Male Nurses/female Patients

justashooter · May 15, 2011

"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."

my daughter had her first child in hospital last week. the baby is a boy, and quite perfect in every respect. the nursing care she received, in my witness, was exemplary. it is what occured after the birth on 2 occasions that was somewhat disturbing.

a social worker stopped by 20 hours after the birth to tell my daughter that her boyfriend looked irresponsible, and that she should file a case for child support against him immediately because she was not married to him, though they do live together, and have for 2 years in what i determine to be a reasonably equitable relationship. my daughter reported to me that the caseworker was not interested in hearing about the nature of their relationship or it's mechanics/duration, preferring to repeatedly pressure my daughter to file. in this relationship, filing would have been an offensive and divisive action and a betrayal of the trust the relationship is based on. my daughter already understands that court mandated child support is not constructive or necessary in a cohabitive relationship.

after the social worker left a nurse interviewed her for half an hour, asking about physical abuse in the relationship. the nurse cited a single bruise on my daughter's thigh as evidence of abuse. my daughter is pale skinned and has bruised easily since she was a child. she had bruised her leg 4 days previously by walking into the corner of a kitchen counter on the way to the bathroom in the middle of the night. my daughter indicated that the nurse seemed not to believe her, and was offended that the nurse badgered her repeatedly over the issue.

speaking as a socially conservative middle aged man who delivered his own children at home, raised them after their mother passed, taught his children that individual responsibility and accountability are paramount character traits, and that such are to be sought in mates, i was offended at the paternalistic attitude and manner of the hospital employees involved in both instances. their actions exceeded what i determine to be reasonable privacy boundaries. the timing and circumstance of their actions was especially disturbing. taking advantage of a person who has just undergone a major medical procedure and is in a strategically disempowered position/circumstance in attempt to convince them to aggress against their family is not advocacy. it is unwarranted abuse in and of itself.

while i'm on this rant, i also should remark that the hospital photographer tried to badger my daughter less than 24 hours after delivery into ordering a $300 photography package that was entirely unwanted and unrequested.

my entire family is socially conservative. we do not need to be told how to manage our lives, that we are being abused, that we need to file law suits against each other, and that we need to pay for things we have already arranged. we don't need for people to abuse us under the color of advocacy.

as for the actual delivery, it went well. the child presented anteriorley, but spontaneously turned in the last moments of labour. i was not offended when the attending phsician asked family to leave the delivery room for the last 30 minutes of process, understanding that he was adequately prepared and simply trying to quiet the process.

so, for those of you who champion paternalistic advocacy, be advised that it is experienced as abuse by persons who have already learned how to advocate for themselves. we live the lives we choose, and do not need your approbation.

OC_An Khe · May 15, 2011

Very interesting points made throughout this thread. And some that made me shiver.

Bottom line is that it is THE PATIENTS CHOICE. That choice should be honored whenever practical. It doesn't matter the reason, whether it be gender issues, religious practices or just cultural beliefs.

In my over 40 years of patient care, at multiple levels of preparation, I have been asked not to care for a patient of both genders. More so in the past then recently. In fact more male patients have asked not to be cared for me (especially during the 80's during the initial HIV epidemic) then female patients.

Is there a double standard, of course just as the is a double standard in all of American society. It is fading now as opposed to years ago. Hopefully it will continue to fade.

Cul2 · May 16, 2011

Interesting post, nursemike. We really don't disagree on most items. I'm certainly not saying this gender problem is the nursing profession's fault. It's a cultural dynamic. And I'm not suggesting we have a 50/50 gender split in nursing. We'll probably never have such a split in such male dominated such as the military or firefighting, etc. But, the number of females in those areas has risen, and not just out of the goodness of the heart. It took action. Some recent research suggests that the genders have certain preferences for professions that may or may not be genetic, or cultural or both or and. It's complex.

But, relative to one of your comments: "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." You probably don't remember the days when there were male orderlies that did many of the jobs female cna's and other assistants do. Talk with older nurses, mostly retired now, and ask them about policies regarding foley caths and other procedures on men. A good number will tell you orderlies did it. You'll see that, even in the 60's, there were debates in the profession as to who should do intimate care on men and what would be proper. So...no...there were male orderlies in the past when there were no male nurses. Conditions varied regionally, but it wasn't a undisputed issue.

Part of the problem is that, although we using term "nurses," were quite often really talking about cna's and other assistants. There can be a difference with patients. The age and gender of the caregiver can make a difference. Gender may not be as much of an issue as maturity and good communication skills.

