Male Nurses/female Patients

[ern91]

I'm interested in knowing if anyone has the issue of male nurses refusing to perform certain nursing functions simply because they are male. Having worked in a large teaching hospital and smaller community hospitals, there seems to be a huge difference. In the teaching hospital, male nurses did everything a patient needed, regardless of gender. In the smaller community hospitals, the male nurses sought out female nurses to take care of all manner of female patient's hygiene, all gyn exams ,and anything else a female patient needed. Have we become such a litigous society that we base our practice on gender? Do you find yourself taking care of your male colleagues patients as well as your own simply because they are afraid to touch their female patients?

[Cul2]

"Whoa, dude, why the hostility? Mike has a valid point. He witnessed what appeared to him controlling and jealous behavior and just said that in hindsight, he wondered whether getting the pt alone for further assessment would have been warranted. That's not bullying, that's advocating, mate."

I agree. These decisions are up to the patient, not the spouse or significant other (and not the system). A spouse that insists on making these decisions for his or her mate, is indicating a potential control problem, assuming it's control and not advocacy. One needs to tred carefully. Sometimes a spouse knows what the other wants and also knows that the other will not speak up for him/herself. It can be a difficult call. But we can be there and actually see and hear. It must be left up to the good judgment of the healthcare professional. This is where one needs to get the patient alone and ask what they want.

[nursemike, ASN, RN]

"Whoa, dude, why the hostility? Mike has a valid point. He witnessed what appeared to him controlling and jealous behavior and just said that in hindsight, he wondered whether getting the pt alone for further assessment would have been warranted. That's not bullying, that's advocating, mate."

I agree. These decisions are up to the patient, not the spouse or significant other (and not the system). A spouse that insists on making these decisions for his or her mate, is indicating a potential control problem, assuming it's control and not advocacy. One needs to tred carefully. Sometimes a spouse knows what the other wants and also knows that the other will not speak up for him/herself. It can be a difficult call. But we can be there and actually see and hear. It must be left up to the good judgment of the healthcare professional. This is where one needs to get the patient alone and ask what they want.

Thanks, Cul2 and Bill. My first example was clear advocacy, and if I had been more confident/competent, I should probably have asked that the patient be reassigned when I saw her Kardex. Of course, if I had been more confident/competent, I would also have been more equipped to care for her. (Sepsis, very bad.) The latter case may well have been advocacy, too. We live in a mostly rural, rather old-fashioned area. And I didn't get to meet either before the change, although I did overhear the S/O protesting to the charge nurse and thought he was a bit vehement. Still, whoever got her was probably alert enough to notice if there were other signs.

[Katie5]

so you are saying that your hospital has created a situation that forces patients to accept medical care under duress, and that you have done nothing to correct the situation? how nice.

If wishes were horses, beggars would ride. As it was, from her explanation, she offered several options to the patient- it was his call to make. And he made one. Don't punish the nurse for something that's not entirely of her own doing.

[ITSSOSIMPLE]

If wishes were horses, beggars would ride. As it was, from her explanation, she offered several options to the patient- it was his call to make. And he made one. Don't punish the nurse for something that's not entirely of her own doing.

Would you be angry if you showed up for your mammogram to be met by a young 20 year old male to do the exam or

what if it was your daughter receiving the exam. Oh wait, there are no male mammographers,what was I thinking. What

would be your response. Obviously,it's an issue as there are no male mammographers period. Is it the patients fault that

a facility decides to discriminate against male patients.

Apparently, these issues were thought out in mammography clinics across the U.S. as well as in L&D. If you are not part

of the solution you are part of the problem!

[ITSSOSIMPLE]

Thanks, Cul2 and Bill. My first example was clear advocacy, and if I had been more confident/competent, I should probably have asked that the patient be reassigned when I saw her Kardex. Of course, if I had been more confident/competent, I would also have been more equipped to care for her. (Sepsis, very bad.) The latter case may well have been advocacy, too. We live in a mostly rural, rather old-fashioned area. And I didn't get to meet either before the change, although I did overhear the S/O protesting to the charge nurse and thought he was a bit vehement. Still, whoever got her was probably alert enough to notice if there were other signs.

