sharkdiver

This is a good point, and I don't disagree - but don't you suppose that there are similar subjects that males would be just as uncomfortable discussing with a female? It cuts both ways......

I never said that they couldn't. That said, as RNator alluded, there is a double standard. A female that requests same gender care, particularly if intimate exposure is involved, is almost always accomodated without comment, while males do not get the same consideration. I have no problem with this type of request being accomodated if it makes the patient more comfortble. The point I was making is that the overwhelming ration of females to males in nursing makes this difficult to do for male patients, and an increase in the number of male nurses would make this option more viable for male patients as well.

I agree that the double standard you referenced does exist - all the more reason we need more males in the nursing profession, so the same sensitivities can be granted to male patients as well.

Not everywhere - several states have removed both the male genital and hernia component from their sports physical exam forms.

You might want to rethink this.... Whether you like it or not, instances of sexual abuse of patients by nurses and other health care workers do occur. If you don't think so, just google "Jeffrey McCallister"....health care facilities have very valid reasons for instituting chaperon policies in opposite gender care situations, and while women can and do commit sex offenses, over 90% are committed by males (FBI statistics).

This! My sister has worked in L&D most of her 30+ year career and is currently the L&D/postpartum nurse unit manager. We've discussed this in the past and they only hire RN's for L&D for these reasons.

You have to look at the whole chronology.... 1. It started with an AAP policy endorsing pediatricians asking these questions. 2. Then, when some patients in Florida declined to answer, some overzealous pediatricians dismissed them from their practices. Additionally, some of these physicians were rather rabid gun control fanatics and took advantage of the AAP policy to push their own personal agenda. 3. Constituents complained to their legislators and the Florida law was the result. 4. The publicity from the Florida situation resulted in similar laws being passed in some other states. So you see, it had nothing to do with "delicate sensibilities" and everything to do with a violation of their constitutional rights to privacy and being discriminated against for exercising those rights. It would have been so much simpler and there would have been no problem if instead of demanding answers to firearm ownership questions, physicians would simply state to all patients that unsecured firearms in the home are a known potential hazard to children, offer them a pamphlet on how to secure firearms safely, and offer to answer any questions they might have. Doing it this way accomplishes exactly the same goal they espouse of "educating patients about firearm safety", without invading the patient's privacy. It would seem to me that any physician or HCW that would refuse to accept this approach and still insist on the patient answering an ownership question either has a demigod complex or some other ulterior motive. Regardless of what they may think, physicians and other health care workers do not have any legal right to any information that the patient does not choose to share.

As I said way back on page one, you can ask, but the patient doesn't have to answer. A provider has no legal right to any information the patient doesn't choose to share. So instead of asking about firearm ownership, simply make a statement to the effect of "Improperly secured firearms in the home have been shown to be a hazard to young children. We are providing this pamphlet on firearm safety to all our patients. If you have any questions please feel free to ask us." You accomplish exactly the same goal without asking a question that is potentially confrontational or unnecessarily invading the patient's privacy.

1 2:10 pm by jrwest Quote from springchick1 Remind them that in most cases, insurance won't pay the bills if they leave AMA (assuming they have insurance). We were told we are not allowed to say this( not sure why) Most of the time they are medicaid anyway, or have no insurance ( maybe thats why they want to leave Because: A. It is false B. By lying to the patient you are engaging in an act of coercion, which invalidates any subsequent consent - exposing both you and the facility to possible legal repercussions This kind of stuff drives risk management folks nuts! Please, Please, Please - just play it straight and do your job!

LOL! Actually it's "bear arms"....or in the case of your pic, arm bears... Seriously, I don't think that anyone here will dispute the idea that keeping firearms and ammunition safely secured is a good idea. Likewise, I don't have a problem with health care workers offering something like a generic firearm safety pamphlet to all their patients. However, asking about firearm ownership and recording that information in the health record crosses the line. With the exception of specific psych situations where it may be relevant, it's simply none of the provider's business. With the implementation of EHR's and the rabid information sharing that goes on, many patients are more concerned with their privacy being violated, and are far less candid with what information they will share with their providers.

