Male RN-assist with pelvic exams?

[walnuttree91]

I'm a male RN, who left ED nursing ten years ago, and just returned. When I left, male nurses had nothing to do with "intimate" procedures on female patients. At my new ER, I have been told that I am to insert foleys and assist male MDs with pelvic exams on female patients.

If anything, I think that all the sexual abuse news should make it even more imperative that I avoid doing these things. Some of the male MDs agree with me. Your opinions?

[wymnwise]

This may be due to the differences between men and women. When I was in the Critical Care Unit with dried blood and fecal matter on my body from a GI bleed, I would have still been grateful if the janitor had been sent in with a scrub brush and a bucket to clean me up, but it was more comfortable for me to have a member of the opposite sex providing intimate personal care.

Also, although I am unathletic and uninterested in sports, I still seem to have my share of macho hangups. To me, it would be unmanly for me to complain about modesty in front of a female health care worker, even if the receptionist wandered in while I was receiving intimate personal care.

It is true. Gender matters. It is a difference that makes a difference. Problem, gender is a social construct, real, but still cultural. Therefore, one cannot assume a universal gender reaction. Thus, be sensitive to gender, ethnic groups, and such and just ASK.

[wymnwise]

I am a male nursing student and have contemplated this question myself. It was always my understanding that as a future male nurse I would have to provide such nursing interventions on female patients. That said, I do think it is wise to have a female colleague present for my own safety, "cya" purposes. Many years ago, I witnessed a female patient make what I believed to be a false accusation regarding a male CNA who she accused of fondling her. Unfortunately, no one else was present during personal care and it was his word against hers. There were two things that always bothered me about this case and led me to believe the CNA:

1) I knew him personally as a friend. He was openly gay (as I am) and had no interest whatsoever in seeing any female bodies, yet alone some 85 year old.

2) The client had moderate-advanced Alzheimer's disease. Her significant cognitive impairment made her a fairly unreliable reporter. She had a history of paranoid ideation. (I am not implying that an Alzhimer's patient is not capable of making an accurate claim.......just that the two issues together with her history....caused serious doubt in my mind).

Despite the above, he took the fall. While no blame was placed on him officially, he was forcibly transferred to another unit within the facility. This was a significant loss to us and to him. He had worked on our unit for many years and was quite talented and well received by patients, families, and colleagues.

Of course, maybe there is more to the story....info that I do not know. Nevertheless, this story has remained in my mind for 12 years now!

Hmmm. To bad he did not have a female assist. Why are the docs protected but not the nurses?

[wymnwise]

Male nurse in earlier quote. "Well, my dear fellas, I've been circulating in a surgery room hearing meds and technicians pondering the nice teats, beautiful body and so on... of a 23 year old female pt."

Ok, this is my final point. Female nurses/med students (and some men) suffer sexual harassment not only from patients, but also from Docs, other nurses,... In fact, it seems as bad as this is in the culture at large, it seems to be worse in hospitals.

There is no good reason to think that a man that acts like a pig, will not act out on a sedated patient. I know you all do not like to admit this, hate it when someone is caught and it is published. Work together to cover up offenses. Then turn around and demand that women who make gender specific requests are "irrational" "unrealistic" ..... well it is more abuse. Also, it is one of so many of your responses that tend to parallel those of abusers outside the medical setting.

[TraumaNurseRN]

Hmmm. I ask for very little care, and do whatever I can for myself. (Whatever you can do for yourself you should.....duh, Nurses are not maids)Hell, nurses tell me, "hey we are supposed to do that for you." when I go get my own drink from the dinning hall. (If you are not on bedrest, you bet your butt you can get your own drink from the dining hall if I am tied up with a sick patient)On the other hand if I had a nurse who had your attitude;( You wish you had me if you had an emergency, thankyou very much)...the question is, would I want you as my patient...wanting a metal for getting your own water...sheesh) I would demand another nurse (sounds like you have lots of demands, frankly), and yes he could be male (if I liked him better) so long as I was not sedated. For a non-emergency sedated procedure, I would not allow most men, and certainly not you. I want people who respect my autonomy rather than look at it as a nuisance.

1. I was talking more about surgery and clinic than E.R. I assume foley training goes on pre surgery not E.R. (Foley training occurs in nursing school in the first clinical year there, no big deal....it's procedure....We don't care to look at your privates or anyone elses...get over it already!) I would love to pawn off a foley insertion onto everybody and anybody....half the time....I have to plug my nose and still clean up big time cause it's a stinky mess down there....so, no...foley insertion is not anywhere near anything sexual for anyone who puts them in.....!!!!:banghead:)

2. I allow exceptions or true emerg. as does the laws on informed consent, and I have said so, before. (There is not consent for foley insertion, except for the consent to be treated in the ER, when you arrive)

3. MY husband worked E.R. (mopping floors? because if he did work in a professional capacity...he would be telling you to lighten up)and still every effort was made to be sensitive

Unrealistic expectations are often a result of medical provider propaganda and lies. (again not talkin' about E.R.) If a surgical patients request for female staff is unrealistic, there is plenty of time (in non emergency situations) to adjust those expectations.