You write: " 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 think too many cna's, nurse assistants, and perhaps nurses too, take it for granted that it's okay with men that they do what they do. Male nurses, I believe, are much more likely to ask female patients, and approach the way you do. Why? First, because there's almost always a solution -- a nearby female nurse who can take over. The same isn't true with female nurses -- there isn't always a male nurse nearby who can substitute. So, why ask if you can't accommodate? Male nurses, I believe, do more often ask because the stakes are much higher for them. There are few cases of females abusing males; more cases of males abusing females.

Anyway. Good discussion. I recall once interviewing a man who had no problem with female intimate care. But he did tell me a story. He was pleasantly surprised, amazed, at one point, when a female nurse offered him a male nurse for an intimate procedure if he desired it. He said, no, I have no problem with you doing it -- but I really appreciate you asking me. He told me the mere asking made him feel more respected, that it mattered to the nurse how he felt about it. And, unfortunately, I don't think that happens enough for various reasons -- certainly not because female nurses don't care about male dignity.

One more point. You write: "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."

What's bogus about that? Would a 23 year old man really understand what it feels like to give birth? Would any man? That doesn't mean we can't feel empathy. But empathy exists on a continuum. The best empathy is from those who have actually experienced something the other is going through. Good empathy is from those who have experience similar events. Shallow empathy is from those good people, who with good intentions, "feel" for people but have really no idea what's it's like to go through the event. Age, experience gives us the opportunity to practice the best empathy.

ITSSOSIMPLE · May 16, 2011

Mike

Your position is that gender doesn't matter and given that there are no male mammographers and virtually

no male nurses working in L&D what have you done to sway female patients into your mindset. After all they never

had to voice their concerns, it was done for them.

If female patients are given options and accomodations then so should male patients. After all my urology

experience is just as special as their birth experience.

A number of years ago I was working at a level 1 trauma center and the female nurses would quickly cover up

female trauma patients yet leave male patients uncovered. One particular male patient complained to administration

and as such the procedures were changed. Fortunately for the nurses he didn't complain to the Bon as with every state

Bon leaving a patient unnecessarily exposed is considered sexual impropriety. They video taped their traumas.

Boundary violations seem to be out of control if you regularly review Bon disciplinary records from state to state

and with that being said do you still believe opposite gender intimate care is irrelevant. It's said really that nurses go to

work to sexually stalk their patients given the numbers are considerably high, 30 to 1. That is 30 females nurses for

every male nurse disciplined and that's just the ones who are caught.

ITSSOSIMPLE · May 16, 2011

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.

If there were male mammographers would that be something appropriate for the male mammographer to say to

you needing a mammogram or say your daughter even if it wasn't verbalized.

But then there is no need for you to be sympathetic as there are no male mammographers.

nursemike, ASN, RN · May 16, 2011

Interesting post, nursemike. We really don't disagree on most items. I'm certainly not saying this gender problem is the nursing profession's fault. It's a cultural dynamic. And I'm not suggesting we have a 50/50 gender split in nursing. We'll probably never have such a split in such male dominated such as the military or firefighting, etc. But, the number of females in those areas has risen, and not just out of the goodness of the heart. It took action. Some recent research suggests that the genders have certain preferences for professions that may or may not be genetic, or cultural or both or and. It's complex.
But, relative to one of your comments: "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." You probably don't remember the days when there were male orderlies that did many of the jobs female cna's and other assistants do. Talk with older nurses, mostly retired now, and ask them about policies regarding foley caths and other procedures on men. A good number will tell you orderlies did it. You'll see that, even in the 60's, there were debates in the profession as to who should do intimate care on men and what would be proper. So...no...there were male orderlies in the past when there were no male nurses. Conditions varied regionally, but it wasn't a undisputed issue.
Part of the problem is that, although we using term "nurses," were quite often really talking about cna's and other assistants. There can be a difference with patients. The age and gender of the caregiver can make a difference. Gender may not be as much of an issue as maturity and good communication skills.
You write: " 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 think too many cna's, nurse assistants, and perhaps nurses too, take it for granted that it's okay with men that they do what they do. Male nurses, I believe, are much more likely to ask female patients, and approach the way you do. Why? First, because there's almost always a solution -- a nearby female nurse who can take over. The same isn't true with female nurses -- there isn't always a male nurse nearby who can substitute. So, why ask if you can't accommodate? Male nurses, I believe, do more often ask because the stakes are much higher for them. There are few cases of females abusing males; more cases of males abusing females.
Anyway. Good discussion. I recall once interviewing a man who had no problem with female intimate care. But he did tell me a story. He was pleasantly surprised, amazed, at one point, when a female nurse offered him a male nurse for an intimate procedure if he desired it. He said, no, I have no problem with you doing it -- but I really appreciate you asking me. He told me the mere asking made him feel more respected, that it mattered to the nurse how he felt about it. And, unfortunately, I don't think that happens enough for various reasons -- certainly not because female nurses don't care about male dignity.
One more point. You write: "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."
What's bogus about that? Would a 23 year old man really understand what it feels like to give birth? Would any man? That doesn't mean we can't feel empathy. But empathy exists on a continuum. The best empathy is from those who have actually experienced something the other is going through. Good empathy is from those who have experience similar events. Shallow empathy is from those good people, who with good intentions, "feel" for people but have really no idea what's it's like to go through the event. Age, experience gives us the opportunity to practice the best empathy.

