Transgender patient and a dilemma

[CBlover]

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.

[CBlover, BSN, RN]

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.

We don't have any security staff issues in that regard, it was just a topic of discussion among us this morning.

[CBlover, BSN, RN]

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.

See, you are trans so you see my concerns and the fact we WANT to make him feel comfortable! That's my point here.

[klone, MSN, RN]

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

No, someone else did.

[klone, MSN, RN]

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.

Why would being 18 vs. 16 make a difference as to what type of escort he would be most comfortable with?

[NICU Guy, BSN, RN]

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

It was me. I will keep my non-PC opinions about Gender Dysphoria to myself.

[LibraSunCNM, BSN, MSN, CNM]

It was me. I will keep my non-PC opinions about Gender Dysphoria to myself.

I think by putting "he" in quotes you made your opinions perfectly clear, quite intentionally actually.

[morte, LPN, LVN]

Why would being 18 vs. 16 make a difference as to what type of escort he would be most comfortable with?

that was not the point. the poster went on to explain his reasoning. reread.

[cec0007]

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.

As a trans yourself, you certainly know more than I do, but in today's lawsuit-happy world, I can see the situation going either way, especially with a minor. ("Underaged little baby boy was disrespected and humiliated...") Sometimes you're danged if you do and danged if you don't.

I can understand the OP's dilemma.

[Sindoriel, ASN, BSN, RN]

In the interest of concern for both the patient and any accusations against staff, would you have been able to send a second staff to chaperone as if it were a sensitive procedure? Also, checking with the patient if they have a preference of gender, or sending staff of both genders.

[MunoRN, RN]

I would just ask the patient, "would you prefer a male or female caregiver to...", although I don't really get the purpose of having security standing outside the door, and usually if they will be doing something were their gender would be an issue then it should be patient care staff, not security, or patient care staff with security standing by. If the patient is considered a threat to themselves then it doesn't make much to have them outside the bathroom. If they are on a hold and an elopement threat then security shouldn't be involved in any way where their gender would matter since they would only ever be outside the room.

[Daisy4RN]

Does your hospital have a policy on that, if not get one to CYA. For sake of conversation, I would ask both the parents (because the patient is a minor) and also ask the patient, if both are in agreement do what ever they say and document that. If they are not in agreement, time for the 16yo to do a self bed bath and document that. I wouldn't put myself in a position for anyone to be able to come back and say/do anything. Its only a shower/bath.

[AnnieOaklyRN, BSN, RN, EMT-P]

I would say if he still has his girl parts then send a female, otherwise if that has been surgically altered to be male parts then send a male.

Annie