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Saturday, March 1, 2008

Equal Employment & Gender Preferences

Equal employment opportunity laws definitely interact with privacy concerns of patients, especially as it involves same gender care. This thread will try to explore this topic in detail.

131 comments:

Joel Sherman said...

This is a topic I started on Bernstein. Equal employment laws certainly interact with patients’ ability to receive same gender care, especially in areas such as labor and delivery. It should be noted to begin with that these laws apply to employment, not to daily assignments. That is even in L&D, a male nurse can legally be not assigned to a patient who requests same gender care. Similar situations happen routinely on other floors in all hospitals. What’s in question is whether a hospital can refuse to hire any male nurses in L&D. The case law here is mixed as I understand it. I’m not a lawyer and this is a complicated subject, but I hope to go through the case law as best I can.
I believe that medicine in this country has been tending towards gender neutrality, and away from same gender care. As examples 30 years ago there were no male L&D nurses, urinary catheterizations of males were routinely done by male orderlies not nurses, and there were very few male technicians in the OR and elsewhere. Nowadays in almost all hospitals in this country, a patient will be exposed to both male and female providers unless they specifically refuse, and even then there may be no choice, especially for male patients.

Joel Sherman said...

The United States Constitution does not contain the word privacy. No privacy rights are granted. All federal privacy rights that we claim for ourselves nowadays derive from court decisions that state that privacy rights are implied. What that means is that privacy is a secondary right that is subject to ongoing interpretation by the courts. Unlike freedom of speech and religion, your right to privacy can be subject to a much greater regulation and interpretation.
A recognition of the right of personal privacy didn’t come about until the 1960’s. Griswold vs. Connecticut was a landmark federal case establishing a right to marital privacy.
As concerns your personal bodily privacy as opposed to information privacy, there is little in the way of federal statute. This is greatly affected by Title VII of the Civil Rights Act of 1964 which prohibits employment discrimination based on race, color, religion, sex, or national origin. This law which has greatly benefited women and minorities is of course gender neutral. Thus it makes it illegal to favor either sex in employment hiring. This law has permeated to all levels of our society and certainly into health care. It makes it illegal to refuse to hire based on gender. There are a few exceptions, BFOQs or bona fide occupational qualifications. These are almost never assumed, but are usually litigated on the basis of narrow criteria. I’m aware of no federal legislation which grants this status carte blanche for various jobs. Every case is looked at individually.

More to follow…

Joel Sherman said...

As noted, gender discrimination is illegal in the US. When exemptions are claimed, it is an admittance that discrimination is taking place. The EEOC does grant BFOQs for a few specified job descriptions. I cannot find an enumeration of these jobs, but likely they concern mainly so called privacy BFOQs such as the use of same gender personnel in locker rooms, bathrooms and other areas of single gender access. The only other area where they have been allowed would appear to be in healthcare where they have been claimed in labor and delivery and nursing homes. These are usually granted on the basis of a personal right to privacy and customer expectation. They are not automatic though, and every case has to be looked at individually. Thus there have been varying decisions depending on the circumstances and the evidence involved. In labor and delivery, decisions have gone both ways in different jurisdictions. In Backus vs. Baptist Medical Center, a California hospital was permitted to refuse to hire male L&D nurses. In Slivka vs. Camden-Clark, the judge remanded the case to a lower court after overturning the lower courts decision that the hospital was entitled to a BFOQ. These cases likely turn on the evidence presented in each case, i.e. how clear was it that women would not accept male L&D nurses, especially in view of the fact that they accept male obstetricians, anesthesiologist, and others who may be present. Given that male L&D nurses are not rare across the country, it seems to me that it will become increasingly difficult to support BFOQs here and in other areas of health care. There is little evidence that women won’t accept them in general, and those who don’t can easily be accommodated.
A strong proponent for gender neutrality in health care can be found in the writings of Amy Kapczynski of Yale law. Here is her summary of the subject and here is her full discourse. I personally find her writing persuasive.
My conclusions on this topic will follow.

Joel Sherman said...

My personal view of this subject is that all patients’ privacy wishes should be accommodated to the extent possible. In fact, all patients are free to see providers of their choice based on any criteria they want, most definitely including gender preferences. However hospitals and other institutions are limited by law to the degree that they can satisfy gender preferences. These laws have been a big help to women and minorities and they should not be disregarded. One has no legal right to specify the race of hospital personnel; in fact hospitals cannot legally accede to such requests. There is also no legal right to be granted gender preferences even though it is perfectly appropriate to ask and make them known.
Medicine has been moving towards gender neutrality for decades. It has benefited all, including patients. I believe there is almost no valid reason for a refusal to hire based on gender, as opposed to accommodating patient preferences when able. The latter should be accommodated when possible, and certainly more could be done in most institutions to make this possible, especially for men who have preferences. The limitations on this are mostly due to the cost and difficulty of hiring more employees and their efficient scheduling. The average person accepts gender neutral care, but there are some for whom this is not possible for a variety of reasons varying from enhanced personal modesty, through a history of sexual abuse, and extending to religious beliefs. I believe most hospitals try and accommodate patients with these desires, but some are far more gracious about it than others.

Anonymous said...

Dr. Sherman:

Given all that you have written,
the bottom line still remains --
modesty men do not have the options modesty women have.

Despite the existance of BFOQ,
nothing much is being done to
address this problem. While
there is a lopsided balance in
male-to-female staffing, only
about a third of men have same-gender preferences. Certainly,
more could be done to assist their needs.

There has been affirmative action to reduce the number of male doctors vs. females. But nothing is being done to push down the number of females in medical support. Male nurses are 2x as likely to leave nursing in the first five years on the job and their number one reason is female dominated management.

Finally, the subtle pressure of
mocking male modesty concerns, while catering to female needs
of the same nature, is clear
discrimination. Yet this goes on
and on without challenge in many
medical venues where it could be
altered to some degree, almost immediately.

What is really needed is a law
which demands that BFOQ be used
with an even hand as regards the
needs of both male and female
patients. I believe that it
will only require a reduction in
female support staffs to 75% of
totals to effect necessary change.
If this means forcing 20+ percent
of assisting females out of medicine then that is what is needed. No one gave a second though about enforcing affirmative action to
push 50% of males out of doctoring.

So let's get on with it. How
do we challenge quota practices
which lead to reduced options for
one sex of patient?

--Jason

Joel Sherman said...

Jason,
I don't disagree with the gist of your comment. I don't think however that there was ever affirmative action to bring more women into medicine, at least not on a national level. It really just wasn't ever needed. Once the barriers were down, there were lots of women interested.
But to bring any parity to nursing, affirmative action would be needed. And I agree that some male nurses are made to feel uncomfortable by their female peers, though I don't think that it's official policy anywhere. The main problem is in perception, male nurses are seen in the same light as male ballet dancers etc. It's just not a macho field. The name is much of the problem; nursing is still considered a woman's profession. To my surprise there is apparently a much higher percentage of men who become physician's assistants (very similar to nurse practitioners), probably because the title is more acceptable and the prestige greater. There may be greater hope of equity in that direction.

Anonymous said...

Dear Dr. Sherman:

You wrote:
"I don't think however that there was ever affirmative action to bring more women into medicine, at least not on a national level. It really just wasn't ever needed. Once the barriers were down, there were lots of women interested."

It wasn't only a matter of interest. More qualified OR NOT, 50% of the seats in medical school were going to be held for woman. That's affirmative action.

You're absolutely right about
the perception of nursing. If
affirmative action is to succeed
against the vested interest of
the female status quo(a type of
medical trust), then a "male
nurse" needs a new description.
The name is socially limiting to men. I suggest "hospitalers" be the new name given to male nurses.
This would help fight the female-promoted stigma attached to males entering "their" profession.

I believe someone on Berstein
has identified the female image
of nursing as "the Nightingale
Syndrome" and dated it from the
mid-19th century. For centuries
before that, men had the job.
Some were actually Crusading
military orders, a "brotherhood"
in chainmail or boiled linens,
depending on the day. It was a
real man's job.

-- Jason

Joel Sherman said...

Interesting historical note, Jason. I have never heard that nurses were men in an earlier age.
One further problem is that male nurses I believe are more likely than women to take an administrative role and not continue floor nursing.

Joel Sherman said...

An interesting twist here. A male nurse in England sued over requirements that he have a chaperone present when doing ECG's on women in contrast to female nurses who had no such requirement when they worked on men. He won on appeal to the National Health Service, but ultimately quit the nursing field. He's not the only male nurse to suffer discrimination.
I know this same problem can arise in some American hospitals though I'm aware of no suit based on it. To my mind the need for a chaperone should be determined by the patient's wishes and not by hospital fiat.
I'll also post this under the Chaperone thread.

Anonymous said...

While affirmative action is often associated with qouta's, there are other inatives that are aimed at the same end that are not so obvious. I was a college student in the mid 70's. In the small liberal arts college I attended there were several intatives aimed at increasing the number of female Dr's. The premed program openly encouraged females to come into the program. They accepted female students with lower GPA's into the final year than males. There was an obvious and overt effort to use gender nuetral terms to refer to doctors and many/most posters and speaker-mentors depicted and used females in the profession. Take notice of advertisements and recruting media for nurses, they are over whelmingly female. The effort to encourage females into the profession are not applied to males in nursing, the same type of barriers exist today...yet even in the face of an extreme nurse shortage, there is no effort to encourage males to enter the profession.........that is a double standard. JD

Joel Sherman said...

I agree with your comments JD. There was never national affirmative action to bring more women into medical school, but it could easily have been encouraged on a local basis. Many liberal arts colleges are devoted to diversity and feminist causes. In the 60's when I was in school, women were 5-10% of classes. That number has gone up gradually ever since to over 50%. But I'm not aware that any school needed to institute quotas to achieve that change. There has also been some shift by men away from medicine as the pay and prestige continues to fall.
Men are not discouraged from entering nursing by schools, but more is needed to bring them into nursing. One of my hospitals has a program to introduce high school students to nursing and allied fields. There are a significant number of boys in this program, so maybe there's hope for the future.

Anonymous said...