FACTS:

1. Women are being lied to about who, how many, and what will be done to them in O.R.

2. Women in clinics are often asked for consent for "a couple of nursing students" to "observe" an exam. (You choose to go to a teaching hospital then you chose to be treated by students...You really need educated on this issue)Then six, eight or more medical/nursing students are brought into the room (often most men) to learn and practice breast, pelvic, and rectal exams each one in turn. >>>>>That sounds like you do not have a primary care physician, or no insurance, because at our teaching hospital....those patients.....get Medical/nursing students)

This lack of fully informed consent for intimate exams leaves women with trauma so similar to rape they call it "medical rape". (OMG......OMG!!!!!!)Rather than listen so many in the field chose to degrade the women further. It is quite simply patient abuse.

I am not saying every clinic and hospital are doing this sort of thing, but enough do it that women are upset and organizing, already forced through one law about practice exams. Again, not a perfect law, but a start.

I understand unrestricted access to our bodies without informing us of what you were doing had been a privilege of the medical profession for some time. (I have never NOT educated my patient as to what procedure the doctor has prescribed and have always asked prior to the procedure if they have an questions....and believe most nurses do as well)Practice exams on sedated women has gone on for centuries. But, in the absence of consent it is wrong. (Sounds like you had a bad experience somewhere along the line)

So, to the woman asking the original question.

If your training this male to do the foley was done without this woman's consent, your instinct is correct, it is like RAPE. Did she give consent? Unless she was verbally informed of trainee participation, and consented, then no it is not informed consent. Was it a bad thing to do? Well, when you do not seek her expressed consent, then how bad it was to do depends on how she would feel about it if she knew? If she were to find out, how would she feel about it? Given she has a right to know who touches her, and a right to determine who touches her, the determination of how bad it was has to be filtered through her perspective. Look, if all this training is so harmless, why don't all you nurses let the students train on you, your daughters, mothers, wifes?

You posted this on a Emergency Nursing Posting sight.....please remember that!:banghead:

[TraumaNurseRN]

male nurse in earlier quote. "well, my dear fellas, i’ve been circulating in a surgery room hearing meds and technicians pondering the nice teats, beautiful body and so on… of a 23 year old female pt."

ok, this is my final point. female nurses/med students (and some men) suffer sexual harassment not only from patients, but also from docs, other nurses,... in fact, it seems as bad as this is in the culture at large, it seems to be worse in hospitals.

there is no good reason to think that a man that acts like a pig, will not act out on a sedated patient. i know you all do not like to admit this, hate it when someone is caught and it is published. work together to cover up offenses. then turn around and demand that women who make gender specific requests are "irrational" "unrealistic" ..... well it is more abuse. also, it is one of so many of your responses that tend to parallel those of abusers outside the medical setting.

again.....this is an er nursing site.....don't mesh the two:banghead::banghead: i really think you have issues.

[TraumaNurseRN]

hmmm. So this is in E.R.? Perhaps what is "unrealistic" is thinking one can go on acting like men and women are the SAME, that gender differences do not make a difference and not expect to have a problem sooner or latter.

You really really REALLY....NEED TO EDUCATE YOURSELF ON THIS ISSUE!

[TraumaNurseRN]

What are we saying here? Male nurses should only have to do certain aspects of the job?

Since Male nurses fingers are normally longer than females nurses fingers.....should the male nurses be the only nurses to disimpact someone???????????hmmmmmmm...sounds good to me...hahahahaha

[wymnwise]

Well, I can see it is you that has the issues. I have one issue, justice in the form of patient rights and autonomy. You on the other hand have a host of issues. You refuse to admit that women are being assaulted in hospitals; that hospitals refusal to provide women under anesthesia adequate protection while also refusing to respect dignity or autonomy, and this has everything to do with the fact that women are being raped in hospitals. You refuse to take the history of most women, not rape, but sexual harassment, giving them every reason not to trust strange men, into account. You cover you eyes b/c you do not want to see.

Do not assume every experience to which I refer is my own. The clinic gang teaching was done by a gang of white students and a white doc to a black woman. She was shaking and crying by the time it was over. This was told to me by one of the female medical students. Then I read a similar story written by another woman and realized I had escaped the experience. I went to a clinic like this once in my life. I was a young single mother. No, not a free clinic, just a woman's clinic in the MW. After being asked if I had anything else to do that afternoon, and not knowing enough to say "LOTS", she then told me the deal, "a couple of nursing students", I asked if there were males, she said a couple I refused it was over. After hearing a couple of stories from women who did not ask the second question, I was glad I asked. So, no not my experience; but could have been, save I am not African American. So, see now you see a case where both race and gender mattered, no? NO, never mind, I forgot, you do not listen you just degrade. That is how I knew you were Republican.

The days of the large public hospitals are over. Teaching hospitals, at least the monster of one in our state have cut deals and placed students in many hospitals in a three state area, many city clinics and even at rural clinics. Not just poor patients, but ALL patients are subjected to the abuse. Does $$$ make a difference. Yes, the more $$$ you have to file a lawsuit them the more they take care not to abuse, or at least make sure you do not remember. It is true when we were young it was the "public" patient taking most of the abuse; not true today.