I actually entered healthcare as an orderly--more or less. Transporter/multidisciplinary worker. At the time, the job entailed a fair amount of patient care and was within nursing services, though a narrower scope than even aides. Had a lot of good experiences, though, that eventually suckered me into becoming a nurse. But it's true, when I entered the field, male nurses, though not common, were far from unheard of. In those days, I was occasionally called upon to assist males with modesty concerns to and from the bathroom, but my scope allowed nothing as invasive as a Foley. I also often assisted aides positioning large, immobile patients for baths, etc. A few of the aides were less sympathetic to modesty concerns, females were told:"Well, that's how it is, men do everything we do, now," and some men got the proverbial "Don't worry, I've seen a thousand." But even among unlicensed personnel, I didn't find that the prevailing attitude, and it has been, in my experience, far less common among nurses. I've only been employed at one facility, which our administration boasts has been voted by somebody or other one of the top however many facilities for male nurses in the US (top 50, I think it was). I've done clinicals in school at three others, which seemed a lot like mine, more or less. So I'm in no position to make a blanket statement that everything is as it should be, I really only mean to say that in my experience, things aren't so bad.

When I had my first colonoscopy, the nurse assisting was a young woman, not a lot over 23, and one of my classmates in nursing school. She had the courtesy to ask whether I preferred another nurse, and I did appreciate it. Female or no, it's potentially awkward receiving intimate care from someone you know. Being me, I was happy to accept her, but did admonish her not to look at my butt. (I'm firmly convinced that if more people had a perverse and inappropriate sense of humor, the world would be a happier place. At least for me.) But yes, absolutely, the courtesy of offering was appreciated as a gesture of respect. Another poster asks what I've done to change the attitudes of female patients toward male caregivers. I can't claim I've been a crusader, but I've done what my friend did with me: approach them with courtesy and respect and provide the best care I can. And a number of them have indeed changed their minds. Some have even said they've come to prefer male nurses. I'm skeptical, really, about the statement of some that male nurses are kinder and gentler. I guess it's possible that many of us are a bit more circumspect in approaching females, more conscious of the potential problems. I think I've seen many instances where being a bit stronger, physically, allows more gentleness in transfers from bed to chair, etc. If you aren't straining, you have more control. And I think there's a significant factor in that people tend to notice more, because they're surprised, when men treat them in a gentle, caring manner.