2006 Judgement of a British Court.

SUMMARY:
The appellant was a student nurse. He was required to be chaperoned when carrying out intimate procedures on female patients whereas a female student nurse was not required to have a chaperone when carrying out intimate procedures on male patients. The respondent accepted that this was direct discrimination and therefore could not be justified as a matter of law, but submitted that the appellant had suffered no detriment. The employment tribunal agreed but the EAT held that this was an error of law. Compensation was limited to injury to feelings only, and at the behest of the appellant that was fixed by the EAT rather than being remitted to the employment tribunal. The amount was fixed at the lower end of the scale, the sum of £750 being awarded.

I believe this means the hospital
pleaded no contest but requested that the plantiff prove injury.

We need a lot more moments like this in American medicine. Might
change the double-standard.
--Alvin K.

Joel Sherman said...

Alvin, as I said above I'm not aware of a similar case in the US. Most hospitals do not use chaperones for nurses, male or female. It would rarely be required, mainly because it's too expensive. I know on allnurses a few male nurses, usually from the ER said that they would not do any genital exam on a woman without a chaperone present just for their own protection, not because the hospital required it. But then again chaperones are common for female genital exams no matter the sex of the examiner.
If it was an actual hospital requirement, I think a male nurse would have a case in this country too. But the same limitation would affect a suit, not much point in suing if there are no damages.

Anonymous said...

Here's a nice read. Has both the pros and cons for both genders. Of cource it's referencing women but still alot of good points. I've seen quite a few articles of late based on these subjects we're discussing, maybe things are already changing, just not a fast as we'd like? Jimmy

http://health.msn.com/health-topics/breast-cancer/articlepage.aspx?cp-documentid=100199754&page=1

Joel Sherman said...

Nice article Jimmy.
A couple points: The article doesn't mention that there is an age differential to women's preferences. Older women are generally quite used to male gynecologists and are comfortable with them. Younger women, perhaps overwhelmingly, prefer to see female gynecologists, which wasn't an option for many of their mothers.
And as you mention, the article doesn't look at the issue from a male point of view. Though men have always had their choice of male physicians, they have never had their choice of male ancillary personnel which is frequently available to women, especially if they request it. It's also completely unknown what percentage of men (or women) avoid medical care completely because of these issues. They certainly exist. I know some general practitioners who claim that their male patients are more modest than the women so there may be lots of them.

Anonymous said...

Joel,

Good points. Although the article didn't get into detail about the age differential in preferences, the ages of the two that preferred female providers was 25 & 32 were as the female that didn't care was 57. I'd guess that if the 57 year old had the same options as the younger females, she may have a different opinion.

This is what I found most interesting: Today, an increasing number of patients are now requesting female gynecologists. As a consequence, male gynecologists may be going above and beyond to emotionally connect with their patients.

This just further tells me that we males aren't doing enough to make a difference. The hot topic is the double-standard and although I agree that's the case, it's obvious that women have done more to state their case than men have at this point. To be perfectly honest, I see nothing wrong with women having these options, I just feel that men should have the same considerations and shouldn't be treated any different because of this. Jimmy

Joel Sherman said...

A different aspect of gender issues in medicine. There have been several articles discussing the fact that women physicians work substantially shorter hours than men seeing fewer patients and thus contribute to the looming shortage of physicians. This is not new information, but it may increase in importance as doctor shortages increase.
Here's an article from Business Week. Of course this finding applies equally to all professions and there’s no cure for it unless men decide to take fully equal responsibility for families. There’s no getting around maternity leaves.

Anonymous said...

Nice article Joel, I never considered that being a problem. I've never went to nor seen a female physician. Most that I've met seem to work just as hard as the males, I know that my wife's female OB/GYN lives at the hospital because most of the OB centers have closed in our area over the past year. Many of the females that I've met are married to doctors themselves and have kids. Most make it work although we did have one to resign after their last child was born. I guess their spouce has alot to do with this and how much they're willing to give up for their wife's career. I do think that this is a problem not with just doctors, but in other fields as well. Jimmy

Anonymous said...

THIS WAS POSTED ON BERSTEIN, YESTERDAY. IT CAPPED A SPIRTED ARGUMENT THERE AND IS NOW SITTING AS THE ELEPHANT IN THE ROOM.

I WANTED TO PASTE IT HERE AS
THE AUTHOR HAS GONE RIGHT TO THE
HEART OF THE DOUBLE-STANDARD AND
THE ONLY POSSIBLE "FAIRNESS".

"Yes, there is the financial reality and
the lopsided staffing situation.

A third of men don't care.
A third of men are homophobic
and want females.
A third of men want same gender.

The doctor needs females for his
own protection when working with
females and women tend to want
same gender. Add the fact that
we have a 92/8% imbalance in
female to male staffing and you've
got one big problem for modest
men.

I believe the ultimate goal has to be
fairness. If medicine can't
accomodate men and women's modesty
request equally, then no one
should be allowed to make any requests.
Now, I understand with
the staff imbalance the way it is
this would still leave modest men
the losers by a great percentage
but this could be balanced and a
great point made if the 8% male
staff total was asigned to OB/GYN
and L&D. Then, at least, females
would begin to get a taste of what
one third of the male population
feels. Let's see if they like
that brand of fair, as indeed it
would be.

That's the bottomline issue of
this great debate."

avram

Joel Sherman said...

Avram, don't know where the quoted statistics come from or what they're based on. Certainly the majority of men prefer male physicians or don't care. That is undoubtedly different from how it would break down for nursing care as men have an increased preference for female nursing care. Though I doubt that 1/3 of men would prefer female urologists for instance. Female urologists are less than 10% of the total and often take care mainly of female patients.
There are also many other variables such as age and racial differences. Older men are not used to female physicians, but are far more concerned with their health than younger men are and less concerned with any sexual or modesty implications.
One thing is for sure though. If you want to see any changes in how patients and men specifically are treated you have to speak up. The assumption in medicine is that the vast majority of all patients don't care greatly one way or the other.

Anonymous said...

There is an excellent thread running on allnurses.com right now. Go to allnurses.com, go to general (topics?, nursing?) and then search male modesty at the top in the search box. It is very encouraging that the providers seem to universally recognize the issue, some have read this and the Bernstein blog and bring up the arguments put forth by people here. Some of the discussion seems to be directed toward communication vs lack of concern. They are pretty good at laying out the issues of not letting the patient know up front what to expect and "ambushing" patients etc. its a good read and I think it supports the feeling that providers by and large are compassionate and care, but....it is still going to fall on us as patients (and payers) to make our wishes known and to take proactive steps prior to going in to find out what to expect and what the options are....they should ask, but the system doesn't work that way..until we cause change its the best we can do...if we start asking-demanding and taking our money elsewhere...it will change....JD

Joel Sherman said...

JD, I believe most if not all nurses and aides are instructed to maintain patient modesty in their training. This has not been the standard for physicians, but if what Dr Bernstein teaches his students is common, it may be prevalent now.
But yes there is a disconnect between preserving a patient's modesty and asking about gender preferences for care. It is rare that providers ever do that. Sometimes women are asked, men almost never. The latter may not be possible much of the time, but there is very little awareness that it is a concern to some men as well as many women.
Maybe these blogs can change the perception. I don't know. The audience we reach is very small.

Joel Sherman said...

Here's the comments of a woman physician who fears she'll have a male gynecologist whom she knew for a vaginal ultrasound:

And then, there’s this alarm that suddenly went off in my head that I could have a male ob-gyne ultrasound specialist doing the procedure on me, because I saw one of the male ob-gynes there and, unfortunately, he was also my professor back in med school. And that reminded me of my article for the recent edition of TBR. Wonderful. Maybe I’m getting my karma for what I said about male ob-gynes. Ahahaha.

Her own link talks about patient preferences and says:
And surprisingly, a lot of men do decline to be examined by female doctors, especially when their complaints concern the genital area.

A repeated scenario, women think they're entitled to gender preferences but don't automatically grant the same privilege to male patients.

Anonymous said...

Dr. Sherman
I read the exchange with great interest. It is interesting to read female providers who openly acknowledge their own preference for same gender providers, yet, act completely surprised or almost offended that males would have the same issues. I thought you did a great job of pointing that out, and you could read a little "thou doust protest to much" into the response. Thanks for the support

Joel Sherman said...

Thanks. I believe that the woman, who is a young Filipino physician, is likely quite nice. But like many women, she assumes that women need their modesty and that men don't care. That's why it's important for men to speak up if you do care. They'll never hear you otherwise.
I personally believe that patients should choose physicians based on finding the best and most competent physician available and that gender is very secondary. But I recognize that it's difficult for patients to know who's best and that they are free to use any criteria they want. But I hold physicians to a higher standard. They can know who's best. They should pick their personal physicians on the same basis that they'd want patients to choose them. I get discouraged when I see physicians (and they seem to be always women) openly express gender preferences as if that was a matter of great importance.

Anonymous said...

Dr. Sherman, I have no doubt the female Dr. is a nice person. I think that, and the exchange is a perfect example of the biggest part of the issue. A vast majority of the incidents we discuss here are not done with malice by mean people. They are done in ignorance of the issue. The fact that female providers would feel comfortable expressing their preference for same gender providers while condemning or not even thinking males may have the same concerns or desires indicates a complete lack of recognization of the issue. They assume it is normal for females to have concerns and just assume males don't. I don't know how else to explain obvious intellegent people not recognizing the obvious hypocracy of the situation. I think if they did recognize it, they would not feel comfortable putting it out there in black and white for all to read. They don't see anything wrong with what they are saying. As stated here and in the Bernstein blog that is to a large degree our fault for not speaking up. Silence is consent. Providers say "its because I know the providers", "it's different", etc., we hear do as I say not as I do, all the "I do it all the time its no big deal, I am a professional, etc all become nothing more than hypocritical justification because we know providers feel different when they are the patient. If these female providers recognized they are sterotyping, being sexist, etc. they wouldn't feel comfortable making those statements.
That said, I agree with you 100% I want the most qualified person of either gender working on me when my health is on the line. Unfortunately for the patient, to a large degree...we have no way of telling who is the best, we can seek references, research, and referrals, but we don't know these people, so we do the best we can and trust you all know what your doing, so we think about the other stuff, like modesty, because to a large degree, the most important part is out of our hands and in yours. JD

Joel Sherman said...

