Pts handpicking assignments, and refusing nurses of opposite gender?

Nurses Relations

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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?

I can't help thinking that some people's objections to patients requesting/refusing certain caregivers, and to accommodating these requests if at all possible, are colored by ego and control issues. The nurse-patient relationship is a professional one, not a personal one. This isn't about being turned down for a date; this is about vulnerable patients trying to exercise some vestige of control over who does what to their own bodies and minds.

I have had patients refuse my care because I was female/African American. I would have thanked them if I had the chance. If they perceive that my care is crappy the likelihood of them lodging a complaint etc. is far greater so the did me a favor by keeping me out of their crosshairs. Let them get their care and go home. Let me work my shift and go home. Happy Happy.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

Just out of curiosity, what would constitute a "legitimate cultural/religious objection." A history of rape or molestation? Being Muslim? Being from a polygamous family? Having "family values"? An absolute conviction that all male nurses are gay and that all gays are perverts? Who gets to decide which objections are legitimate and which ones are not?

At some point, these requests cannot be accomodated . . . what then? If it's "legitimate" do we call our female nurses and mandate overtime while we send our male nurses home?

Specializes in Critical Care.

Not to mention the increased potential for legal action or baseless claims of poor nursing care if you attempt to provide care to a patient who is, for whatever reason, prejudiced against you.

I'll never forget one of my nursing school profs saying, "if they like you, you will be forgiven for a heck of a lot more."

I never took that advice as a pass to provide sub-par care, but it does speak to the dynamic we see with good HCAPs/poor outcomes, and I think it's relevant here.

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

I'll never forget the guy for whom I moved heaven and earth to get an eval by a terrific neurosurgeon whose expertise he really needed.

So we're sitting in the waiting room and he turns to me and says, "Is Dr. Soandso Jewish?" I was momentarily speechless. "I have no idea, it's not something we ever discussed. He's the best for what you've got, that's why I got you in here. Why do you ask? You wouldn't refuse his care if he was, would you?"

Yes, he would. He said he believed ... all sorts of offensive crap I will not repeat, and insisted I ask. I asked the secretary and she didn't know, either. Eventually the guy just up and left. I stayed behind to see the doc and explain why this jerk wouldn't see him.

Funny thing was that I, with the classic WASP name, am 1/4 Jewish, and the doc, with the middle-European name, turned out to be Catholic. All in all, a new one on me. Fool.

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