I can't dispute that common experiences play a part in how we identify with our patients. I don't really like your expression of "shallower" empathy. (Not criticizing, just think it isn't quite the right word.) I'm not sure how much I think empathy and the ability to identify with someone are linked. We are, after all, all humans, which is arguably more in common than all our differences. And I'm not entirely convinced that even the human element is all-important. My cats and I are pretty attuned to each others needs. But when another poster stated that a 23 year old unwed mother doesn't give a crap about a 50 year old male, well, that's bogus. I have cared for patients who were 20-something unwed mothers, and I cared about them. I couldn't be them, but I could observe their emotions, listen to them, imagine what some of their concerns and needs might be--in short, feel empathy for them. Now, I do think the life experience of being 50-something can be helpful in such instances. I'm wiser now then when I was young. But I wasn't a fool when I was young, and I don't think the young people I work with are unwise. Honest to God, it says something to me that someone would want to be a nurse in the first place, and more when they stick with it after they see how it really is. It's true, there are some old battleaxes and young robonurses, but by and large, we're privileged to work with a lot of really good people, and we shouldn't forget that. I have seen nurses I don't really care for, personally, provide exemplary care to their patients. This thread began with what I took to be a bit of resentment for males who palm off their work on others and has evolved to include what appears to me to be some resentment for women. (I'm not referring to the quoted poster. Thoughtful consideration of these issues is a whole other matter.) Now, it's true I'll never been a 30-year nurse. I'll be retired or dead before I'm a 25-year nurse. But I do not for a moment believe that my general respect for nurses is naive. My mentor, a 40-year nurse, was in her quiet way a champion for what we can be, and far more discrete in criticizing what a few of us are. She was only a couple of years older than me, just a kid when she started, but she really reinforced in me a sense of joy in what I do. The paperwork, the politics, the red tape are things we can try to keep from taking over, but to some extent, they're also just the price we pay for the time we get to spend at the bedside. What we are, what the vast majority of us are, is kinda freakin special, and I have witnessed people who've come in thinking one way, and when they see what we are, don't care nearly so much how fat we are or pretty we are or what color we are or what gender we are. I'm sorry my "gender shouldn't matter" has been perceived as blunt or insensitive. I don't mean it that way. I'm trying to argue that instead of trying to modify nursing to meet the prejudices of our patients, I think we can make substantial progress by showing them who we really are, humans who spend a significant part of our lives--at work and elsewhere--actively caring about others. I'm not opposed to equity. I'm not opposed to modesty. But I'm actively trying not to be the sort of nurse who comes to work and looks at everyone else's assignment to see if it's fair. I much prefer to look at my assignment and try to plan how I'm going to manage it as well as I can. And while I'm a long, long, long, long way from Supernurse, a substantial majority of my patients seem to appreciate what I do. And I think that's a step toward how things can be.

Cul2 · May 17, 2011

nursemike: First, I want to thank you for such thoughtful posts. As I said before, I don't think disagree over too much. Yes, "shallow" was not a good word to describe any kind of empathy. But I do think that too often sympathy is confused with empathy. Empathy implies a kind of connection that sympathy doesn't necessarily have.

And yes, there is a small group of nurse-haters who are misogynists. They hate and resent women. We're not talking about them. Most patients, male and female, have great respect for nurses, esp. those who have been under their care and have benefited from it.

One of your comments: "I'm trying to argue that instead of trying to modify nursing to meet the prejudices of our patients, I think we can make substantial progress by showing them who we really are, humans who spend a significant part of our lives--at work and elsewhere--actively caring about others. I'm not opposed to equity."

I'm not sure if I'm interpreting this correctly, but...are you saying that those who want same gender intimate care are prejudiced? They certainly are if they assume that the gender they don't want can't do the job because of their gender. But do you really believe that patients who prefer same gender care feel that way? I don't. The gender any patients wants for nursing care is very contextual. Most people, male and female, don't care one way or the other if the care is not intimate. Does it matter which gender draws your blood, or takes your oral temperature, or blood pressure? That suggests to me that it isn't the nurse gender as much as it is the type of care involved that is the key. When the care is intimate, the patient may want same gender. That's not prejudice. The patient isn't implying or saying that the opposite gender can't do the job. The patient is saying that the patient doesn't feel comfortable with opposite gender care in that particular context -- just as you suggested that some patients don't want people they know doing intimate care on them. This is not prejudice. It's not about what the nurse can or cannot do as much as it is about how comfortable the patient feels.

nursemike, ASN, RN · May 17, 2011

Cul2, I appreciate your posts, as well. "Prejudice" may not have been well-chosen, either. I meant it in the sense of having preconceived notions, not as an accusation of sexism or any other -ism. Technically, the belief that I had an unhappy encounter with one female nurse, so the next is likely to be unhappy, as well, is a pre-judgement. Logically, the next caregiver might be very different. But, hairsplitting aside, I recognize that the ability to observe past patterns and predict future situations is one attribute of a rational mind. A patient who found pericare by the opposite gender very uncomfortable before could reasonably expect it might be uncomfortable again. It would be more a belief about the patient himself than about the nurse. But, to a lesser extent, it's also an assumption that the next nurse won't be able to alleviate his

concerns.

I'm also not really trying to say we shouldn't make any accommodations. One change we as a profession could make immediately would be for nurses to recognize that men are as capable of modesty as women. I actually think most already do. I agree, though, that we have some work to do to educate some portion of unlicensed caregivers who may be more task-oriented and less attuned to the patients' needs. We could start that on our next shift. Actually, I've already been doing it, and I'm sure you have, too.