JD, I believe the majority of nurses and women physicians are sensitive to the issue, but some need their consciousness raised. I suspect that the good Filipino doctor will think twice before again posting that seeing a male provider raised an alarm.
It's too bad that 'Dr Keagirl' won't enter into a conversation on the topic. Some women label all men as sexist without ever considering that they act the same. I found a medical poster who apparently was able to email with Keagirl and posted that her practice is 2/3's women and that 2 out of 10 male patients reject her. That's a believable figure though rejection is not the same as a preference. The percentage of young women who prefer female gynecologists is closer to 80%, much lower in older women who are more used to male physicians.
The link to this doctor’s comments only worked for me through google for some reason. Otherwise it asked for a password.

Joel Sherman said...

Two links were just posted on Bernstein by 'gve' which illustrate some of my thoughts on equal employment and gender preferences.
link 1.
link 2.
They both concern Muslim men being subjected to strip searches by female guards. The first link is from the UK, the second from Texas. It should be no surprise that in the UK the Muslim man was upheld whereas in Texas the state's practices were upheld. I believe we are the only country in the world that routinely puts equal employment rights ahead of privacy rights especially if men's rights to privacy are at stake. Our practices are against international law. Privacy rights in the US vary state by state but many states uphold the right of women to routinely strip search men or more commonly be present at strip searches. Almost all states restrict male guards from strip searching women except in emergencies.
What is the reason for this? Well every decision is different but women have been subject to more sexual abuse and have a harder time with it (so we are told). I honestly am not sure of the percentage of men who have been subjected to abuse by women, but it is much higher than we are led to believe. Certainly many men have been abused. The other point is that women have been raped by male guards. Most often this is statutory rape in that it was consensual, but all sex with inmates is against the law likely in every state. But who is the biggest abuser here? Very surprisingly to me it is female guards having sex with men and juveniles! Here's the reference from ABC news. Another reference on video concerning female guards in a Georgia juvenile prison is here. I believe the whole topic cries out for equal justice under the laws. I personally don't ever see a reason why prisoners should be routinely strip searched by opposite gender guards.

Anonymous said...

That is true! Female prison guards
ARE the biggest sex offenders! What
do you think happens when a male
prisoner is released from prison.
This same male prisoner who has been continually sexually harrassed
and strip searched by female prison
guards now whats to sexually harrass and assault women. So much
for rehab!

Joel Sherman said...

Here's another post concerning female guards having relationships with male prisoners.
I don't know how reliable this web site is.
But it's clear that female guards are as prone to mistreating prisoners as male guards are. Too bad.

Joel Sherman said...

Here are two more references I came across today documenting sex between male prisoners and women guards. The second one claims this was done by 15 guards at this institution giving further credence as to just how common this really is.
It's amazing that some courts have held that women prisoners need more privacy from the male guards than male prisoners do from female guards given that the abuses performed by female guards are greater.

Post one.
Post two.

Joel Sherman said...

Here's a better link concerning the same subject in Texas. It documents 178 complaints against female guards versus 143 against male guards for sex with inmates. The article concerns multiple instances in a juvenile boys' prison. Incredibly some of the female guards are 18 years old in charge of 17 year old boys. What possible sense does that make?
I'm not against equal employment, but it shouldn't be at the expense of privacy, especially with juveniles. And offending guards need to be treated equally. The article makes it clear that almost no women guards have faced criminal charges although it is against Texas law, as is true in most states. Although the sex is presumed consensual, that is the case with male guards too though statistics are hard to come by. Of course the law in most states makes any relations with inmates, teachers and students and often physician and patients criminal no matter whether it's consensual or not.

Joel Sherman said...

Here's a thread on allnurses called 'young female patients.' The comments as always are all over the place but I think it presents the quandary very well.
Males have to be far more careful when treating women than the reverse situation. Whenever I see an adolescent girl I always have the mother stay in the room. If she perchance came with her father who wouldn't stay in the room, I'd bring in a nurse. Male nurses are probably at less risk doing a minor procedure like an ECG in this example, but it's still worth worrying about. And I agree with the comment that the patient's preference should be asked if possible.

Joel Sherman said...

Here's an interesting post on gender preferences by the same Philippine woman physician that I've quoted before:

Another indication perhaps of this is that patients do think that some medical specialties are inherent to men or to women. I’ve known quite a number of women who’d rather not seek medical consult than be examined by a male obstetrician-gynecologist. And surprisingly, a lot of men do decline to be examined by female doctors, especially when their complaints concern the genital area.

Notice how she finds it surprising that men have preferences whereas she thinks it's natural that women do. And she's a physician who is sensitive to these concerns. There's a long way to go before male concerns are as recognized as women's concerns. The rest of the post is worth reading as well as states that her hospital always tries to have both male and female physicians available.

Joel Sherman said...

Here is an interesting thread on allnurses exploring whether male nurses or aides should be doing procedures on women patients. It's amazing to me how many different views are expressed and how many different customs are apparent. Some places men do perineal care routinely on women, in others it rarely happens. But all at least give lip service to patient preference. You would think that there would be some generally accepted standards.

Joel Sherman said...

Moved here by Joel Sherman

MER has left a new comment on your post "Group Physicals":

The last two posts bring up a question that, although it might belong on another thread, seems to follow what we're discussing here. Joel -- if you want this on another thread, go ahead and put it there.
The following are not rhetorical questions. I don't have the answers. I do have some ideas that I'll express further on.
Why are there not more men in nursing?
Are women better at nursing than men?
Why hasn't nursing been subject to "desegration" as have other occupations and professions?
Why has nursing been allowed to be dominated by one gender?
Why hasn't affirmative action or quotas applied to nursing?
Why are there not more incentive programs (to get men into nursing? Or, if there are, why don't we hear about them?

First, I don't think women are necessarily better nurses than are men. This is a vocation, or should be, not just a job. And some men have that vocation as well as women.

But I do believe that, since the 19th century, there has been a deep social belief that women are better suited to nursing than are men, and are better at it. In fact, during the American Civil War:
"A Confederate congressional investigation discovered that the mortality rate among soldiers cared for by female nurses was only half that of those tended by men." (American Women: 400 Years of Dolls, Drudges, Helpmates, and Heroines" by Gail Collins, p. 198). By the way, one of the sources for this book is "Ordered to Care: The Dilemma of American Nursing (1850-1945) by Susan Riverby -- a book I highly recommend.
Citing that study, a U.S.Senator from Louisiana said: "I will not agree to limit the class of persons who can affect such a savings of life as this."
Before that "study" (and I'd like to see the data), there was great concern about how dealing with men's bodies would affect the sensibilities of women nurses. Note, the concern wasn't about the modesty of the men. It was about the modesty of the women. Battlefields and field hospitals are not places where the is time to focus on modesty.

Dorothea Dix required females nurses to be "plain looking women" and at least 30 years old. In some cases they were required to be married -- with the assumption that they at least had had some exposure to male bodies. But these were desperate times, and even Dix ignored her requirements.
So -- consider this. Nursing as a female profession came out of two social events: (1) War (the Crimean War and the American Civil War. But World War I was the event that put the final touches on professionalizing nursing as a women's occupation), and the Industrial Revolution (people moving from rural areas into cities and the social reformers working to improve conditions for women and the poor).
If you study these wars, you'll see that these women nurses saved thousands upon thousands of lives. Much credit must go to them. Although men had been nurses in the past, now they were desperately need to fight the war. These three wars I mentioned above represent the beginning of modern warfare, and by the time we get to WWI, we dealing with weapons and mass casualities never experienced in war before. Modern nurse with females dominating came out of these desperate conditions.
Also, this was a time when females couldn't become doctors (or other professionals)and were not considered suited to be doctors. Before modern medicine, most hospital work dealt with cleaning -- wounds, bodies, waste, body fluids, floors, beds, sheets -- or with cooking. Even reformers like Florence Nightinggale agreed that women shouldn't be doctors. But there were adament that nursing was in the female, not the male, domain.
Early nurses were recruited from the lower classes. This wasn't a respectable job for the upper classes. It was dirty work, the kind of work servants and housekeepers did. This wasn't considered men's work.
Also, there was great concern that these lower class women from rural areas needed an occupation in the growing cities to keep them off the streets -- a respectible occupation suited to their class and education. These young girls were strictly supervised by matrons who were from the higher classes. Doctors didn't want them too educated. Just enough so they could follow orders -- not enough so they could question orders.
So -- what I'm saying is that nursing as a female occupation is a social construct that came out of war and social reform. Nursing (like teaching) is also an economic construct. Historically, nursing (like teaching)has not been a highly respected or high paying job.
But times have changed. Social roles have changed. But the social codes associated with the occupation haven't caught up with the times.
But more men are going into nursing and it looks like the future will bring more balance to the profession.
Why hasn't nursing been "desegrated" as it has with physicians? I don't know, but I do have some ideas.
Much, I think, has to do with the male macho personality, and with homophobia. Most men, I'm guessing, either think it's unmanly to object to intimate female care, or they don't want men dealing with their private parts. Men won't speak up, it seems, if they want a male nurse. But apparently, more of them speak up if they don't want one. At least that seems to be the report from many nurses.
And, in some cases, I still think we're dealing the the social perception that quite often the sensibility of the female nurse trumps the modesty of the male patient. That is, we need to make sure the nurse isn't offended by having to do this intimte care.
The nursing professiona and healthcare system hasn't perceived a need for more male nurses. And it's still assumed in some circles that nursing isn't a man's job. It takes time to change attitudes.
I'm trying not to make judgments here, but I'm attempting to explain perhaps how we got to where we are today. This isn't a complete picture. There's much more to it. But if you read about the history of modern medicine, especially, nursing, you'll get a better overview.
But, as the last post said, medicine is big business today. And business caters to consumers and clients or they go out of business. That's why it's so important for men to be clear about what they require.
Sorry for the long post.

