Transgender patient and a dilemma

[CBlover, BSN, RN]

So my coworkers and I encountered a bit of a dilemma with a transgender pt. 16 y.o. born female transitioning to male. The pt preferred to be called he so I will refer to them as he. He was a 16 year old who definitely appeared as a female outside of a small amount of chin hair, male haircut and clothes. He was a psychiatric pt who needed a shower. We always send our pts to shower with a chaperone since we are not a psychiatric unit, we are an ER who holds overflows from time to time, and we don't have a shower on unit obviously. With females we send a female security staff member, with males we send a male staff member. We encountered a dilemma here. Obviously the pt was a minor first off. Then we all just looked at each other in confusion as to what gender to send as a chaperone. Do we send the male or the female security?? I mean for the pt's safety and the security staff safety, this was a tough call. The pt could have brought accusations against the staff untruthfully AND who knows anymore the security could have assaulted him! It's like what do you do?? What do yall think? Have yall encountered similar situations? I just feel like we in healthcare are going to be encountering things like this more and more and it could get a bit sticky.

[203bravo, MSN, APRN]

Would the staff member or security officer have to remain in the shower room and maintain direct observation of the patient at all times?

[meanmaryjean, DNP, RN]

Family member plus security?

[CBlover, BSN, RN]

Security doesn't remain in the bathroom with the pt at all times. Just outside the door. So the answer to your question, no.

[CBlover, BSN, RN]

Family member plus security?

That would be the best answer MMJ.

[203bravo, MSN, APRN]

Thanks -- if they are posted outside the door, then I personally don't see the issue.. You would simply follow the policy as for any other patient.

While I do see your concern that this patient could potentially report the escort for inappropriate actions or comments, this could just as easily happen regardless of the patient and escort gender, sexual identity, or sexual orientation.

[NICU Guy, BSN, RN]

Send a male security escort. "He" wants to be treated like a male, so treat him like a male. End of discussion.

[heron, ASN, RN]

Perhaps ask him which he preferred or how he would feel safest?

[macawake, MSN]

Perhaps ask him which he preferred or how he would feel safest?

This is to me the common sense response. If the facility is sufficiently staffed to have both male and female staff available at all times, it's a respectful and considerate question to ask any patient really.

Ultimately, I suspect that one of the most important qualities in the person assigned to this young psychiatric patient's care, is not thinking of him as a "he" in quotation marks.

Then we all just looked at each other in confusion as to what gender to send as a chaperone. Do we send the male or the female security?? I mean for the pt's safety and the security staff safety, this was a tough call.

If a specific patient makes you concerned about the staff's physical safety, then I would simply bring more than one member of staff. The threat assessment isn't tied to a person's gender, sex, sexual orientation etc., but to their behavior and physical strength/capability/presence of objects which can be used as weapons.

The pt could have brought accusations against the staff untruthfully AND who knows anymore the security could have assaulted him! It's like what do you do?? What do yall think?

Any patient can level accusations against any member of staff. Again, I think every situation needs to be assessed individually and if something in the patient's previous or current behavior is concerning/alarming, then bringing along an extra member of staff is probably a good idea.

[chare]

...I mean for the pt's safety and the security staff safety, this was a tough call. The pt could have brought accusations against the staff untruthfully AND who knows anymore the security could have assaulted him! ...

If this was truly a concern, that your security staff would have assaulted the patient, then you have bigger fish to fry than what gender security officer to send.

[CBlover, BSN, RN]

Ultimately, I suspect that one of the most important qualities in the person assigned to this young psychiatric patient's care, is not thinking of him as a "he" in quotation marks.

I did not put he in quotation marks. (Not implying that was towards me, however.)

[OpinionatedCNA, CNA]

In a perfect world, it wouldn't matter what gender you send with him. However if I were you I would send a female. This is not a perfect world its a CYA world. It would be different if he was 18 and he could request a male escort. He doesnt know the policies of your facility, Im assuming, so it's not like he would feel ostracized for not having a guy escort him to the shower room. Im also a trans guy and it's great that you all are so caring about respecting him but also dont screw yourself over in the process. All you need to lose your job is his (unsupportive) family to come in and make a big stink about how their underaged little baby girl was exposed to a man against your own hospital policy in the shower room.