Pts handpicking assignments, and refusing nurses of opposite gender?

[jdub6]

I'm an old lurker, new poster around here. Although I work in s specialty I'm posting this here because I think it applies to most nursing areas. This is a partial vent and partial request for input. How do you respond when female pts (or their families) refuse to have male nurses/aides involved in their care? Recently on my floor, we have had multiple (usually elderly) women refuse male nurses. If they can't speak, often the family says the same thing. Ditto with not wanting men involved in foley placements or hygiene care, transfers to bathroom/commode, etc.

Often, these patients are obese, require multiple staff for hygiene care, etc.

While I certainly understand the embarrassment they feel, I have never, ever, not once had a male pt insist on male caregivers. (Some say that men enjoy female attention, and this may be true for a few, but most seem just as embarrassed as the women. However, whether there are just so many more women than men in nursing that they haven't had the option enough to think to ask, or whether they just think of it more as a professionak relationship, I have never in 10+ years had an adult male ask for male only caregivers.)

There are some nurses on my floor who will move heaven and earth, make assignments that make no sense and try to do full bed changes on 500 pound women with diarrhea themselves because of these requests. Most don't even try to reassure the pt and see if they can work it out first, they believe these women have "a right" to choose the gender of their nurses. Personally, I think that preferences can be taken into account but not guaranteed, particularly when no one makes any effort to give male nurses to male pts. When there are only 3-4 staff on a busy floor and 2 are men, often you gotta use at least one man to help with the total care pts. And I see nothing wrong with using the same reassurance on the women than we use on the men, ie that we are licensed PROFESSIONALS doing our job, etc. (Not to mention that I.do believe facilities with CMS accreditation cannot be discriminatory when hiring, including gender discrimination)

In a similar vein, what do you do when pts do the "I only want nurse x, if she's not here then nurse y. And I hate nurses r, s, t, l, n and e and refuse to have then involved in my care." Occasionally one of the shunned nurses has done or said something worthy of a complaint, but I have heard reasons as benign as "when we asked if she worked days all she said was yes, and we don't like one word.answers."

So what are your thoughts? Does this happen frequently in your facility? Does the gender exclusion tend to always be female pts, like at my unit? Any strategies to resolve the gender concern without totally messing up continuity of care for others, not to mention throwing the fairness of assignments off balance. And do you allow pts to hand pick staff and to ban staff for any reason at all? Our admin is all about pt satisfaction, so often we just have to deal, but it feels unfair to allow a few pts to dictate the assignments. Or maybe I'm just a jerk. Thoughts? Suggestions?

[klone, MSN, RN]

Okay, I'll try this again (cut and pasted from the other thread)

I work for a facility that sees a very high percentage of immigrants, including northern Africa and Middle Eastern countries. Many of these women are devout Muslim, or Orthodox Jew, and request no male care providers. Because we try to give culturally sensitive care, we accommodate them whenever we can.

Same with a nurse being "fired" by a patient. We're not going to put that nurse with the patient again, both for the sake of the patient as well as that of the nurse. I certainly don't want to take care of a patient who doesn't want me there!

[Susie2310]

As I posted on your thread that you deleted: Respectfully, if you are new to AN and utilize the search tool, you will find that the topic of patients refusing care from nurses of one gender or another has been discussed multiple times. If you are truly seeking peoples views on this topic, I believe these previous threads will be of help and recommend taking the time to find them.

[Susie2310]

As far as I know, unless a court order exists, or the patient is, for example, in the ER requiring life-saving care, patients have the legal right to refuse care from any caregiver, for any reason. To touch a patient, in spite of a patient's refusal, is to commit battery, which is a crime. Nursing care is centered on the patient, not on the nurse's convenience. If a female patient refuses care from a male caregiver, it is not appropriate to persist in trying to coax or coerce the patient into accepting a male caregiver.