Anonymous said...

" Men won't speak up,it seems,
if they want a male nurse.But apparently more of them speak up
if they don't want one.At least that seems to be the report from many nurses."

Sure, that's the line female nurses want you to believe.

PT

MER said...

I'm not sure what you're getting at, PT. Clarify.

Are you saying that men do speak up and are refused same gender care as regular policy?

Are you saying that there's no or little homophobia on men's part?

If what I've described isn't the reality, what is the reality from your perspective?

Anonymous said...

Few men know that they have a choice. Those that ask are given the excuse, "we have no male nurses
available". Despite the fact that
there are male nurses available.
I believe this issue of male
homophobia is a tatic female nurses
use to exacerbate the myth. The fact of the matter is if a male nurse is gay, who would be the first to know? You guessed it. His
coworkers, and who are his coworkers. Female nurses. Female nurses enjoy this status quo,for reasons of power and satisfaction.
Satisfaction not in a good sense but in a bad sexual sense.All the while maintaining the cloaked aura
of double standard and discrimination. Male nurses are frowned upon and prevented to work in areas such as LD.
You said "Men won't speak up,it seems,if they want a male nurse. But apparently more of them speak up if they don't want one. At least
that's what the nurses say."
Where are the hard data for this. Based on what some nurses say. Do you see the falacy of it.
Thats what they want you to believe!

PT

Joel Sherman said...

MER, I of course don't have the answers to your questions, but they're certainly a good topic for discussion.
I don't know if women make better nurses, but I'm not sure it is an important question. I've seen both men and women who are great nurses and also horrible nurses. The question should not be posed by gender in this day and age, but more basically, what qualities are needed to become a good nurse.
Although female nurses became standard in the military, they have also been a source of male nurses. After each major war there has been an influx into nursing of men who were medics in the army. So it works both ways.
Why aren't there programs to bring more men into nursing? Much of it is just political correctness: white men don't need help, only women, blacks and minorities. But at least I think any overt prejudice against men in nursing is waning. When I was young, many nursing schools didn't admit men. I don't think that is legal now. Men do face some harassment and discrimination in nursing though it varies from school to school, hospital to hospital and floor to floor. Most guys can deal with it, but many men decide to go into more administrative roles instead of floor nursing.
I would certainly support affirmative action to get more men into nursing. There is an onus in being a male nurse; I remember a comedy routine by Elaine May and Mike Nichols about it. The onus is waning but far from gone. But there are so many more opportunities in nursing nowadays that it may be overcome, both by financial incentives and the availability of more macho roles. I note that though male nurses are only about 10%, male physicians assistants are a much higher percentage, though I haven't seen real good statistics. So maybe a different name for the profession would help. There are certainly many men in related fields such as EMTs and medical technicians.
Keep the discussion going.

Joel Sherman said...

Haven't seen this thread until now.
It's a long post on Allnurses based on the ? 2005 Alaskan proposal to mandate that patients be granted the right to request the gender of their providers. The discussion is long. I don't think the bill passed. As usual lots of varied comments.

Anonymous said...

Who cares about the bill! If I want
a male nurses vs a female nurse then the discussion is over. If they can't provide me one then I'll
call administration and find out why. Thats when all hell breaks loose. Read the disturbing comments
on allnurses by discriminating female nurses.

Joel Sherman said...

Here's an interesting thread on AllNurses again started by a male nurse who thinks he has been falsely accused of sexual impropriety. The issue is clearly a serious one. Although this effects female nurses as well, the issue is far more serious and more common for men and clearly one of the reasons that many drop out of clinical nursing.

Joel Sherman said...

I have been reviewing the thesis that Mike posted on the 'we're all professionals' thread. There is a long section dealing with women's preferences for their providers including obstetric and geriatric care. Perhaps not surprisingly the results of various studies give different results depending on age, prior experiences with male nurses, and the intimacy of the care needed and other factors.

Here's some quotes from the paper. More will follow. This section starts on pages 30+ in the paper.

Similar findings were reported by Kelly (1980) in a survey of 50,018 patients,
56.7% of who were female. Kelly found that "female patients were 1.49 times as likely to select a female physician" (p. 430). A study of 409 female patients by Haar, Haiitsky and Stricker (1975) revealed that 33.9% of the women preferred a female physician, 19.3% preferred a male, and 36.2% did not have a preference. All of the studies were performed in North America or the British Commonwealth. The size of the populations of these studies enable the reader to accept that the results may be valid, reliable and generalizable to the general populations within these areas of the world and within the cultures that they represent.

Results of these studies have also been inconclusive as to the preferences of female
patients when it comes to male nurses. Sweet (1974) surveyed 1,000 patients in various
stages of their pregnancies. Thirty-three percent of the women questioned would not want a male midwife to care for them at any point in their pregnancy, while 7% totally accepted the concept of a male midwife. However, 60% of the women provided mixed responses as to the acceptance of male midwives. The areas of least acceptance of male midwives had to do when more intimate personal bodily care was required. The procedures where concern was noted included: examining the breasts and providing advice about breast care, giving advice about vaginal discharge, performing intema1 examinations, delivering the baby, washing the patient after the delivery and examining pads, stitches and breasts or helping with breastfeeding in the antenatal period. "Between 80% and 86% of ail patients would dislike the attendance of male midwives for these procedures" (Sweet, 1974, p. 1620)

Tagg (198 1) obtained the results of a questionnaire from 34 women on an obstetric
unit all of whom had been cared for by a male nurse during that particular hospitalization. Seventy-six percent of the women believed that they could confide in the male nurse, 65% were never embarrassed by the presence of a male nurse regardless of the type of care provided, and 100% of the women had no objections to being attended to by a male nurse.


I don't think the thesis will cover at all the opposite question, which is how male patients feel about nurses, i.e. how many are uncomfortable with intimate care from them, versus the number who would prefer males or who don't care. It’s still assumed that all men are comfortable are there’s no choice to make it worth even discussing.

MER said...

Joel:

I read that thesis, too. The fact that it doesn't cover the female nurse treating male patients, tells the story. That makes a statement in itself.

It's assumed in our culture that female nurse treating male patients is perfectly acceptable and the norm and that male nurses treating female patients may be acceptable in some cases but isn't the norm. Also embedded in that assumption is that female modesty needs protection and that, either there is no male modesty, or if it's observed, its an anomoly, and in some cases a condition that needs therapy. Male modesty doesn't fit in to the concept of what it means to be a man in our culture.

In our current culture, it would be daring, dare I say politically incorrect, for a male nurse to write a thesis focused on the propriety of female nurses treating male patients -- because it would challenge a strongly embedded belief -- so strong that the belief isn't even questioned in mostcircles.

Having said all that -- there is valid concern based upon history and quantitive statistics regarding male violence against females, and males raping and abusing females. That can't be separated from this whole discussion. But that research tends to stereotype men, especially male nurses.

Joel Sherman said...

I think it's understandable MER that a male nurse would write a thesis on how male nurses are accepted by patients and not the reverse.
Yet there remains a notable absence of discussion on the problems that males also have with women providers. This is despite the fact that on an individual basis many nurses and physicians freely acknowledge that men also have modesty issues and are embarrassed. Certainly Dr Alex was notable. I really don't know why there's such a public silence on the matter. Don’t blame it all on a so called conspiracy of nurses; men are also reluctant to speak up.

MER said...

Of course, Joel. I agree with you. I'm not assigning blame to anyone. And I agree that that kind of thesis could be expected from a male nurse because of how a male nurse may see himself within the profession of nursing. We've talked about, I think, how male nurses are sometimes perceived within healthcare and what they are allowed or not allowed to do depending upon the culture of their workplace.

And you're right, of course. Men don't speak up. But I think this brings up another question.

The fact that men don't speak up, the fact that men don't articulate their feelings as well as women, the fact that generally they aren't as good communicators -- these are some recognized traits claimed by psychologists today. All this is not really new, although we haven't quantify it in the past where as now we can do that better.

So, do medical professionals know this about men? Do they understand male psychology? Do they understand how the macho attitude (which includes don't speak up or complain or reveal any weakness) -- do they understand how that attitude affects how men respond in medical situations requiring intimate care?

I have to assume that, being well-trained professionals, most doctors and nurses know enough about male psychology to have, if not an academic knowledge, at least an experiencial knowledge of this.

If they know this about men, why don't they help men to express their feelings, to talk about their values and preferences? Why don't they try to offer them choices, empower them in their weakness? That's what Catherine Dube is doing with her research, with her male focus groups.

I don't know the answer to this question. Is it just easier if patients comply without asking for accomodations -- so why rock the boat? Why elicit "trouble" or cause complicated scheduling and staffing problems when you don't have to? Is that it?

Or perhaps I'm wrong. Perhaps medical professionals are not in tune with male psychology. How well are female (and male) nurses trained in how men and women communicate differently?

What are your thoughts on this?

Joel Sherman said...

It's hard to respond to your questions MER. I don't think most medical practitioners are very attuned to worrying about the psychology of their patients. Hard enough to try to take care of their physical problems. Getting into the psychological concerns would take a lot of extra time for the average practitioner and few of us are really trained for it. None of the extra time would be reimbursed either.
Do most practitioners know about men's reluctance to speak up? Probably, but not because we're trained to take that into account, only because it's commonly appreciated in our society.

MER said...

Joel:

I suspect what you say is correct. But this needs to change. In healthcare, we should be striving more toward the ideal, that is, treating the whole person. Have you read the book "How Doctor's Think?" I highly recommend it.
It's not good enough to just cure the body, the disease. How one treats a patient is intimately connected with the result. It's not good enough to say, "Well, at least he's alive." Don't misunderstand. I'm not denegrating the importance of saving lives. I'm pushing this to the extreme to make a point. Sometimes saving the life may be the bottom line. But, as Marshall McLuhan said, "the medium is the message." You can't separate good communication from good medicine, respect for human dignity from good medicine. It's one and the same.
I do think this ideal is being met more than we realize. But, from what we read on these blogs, it's also being violated. I'm confident that leaders in the medical profession are fully aware of this and are striving to meet this idea. But we need to get patients more into the conversation among the professionals. That's one thing I've been trying to do. And I've found that I've been welcomed, invited, respected and listened to. We need to get that across to people on this blog. For every medical professional you find who won't listen to you, you'll find ten who will. Get out there and respectfully invite yourself into the discourse.