Maybe she had a history of abuse,perhaps she is not adept at standing up for herself,who knows. Have you walked in her

shoes. You make the automatic case for abuse. Are you assuming this because society has brainwashed us into believing

that all men are abusers.

If she had a past history of assault by a male caregiver,her significant other is advocating for her. Had you stepped in and

said this is wrong that I should be her nurse.Now if I were that patient I'd think you were more than weird and that for you

To resolve this yourself personally would require an interview.

Let's reverse the roles for a moment. Assume you are a female nurse and the patient was male,his girlfriend demanded

that he have a male nurse. Do you want to interview the patient then? What is the end result. Why is it so important

To you to be assigned as this patient's nurse?

[ITSSOSIMPLE]

Twice in my career, both early in my career, I've been refused for a female patient by someone other than the patient. First time, the patient's mother was an employee at my facility, and the patient wasn't able to speak for herself. I don't know whether I was refused because I was male or because I was inexperienced, but I was relieved, because the patient definitely needed a better nurse than I was. The other time, the patient's boyfriend, on learning she would have a male nurse, vigorously objected and I was reassigned. Even then, I knew that was wrong--it was the patient's prerogative, not the visitor's--but even now, I know it avoided a lot of potential BS. The only thing I would change about the latter instance is that we should have made sure (and maybe the new nurse did) to interview the patient away from the boyfriend, because his behavior should have been a warning sign of a possible abusive relationship. I'm not saying everyone who cares about their loved one's privacy is an abuser, and I'm not sure it relates to this discussion, but I thought it was interesting.

I want to add a final footnote to this topic. There were 28,000,000 complaints made against the tsa regarding the full

body scanners and subsequent pat down and searches. Men complained about being pat down and groped by other men,men

complained about men seeing their wives body by the men operating the scanners and vice versa. Women complained about

being groped by other women. We live in a service industry and make choices everyday. We decide who cuts our hair,our lawns

and our pets hair.

We decide in many cases who we are comfortable with and often don't even have a second thought about it. But how often

do we make these choices and are then interviewed as too why. Would you expect that? If your spouse made a choice for you

and had an individual come back to you and question that decision would you be taken back by that.

Referring to the female patient and her boyfriend,significant other,etc. If the male was jealous let's say of the male nurse

would that constitute abuse. Regardless of the scenario interviewing the patient would only create anger and distrust amoung

both parties. Personally, I would not even want to be alone with that patient let alone interview her. If she had a hx of abuse in

her life certainly that is something I seriously doubt she would want to discuss. Should she have to discuss it,would she have to

give a reason. Do we resort to interviewing everyone.

Often,I visit patients in the emergency room to discuss their complaints. No sooner do the words leave my mouth that the

family members, significant others speak up rather than the patients. Yes,I would much rather hear it from the patients mouth

but it is what it is.

In conclusion I want to make a few points. There was no hostility in my posts. Many times one needs to know that if a

patient or their significant other,family member etc prefers someone else providing care, walk away. It's not about you,never

was. It's about the patient. Pushing the issue only puts them in more distress and could put you in hot water.

Since we are on the subject of someone else deciding who delivers care for the patient consider this. Some

obviously felt,considered the possibility that the boyfriend was controlling and felt that was abuse. Long before most of us

thought about working in healthcare, women in healthcare,ie nursing, administrators,directors had decided that only women

should work in mammography and labor and delivery. I won't go into the long history of discrimination against male nurses

but realize that female patients never stood outside of hospitals with big signs and said, " we only want females doing our

mammos and assisting in delivering our babies.

Those decisions were made by someone "OTHER" than the patient! What was their reasoning and does it strike a parallel

with the concerns of the boyfriend. Would you consider that abuse? Certainly, if you consider that 95 percent of all nurses

are female that corresponds to a ratio of roughly 19 to 1. Yet, if you look at disciplinary reports from each state Bon the

statistics of boundary violations well exceed 30 to 1. That's 30 boundary violations committed by female Rn or lpn

compared to male rn,lpn.