[blondenurse12, MSN, NP]

I have not seen this frequently but it does bring up an important issue. Does the patient's preference usurp your safety? In the ICU, males nurses and staff are precious. Many patients weigh 5 or 6 times more than myself and males help with lifting more than another 100 pound female does. Some patients require 4 or 5 nurses for bathing and turning. The average nurse lifts...what...over 1 ton over the course of their shift?

I guess try to explain that it's a safety issue if the patient needs to much staff assistance. Get the manager involved? Obviously you want to respect the patient's wishes as much as possible but you cannot be a martyr to sacrifice your own body. Just my two pennies.

[Purple_roses]

I think it's hard for people who do not work in healthcare to change their mindset on nudity. These people often view nudity in the context of sexuality, whereas those of us involved in healthcare view private areas as another body part that needs just as much care as the rest of the body parts. I think it's hard for some patients to make that mental switch, and it makes them uncomfortable.

[klone, MSN, RN]

I think it's hard for some patients to make that mental switch, and it makes them uncomfortable.

I would say that it's hard for almost everyone who is not in healthcare to make that mental switch

[nrsang97, BSN, RN]

If possible always grant the patient their wish of having a female caregiver for a female patient. Why make someone uncomfortable? In regards to helping lift the patient or turn always assure the female patient that the male nurse or aide will be there for lift assist and explain that the patient will be kept covered, have the men help with lift and turn and then leave.

I work in an area with many devout Muslim immigrants and if possible we always granted these requests.

As for not liking another nurse then we will always keep the not wanted nurse out of the room for comfort of both the nurse and the patient.

[Altra, BSN, RN]

There is a line, and the line is when preferential promises in making assignments jeopardize other patients on the unit, or set up barriers to good teamwork and camaraderie among the staff.

I work in two departments where more nurses are males than is typical of some other specialty areas. The sole tech on shift is likely to be male. To avoid any care involvement by male staff, particularly for an ICU patient with a long stay, would be highly problematic.

Do these patients' request also include an all-female provider staff, and is that request accommodated?

[MunoRN, RN]

Do these patients' request also include an all-female provider staff, and is that request accommodated?

I work with a population that also often refuses male nurses, oddly they like their Physicians to be male and will even refuse female physicians.

[MunoRN, RN]

I think assignments should always consider patient preferences, patient needs, skill mixes, etc, so a patient's preference for a female nurse should be generally accommodated, so long as it doesn't risk the care of other patients.

I work in an ICU where it's not unheard of for the majority of nurses to be male, so the ability to accommodate these requests are not limitless. We don't turn, ambulate, etc patients with one person who require more, if we really can't accommodate their gender request then we just have to document the patient's refusal to be turned, ambulated, etc.

[Here.I.Stand, BSN, RN]

I live in an area with a large, almost exclusively Muslim immigrant population, as well as many others from North African and Middle Eastern countries. In my experience, the patients requesting female nurses has nearly always been members of these populations. It is my job to provide culturally sensitive care. Like it or not, these cultures do not have the same modesty norms for males as they do for females -- hence, no male pts requesting only male nurses. It is what it is, and my male colleagues choose not to get all butthurt over it.

Otherwise, I have only had one or two female patients who were expressly uncomfortable with male nurses/CNAs. Whenever possible I did the ADLs with them because I understand modesty and want to do what I can to help feel comfortable. This was in a SNF, so different staffing than in the hospital, and sometimes both nurse and CNA were male, but we did what we could. I know sometimes the CNAs would trade care among themselves.

I've had one patient who was an absolutely vile person, who made no secret that she had white supremacist thoughts. She said some things to African/African American staff that I won't repeat. But anyway, her "requests" were accommodated -- not because management wanted to give her what she wanted, but to protect their staff from the hostile work environment she was creating for them. Colleagues agreed and refrained from complaining.

Now as far as pts who request certain nurses out of personal preference, they are explained that staffing can be complicated, requests are not always able to be considered.