Joel Sherman said...

The two references on Bernstein remind me that I have not talked about this topic in awhile, but I think it is a very revealing and important topic. The two articles discuss women's gender preferences for gynecologic care and some discrimination that has occurred against male gynecologists.
1.) NY Times article
2.) BMJ article.
I can add a third article which gives a military study for women's gender preferences for ob-gyne care. This study reveals that about half the women prefer female care, 4% prefer male care and the rest are at ease with either. My guess is that you would get somewhat similar number if you asked men what gender urologist they would prefer, though the number preferring women would probably be closer to 10%.
But no matter how you look at it, a large number of people do prefer same gender providers for intimate care. There are now many articles about women's preferences, but you have to look a lot harder to find male preferences. Of course until the last 20+ years, women providers weren't an option so there was no point on doing studies on men. A major difference though remains that men can see a male urologist but still nearly always have female nurses while women rarely have male nurses for intimate care, at least in physicians' offices.
Presently 90% of urologists are men and the women frequently specialize in women's urologic problems. The percentage of female obstetricians in training is approaching 90% as well so that an analogous breakdown by gender will soon be present in ob-gyne. None of this excuses gender discrimination in hiring physicians in my opinion. Out of curiosity I checked some ob-gyne journals and they specifically prohibited advertising hiring practices based on gender, but on the web there were indeed ads that got around this by saying that an all female ob-gyne group was looking to hire an additional doctor. That of course is just a subtle way of saying that men aren't welcome to apply.
So in summary, gender preferences are well established for intimate care, but they are not overwhelming percentage wise. Certainly it does not justify any gender discrimination in hiring.

Anonymous said...

Dr. Sherman

I agree to a point, the BFOQ is an issue, being in business I understand that is a concern. However, the BFOQ is usually applied against men and rarely against women. Men have been banned from L&D, men have been discriminated against using the BFOQ much more often than females. If the practice truely felt they would not be able to attract patients becasue of the male GYN one could understand, however the arguements that are used against males are often not applied to females. I have read cases where the measuring stick was since some males use females in these circumstances it does not justify a BOFQ since it isn't all, etc. My question, and one that I feel is just or more important, given the shortage of nurses, and given only 10% are males, why is there not more effort to draw men into the profession......alan

Joel Sherman said...

Alan, I basically agree with you that women have been favored under BFOQ. Still and all, as I point out, the law is hazy and can go both ways. Clearly the fact that at least half of women prefer women ob-gynes would not be a sufficient criterion to refuse male ob-gynes in employment. Preferences alone have not generally been held to be sufficient cause to justify discrimination. But most newspapers and journals will not accept ads that clearly mandate a gender preference for employment so it has to be done surreptitiously. I don't know how common all women ob-gyne practices are. As men are in general more willing to tolerate obtrusive call hours than women who generally have greater family responsibilities, most practices still want them. But it may be changing. Obviously it is impossible to argue that women won't accept male physicians when they've been seeing them for centuries.
Can't give you any reason why male nurses are not more actively recruited into the profession. There could be many reasons. I certainly would like to see it. Though I don't think male applicants to nursing schools are discriminated against to any significant degree which used to be the case.

MER said...

Joel: You write:

"Can't give you any reason why male nurses are not more actively recruited into the profession. There could be many reasons."

I think there are economic and political and legal reasons -- if not for the lack of recruiting -- certainly for the hiring practices.

The public reason for not hiring more male nurses is that they're just not available, they're hard to find, or that men aren't really interested in this field.

The underground reason? We can't ignore this fact: Male nurses, medical assistants, techs, need a female chaperone when they work with a female patient for intimate care. That ties up two employees. I've actually been told (in whispers) that by large practices that have only female medical assistants. Male doctors need a female chaperone when with female patients. It's easlier, more convenient, to have an all female staff.

This is what annoys me most about this whole issue. The discrimination is underground, acknowledged and discussed underground, denied publically.

Joel Sherman said...

You exaggerate somewhat MER. Hospitals don't use chaperones for male nurses routinely. There certainly are male nurses in clinical nursing with women patients. They also don't use chaperones for techs who usually wouldn't be doing anything intimate, but many see women's breasts routinely. Male CNA's are rare and I think few would ever be used to bathe women although it happens in nursing homes.
Offices are different and there I agree with you. I find it surprising that some urology practices don't have any male assistants. A general practice wouldn't have much use for male assistants unless women physicians use chaperones with men. There I think they ought to have them. Male home health aides are almost non existent and most services won't hire them. They just see the potential for trouble as being too great. But yes, they can't advertise for female aides; they just reject the few males that apply.

MER said...

Joel:

You may be right about hospitals, but my take has convinced me that quite a few male nurses either avoid working with females if possible, especially if they have to use chaperones. It seems to them a waste of time to use up two people for one procedure. And when they do work with a females, many get a chaperone for their own protection, whether or they are required to.

Anonymous said...

I understand that in most cases the lack of privacy or respect (concerning opposite gender intimate things) most often concerns money. What I don't understand is why it doesn't seem to be a general practice at many hospitals and clinics to send in male nurses for male patients and female nurses for females if it is at all possible. If a patient wants to he/she can request someone of the other gender. If someone of the same gender isn't available they should ask the patient if it's OK to send in someone of the opposite gender. Why would that be so hard to do?

Obviously, emergencies would be a different story but even then, if there is a male nurse and an unconscious male patient comes in, it should be obvious to send in the male nurse for him.

I've heard so many experiences, probably some of them here, where a male nurse or tech is sent to a female patient while at the same time a female nurse/tech is sent to a man, just because the hospital or clinic has a policy to send in each nurse/tech in the order that the patient arrives. The nurse/tech happens to be at the top of the list as "available" no matter what the gender. It's just disgusting and unethical.

I would bet my life savings that if I, a male, was a well-trained nurse or tech I wouldn't be hired at the first few places where I apply. Not because I bombed the interview but because I'm a guy. I'm tired of hearing everyone say there are so few male nurses/techs out there because men never apply.

Joel Sherman said...

Anonymous, most hospitals would find it difficult to accommodate same gender requests. They're just not attuned to it and not enough people ask for it to be an issue for them. Certainly most could offer better accommodation if it was a priority.
I really don't believe the average male nurse or technician has much trouble finding a job. There are quite a few of them and I believe the number is increasing. There is a scarcity in most fields and with a few probable exceptions such as obstetrics, gender isn't a great concern for hospitals. It would be a bigger concern for some offices depending on the role they would serve.

Joel Sherman said...

MER: You may be right about hospitals, but my take has convinced me that quite a few male nurses either avoid working with females if possible, especially if they have to use chaperones. It seems to them a waste of time to use up two people for one procedure. And when they do work with a females, many get a chaperone for their own protection, whether or they are required to.

In my experience MER, male nurses don't avoid women patients, but if intimate care is needed, they may well trade off with a female nurse for the procedure. Depends on the setting.
At any rate, it's rare for a female nurse to offer men the same consideration even when it's clearly feasible.

MER said...

Joel:

I hear what you're saying, but what's the motivation for "trading off?" Is consideration for the female patient? Is it to avoid having to call in a chaperone? Is to protect themselves legally? Is it because they don't feel comfortable doing this for whatever reason? Is it a combination of all of these?

What's the line between "trading off" and "avoiding?"

Joel Sherman said...

Don't really know MER. I got this info from female nurses on the unit.
My guess is that they don't use chaperones, but trade mainly for the patient's comfort.

MER said...

Joel:

I know we shouldn't assume too much about anonymous posts, but read this link on allnurses -- male nurses talking about how they protect themselves from false accusations and lawsuits. Although not conclusive, I think it is a fair indication of what's going on much of the time.

http://allnurses.com/male-nursing-forum/what-do-male-375554.html

Joel Sherman said...

Thanks MER. I looked at the thread. I really don't know how common a problem this is. I don't know of any male nurses in my area who have been accused of sexual misconduct, but if it was never public, I might not know. I have read through other threads on allnurses where some male nurses said they have had no problems. But they are all cautious and need to be wary of certain patients. I myself would generally not do an exam on a new teenage female patient without a parent in the room, and I don't even do intimate exams. So we all live with that to some extent.
It's not just in medicine by the way. Male grammar school teachers in lower grades have similar issues. Time Magazine had an article within the past year or so quoting one male teacher who said he would not help his young 1st or 2nd grader girls in the bathroom without leaving the door open to protect himself. Society at large has a much greater fear of male sexual predators than of females, and undoubtedly the incidence of abuse by males is greater.

Anonymous said...

JD, Do you realize that women are just as intelligent as men? Where I am in Australia, educators are worried about boys not performing academically as well as the girls. Girls and women don't need any affirmative action here, the boys do.

Joel Sherman said...

Not sure what post you're referring to but there is little doubt that women don't need any affirmative action in most areas anymore. Boys are falling behind scholastically to a great extent. Some colleges are now 60-40 women which is becoming such a problem that some schools are giving male applicants priority over equally qualified women. See The Trouble With Boys by Peg Tyre. Women have made great strides in this country while men have stood still or fallen behind.

Anonymous said...

I read a article in USA today awhile back that just infuriated me. Some time back it was determined that girls were not performing in school as well due to social issues and the manner in which schools operated. A great effort was made to correct that though programs and educating teachers, it seems it worked so well the trend not only reversed but males are now far behind...yet, the people who did the original study which was a womens study organization challenged the study and said it could be a lot of things so they did not see the need to change anything but take a wait and see. The same group that was the cataylst for change when females were thought to be on the short end, challenged and thawrted the effort to address it when males were on the short end....we need to get past the historical aspects of discrimination and look where we are today, yesterday wrong or right is gone, we can not change that....but we can effect the future by what we do today....

Joel Sherman said...