You are certainly free to ask - the patient is also free to tell you that it's none of your business, or as Annie indicated they may just lie. IMHO, unless health care workers are thoroughly trained in firearm safety, they're better off leaving it to those that are.

AuDDoc: FYI, Federal law permits recording telephone calls and in-person conversations with the consent of at least one of the parties. See 18 U.S.C. 2511(2)(d). This is called a "one-party consent" law. Under a one-party consent law, you can record a phone call or conversation so long as you are a party to the conversation. vid123: The key word is "audio" - doesn't apply to video if the audio is not recorded. The laws vary from state to state.....the following link is a couple years old so there may be some changes, but it will give a general idea... https://www.rcfp.org/reporters-recording-guide

There have been some very good comments on this thread. There is a very distinct difference between a patient requesting a specific caregiver and one who either "fires" a specific caregiver or requests an accommodation for same gender care for intimate procedures. In the first situation it's pretty easy to resolve by simply explaining that while you would like to assign someone they request, it's not always possible to do so, and the vast majority of patients would accept this. When a patient "fires" a caregiver the best solution is to assign another caregiver. The reason doesn't have to be something egregious - it might be as simple a personality conflict.....or someone that is a dead ringer for your wicked stepmother or something similar. I can't for the life of me understand why anyone would want to care for someone that doesn't want them there. It's going to create a tense situation for both the caregiver and patient, and the likelihood of a patient filing a complaint probably goes up by an order of magnitude. The situation where a patient refuses opposite gender care is a little more complicated. As others have stated there could be any number of reasons from cultural beliefs to prior abuse that a patient might do so......it really doesn't matter and the patient doesn't have to justify it to you. The tricky part is that they're not really refusing care, just a specific caregiver.....gotta be real careful here. Forcing an opposite gender caregiver on someone that doesn't want one is a recipe for disaster, especially where intimate care or exposure may be involved. You create an adversarial situation and the likelihood of a complaint again goes up by an order of magnitude. If they say no, and you touch them anyway, you are doing so without their consent and as someone stated earlier, committing a battery (a criminal act in all 50 states), and if intimate care or exposure is involved, you're now potentially looking at a sexual battery complaint, which is a whole lot more serious. In a male caregiver/female patient situation, the male caregiver is going to be assumed guilty until proven otherwise - it's not right, but it is the reality of the world we live in. The only way to protect yourself is to include a chaperone of the same gender as the patient, which ties up another staff member. It's simpler and easier to just assign a same gender caregiver in the first place. The bottom line is this: in the US, when push comes to shove, a patient has the absolute legal right to refuse any caregiver for any reason and a facility only has three options: 1. Accommodate their request 2. Discharge them if their condition permits, or 3. Transfer them to another facility if it doesn't

Whoever told you that is flat wrong - ask them to produce written confirmation of what they told you....and that they might want to consult the legal dept. In the U.S., a patient has the absolute right to refuse any test, treatment, medication or procedure as established by all or part of the 1st, 4th, 5th, 8th, 11th, and 14th amendments to the constitution, and has been repeatedly upheld by case law. To proceed anyway after a patient's refusal is an act of battery and is a criminal act in all 50 states. Anyone who does so opens themselves to the potential of both criminal prosecution for the battery and civil action for the rights violation. I have never seen anyone fired or otherwise disciplined for complying with a patient's right to refuse - I have more than once, however, seen an employee fired or disciplined for attempting to force something on a patient that they have refused. Attempting to coerce or intimidate a patient is also a major violation of CMS rules governing patient's rights, and can result in the facility being penalized.

Agree - rarely will something like what was described happen purely out of the blue. What was the trigger event?