Equally as important you see significant sexual assaults committed by female nurses against male patients as well. Point

being do you see anyone advocating within the system for male patients as far as same gender care. I think we all know the

comments and the attitudes. You don't have anything I haven't seen.

Would that be something a male nurse might say to a female patient requesting same gender care. Certainly not, yet why

are male patients given this line.

[nursemike, ASN, RN]

Maybe she had a history of abuse,perhaps she is not adept at standing up for herself,who knows. Have you walked in her

shoes. You make the automatic case for abuse. Are you assuming this because society has brainwashed us into believing

that all men are abusers.

If she had a past history of assault by a male caregiver,her significant other is advocating for her. Had you stepped in and

said this is wrong that I should be her nurse.Now if I were that patient I'd think you were more than weird and that for you

To resolve this yourself personally would require an interview.

Let's reverse the roles for a moment. Assume you are a female nurse and the patient was male,his girlfriend demanded

that he have a male nurse. Do you want to interview the patient then? What is the end result. Why is it so important

To you to be assigned as this patient's nurse?

I'm afraid you are reading entirely too much into this story. It was never my intention that we lynch the man. As you state, he may merely have been advocating for his loved one, and his belligerent tone may have reflected some generalized mistrust of male nurses. I find it unlikely that he mistrusted me personally, since he never did meet me. But there is a well-documented pattern of abusers--parents, spouses, whatever--attempting to control their victims' relationships with others, including in a medical setting. As you so condescendingly pointed out previously, I don't have decades of experience as a nurse, and only a bit over one decade in healthcare. I was even less experienced at the time of the cited incident, but any ER nurse with over a month on the job would probably be appalled at my failure, at that time, to recognize the pattern and call it to the attention of at least my charge nurse. I wouldn't really say, even now, that I suspected abuse, merely that it was worth someone talking privately to the patient to further assess. If, then, there was even a suspicion of abuse, in my state we are required by law to notify the appropriate authorities, who would then conduct a thorough and unbiased investigation. We do, in fact, ask every single patient we admit whether they are being abused. We are required to.

Now, hovering is not necessarily indicative of abuse. I had an adult patient, once, whose mother would answer for her whenever I did neuro checks. I had to explain several times that I wasn't asking the patient's name because I didn't know it, but rather to see whether she, the patient, knew it. It was abundantly clear that this mother was simply doing the best she could think of to try to help her child get better. I've also had several patients who were attended at the bedside by their spouse of 40-50 or more years. Of course they want to be involved. Another poster suggested, in what I consider a seriously narrow view of empathy, that a 23 year old woman can't possibly know what a 50 year old man is going through. I am not a mother, I am not a devoted husband, or wife, to anyone for most of my life--perhaps all my adult life. I have not and cannot "walk in their shoes." But I'm a caring human being who can often understand what others are going through. I've had meaningful conversations with patients with expressive aphasia. And over my few years as a nurse, those skills have improved considerably. If I ask a child how he got a bruise and his mother answers for him, "Oh, he's just clumsy," you can bet I'll investigate further. If a wife or girlfriend seems not to want to allow a male patient to speak for himself, I'll make sure he has a chance to speak for himself. If I have reason to believe that any patient has been abused, by a wife, husband, parent, child, or another caregiver, I'll report it.

I understand that you feel strongly about your position in this discussion, and that's fine. To suggest that I must be "brainwashed" if I don't agree with you seems petulant, at best. I don't automatically assume much of anything about anyone. You've mentioned several times the absence of male mammographers and male nurses in L&D. I don't know much about mammography, but I know for a fact that there are some men in L&D and other perinatal care. I was recently surprised that there have been a couple at my facility. In my opinion, for what it's worth, I think it's fine to advocate for better accommodation for the concerns of male patients. It probably is something that hasn't been given as much consideration as it should have. But when I read your posts, I get the feeling you might begrudge female patients an accommodation we can easily make right now. Contrary to your suggestion, it was not important that I should be the nurse for the young woman I mention. My whole investment in her was listening to report, and all that was necessary to reassign her was to repeat that report. As I stated before, making the change probably saved me a world of grief. And I have every reason to believe the nurse who picked her up provided her with appropriate care.