To my knowledge, your comments are factually correct. The National Organization of Women and the American Association of University Women have consistently portrayed girls as being under served and discriminated against in schools. This was true in the past, but it is no longer valid. They have tried to undercut all evidence to the contrary. As far as they are concerned, anything that helps boys takes opportunities away from girls. USA Today published an article written by NOW in the past year trying to debunk the increasing evidence that boys are failing in school.
There are other groups that have taken notice of the trouble boys are having in school so there is much contrary information which doesn't get anywhere near as much publicity as NOW can generate.
If you want more information, The War Against Boys by Christina Hoff Sommers is a good place to start. There are also more recent studies.

Joel Sherman said...

I post this article only because it's so unusual. A 55 year old male nurse is suing a nursing home for discrimination and sexual harassment. He started being harassed when it was found out that he had previously been a male stripper! Don't know how you go from being a stripper to a RN. That would give me some second thoughts too, male or female. But anyway, it's such an unusual tale that I thought I'd reference it.

Anonymous said...

It would be interesting to know the details the case and what they based the ruling on. Did the staff deny the events happened, did they say he was a willing partcipant? There is obviously a different measuring stick depending on the gender of the accuser/accused. I read a court case where a female prisoner won a court case that ruled it was cruel and unusual punishment for a male gaurd to pat search her, yet they ruled females could pat and strip search males. In other cases the court ruled two female gaurds did not violate a prisoners rights or committ sexual harassment when they strip searched him and made him stand there while they pointed and laughed at him, the court ruled since he didn't touch him it wasn't haressment. A muslim prisoner lost his case for relief from having a female gaurd repeatedly and randomly strip searching and watching him shower him under violation of his religous freedom. I found it interesting that we recognized this as being unacceptable (though granted Abu went further) in war but not at home.....in the medical community there has been a mixed case history with males in the labor and delivery as being a bona fide employment qualification. This definately seems to be a double standard. If the facts as presented are accurate and complete...there would be no doubt it would be considered harassment if the accused were male and the accuser female...alan

Joel Sherman said...

This link was posted anonymously under male modesty, but is more pertinent here.
It discusses gender differences in a general way, but is very applicable to employment differences. It does not target health care.

Joel Sherman said...

I've now read thru the entire article. It makes many very interesting points that at least I've never come across before. It provides a rational basis for explaining how and why individuals and society treat men and women differently and expect different behavior patterns from them.
A few basic points are that women interact more on an intimate one on one level whereas men deal with larger and less intimate relationships. Men take greater risks, and gain and suffer greater benefits and losses including death.
The article lacks any quantitative proofs but should serve as food for thought. I think it is surprisingly free of any feminist or male rights ideology.

Joel Sherman said...

Alan, from April 22, I assume you're referring to the case above of the nurse ex-stripper. There has been no ruling in the case yet that I know of, but it will be interesting to find how it's decided.
But I have mixed thoughts about the case. I think if it had been a woman, she too would have been subject to many comments and perhaps harassment. You just don't expect strippers to become nurses.
Certainly several women teachers have lost their jobs for appearing in nude photos. Don't think any have successfully challenged their dismissal. It's hard to maintain professionalism when your coworkers and patients have nude pictures of you.
The guy's case would be much stronger if he had not apparently hid his background.

ESF said...

Equal-employment opportunity is a one-sided coin: in theory it applies to everyone, but in practice, only to women and minorities.

The other point is that both public-health and patient care facilities have women's programs but not men's programs - and the women's programs are staffed exclusively by women! That sure is a BIG gender preference

Joel Sherman said...

Here's an article from the UK which predicts that women physicians will be in the majority in 8 years there. The same trends are apparent in this country.
The article documents some differences in job preferences between male and female physicians. Not surprisingly, women tend to go into a few specialties (such as pediatrics and obstetrics) and greatly prefer flexible work schedules over the traditional grinding hours that doctors have served. Men also are avoiding grueling hours, but still many more are willing to accept them than women.

Joel Sherman said...

Here's an interesting thread on allnurses under the topic 'do male nurses receive as much respect.' To my surprise, most of the respondents that I read said they thought male nurses got more respect than females both from doctors and patients. The reasons for this when offered though seemed to be mostly that it was a form of prejudice, that men are held in higher regard in general.
Interesting thread.

Joel Sherman said...

Here's another thread on allnurses which is worth reading, especially if you believe that more male nurses are needed.
A guy states that he's thinking of becoming a nurse, but people tell him that doing so is 'gay.' The responses are good and should be more widely known.

Joel Sherman said...

Here's another thread on allnurses. This concerns a male ICU nurse who was reassigned from a pregnant patient because the head nurse thought it was inappropriate even though he had already taken care of the lady. He wasn't doing any obstetrical care on her; she was in the ICU for other reasons. He complained to the nurse manager and was backed up.
Male nurses are generally well accepted but can still face prejudice from other nurses although I think it is the exception and not the rule.

Mandy said...

The increasing preference for female gynecologists means many hospitals, clinic's seek to employ females.
This is causing a lot of concern amongst male doctors. I suppose their livelihood is at stake.
Even my grandmother now chooses a female doctor for most things. She hated seeing male doctors for personal things and avoided them.

I was reading the ObGyn.net website. It's a very touchy topic and the men are VERY defensive.
This preference has been challenged in the Courts and it now seems clear that women can request same sex intimate care and employers can employ to meet that need. An exemption to the discrimination laws.
The same exception enables us to have all-female gyms.
I think these laws would enable men to express a preference for same sex intimate care and would protect a urology clinic seeking male nurses only.
It is a precedent...not based on fear of sexual assualt.
The decision was more about "the patient being more comfortable in a confronting and vulnerable position" or words to that effect...
I think that would equally apply to male care.

I needed to see a gyn last year and attended the emergency room.
A male gyn was readily available. I declined and said I'd wait for the female. I was told she was rushed off her feet, but I could wait if I liked...at least 2 hours.
Even though I felt shocking, I simply couldn't face a male doctor for something so intimate.
Several times the nurse approached and said the male Dr was available and could see me immediately if I was sick of waiting.
I preferred to wait...
I eventually saw the female gyn 3 hours later. It was clear she was flat out.
My question: the nurse said it always happened, long waits to see their female gyn's while the men were standing around or with less to do certainly.
Why not employ more female gyn's? The patients have clearly expressed their preference.
Do they employ the male hoping women will get tired of waiting? What's the point? Surely the problem is solved by employing more female gyn's.
I spoke to the nurse briefly and was told that it was probably something about equal opportunity, but it was causing problems with sometimes 6 patients waiting for the female doctor with the male gyn's underwhelmed with work.

It doesn't make sense to me - equally having a female urologist hanging around the coffee machine while her male peers are flat out...doesn't make sense either.
It seems the Law isn't the issue, so why the resistence to using common sense? Is it the profession refusing to believe gender is an issue for many patients in face of overwhelming evidence to the contrary?

Joel Sherman said...

Mandy,
Do you have a reference for the legal cases you refer to? Are they on the ob net?
Isolated cases do set precedents, but do not establish state law unless they are appealed to the state supreme court.

Mandy said...

Dr Sherman, Here is an article from the New York Times that covers a few points.
There have been cases since this Article was published...
Basically the sex-bias cases have failed using case law that sets a precedent for using same sex in some position....like wash room attendants, gyms and nurses.

http://www.nytimes.com/
2001/02/07/us/women-s-health
-is-no-longer-a-man-s-world.
html?pagewanted=alls

Joel Sherman said...

Thanks for that link, Mandy.
It gives a balanced view of the present situation. I note that it is 8 years old and the preponderance of women in ob-gyne has undoubtedly increased since then.

Anonymous said...

At least you got to choose Mandy, even with the long wait. Men don't often get a choice to have a male nurse. It's "take the female nurse or get lost".

The preference question hardly ever even comes up. The send in a female or two and they just start ordering you around, assuming there will be no objection. Unfortunately there usually isn't an objection. As horrible as it may be most men just follow orders and feel humiliated beyond belief, but allow the female nurses to see and touch anything they want, no matter how unnecessary and unethical.

Joel Sherman said...

Here is a thorough and illuminating article on the present status of male nurses in the US. Among many other facts, he states that only 5% of working nurses are men though they are 10% in nursing schools.
The article outlines many of the problems they face and also talks about male minority students.

Joel Sherman said...

Here's a good reference first posted by MER on another thread that explores gender diversity in medical personnel. It gives statistics for the gender ratios in various medical specialties and for nurses where it is still lacking to a major degree though showing some improvements. Lacking is a full discussion on the value of gender diversity and how to improve it in areas where it is lacking.

Joel Sherman said...

Here's an interesting thread on allnurses which I haven't gotten through yet. It discusses a trend in Ohio to retrain laid off factory workers to become nurses with slogans of guaranteed employment. The nurse who posted thinks it's going to reduce the status of nurses, but so far many disagree with her(?). It will certainly increase the percentage of men in nursing professions.

Joel Sherman said...

Here's an interesting story about a black male nurse who is suing his former NC hospital for falsely discharging him after he was accused of touching the breast of a female psych patient. He was tried in a court and found innocent. He is suing the hospital for 10 million dollars.

Anonymous said...

I'm glad the black male nurse was found innocent but 10 million dollars is ridiculous. He couldn't make that much money in 100 years.

Anonymous said...

An interesting discussion about men who have been discriminated against in nursing school and in the profession. Quite disturbing. Apparently, it's a larger problem that is publicized. I realize that some nurses claim that men sometimes get the opposite. It probably varies considerably from region to region, site to site. But this thread is not pleasant to read. It's a long thread. Start at the end and read backwards.
MER

http://allnurses.com/men-nursing-forum/discrimination-against-men-116888-page17.html#post4170021

Joel Sherman said...

Haven't gone thru all the comments yet MER, but there is no question that male nurses can face harassment and discrimination in nursing school and the work place. Of course women face the same in occupations where men predominate. Two wrongs don't make a right though.
I don't think the discrimination against male nurses is pervasive, but solely dependent on the personalities involved. It varies from school to school, floor to floor. I have talked briefly to a few male nurses in the hospitals I attend and none seem dissatisfied. Of course I have no way of talking to those men who have been casualties along the way.

