Trans Patient

[Neo Soldier]

We had a patient who wished to be identified as a female. She recently started hormone treatments and she looked female. She hadn't gotten the reassignment surgery. The day shift decided to let her sleep in the female room the entire shift without incident.

The night shift came in and asked that she stay in the general day room or the male room. This made the patient very upset.

This became an interesting discussion. We agreed she is male and so couldn't be in the female room. It would have been uncomfortable for the other women. But she couldn't be in the male room because she chose to identify as female and also looks like a woman; it wouldn't be safe anyway. This was in the emergency room where there were no assigned beds and the general area had pull out chairs that patients could sleep in.

The dilemma is, how would that work on a patient unit where women and men are separated?

[Meriwhen, ASN, BSN, MSN, RN]

If we have a trans patient, they get a single room.

Patients aren't allowed to enter other patients' rooms even if both patients are of the same gender (only exception being, naturally, if they are roommates).

Our units are usually not divided into male/female sides, though if we have a hypersexual patient, we will try to somewhat separate the room assignments, or at least place the hypersexual patient in a room where we can keep a closer eye on him/her.

[Nimrodel, BSN, RN]

Trans guy here -

She's not male. That's an inaccurate and harmful assumption. Other people have made good points regarding policy and patient safety, but I'd like to address something else.

Nearly half of trans people have attempted suicide. The less supportive their family/environment is, the higher the rate of both attempts and completed suicide. As a nurse, particularly in a psychiatric setting, it is your job to facilitate their healing, and that means supporting their identity. Whether that's a single room or with a female roommate doesn't particularly matter in my opinion. Her genitals shouldn't matter either, because people are more than their parts. But it is staff's job to do the best they can to give her a chance to heal. Which means treating her as female, and using the correct name and pronouns. Otherwise you are doing her health a grave disservice.

[FolksBtrippin, BSN, RN]

We had lots of trans patients in child adolescent mental health. They got a single room generally speaking. Gay pts did not automatically get.a.single room

I wouldn't think you would need to separate anyone if you have a large room with multiple pull outs. If you do separate, it needs to be based on the patient's stated gender, no matter the genitalia.

[TerpGal02, ASN]

One facility Inworked in had all private rooms so problem solved there. Another facility had double rooms and the policy was that trans patients got a private room. The unit eventually moved to all private rooms so again, problem solved. That trans patient is not a Male, she is a woman and should be seen and treated as such, period. The second unit I worked on had a lot of older, conservative nurses who would cisgender trans patients all the time. Us more open minded nurses would cringe and shake our heads.

[offlabel]

On 11/18/2018 at 8:31 PM, heron said:

I agree, get an empty room.

Meanwhile, do I understand you to be saying that the trauma experienced by cis-gendered women is legitimate, whereas the experience of trans women is "trauma" that is merely "accommodated"?

No you don't, but that is a false comparison anyway. The "accomodation" is simply superimposed on the psychiatric situation at hand. There is the reason the transwoman is there and then there is the logistical issue as to where to admit them.

But the general outrage at the notion of protecting women in a psychiatric emergency facility from a transgendered woman acting out in their crisis is quite telling. Compassionate and professional care aside, the requirement of any and all individuals, even in crisis, to a potentially harmful situation is a foregone conclusion. i.e. a biological male in crisis being housed with a biological female in crisis. It is an irrational and non-scientific decision to put the two together.

[hppygr8ful, ASN, RN, EMT-I]

In adolescent units like mine we do everything possible to honor and respect their status/orientation. We do allow them to be housed in the area of their identified gender but in private rooms. Still they are required to attend all groups with their specified gender. We do get a lot of adolescent transgender patients who want to pick and choose because they perceive one milieu is more fun than another.

Hppy

[verene, MSN]

My facility has a mix of double rooms and private rooms. Rooms are in a horseshoe shape around staff bubble and there is no men's side vs. women's side. Transpatients are automatically granted a private room (though sometimes will end up with a roommate if we have multiple transpatients of same gender expression and/or if someone in a shared room and transpatient specifically request to be roommates with one another - this is only done with consent of all parties involved).

[offlabel]

24 minutes ago, verene said:

My facility has a mix of double rooms and private rooms. Rooms are in a horseshoe shape around staff bubble and there is no men's side vs. women's side. Transpatients are automatically granted a private room (though sometimes will end up with a roommate if we have multiple transpatients of same gender expression and/or if someone in a shared room and transpatient specifically request to be roommates with one another - this is only done with consent of all parties involved).

Best of all worlds.