Cul2 mentioned the possibility of adjusting schedules so that a male nurse is available as often as possible. That's well worth consideration and would not require years to put in effect. Still, I continue to maintain that it isn't ALL about the patient. Make my schedule too inconvenient and there are plenty of other facilities, or if not, I can serve humanity as a plumber. Frankly, I would prefer not to always be the only male on my unit. As it happens, we have enough males on my floor to spread us around a bit, and most of our patients seem quite comfortable with female nurses. It probably wouldn't hurt a thing to ask each patient on admission whether they have a gender preference, although I continue to believe it would be constructive to educate--not bully, not badger, but to gently educate--all patients that the nurse-patient relationship is a professional, asexual one. And I think it might be entirely adequate before performing intimate care on a male to do as I do with a female: explain the intervention and ask whether I may proceed, or offer to find a same gender caregiver if the patient objects or appears uncomfortable.

Finally, since you seem to like to challenge the reader with hypothetical "shoe on the other foot" situations, I will respond with one which is not hypothetical. On an earlier post, you cite purported specific examples of male patients abused by female nurses, such as striking erections with steel spoons. What have you done about them?

[ITSSOSIMPLE]

Nursemike

I responded to the website in that first do no harm. What else can I do. It is a known fact since the 60's

some nurses would indulge in this behavior. Nursing school instructors advised nurses to do this. Actually, mike if

You want to find more info on this do a google search,it's called nurses secret weapon.

With all do respect mike I'm sure you are an excellent nurse,I don't doubt that and I've always felt there needs

to be more male nurses in the industry. I am old school and have worked in this industry for well over 30 years. The culture

has changed somewhat but it's not a far cry from what it used to be. That being male patients simply don't get the same

respect for privacy and choices female patients get.

In conclusion I would like to add that once a patient refuses care as was in your case, that's it. For you

To go back and conduct an interview with this patient could be construed as a hipaa violation,because you would be

be seen as attempting to obtain medical information on someone that is not you patient. Furthermore,considering

the circumstances she could file a complaint with the Bon,that you were badgering her. I've seen it happen.

[Katie5]

Would you be angry if you showed up for your mammogram to be met by a young 20 year old male to do the exam or

what if it was your daughter receiving the exam. Oh wait, there are no male mammographers,what was I thinking. What

would be your response. Obviously,it's an issue as there are no male mammographers period. Is it the patients fault that

a facility decides to discriminate against male patients.

Apparently, these issues were thought out in mammography clinics across the U.S. as well as in L&D. If you are not part

of the solution you are part of the problem!

I don't get this- male patients recieving mammograms? You'll need to rephrase this whole statement- I fail to see what point you're driving at.

[nursemike, ASN, RN]

I don't get this- male patients recieving mammograms? You'll need to rephrase this whole statement- I fail to see what point you're driving at.

I believe he's saying that special accommodations for women and not for men amount to discrimination. I disagree. I believe a lot of the impetus toward "women's health" facilities has been that for so long, men's health was the default position. But it's true that if I were to develop breast cancer and go to my facilities breast care center, I would be under the care of all female (or very nearly so) staff. If I develop prostate cancer and am admitted to my facility, most of the nurses I see will be female, unless I request otherwise, and even if I do request otherwise, I can't be sure I will have a male nurse on every shift, every day. Again, I just don't believe that amounts to discrimination, or duress, or even a serious failure on the part of our profession. I readily concede that more flexibility to accommodate those male patients who prefer a male caregiver is one of several valid reasons to encourage more men to consider a career in nursing, but I don't see a need to go much beyond encouraging. I continue to believe that a nurse's primary purpose is to provide competent, compassionate care to anyone who needs it, and I firmly believe most of us do exactly that. The general public would benefit greatly from a better understanding of what a nurse's role is. We aren't there to laugh at, admire, or otherwise pass judgement on your hoo-hoos. We aren't there to inspire or fulfill sexual fantasies. Clearly, it would be naive to expect every patient to immediately jump on board that bandwagon, but that doesn't mean it isn't a good tune.