Anonymous said...

You're right, Joel. Women face the same things, maybe even worse in some cases. I'm not in any way diminishing the problems women have and are having breaking into legit fields dominated by men. And both men and women do have a basic obligation to tough it out when they can and prove themselves, which many of them do. What bothers me is the "recognition" factor. We have the same "recognition" factor in education regarding gender learning styles. Girls have problems within out ed. system. It's been recognized and is being dealt with. But boys have problems too -- if fact the research is stunning (percent of men and women going to and graduating college; percentage of boys in special education classes and being treated for ADD and ADHD; percentages of boys who are successful in committing suicide, etc.). In some cases these stats aren't even acknowledged as relevant. When they are, very little is being done about them. Politicians are reluctant to touch this hot potato.
It's a question of recognizing that these problems exist for both men and women, and extending the same kinds of reliefs to help them, the same treatment, real gender equity.
It's not a question of gender wars, pitting one gender against the other. It's a question of recognizing that both genders have specific problems with discrimination and being willing to recognize and acknowledge that.
Men in nursing is just part of a large problem within this context.
MER

Joel Sherman said...

Talking about higher education, I'm sure you're aware that women are now going to college in far higher percentages than men. It's gone so far that many colleges are giving preference to less qualified men to try to equalize the numbers; in fact women don't want to go to schools where men are unavailable. The United States Commission on Civil Rights is looking into this to see if women are being discriminated against. I await their report, probably years away, with great interest. Will the emphasis indeed be discrimination against women, or will they talk about equalizing opportunities for men and diversity issues. I am skeptical that they will go beyond discrimination issues though the parallels with women's access issues of prior years are inescapable.

Anonymous said...

Joel:

For a very recent article about this issue, check "The State of American Boyhood" by Judith Kleinfeld published in 2009 in Gender Issues.26, 113-120. This has the most recent data and gives a very fair and objective view of the issue. Here's the article:

http://www.boysproject.net/papers/stateofboyhood.pdf

MER

Joel Sherman said...

Excellent reference, MER

Sommers book, The War Against Boys stated the problem clearly but was so antagonistic towards women's group that it caused a negative reaction from women's groups. This report just gives the facts and avoids gender wars. I quote from the conclusion:

Advocacy groups who proclaim either a “boy crisis” or a “girl crisis” are misguided. Neither sex is in crisis with the exception of Black boys and young men. The characteristic difficulties of girls, however, have been and are still being addressed. The difficulties of boys, however, which span far more areas, have been generally ignored. Those who call attention to the problems of boys are not anti-feminist or resentful of girls’ progress and success. The debate over which sex is worse off goes in no useful direction. Both boys and girls face characteristic problems which need policy attention.

Anonymous said...

I scanned the Kleinfeld report and read Sommers' The War Against Boys and her prior book Who Stole Feminism?, neither of which call for a "gender war." Rather, they are more like exposés of the harm that feminism has knowingly wrought; those groups do not promote gender equality. There really are no major educational difficulties that girls have at present, nor have there been for at least two decades. A brief (9 min.) discussion can be found on YouTube. Judith Kleinfeld is trying to be conciliatory in her report, possibly to avoid having it attacked by the A.A.U.W. and other feminist institutions.

Do not underestimate the degree of discrimination males face in nursing or any other medical support fields. Unlike women breaking into largely male fields, they do not have immensely powerful advocates behind them, nor any kind of massive outreach to increase their numbers. Much like individual male patients trying to protect their modesty, they struggle alone, and the people that would deny them know that.
--rsl

Joel Sherman said...

Here's an interesting thread on another nursing forum. A student nurse told her professors that she's not comfortable doing intimate procedures on men. Most look at her like she's crazy.
The comments are interesting. Most tell her she needs to get over it.

Anonymous said...

A short, free online class for nurse instructors called "Teaching Tomorrow's Nurses: What's Happening in the Classroom" written by Maureen Habel, RN, MA, a nurse author from Seal Beach, Calif. and Ann Kim, RN, BS, MSN, MPH, CNS, a full-time lecturer in the School of Nursing at California State University, Long Beach.

A quote from the course:

"Today’s nursing students are much more ethnically diverse — and an increasing number of them are men, and faculty must adapt. Because of their socialization, some men may have a different, but valid, approach to some elements of nursing. Some men, for example, have a harder time expressing emotion and may not establish therapeutic relationships with patients in the same way that most female nurses do. Men may be more likely to use humor and less likely to use touch. Women may view that way of relating as inattentive and nontherapeutic, based on their female expectations for communication."

Very encouraging. A clear understanding that men and women differ in how they may approach nursing, and both approach are valid. It's an interesting read, if you're curious about how the profession is reacting to educating a new generation of nurses. You can find it at:

http://ezines.nurse.com/PowerEmail/GHG_J+J/J+JCESponsorship_050810.html
MER

Joel Sherman said...

I'm not sure I agree with your take on that post MER. I find it somewhat sexist, though well intentioned I'm sure. Guys who choose nursing as a career are far more likely to be in touch with their emotions and comfortable with 'touching' than your average guy.
Secondly, I don't think many nurses have time for touching and emotional involvement with their patient anymore. Some nurses predominately pass meds and spend the rest of their time ministering to the computers that demand constant updates.
Certainly the comment was meant to be sympathetic though.

Joel Sherman said...

Here's an old thread on another nursing forum which asks the question 'should male nurses do bed baths on women.' As usual a variety of responses are given which are worth reading.

Joel Sherman said...

Here's a relevant discussion on allnurses patient modesty thread:

Today, June 6th, tbrd450 has posted what to me is an interesting point of view, that is if same gender care is available to women it should be available to men as well as a matter of law as to do otherwise results in employment discrimination. Don't know if that has really happened, but it is certainly a legal argument with some validity.

swf said...

I'm sure my problem with all of this has been stated, restated, and even perhaps overstated, but here goes:

I read all sorts of posts from male caregivers who seem to respect the modesty of women. Males who find a female to trade with when a female states hesitancy. Males who send females in to make sure the female patient in the shower is O.K. And male nurses who have to sign forms regarding being alone with a female patient. Aside from not wanting to be part of liability, some of these males seem to have an inate desire to make the female patient feel safe and secure in the environment. Is that a matter of men traditionally wanting to protect women? Is it a matter of understanding how it feels to be on the uncomfortable end of opposite gender care? Is it CYA? All of the above?
My opinion: female nurses can learn from male nurses, or they can simply fight the entitlement issues and keep using the same tired arguements over and over and over and over......

Anonymous said...

"Is that a matter of men traditionally wanting to protect women? Is it a matter of understanding how it feels to be on the uncomfortable end of opposite gender care? Is it CYA? All of the above?"

Yes, swf,it's all of the above, but it's mostly a survival strategy. The latest stat I read on men in nursing is just over 5 percent, over all. They are an extreme minority in a female dominated profession -- in a society where females in general are legally a protected minority. If they don't practice with care and empathy they won't last long in most healthcare areas. I'm not saying those other elements don't come in. I'm sure they do. But male nurses see the writing on the wall, and they'd better be extremely proficient in reading and interpreting it.
MER

Joel Sherman said...

The Atlantic (Monthly) magazine has a long article this issue called 'The End of Men, How Women Are Taking Control - Of Everything.' It's an article that should be of interest to many readers here. It covers more than just employment, talking about the preponderance of women graduating college and other issues as well.
I highly recommend it.

Anonymous said...

If you think that Atlantic article is interesting, go to the website and read all comments that the article has elicited. Talk about gender wars! Some of the comments on both sides have merit. But overall, the comments demonstrates the potential harmful, even violent backlash that could result from the kind of situation the article describes.
MER

Joel Sherman said...

Here's an interesting article on affirmative action which contains the amazing statistic that in Quebec, specifically McMasters University Medical School women have been over 75% of the students and that affirmative action is needed for men.

Anonymous said...

I haven't read all the posts but I want to just draw your attention to the situation in Australia. Here we have a slight majority if girls performing better than boys at school and slightly more women than men at university and doing post graduate studies. But once women enter the workforce they are not promoted or earn as much as their male counterparts. In fact only 8% of boards of public companies are women! I don't have the numbers of female CEOS but it is truly abismal. So they is a huge waste of talented women just not getting the rewards for all their hard work.

Joel Sherman said...

The situation is similar in the US. Girls have performed better than boys in primary education here for decades. Women are an increasing majority of college students, over 60% at some schools. Many schools have started giving preference to men in college admissions to redress the imbalance.
There is still a salary imbalance in the states though it is improving. Some of it is unfortunately due to the Great Recession here which has hit men much harder than women. In a few markets such as New York City however, it has been shown that women entering the workforce actually earn more than men. There remains though a large imbalance in executive positions.

Joel Sherman said...

For the first time in history, women make up over half the work force in the US. The shift is related more to the unequal effects of the recession cutting far more severely into men's jobs than women's.

Daniel said...

I am a male who just got my CNA license and I came here to vent.

I was in a class of 12 and 4 of us were males. I had the highest grade in the class and I'm pretty sure I had the highest grade in our college's whole program. I got some great references from my instructor and clinicals supervisor as well as past supervisors. I have no criminal history. I'm 29 years old. I have a lot of experience in supervisor roles. I have a ton of experience in service roles and working with the public. I've plans of finished my bachelor's degree online and applying for PA school and I had hoped that getting my CNA license would provide with opportunities to get clinical experience. I'm in great shape. There's nothing wrong with me except that my only experience as a CNA was in the 100 hours of clinicals.

I. can. not. get. a. job. to. save. my. life.

I know people are going to read this in think that I'm hiding something or that I must lack the self-awareness to realize that I'm doing something horribly wrong, but it's really not the case.

Over the past couple of months I would guess that I've applied for over 100 different positions at 40 different LTCFs and hospitals. I've often done research on the company and it's values and written personalized cover letters. I have never, not once, walked into a facility wearing anything less than a tucked-in white dress shirt with tie, black socks and dress shoes, and ironed khakis. I've made phone calls and post-application inquiries and I've gotten back nothing. I've reapplied for jobs that are somehow "still open" and I've gotten nothing. No job offers. No interviews. No phone calls. Nothing.