I'm actually in favor of recruiting more men, and other minorities, into nursing. Patient comfort aside, greater diversity would, I believe, strengthen us all. We haven't really discussed, for example, a black patient who would be more comfortable with a black nurse, and it does risk clouding the issue. But given the demographics of my state, such a patient would be largely out of luck at my facility. We have black nurses, but nowhere nearly enough to cover every floor for every shift. And, being one of the more "cosmopolitan" cities in my state, we may actually be a little over-represented with black employees compared to the general population. Probably not very overrepresented in nurses, though. There are only a handful. And among our patient population, we'd be more likely to encounter an occasional patient who was very anxious about having a black nurse.

The matter of race was a mere parenthetical aside when it popped into my mind a moment ago, but now I think it might be worth following a bit. I don't think every example of race prejudice is necessarily bigotry. Or at least not hateful. Some of our elderly, rural population may have had very little contact with black people. Some others may have had a very negative interaction with a black person in the past. As it happens, the only instances I've seen (not many,) of a caregiver refused on the basis of race were pretty blatant bigotry, and while the refusal was necessarily honored, I'll go to my grave thinking the patients were jerks. Actually, I think I recall one manipulative bigot who happened to be black and tried to demand only black caregivers. We recognized his or her (I don't remember--it has been awhile) right to refuse care, but did not round up every black caregiver in the facility to accommodate them. It pretty much was "take it or leave it." But a patient who was very anxious about a caregiver through ignorance or due to a past trauma wouldn't necessarily seem like such a jerk. And while most of my black neighbors are probably accustomed to being surrounded by white people, I'm sure there probably are different degrees to which they are comfortable with it. Not to mention that not all of our patients are Americans.

So, thinking about a patient who displayed clinical anxiety with contact with another race, if that patient were white, we could pretty easily adjust assignments to accommodate them. If the patient were black, we'd have a real problem. And to apply some of the same reasoning we have with gender preference, we can't just assume that all of our black patients (both of them, housewide) are comfortable with white caregivers. An old black man who narrowly escaped lynching in the 30's might feel really uneasy with a white nurse, and I'd find it hard to blame him. But if I'm making the assignments, about the best I could do for him would be to assign our most sensitive white nurses and maybe see if a family member could stay with him. And a couple of our aides, as it happens, are black, so maybe they could "chaperone" if they were present.

So, here I am, making a distinctly nurse-centered judgement that some objections based on race are more legitimate than others, and I'll go farther. Given a black patient who was just a little uneasy about a white nurse, I'd feel reasonable taking the opportunity to demonstrate that such uneasiness was unnecessary. I can't really know what it's like to be black, but I can respect and care for a black person. I can listen and I can watch and make an educated judgement whether he's getting more accustomed to the situation or growing increasingly anxious. I can offer to make what accommodations I can. And, frankly, my expectation would be that I would be about as successful in that scenario as I've been with females who were a little uneasy. None of which, in my opinion, makes me a racist or a sexist. A fair test of my convictions might be, if I had a white patient who I knew to be "a little uneasy," about a black caregiver, would I go out of my way to assign a black caregiver to "educate" them? Eh, I think I would try to be neutral, but probably end up just assigning to avoid conflict ahead of time. If I know a patient has issues with opposite gender care, I do tend to try to assign same gender caregivers. Here on the internet, I'm all about principles, but in real life, there's enough unavoidable drama without rocking the boat. Hey, maybe he'll be a tough stick for IVs and get a little lesson in appreciating our female nurses that way. A patient who leaves saying, "I'd still rather a man washes my johnson, but she can start my IV anytime," might be enough of a step toward my Utopian dream for this visit.

Cul2 · May 18, 2011

nursemike -- On other posts I try to disconnect racial prejudice from this whole modesty issue. In most all cases, they're not the same at all. I'm not saying it can never be the same. In my last post, I described the contextual nature of modesty and gender preference for intimate care. It has mostly to do with the body area needing attention -- not any inherent qualities in the nurse's ability to do the job based upon gender. Now, for example, if a many won't be treated by any women because he thinks women are not qualified to be nurses or doctors, that's gender discrimination. But I think that happens in only few cases. On the other hand, racial prejudice is more often based upon real stereotypes and real prejudice -- real beliefs that certain races are not capable of doing certain things.