1sttime, There are a couple of separate issues here I think are getting intertwined, and they really need to be addressed separately. This might get a bit long, but I will try to be concise. The first issue is Title VII, part of the Civil Rights Act of 1964, which outlaws discrimination in employment based on several factors, including gender. But what many people do not understand is this law is not absolute - there are exceptions included in the law and which have been backed up by case law, the most significant of which is based on privacy. This means that if the employer can meet certain strict tests called a BFOQ, they may legally hire only a specific gender for that job. OB is one area where the use of a BFOQ in hiring based on gender has been legally upheld when the employer can meet those strict tests. The second issue is that a patient has the absolute right to refuse any specific caregiver for any reason, including their privacy or modesty. In fact, they don't even have to give a reason other than they are not comfortable being cared for by that person. These rights are established under portions of the 1st, 4th, 5th, 9th and 14th amendments to the US Constitution, and backed up by case law. When a patient chooses to exercise these rights, a facility has three options: 1) comply with the patient's request; 2) discharge the patient if their condition permits; 3) transfer them to another facility where their request can be complied with. There is no circumstance (excepted very limited situations which require a court order) where a facility can legally force a patient to accept care from a specific individual against their will. If a patient refuses a caregiver and that caregiver ignores the patient's refusal and attempts to carry it out anyway, the caregiver has committed a criminal act in all 50 states. So here's the bottom line: While Title VII, with limited exceptions, prohibits discrimination in hiring based on gender and may allow you to get a job in say, OB, it doesn't give you any right to care for any specific patient - who they will allow care from is strictly up to the patient. Whether you like it or not is irrelevant - it is the law. I think what a lot of the folks here have been trying to say is that you can choose either let it get to you, or to accept it and move on. In the OP"s situation, regardless of why, the patient's refusal of a male nursing student must be complied with. That said, if the staff person was making derogatory comments with regard to male students, regardless if it had an effect on a patient's decision, that is wrong and should be addressed with the facility through the instructor.

Actually, assuming that the airway is open, the pressures are equal at both the end of inspiration and end of expiration - simple law of physics...the airway is an orifice, and when there is no flow through an orifice the pressure on both sides has to be equal. A balloon is not really a good example - a syringe would be a better one. When you draw out the plunger (inspiration) it creates a negative pressure and air flows into the syringe...when you stop drawing it out, the pressure equalizes and the airflow stops. When you push the plunger in (expiration) the internal pressure increases and air flows out of the syringe....when you stop pushing it in the pressure equalizes and the airflow stops.

Not for much longer I suspect. In 1990, 22.4% of all OB-GYN's in the US were women - by 2010 the number had increased to 49%. Further, in 1990, 49% of all first year OB-GYN residents were women - by 2012 the number was 83%. (data from ACOG). .................................... To the OP, if being a midwife is your passion, then go for it. Just be aware that you will likely face some roadblocks that you will need to negotiate. One of these is patient preference for gender of their OB-GYN provider. Some brief cursory research turned up several studies that have been done regarding female patient's for the gender of their OB-GYN provider. Most I found had a relatively small sample size, anywhere from 125 to 500 patients, and the results were all over the place with results ranging from 22.8% to 53% of participating women strongly preferring female providers. The largest study was published by Kaiser Permanente in 1999 - they surveyed over 8400 patients, and the result was 52.2% of women preferred women providers. There are a number of factors why a woman would choose to have a female provider, including cultural and religious reasons. Most female survivors of childhood sex abuse also prefer a female provider. For some others, especially younger women, there is an "ick" factor involved as well. According to statistics from AAP, in 1990, 37% of pediatricians were female - by 2011, that number had increased to 57%. As a result, significantly more young women coming into childbearing age have never seen anyone but a female provider, and for many, seeing a male for intimate medical care is something they are not comfortable with. Because of this, I think the the number of women that strongly prefer a female OB-GYN provider is only going to continue to increase. Like I said earlier, if being a midwife is your passion, then go for it. Just be aware of the potential hurdles.....

All valid and excellent points. A patient has the absolute legal right to refuse any test, treatment, medication or procedure without prejudice to any other needed care - hospital policy does not trump that. I would hope that the facility would listen to the patient and respect their rights. The bottom line is that the facility only has three options: 1. Comply with the patient's request 2. Discharge the patient if their condition permits 3. Transfer them to another facility that can comply if it doesn't If they stonewall you, there's always the pseudo passive/aggressive option - move in such a way as to deliberately set the alarm off every 10 minutes or so. They'll get the message pretty quickly.