The point has been raised that if you aren't part of the solution, you're part of the problem. I don't believe it's that simple. Well, okay, if you are abusive, or even just insensitive, to male patients, yes, you are part of the problem. But a nurse who approaches her patients with respect and care, who does the very best she can to keep all of her patients as safe and as comfortable as she can, is exactly what we need in our field, and if she happens to be a he, that's peachy. Being a female nurse does not, in itself, make you part of some grand conspiracy. Or, at least, I don't think so. You would tell me, wouldn't you, if there was a conspiracy? Sure, I'm a guy, but I'm not like those other guys. You'd let me in on stuff, right?

[Cul2]

nursemike: Attempting here to play the Devil's Advocate -- I think what annoys some men is what they consider the double standard regarding this whole issue of men's modesty and accommodation. You write: " I readily concede that more flexibility to accommodate those male patients who prefer a male caregiver is one of several valid reasons to encourage more men to consider a career in nursing, but I don't see a need to go much beyond encouraging."

The double standard some men see is going way beyond encouragement in legally allowing female reporters into male locker rooms (and not the reverse), as well as allowing female prison guards to not only intimate pat down male prisoners but in some cases to be directly involved in strip searches (and not the reverse). This is all done because women claim they can't advance in these professions unless they have this kind of access. Thus, their career advancement trumps any kind of male dignity. Case law in this area is quite complex and sometimes goes both ways, but generally females are granted this kind of access. This isn't a matter of encouragement. It's a matter of law. That's why some men feel it discrimination if they can't get the same kind of accommodation women most often get with intimate medical care.

The rest of what you say I agree with completely from your point of view. And, frankly, my experience with female nurses has all been great. But, again, you're looking at things from a nurses perspective, which is completely valid. But the patient point of view, and as part of our discussion, the male patient's in particular. Dare I tred on dangerous ground? Remember, I'm playing the Devil's Advocate. You write: "We aren't there to inspire or fulfill sexual fantasies." Of course not. Any rational person knows that. But, as you know, a male may become, shall we say, stimulated, during some kinds of intimate care. That's a natural reaction to touch. But once that stimulation begins, it may elicit more sexual feelings in the male, perhaps even toward the nurse. With most straight men working with a male nurse, though the natural stimulation may occur, the sexual feelings toward the nurse most likely won't happen. With many straight men working with a female nurse, the reverse may be true. My point is, you need to look at sexuality and sexual feelings from both points of view. I'm not at all suggesting nurses can't control any potential sexual feelings they may have. But they do these things every day and become used to it. For a patient, it isn't an every day happening -- in a man's case, having a strange female work on our intimate parts. All nurses understand what I'm saying intellectually. How many understand it emotionally? The older, more experienced, mature nurses do. But, frankly, who's doing most of this intimate care today. Cna's and other nurse assistants. Many of them young and less mature and less experienced in life. I am saying that, from some male patients POV, once any genital stimulation begins, sexual feelings may develop, esp. with opposite gender care. I have heard this from a number of male patients. And they won't complain. But a significant number may not seek medical care again if they don't feel they will have a choice of genders. Just something to think about.

Then there's the whole issue of homophobic men who, though they don't necessarily want a female doing intimate care on them, would never allow another man to touch them. But that's another topic.

[nursemike, ASN, RN]

Cul2, I'm sure you're right that there is some resentment of what I agree have been some excesses in the name of women's rights. I've read of examples and have known some men personally who've been treated rather brutally in divorce cases. I'm having a hard time, though, buying that nursing is prejudiced against males, either as nurses or patients. Of course I can appreciate that not everyone, everywhere, has the same experiences, but my own experience has been that I've been nothing but welcomed since I entered the healthcare field, and especially since becoming a nurse, and that has been far from unique among other male nurses I've known, and not just at my facility. It isn't the fault of nursing entirely, and certainly not the fault of any caring, conscientious individual female nurse that so few men enter nursing, nor even, I think, that so many leave nursing so soon.