So, do you all have a special all female team for a rape patient that comes into O.R. as one nurse posted here hosp. does?

[mwboswell]

From reading WYMNWISE's post I wanted to chime in.

In my experience I will tell you the training I received on women's exams (Pelvic, breast) was OUTSTANDING! As Nurse Practitioner students (in 1998) we had our "first" pelvic with a professional medical model. This was a girl who VOLUNTARILY decided to do this role. The requirements were that they be a college graduate (preferred with a degree in health or biosciences) AND they themselves be skilled at doing pelvics.

There were three of them and each one took 4 of us students into her "room". We had already done the "reading" part of the procedure at home. Now "she" took over and she actually demonstrated her pelvic anatomy to us, she self-inserted the speculum and using a mirror was able to show us what her cervix looked like; so when it was our turn we knew what we were looking for.

Each of the four of us proceeded to do a pelvic exam on her (speculum, bimanual and recto-lady partsl). I must tell you this lady was so professional it was awesome! She was calm, well spoken, clear and had a warm personality.

During the exam, she would give us feedback on things we might not have ever learned, like palpate firmer here or be gentle here or "that's not it" or whatever, you get the picture.

Of course the four of us were all nervous as hell!

After our "session", she got dressed and cleaned up and we came back in to discuss other topics. During the discussion it came around to "why do you do this" and "How could you do this"? Well first of all, she wouldn't say exactly but she hinted that she got paid VERY WELL by the university for this. She explained the recruitment and training she had to go through. The models even use pseudonyms to guarantee their anonymity. But anyways, the people in charge of the "medical model" program have VERY strict, stringent guidelines, requirements and protocols for this. Our College of Nursing was also affiliated with our College of Medicine through the university and the model said that their "model group" is used for all the medical interns as well.

She said she does it because she knows how important women's health is and that a GYN exam can be very intimidating, uncomfortable, humiliating and possibly "dirty" to some women that they won't go to their MD's/NP's. Therefore she wanted to do "Her part" to help young practitioners "get it right".

She did say it does take some mental preparation for each "session" and that it usually takes her a few days to "recover" following a "session". And too she, herself, must be medically screened to know her anatomy is free from illness or infection.

She also said the program recruits male models for rectal/prostate exams (I DIDN"T VOLUNTEER!!!!!)....

Bottom line, I just wanted to present at least one example of where I think we "GOT IT RIGHT" on this one. If you read WYMNWISE's post you get the feeling that this "medical rape" and exploitation goes on EVERYWHERE.... but let me tell you, if my Alma Mater University has been doing this for AT LEAST a few years prior to me coming there and the program is well established, you've got to believe that other places do it also the CORRECT WAY.

So not to steal WYMNWISE's thunder, I just wanted everyone to know that there is a "correct" way and a "professional way".....and it IS BEING DONE.

Oh, BTW, I've been practicing as an NP now for about 8 years and in the ER - i have done my fair share of pelvics!!!!!

I'll go ahead and say it, the university I went to was University of South Alabama (USA) in Mobile AL - I'm definitely PROUD of the way they "got this right".

[TraumaNurseRN]

"trauma, i hate to say this, but, just let it go with wmwyse. she or he appears to have some very unorthodox views that border on zealotry. in the panty line tattoo thread she accused 60% of all males of wanting to rape if they could get away with it. the research she quoted was from a a survey of a couple hundred college students from the same college that was completed in the 1980's. when anybody called her out on the flaws of her thinking, she resorted to name calling and personal attacks. she went as far as to call one of the female members a bad mother because the said member had a son in the military.

you simply cannot engage in any kind of productive argument with somebody like this. i understand and agree with your points; however, i do not think she will be up for any type of intelligent discussion."

i received this in private message and couldn't agree more. so i won't engage with this woman any longer.

[mwboswell]

i don't know why "rape" patients are coming into the o.r.

however when they do come into the er, yes, we do have an all female rape team: a credentialed/certified sexual assault nurse examiner (sane) [who stays with the pt 1:1 the entire time], the patient advocate from the rape crisis center and the officer from whichever jurisdiction is taking the evidence and working up the case - they are all female......

i myself took the 48 hour sane training as well. i only took the classroom portion (lectures) and i did not do the practicum of doing dozens of pelvic exams. as a male, i felt it would be innappropriate for me to be doing this "on the job"...i wanted the classroom training however to learn about the process and understand it.

so in answer to wymnwise's question - yes, we do have an all female special team for rape patients. matter of fact, this is becoming more and more of the trend across the us - to install sane programs.

-mb

so, do you all have a special all female team for a rape patient that comes into o.r. as one nurse posted here hosp. does?

[TraumaNurseRN]

"hell, nurses tell me, "hey we are supposed to do that for you." when i go get my own drink from the dinning hall."

i could not resist.....dining hall........sounds like the psych floor to me