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?
]It's fine for you to have these ideals for yourself, but other people have their own life experiences and realities, and, noble as these ideas are, they are not acceptable for many people.
I am not very cerebral....I need a specific examples to understand your point.
For example what would tell an obese female patient requiring assistance to ambulate, if only two relatively small/weak female nurses were available to help her out of bed to the toilet while two burly male nurses were available to help, but she requests only female nurses help her?
Or if the census was 32 patients, 24 female, 8 male, and the females were requesting female nurses only, with 2 female, 2 male, care givers on the floor?
@brownbook: I think you missed the point of Susie2310's post.
To be entirely blunt, we are not the thought police. Political "re-education" is not part of our role. I question the ethics of using our position of relative power to force vulnerable people to think according to someone else's socio-political ideals.
Trust me, as a tool of social transformation, bullying does not work.
The "no male caregiver" request is one that we have to deal with A LOT where I work because of our proximity to the polygamist communities (Warren Jeff's old sect and their offshoots). We honor all of these requests because they are religious in nature. Once in a while we will have someone else request it and we will comply.
Occasionally, a patient will "fire" their nurse, and not ask for that nurse to come back. We will honor that request as well. This happens probably once a month and usually a result of a misunderstanding.
Other than these, I have never heard of a patient handpicking their assignments, and it probably wouldn't fly if they tried.
I think these requests should only be honored if the patient has a legitimate cultural/religious objection to male nursing staff. Otherwise it's pure sexism. A male is every bit as capable of behaving professionally and being a good, nurturing nurse as a female. I work with some male nurses I would rather have caring for me any day than some of my female coworkers.
I think these requests should only be honored if the patient has a legitimate cultural/religious objection to male nursing staff. Otherwise it's pure sexism. A male is every bit as capable of behaving professionally and being a good, nurturing nurse as a female. I work with some male nurses I would rather have caring for me any day than some of my female coworkers.
Nursing care is patient centered, not nurse centered. It doesn't matter what you think on the subject; it's the patient's preference that counts.
I'm not arguing that nursing care is patient centered, because we all know it is.
I'm just saying maybe, just maybe sometimes the nurse's feelings should be considered.
When you have an employee who is completely under the thumb of the customer, you don't have an employee, you have a servant.
Can you specify how you think the nurse's feelings should be considered by the patient in regard to patients expressing preferences for a caregiver of a specific gender?
Can you specify how you think the nurse's feelings should be considered by the patient in regard to patients expressing preferences for a caregiver of a specific gender?
If you're asking me if the patient should consider my feelings, of course not.
My argument is and always has been with management. We are a small facility. If men are prohibited from taking care of certain patients, then that means the work load of the female nurses is heavier.
@brownbook: I think you missed the point of Susie2310's post.
To be entirely blunt, we are not the thought police. Political "re-education" is not part of our role. I question the ethics of using our position of relative power to force vulnerable people to think according to someone else's socio-political ideals.
Trust me, as a tool of social transformation, bullying does not work.
This, yes. My patient population is largely much more religiously and politically conservative than I am, and on a personal level, I probably disagree with them about all sorts of things. And I can't identify with being afraid of or uncomfortable with having a member of a different gender or race or religion caring for me. But I can identify with the idea that it would be very upsetting to have someone I was uncomfortable with for some reason providing intimate care, especially in a situation where I'm already in pain, afraid, and vulnerable.
I've seen patients "fire" nurses (including myself) for all kinds of reasons, most of them having nothing to do with the abilities of the nurse in question, and I may have rolled my eyes to myself and/or thought less of the patient if I suspected it stemmed from an ugly place, but in none of those situations do I think it would have improved matters or enlightened anyone to try to force the patient to accept care from someone with whom they weren't comfortable.
If your patient doesn't trust you- even if the reason your patient doesn't trust you is because they're sexist or racist or just generally a jerk- then you are going to struggle to communicate effectively or provide care that satisfies them, no matter how good you are. Unless there's truly no alternative, why put them and yourself through that? You're starting off already behind the eight ball and you're denying them autonomy and comfort in a time when they already have so little.
On exactly one occasion I've seen a patient fire a nurse where it absolutely wasn't possible to give her a totally new nurse (and this was because she was a very difficult frequent flyer who had already previously "fired" every nurse working that night). This situation was explained to her by the charge nurse and she agreed to be assigned to a different nurse who, I guess, she liked better, despite having fired her as well in the past. This worked so much better for everyone than if we had "required" her to take a nurse without input, because she understood what was possible and what wasn't, and she still felt like she had some control. A lot of difficult patient behavior stems more from a desire to feel some sense of control than from anything else.
If you really, truly don't have a staff member that meets the patient's requirements available, that's one thing. But most patients, even really mean ones, will accept that, if told. But requiring patients to accept a caregiver they don't want just because we think they should be okay with it? That's not okay.
Well.....I still don't know how an obese female patient is going to transfer out of bed, get assisted to the bathroom, if she won't let male staff help her? (Sorry, sexist statement...I know many female nurses are capable and strong enough to do the task.)
I don't know where you nurses live? I haven't heard or seen any such demanding patients...well ever?
So if the patient said no homosexuals or minorities are allowed to care for me, you would honor that request?
I've seen these requests made (rarely) and yes, where it was possible, the person making the assignment did comply. Did their choice to make that request make me think poorly of the patient as a person? Yes. Does that affect whether the patient deserves autonomy in their care? No. And on top of that, why would anyone put their coworkers through the misery of caring for a patient who hates them if there's any alternative?
I've taken care of convicted pedophiles and murderers with professionalism, too. "The patient being a nasty person" doesn't cancel out our professional obligation to care for the patient to the best of our ability- and that includes making reasonable accommodations. Swapping caregivers at patient request, even if their request is motivated by ugly beliefs, is usually a reasonable accommodation (and one that most nurses are relieved to have happen, if they're the target of the patient's ugliness). If it isn't possible for some actual reason, that's explained to the patient, and they can choose to accept the original caregiver or seek care elsewhere.
"You'll have this nurse and like it" is a pointlessly antagonistic attitude.
brownbook
3,413 Posts
]It's fine for you to have these ideals for yourself, but other people have their own life experiences and realities, and, noble as these ideas are, they are not acceptable for many people.
I am not very cerebral....I need a specific examples to understand your point.
For example what would tell an obese female patient requiring assistance to ambulate, if only two relatively small/weak female nurses were available to help her out of bed to the toilet while two burly male nurses were available to help, but she requests only female nurses help her?
Or if the census was 32 patients, 24 female, 8 male, and the females were requesting female nurses only, with 2 female, 2 male, care givers on the floor?