I would be that if you asked patients why the didn't want a patient of a certain race, if they answered honestly, you'd real prejudice. On the other hand, if you asked why most patients why they don't want a certain gender "for a certain procedure," it will be more a matter of their culture, their religion, or their embarrassment and feelings. Most won't mind either gender doing basic kinds of care for them. Those who are really racially prejudiced, don't want a certain race doing anything for them.

You write: "An old black man who narrowly escaped lynching in the 30's might feel really uneasy with a white nurse, and I'd find it hard to blame him." Of course. But how often are nurses privy to that kind of information? Patients who state these kinds of preferences won't often talk openly as to why, esp. with people they don't know. I once had a man tell me he didn't want female nurses because he had been abused by a women as a child. I asked him why he didn't tell his doctor or the nurses about this. He told me he didn't even know why he told me because he had never even told his wife. How does one deal with situations like that?

That's why I think the standard ought to be accommodation whenever possible, with a real effort made to make it possible most of the time. At some point, you have to take the patient's word. You can't psychoanalyze each patient.

I'm not claiming to have the answers. But I think it's important find the right questions and get the discussion out in the open -- with both caregivers and patients.

And yes, some of the men I've interviewed have had bad experiences with a female nurse -- interestingly, not necessarily the nurses's fault. In some cases, the man didn't ask for gender accommodation so the nurse probably assumed everything was okay. It wasn't. We've already talked about the value of asking how patients feel about this. But then these patients felt embarrassed, humiliated, and angry at themselves for allowing the incident to happen. I think they then transfer that anger toward the nurse -- it becomes her fault. Other cases are pure examples of violated modesty -- open doors, poor draping, unprofessional comments, "extra" eyes wandering in and out of the room -- and the men lost trust in female nurses. It's not that these men distrust all women, or all female nurses, but they become very suspect of them. Some will avoid medical care because they are not comfortable asking for accommodation. I'm not defending that position. But it does happen.

nursemike, ASN, RN · May 18, 2011

Thanks, Cul2. I appreciate your thoughts, as well, and you've brought me around a bit. I never really meant it was just tough patooties for patients with a gender preference. I did argue on another thread that there was no reason to just assume that men couldn't work in some units, but I wouldn't argue in favor of an all male staff in L&D, and I certainly don't mean to argue in favor of an all-female staff in med-surg. I think I just got a little testy at some suggestions, such as one apparent implication that a female nurse who offers a patient the choice of her performing an intervention now or possibly waiting while she finds a male was somehow abusing her patient. This isn't an issue, for me, that is all black and white. There's a lot of gray areas. In dealing with female patients, I've seen a spectrum from those who are tickled to have a male nurse to those who are a little uncertain, or even a little uneasy, to those who are genuinely uncomfortable. I can't actually recall any who were terrified or mortified, but I have no doubt they exist. And I'm sure it's very similar for male patients regarding female nurses. I can't think of a single argument to support any patient being terrified or mortified if we can possibly avoid it (some of ours are in pretty bad shape for no reason within our control, but that's another matter).

I have to admit, I've grown lax in my previous resolve to ask every female I admit whether she has a strong preference for female nurses only, or even to inform them they have the right to refuse a male. It's so rarely an issue, and it hasn't seemed a problem to recognize the ones who are likely to object. I think you may be right that males may be somewhat more inclined to suffer in silence, although I also think males are--in general--less likely to have a problem with it. Many men with military experience, for example, have been schooled to overcome their modesty. On our neuro floor, a lot of our patients have lost some of their baseline inhibitions and I find myself educating my female co-workers on the importance of "letting the boys breathe." The older gent who is more comfortable without a gown or sheet has rights, too. Of course, that can be problematic when closing the door, or even the curtain, is inappropriate. I think we are safe in assuming the patient wouldn't choose to expose himself to kids coming in to visit their grandma. Probably if he were able to choose, he might not choose to expose himself to the nursing staff. But I wouldn't restrain a patient to keep him covered--the nursing staff can get over it. I'm not really sure what my point is--I think I may just be free-associating, at this point. Still, if you walked onto my floor and found a patient airing them out, it might not mean we were insensitive to his modesty. Sometimes all you can do is be glad you're on nights.

So, anyway, if I'm closest when a female pt calls for a bedpan, I'll offer to help. To me, at least, I can't think of too much more uncomfortable or degrading than having to wait on someone else's convenience to poop. I'll put pain meds in my pocket to assist another patient to toilet (okay--partly nurse-centered: the patient waiting for the pain meds is less likely to need a bath if he has to wait). I usually just say: can I help? When the patient is finished, if they need help to wipe, I'll ask whether they prefer me to do it or find one of the girls. And, you know, however much fun it isn't to wipe someone else's butt just doesn't compare to how much fun it isn't to need to have someone wipe your butt for you. And a lot of people appreciate not having to wait until an aide can come.