I know I am, to some extent, being a typical guy, arguing that we don't need special advantages or incentives, that we ought to be able to just John Wayne it out. And I get your point that male patients shouldn't have to be included in that suck it up mentality. I've tried to resist the argument that generations of male patients dealt with female nurses while there were virtually no male nurses because I don't think we should perpetuate past problems. But I find most of the arguments that the gender imbalance in nursing constitutes an intentional injustice a bit childish.

I consider myself a feminist, of a sort. Years ago, I read Mary Wallstonecraft's Vindication of the Rights of Women, and it rang true to me. Since then, some modern feminist reforms have made sense to me, while others have smacked of Rush Limbaugh's "feminazis." I think we can work to ensure appropriate recognition of men's rights without resorting to painting ourselves as victims or insisting on mirroring some of the excesses committed in the name of women's rights. I think we are in a position to play fair and still achieve our goals.

We can look at the gender imbalance in nursing and take what I consider a simplistic view, that it must indicate discrimination and ought to be fixed by any means necessary. But consider another statistical imbalance: men in nursing are paid significantly more than women in nursing. So, clearly, nursing discriminates against women. Or does it? At my facility, all new nurses start at the same rate. Newly hired experienced nurses can negotiate a better rate, based on experience, but gender is not a consideration. It's possible that experienced female nurses are more apt to accept the first offer, rather than negotiate. But I can see plenty of other reasons for the pay imbalance. Perhaps men are more inclined, as I have been, to work off-shifts and weekends for the extra differential. It does appear that some men are more inclined to aggressively pursue higher-paying positions, such as administration. And men are much less likely to leave nursing for a few years or work limited schedules while raising children. So the assertion that nursing discriminates against women seems, to me, unlikely.

Your argument that some men may be very uncomfortable with a female nurse and even avoid needed healthcare is a serious one. In my opinion, the idea that a 23 year old woman can't possibly understand the needs of a 50 year old man is bogus. Some of the posts on this thread have seemed downright hostile to women, and while the posters are entitled to their feelings, we are not obligated to be swayed by them. I cannot deny that some significant portion of male patients could be better served if there were more male nurses, but I seriously doubt we need to take emergency measures to assure that 50% of nurses are male by 2015. My own, direct but necessarily limited observation, has been that most patients are content to be cared for by female nurses, and most are content to be cared for by male nurses. At present, it is easier to accommodate the few females who object to a male nurse. I don't mean to argue that means we can ignore the needs of the male exceptions. But I have had direct, personal experience caring for women who were initially uncertain about having a male nurse and, by mid-shift, were all for it. Some patients have issues we can't fix. But some, perhaps many, can learn that the gender of a nurse isn't nearly as important as his or her skill, caring, and empathy. Again, those we can't "fix" do still matter and I'm all for trying to find ways to help, but I don't think it's fair to say their problems are an indictment of our profession. My approach to intimate care on females is typically not the "consummate professional" attitude I was taught in nursing school. Rather, I approach the patient from a place of caring and respect, explain what needs to be done and why, often admit that yeah, it's a little awkward for me, too, but if you are willing to bear with me, we can do this, or if you're really uncomfortable, I can probably find a female to do it in a few minutes. And I truly believe that if female nurses approach male patients in the same general way, as one human caring for another, a lot of male patients will be fine with it.

I have to admit, I've heard a few, older aides say, "Oh, don't worry, I've seen thousands of them." Frankly, one of the duties I've had to undertake as a nurse has been educating aides. I've had to instruct aides that deflecting a blow is self-defense, but returning one is patient abuse (fortunately, before it became an issue). I have not seen some of the behaviors described by female nurses, and I just can't help feeling that some of those reports are exaggerated. It would be naive to assume that no nurse ever did anything wrong, but the direct evidence of my own eyes and ears has been that most nurses are responsible professionals, and it's hard to persuade me that things I've never seen are commonplace. It's probably axiomatic that all of us who post here have agendas. If we didn't, why would we bother? And I think in many cases our agendas are based in, or at least connected to, reality. I can appreciate, and often learn from, opinions different from my own. But on nearly every thread, there are examples of posters who are willing to use specious arguments--you haven't been a nurse long enough, or watch the wrong t.v. shows--whatever--and I reserve the right to doubt their willingness or ability to consider a question objectively.