Actually it's not that tough. If the staff won't listen, don't waste your time and theirs arguing - go over their head. You pick up the phone and call the patient advocate and find out who is the hospital CMS compliance person. You then call that person and inform them that the purpose of your call is to file a formal grievance for violation of your patient rights under 42CFR482.13, and if the situation is not immediately resolved to your satisfaction you will be filing followup written complaints directly with both CMS and your state agency that regulates hospital licensing and operations.

This is absolutely incorrect. A competent patient has the absolute legal and constitutional right to refuse any test, treatment or procedure for any reason they may choose, without prejudice to receiving any other needed medical care. This includes refusing a specific caregiver. Touching a patient after they have said or indicated "NO" is an act of battery, which is a criminal act. When a patient refuses you have limited legal options. 1. Comply with the patient's request. 2. If unable to comply with the request, discharge the patient if their condition permits, or transfer them to another facility if it doesn't. To the OP: What your teacher did violated the principle of informed consent - what they should have done is to introduce you to the patient as a nursing student and ask her if it was OK for you to perform the exam in question. As Esme said you can try talking the patient through it by explaining what you propose to do, but if she continues to shake her head "no", you must comply with her wishes. Some patients do not want to be seen by students at all, and that is also their right. By putting both you and the patient in an uncomfortable position, your teacher was being disrespectful of both of you. You were correct to want to respect the patient's rights, and what your teacher did was wrong.

THIS! (emphasis added to quote by me). One of my pet peeves is the term "non-compliant". By definition it implies that medical staff have some legal authority to require patients to follow their instructions, which except for extremely rare circumstances involving a court order, they do not. Regardless of what you call them, doctor's "orders", or instructions from nurses or other medical personnel have no legal standing, and are effectively nothing more than recommendations and advice that the patient is free to accept or reject as they choose. In the vast majority of instances they certainly would be better off if they follow those recommendations and advice, but the bottom line is they have every legal right to refuse to do so. Document the teaching and note that the patient chooses not to follow the recommendations. On a final note, I'd recommend never using the term "non-compliant", especially when charting. A couple years ago we had a staff member receive a written reprimand when they did so and the patient filed a formal complaint that the comment was defamatory.

Yep - that's why we had a 10 minute hard limit on the bottom time on the 10/80 trimix. We preplanned it very carefully with appropriate safety reserves. Sorry for sidetracking the thread.....

Unless you have them on high PPO2 levels for extended lengths of time, I wouldn't worry too much about oxygen toxicity. For example, because they see the highest concentrations of O2, the lungs and the rest of the respiratory tract are the first organs to show toxicity. Pulmonary toxicity starts to occur occur at a PPO2 level > 0.5 bar (50% O2 at normal atmospheric pressure). Symptoms typically appear somewhere between 4 and 22 hours after exposure to greater than 95% O2 concentration, with at least one study suggesting approx. 14 hours at this level. At PPO2 of 2 to 3 bar (100% O2 at 2-3 times atmospheric pressure) symptoms may show in as little as 3 hours. Slightly off topic: In scuba diving (note my user name) we deal with this all the time, because a seizure at depth is almost always fatal. Depending on the length of the dive we try to keep the PPO2 between 1.2 and 1.4 bar. Normal atmospheric O2 concentration starts to become toxic at depths greater that 184 FSW, so for dives at greater depths we actually use a hypoxic mixture - the deeper the dive the lower the O2 concentration. I rarely do any tech stuff anymore, and nothing really deep, but my deepest logged dive is 458FSW with a bottom gas of 10% O2 concentration trimix and a bottom time of 10 minutes....followed by a couple hours of staged decompression - the last of which is usually 10-15 minutes on 100% O2 at a depth of 15-20 feet.

Actually, that's not quite accurate. The patient always has a choice, and still has the right to postpone a procedure and request rescheduling that allows for same gender care. Hospitals always say they can't make the accommodation, but you'd be surprised how quickly many are suddenly able to arrange it when the patient stands their ground. It doesn't happen often, but I have seen it happen more than once. If they can't or won't make the attempt, the patient is always free to take their business to someone that can.