Uh, okay, I think I see my point coming around! Woo-hoo! The patient who is not encumbered by modesty, or who can overcome it to some extent, has more options than those who can't, and that will always be true. The female patient who doesn't need to wait for a female sometimes gets to toilet sooner, and no one is saying that's because there aren't enough females, at least not in proportion to males (Obviously, more staff, period, should mean less waiting, period--but that depends a lot on the staff. Some of the ladies I toilet have an aide who is outside, smoking.). So I still think those who can be brought around to my view, that gender shouldn't matter, are more likely to have a better stay. And I hope it has been implicit in my posts that I think the way to do that, first and foremost, is by showing respect and preserving dignity, even in situations that can seem inherently undignified.

Part of this discussion has been about patients' inhibitions. But part has also been about nurse misconduct, ranging from outright abuse to simple lack of consideration. The solution to outright abuse is actually fairly simple: we are obligated to report it to the governing body, whether the abuser is our best friend or our CNO. Other examples are less clear cut. A nurse or aide who neglects to pull the curtain can be reminded, and if reminding doesn't work, written up. But, hey, I've gotten task-oriented and forgotten, and a reminder is usually sufficient.

Now, modesty is an inhibition, rather than a prejudice. I remind the reader that it is an acquired trait. We aren't born with it. Doesn't mean it isn't important. In my culture, public nudity is not the norm, and in most instances I would feel wrong showing my member to someone I didn't know. In some contexts, it would be illegal to do so. In saying it shouldn't be sacrosanct, I didn't mean it doesn't count. I'm just saying there's a pretty huge difference between performing CPR and copping a feel.

On the other hand, the belief that because some other woman behaved badly, a present woman is more likely to do so is definitely a prejudice. Once bitten, twice shy is a prejudice. Prejudice isn't necessarily bigotry. Sometimes it's just common sense. I have a prejudice that if I touch the burner of my stove, I might get burnt. I'm not saying anyone should be so non-judgemental as to touch it and see. And I think a lot of prejudices fall between those extremes, very much in the once-bitten realm, where a bad experience teaches us to be more cautious, next time. Honest-to-God, if I find an elderly woman cowering in her bed in terror because a black man entered her room, I'm not going to call that a teachable moment for racial equality. Dr. King had a dream, but I don't think he was stupid. We shouldn't ask patients to handle things they can't handle, and you're right, some of us shouldn't just assume they all can because some do. Care must be tailored as much as possible to each particular patient. And yes, we should surely work to make it possible as much as we can. I didn't ever mean to say we shouldn't try to do better. But I'm also never going to buy the idea that a nursing unit with no male nurses is inherently abusive. Sometimes it's just bad luck.

Cul2 · May 18, 2011

nursemike -- Good post. A few points.

1 You write: "Many men with military experience, for example, have been schooled to overcome their modesty." That may be true for some but not all. I bothers more military men than you think. But, God forbid, a marine or army specialist complain or not "man-up." It's not that they don't care or it doesn't bother them. It's that they're socialized to hold it in, don't complain. Just shut up and "be a man," men are told from a young age. "Don't cry." For some, it eats away inside. Esp. the cases that many draftees went through in years past, being paraded around naked while female clerks and other non essential medical personnel just gaped. Abject disrespect. There's much more to what happened at Abu Ghraib that often meets the eye. Forced nudity is a way to control people, esp. men -- a way to exert power. Please now, I'm not saying medical professionals have that motivation -- but when one forces or intimadates someone to become naked before the opposite gender, you're tredding on dangerous psychological ground.

2. Keep this in mind. Both male and female nurses are obliged to learn to treat both genders, intimately. But's it's more acceptable for a male to go get a female nurse when he has a female patient. It's just considered more proper. I think more female nurses are under pressure to "do their jobs," i.e. treat those male patients and don't always go running for help. Probably because it's not always so easy to get a male nurse. I've had female nurses tell me that they don't often ask because their DON expect them to do the procedure without always finding a male nurse. That puts pressure on them, even if they see the patient isn't comfortable.

