Published May 27, 2009
As a male in nursing, I realize that we have many challenges that require us to be more careful when caring for female patients. I, fortunately, have had no issues with this charge. However, there was a recent incident at my facility with a male RN (new grad) who was accused of impropriety by a female patient. The incident has been fully investigated by hospital and local law enforcement and determined to be false. The RN has been returned to work. Not that this is any excuse but the patient had a psych history and a recent hx of abuse by her spouse. The psych hx was known upon admission but the latter was withheld till after the event occurred. As the only male clinical nurse specialist/educator in the facility, I have been asked to work one on one with him to discuss how to work as a male nurse on a surgical unit. I have not had to do this as it has been engrained in my head as how to be a nurse. I do not like the term Male Nurse or MURSE as I am an RN, a nurse. I have worked very hard to get where I am in this profession and this incident sheds negative light on nursing. Does anyone have any resources that may be of assistance? I personally have never put myself in this position so I am at a loss as to where to begin. HELP!!!! Thank you.
Ken, RN, MSN, CEN, CCRN-CMC
Orca, ADN, ASN, RN
I don't have specific resources, but this is an area in which common sense can keep you out of trouble. I never go into a female patient's room without a female staff member present. The stakes are too high, and anyone can allege anything. It's cheap insurance for your license and your career.
classicdame, MSN, EdD
Technically, female nurses should be at risk as well. Your story is a good lesson to all of us to be careful about appearances and how we approach others. Thanks for sharing
This is my worst fear.
It is a well known fact that doctors and nurses who mostly get in trouble and get sued are the most unfriendly or arrogant toward their patients. I am not saying that you are one of those. But as I said people who like you won't sue you or get you in trouble even if you were mediocre.
People with documented psych issues or so called "trouble makers" will not get you in trouble. If they do, the investigation will not lead to you being in trouble and will end up like your co-worker as unfounded.
Try your best to build rapport with your patient. Gain their trust ALWAYS by demostraiting competence in your knowledge and in your ability to be responsive to their needs. If you don't know something tell them that you don't know but you will get the info and get back to them. Make sure that you get back to them at a reasonable time and update them on the status of your research.
Always gain your patients trust with a compassionate words or appropriate touch of the hands. Do your best to explain and communicate with your patient what you are doing to them. Say I am going to expose your abs and chest to auscultate them. Make sure while you are doing that that their private parts are covered by a top sheet (you can even tell them I am not going to check your private part yet but I will do that after I cover your abs and chest to make sure that your privacy is maintained).
Try to read the subtle sings of people who are modest and others who have been through the mill and don't care any more about what is showing like nursing home residents. You will develop these skills in time. I think that to ask for a female nurse to accompany you every time you enter a female patient's room is not realistic unless you are over staffed and your other co-workers are sitting and twirling their fingers.
I hope these suggestions help. All the best to you. We need male nurses. You complete us :)
HouTx, BSN, MSN, EdD
My organization is considering the development of 'chaperone' guidelines as a response to this same situation. In addition to psych patient, there are always situations that involve people with 'evil intent' and of course, perfectly nice patients who misinterpret clinical events because of a temporary cognitive impairment as part of their illness or treatement (tranqs, sedatives, etc).
It's just awful that we have to practice 'defensive' nursing to protect our male colleagues from vulnerability to this type of accusation. Remember, it's not just nursing, but also radiology and other allied therapies that can also be targeted.
I find this statement quite offensive. People with mental illness are not trouble makers - they have legitimate illnesses and past traumas that may distort their perceptions and reality. As well people with mental illness and other vulnerable populations are actually at higher risk of abuse than other populations so the fact that someone has a mental illness does not necessarily invalidate their reporting of abuse.
Now to the OP. The reality in dealing with folks with mental illness is that sexual assaults or abuse as well as hallucinations and delusions can alter how someone perceives men and their intentions. For someone who has been abused sometimes even simple touch can feel very violating. Nursing care that involves physical contact can be misinterpreted as something 'wrong' because of the feelings (fear, terror, horror, helplessness) and painful memories it can bring up. Delusions and hallucinations can completely distort the whole event and situation. Accusations that come out of such misinterpretations or distortions are not intentionally evil - they come from that individual's reality and that to them, the experience of the situation was inappropriate.
Boundaries are really important - sometimes even being too friendly or too nice can be misinterpreted as 'something more' and then the patient feels rejected when that ends or the RN doesn't work with them etc... One thing that can help is to be sure to explain everything you are going to do so their are no surprises in care - i.e. they weren't expecting to be touched there or moved that way...for someone who has been abused by a spouse - it could be that even holding her arm tightly while turning could trigger difficult feelings or make her feel threatened. So being very clear on what you are doing before you do it helps to reduce the unexpected. If you know someone has a tendency towards perceptions that may not be accurate then male or female you should have someone with you when providing care. The point someone else made about not coming across as arrogant/ powerful / controlling is important too...the more low key and non threatening someone is the less chance the person will react. Size - being bigger male or female can be threatening too so physical posture - talking at eye level instead of towering over the bed helps. Another helpful approach is to give the patient lots of space, approach slowly, stay in their line of vision, avoid moving belongings, linens without asking etc... Also letting the patient know as part of your 'explaining what you are about to do speal' that if they feel uncomfortable or aren't sure what you are doing to speak up and ask. And understand if they do make an unfounded accusation that it really isn't personal - it is a reflection of their illness, their pain, their past, their personality and their perceptions.
There are people with and without mental illness who make knowingly false accusations shearly out of spite or anger or pure evil or whatever...but in my experience in psych - these are few and far between.
I work with RN's, about equal male and female- quite a few have been through what your colleague is going through, and it isn't fun. A nurse is a nurse but you are still male or female and patients don't just see you as their nurse but also as a person. Sex is just one of factors that can inadvertently cause problems - female nurses can end up in similar situations for other reasons as well.
It is great that you are there as a support for your colleague.
wherehastimegone you are reading my statement wrongly. Please allow me to elaborate. Some people are "trouble makers". Those are the ones without psych issues but want to get you in trouble just because. You said it above; there are evil or angry people and they are the ones that I was referring to as "trouble makers". People with psych issues are just that. They have an illness. I get it. I worked as an advocate for people with mental illnesses for years and I still do. When some family struggle with their loved one who has mental illness they call me and I am always happy to assist with resources and whatever else I can do. I soooo get mental illness.
I hope that makes things a bit clearer for you and others.
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