+ years with certain "beliefs" is as discriminatory as satisfying "no such and such people near me" request of middle-aged someone who is A, Ox4. It might be so on paper, but life is kinda more complicated sometimes.

But, again, it is one thing if the team discusses the issue openly before the shift and the Powers do their job, and another one when you are humiliated in front of the patient and everyone and then see a label "no such and such people allowed in", like the nurse described in the article had to endure.

nutella, MSN, RN · Jun 24, 2016

Riskmanager - thank you for this interesting article...

This organization dedicates themselves to modesty in healthcare - from looking at their information it is hard for me to figure out if they are some kind of religion based organization or just concerned about modesty and advocacy in sexual abuse. They do make some good points though and some interesting thoughts:

Risks of Gender Neutral Nursing Assignments

While it seems pretty clear what constitutes race discrimination and that it is absolutely not acceptable to support patient's or families "preferences" - it seems to be somewhat different from gender specific assignment.

Plus - there is a difference between the nurse claiming that they can not for example catheterize a male patient because it is the nurse's preference or the patient asking for same gender nurse for specific tasks.

I remember one case where a female patient had a history of sexual abuse in the hospital and asked not to be assigned to male nurses. That was not a problem. But there are many other male professionals out there... so it was made mandatory that all male personnel had a chaperone going into the room no matter if door was open or closed. That seemed very acceptable to the patient and staff felt comfortable. It was also good for the male staff as they did not want to get into the situation of being accused because of misinterpreted behavior.

NOADLS · Jun 24, 2016

"I am psychologically traumatized from a past experience and require a nurse that is female, under 30 years old, white, thin, has a flat stomach, prominent collarbones, inner thigh gap and has an aesthetically pleasing face."

Kooky Korky, BSN, RN · Nov 27, 2016

"I am psychologically traumatized from a past experience and require a nurse that is female, under 30 years old, white, thin, has a flat stomach, prominent collarbones, inner thigh gap and has an aesthetically pleasing face."

And then this lovely woman turns out to have a hidden weapon with which she surprises you.

You never know what to expect in our insane world.

Personally, it's OK with me to not be wanted as someone's nurse due to my race or gender. I am confident enough in myself that I don't need everyone to love me.

And in a case like the article talks about, I think it would be better for all concerned to let the patient have whatever color or gender nurse she feels best about.