3. " But I'm also never going to buy the idea that a nursing unit with no male nurses is inherently abusive. Sometimes it's just bad luck." Abusive? No, of course not. But it's a question of respect, isn't it? How about a nursing unit with no female nurses? How would some female patient's feel? I don't blame the nurses who staff an all nurse unit. They didn't hire themselves. They didn't create the schedule. They're just doing the best they can. But, if the administration has made no attempt to give their staffing some balance, to me, that's at the very least obtuse. It may not be conscious disrespect for men, but that's what it feels like to some men -- just as it would for some women in a similar situation.

nursemike, ASN, RN · May 19, 2011

nursemike -- Good post. A few points.
1 You write: "Many men with military experience, for example, have been schooled to overcome their modesty." That may be true for some but not all. I bothers more military men than you think. But, God forbid, a marine or army specialist complain or not "man-up." It's not that they don't care or it doesn't bother them. It's that they're socialized to hold it in, don't complain. Just shut up and "be a man," men are told from a young age. "Don't cry." For some, it eats away inside. Esp. the cases that many draftees went through in years past, being paraded around naked while female clerks and other non essential medical personnel just gaped. Abject disrespect. There's much more to what happened at Abu Ghraib that often meets the eye. Forced nudity is a way to control people, esp. men -- a way to exert power. Please now, I'm not saying medical professionals have that motivation -- but when one forces or intimadates someone to become naked before the opposite gender, you're tredding on dangerous psychological ground.
2. Keep this in mind. Both male and female nurses are obliged to learn to treat both genders, intimately. But's it's more acceptable for a male to go get a female nurse when he has a female patient. It's just considered more proper. I think more female nurses are under pressure to "do their jobs," i.e. treat those male patients and don't always go running for help. Probably because it's not always so easy to get a male nurse. I've had female nurses tell me that they don't often ask because their DON expect them to do the procedure without always finding a male nurse. That puts pressure on them, even if they see the patient isn't comfortable.
3. " But I'm also never going to buy the idea that a nursing unit with no male nurses is inherently abusive. Sometimes it's just bad luck." Abusive? No, of course not. But it's a question of respect, isn't it? How about a nursing unit with no female nurses? How would some female patient's feel? I don't blame the nurses who staff an all nurse unit. They didn't hire themselves. They didn't create the schedule. They're just doing the best they can. But, if the administration has made no attempt to give their staffing some balance, to me, that's at the very least obtuse. It may not be conscious disrespect for men, but that's what it feels like to some men -- just as it would for some women in a similar situation.

1. No argument.

2. Really? I haven't noticed the phenomenon you describe. I don't get asked to do care for a female nurse's male pt very often, or at least not the care we've been discussing. But I don't often ask females to care for my female pts, either. I get asked to help with lifts a lot, I get asked to take patients (male or female to the bathroom). I think our mgt actually gets that one of the ways our floor works is teamwork. A lot of our patients are pretty immobile. A lot of our patients are confused and combative. It could be our nominal population colors my perception more than I realize, although things haven't seemed all that different when I've floated. I really don't mind helping with lifts or with combative patients. Both are tasks I feel especially comfortable with, having done them a lot before I became a nurse. And I don't mind being asked to do a foley or suppository on a male. Also, by far most of the time I've asked for help with a foley on a female, it's because I've already tried and can't get it. Of course, we pull more foleys than we start. I'll have to see what the gals I work with think, or if any women are still following this thread, it would be interesting to hear what they have to say.

3. The last couple of days, this thread has begun to look like a dialog, but I hope you get that not all of my comments are directed at you, or at anyone else necessarily. It seems like any thread dealing with any question of discrimination against men brings out various levels of militancy. But, yeah, I'll grant you, the very definition of "thoughtless" would be failing to think of something, particularly something that should be thought about. Still, before I started nursing school, I heard a fair bit about how nursing needs more men. Some of my instructors (all women) were downright excited about it. During and since school, I've heard both that I would be discriminated against and that I would get special advantages because I was male. Haven't found either to be true. I feel I've been treated fairly. I also haven't seen patients abused. I've occasionally seen a lack of consideration. Well, more than occasionally, if we count all forms and all patient. Excessive noise in the halls is inconsiderate regardless of gender. Not preserving a patient's modest--even a female's--is inconsiderate. Not knocking before you enter. Not smiling. We could improve a lot without doing anything at all about the gender imbalance. We could probably improve the gender imbalance by making nursing more attractive to everyone--remember, we lose a lot of the men we do recruit. It seems to me a complicated problem, and I'm not optimistic for finding simple answers.