I've responded to dozens of internet job postings that say, "experience not required". I've gotten referrals from our college's program director, from companies *asking* for new graduates. I've gotten nothing back.

When I started, I was given the impression that being a male would work to my advantage -- not because of male patient modesty, but because I can do a lot of heavy lifting. I've now come to realize that it's all bunk. People say, "we need male CNAs" like they say, "we need to hire a professional organizer". It doesn't actually translate into action.

Never in my life have I had this much trouble getting a job. Between the CNA class and my recent (record) unemployment time, my finances are blown. I've finally come to the point where I've made a decision I really, really, really, did not want to make. I'm now going to leave the are I've lived and grown attached. I'm going to leave all the friendships I've developed. I'm going to move into my mother's house, where she can help me get a job. My mother has worked a fairly high-up position in area nursing homes for the past thirty years and she's more baffled by my situation than anyone. I just can't figure it out. I can't find anything that I am doing wrong and neither can anyone I've talked to.

(CONT'D)

Daniel said...

(CONT’D)

I can not say with certainty that there is a push *against* male CNAs, but I do know that there is not a push *for* us.

I'm a big believer in respecting the modesty of female patients and I think that if they don't want a man seeing them undressed then that should be respected. But it should be respected by working around it, whenever that's possible, even if that entails a little more added effort than just refusing to hire males.

I'm also a big believer in respecting the modesty of male patients and I think that if they don't want a woman seeing them undressed then that should be respected. But they don't have much of a choice, do they? While the female residents can always be assured that there's another woman to take care of them, for the males this is a luxury -- an occasional possibility. And even when there is a male CNA like myself present, are all the men going to wait for the guy on level 2 to come up and clean the diarrhea off of them? Are they going to have to have the energy go through that hassle, day-in and day-out, for the final years of their life? Their gender preferences, their 'choice', is really rather illusory. No matter how modest they may be, they always end up having to accept that this is the way things are.

And they're told that reason for this is because, *ahem*, there is a shortage of qualified males in the field. Riiiiight.

Joel Sherman said...

I too am puzzled Daniel. I think there is unquestionably a heightened suspicion of male CNAs. Add that to the fact the some female patients will refuse male CNAs whereas women are rarely refused, I'm not aware that many places are actively seeking out male CNAs.
But despite that there are male CNAs working in convalescent homes and hospitals; my mother was frequently taken care of by one in a nursing home and there were no problems. Can I ask what geographic part of the country you are in? There may be differences. Good luck. Let us know how you make out. If you can prove gender discrimination against any institutions, you might have a good legal case. But that is a difficult road to travel.

Daniel said...

Difficult indeed.

One thing I forgot to mention (in case anyone wonders) I always checked that I was available for any kind of work and for any kind of shift.

I'm in the DC area. In Maryland. I've thought about how my location might affect things and I can think of two complicating factors: 1. The area is stressful, high-traffic, and expensive and might have fewer elderly because of this. 2. The area has a large foreign-born population -- especially African and Central American. For whatever reason, the CNA (or GNA, as we say in MD) field seems to draw a lot of foreigners.

Anonymous said...

Daniel:
My guess is that this is a regional situation, and can even vary institution to institution. LTC facilities can justify hiring females only under the BFOQ laws if they can demonstrate that their female residents won't permit men to work with them. They won't tell you this, but if you walk into a LTC facility that's all female staff, you might assume that's the case. I don't justify this, and I wish you all the luck in the world. I see a good number of male nurses and cna's where I live, and generally an open attitude toward them.
MER/Doug

Daniel said...

After taking a big breather, (phew), and checking my other options, it turns out that mum *can't* get me a job after all. The 'open' positions she knew of are not really open, but are just listed that way so that they have a pool of applications anytime someone quits. I imagine many of the places I applied to use the same practice.

I really don't know what the deal is and it wasn't fair of me to drag gender into the issue. I know a lot of area LTCs have taken hard hits because of the economy. It could be this way for everyone. I hear that new RN graduates are having a surprisingly tough go of it as well.

What I do know is that there is no LTCF in my particular county that can honestly say, "We'd like to hire male CNAs for our male residents, but we just don't have the applicants."

Joel Sherman said...

I have no clear category for this. A just released federal report on prisons for juveniles looking at rape of inmates found these conclusions. 80% of rape was perpetrated by correctional officers and 95% of them were done by women guards. Here's a quote:

Approximately 95% of all youth reporting staff sexual misconduct said they had been victimized by female staff. In 2008, 42% of staff in state juvenile facilities were female.

This is the end result of putting equal employment rights above privacy considerations in prisons.

Daniel said...

I'm back (see above comments) and I have updates. I feel I can confidently say now that if there is a shortage of male CNAs, it's a shortage in demand, not supply.

Today, I counted the number of 'auto-replies' in my inbox. I have collected exactly 80 auto-replies. Each and every one of them represents a unique application submission.

To give that number a little more scope: some of the online application systems I've used give 'auto-replies' every time you apply for a position. Many-if-not-most of the online application systems don't give auto-replies at all. And then, of course, many of the facilities I've applied to don't have online application systems at all.

Given all that, I can guestimate that I've made approximately 150-200 application submissions -- and I only applied to facilities or for positions that did not say "experience required".

I think I've gotten a total of 8 responses, now. One was from a facility my Mom works at – it resulted in a rejection following my only interview. One response was only won after repeated follow-ups that ended with me making a discrimination complaint (long story) -- I might still get an interview for that and it might result in an every-other-weekend shift. This came after I met in person with an HR director, who told me that his facility does employ many men, but that my gender probably was a deciding factor in other applications -- since most residents are female and don't want males taking care of them (what he didn't say, but we both knew, is that male residents don't demand male CNAs because they don't know that this is an option).

The other six responses I got died the moment that they heard my voice. I did not receive a single follow-up for the first 100-150 submissions I made. So, late in the game, I decided to try something different and took a few things out of my apps/cover letters, including any and all references to my gender (my real name is androgynous, but it's a little more common for females). I got all my responses within days of this adjustment.

The most recent one happened while I was driving home from the grocery store. A woman left a voice-mail giving her name, facility, phone number, and saying she would love to have me come by that afternoon. I called back exactly 20 minutes later, a woman (who sounded exactly like the woman who left the message) picked up and when I told her my name and why I was calling, she said, "The person who handles those things has left for the day." She got my name and number and said that she would have "the person" call me back, which, of course, never happened.

Joel Sherman MD said...

Daniel, it sounds as if you have enough evidence to file a federal complaint against one or more of these institutions with the Equal Employment Opportunity Commission (EEOC). I don't know the details but you can find out what you need to know online. Probably you don't need a lawyer to file. I think it would be worth your while and would help any men after you. These institutions can't claim that women patients don't want men taking care of them as a sole defense as they all have enough male patients to keep a CNA busy.

Daniel said...

Yes, discrimination complaints can turn out quite well. The aforementioned complaint actually did get me a phone call today and then it got me an interview.

The charge nurse asked me three questions and he seemed quite smitten by me. He said he wasn't going to ask me any more questions because I had given pretty-much-perfect answers to the ones he asked. He told me he was going to try to get me on his unit and he said that he really needs a male CNA. I've pretty much secured a part-time position now -- the day after I had decided to completely give up on the job search.

All this comes after (and as a result of) a written discrimination complaint that had me in a sit-down with the facility's head of HR (I mentioned this above).

This is not at all what I had expected when I made the complaint, and now I kind of regret the hostile way that I wrote that complaint. Reading all this, you might think they've pushed my application along to avoid a law suit. I don't think this is the case. I think that the complaint resulted in a job because it resulted in HR pulling up my application and giving it a close look. It resulted in them meeting me in person. I was no longer just another piece of paper in the stack.

Funny, how things work sometimes. If there's one lesson I've learned from all this, it's that it really is about who you know. If I had to do the job search all over again I wouldn't spend any of my time on applications or resumes or follow-ups, I would spend it pursuing volunteer opportunities that would put me in contact with people who can see my work ethic.

As for EEOC charges, I'm kind of sick of paperwork at this point and I don't want to drum up government investigations until I've given them a chance to tell their side of the story. By now, I'm too exhausted to bother with it. There's only one facility where I feel really confident that my gender was a factor, and they might have wanted me for an at-home-care position.

Joel Sherman MD said...

Here's an interesting thread on allnurses.com.
A male nursing student complains about how his instructor treated him on his obstetrics rotation. In usual allnurses fashion they have now closed the thread, but the responses are interesting. Many male nurses responded, some with identical experiences and others with good experiences. It is clear that most of the difficulty comes not from patients but from female nursing staff. I have seen this same problem before in this and similar circumstances such as male medical students learning how to do pelvic exams.
The problem can be generalized to one gender predominant professions protecting their own. Similar problems happen to women in male dominated fields, but they are far more likely to bring lawsuits.

Joel Sherman MD said...

Here's an interesting thread on allnurses. A questioner, probably male, asks whether male nurses get preference in hiring. The question aroused considerable passion mostly from women who understandably were upset at the idea. But there's some good discussion too.

Joel Sherman MD said...

Here's a NY Times op-ed column discussing the work habits of male vs female physicians. A striking difference is that a far higher percentage of women over men work part time. This does indeed have consequences for the entire health system in this country, especially given the increasing shortage of physicians in general practice. With nearly half of medical students now women, the physician supply problem can only get worse.

Joel Sherman MD said...

An interesting case has been filed by the EEOC (Equal Employment Opportunity Commission) against a Missouri Hospital who is alleged to have discriminated against a male nurse who applied for transfer to the OR. They turned him down allegedly because they preferred women for the job.
The EEOC obviously thinks the case has merit. No BFOQ can apply here. Only a small minority of these case are brought on behalf of men. It will be interesting to follow the case, which will likely take years.

Doug Capra said...

Yes, we need to follow this case. It will be interesting to see why they prefer women for the job. I assume they'll need to justify it with some evidence. I think this is an example of how audacity plays a role here. "We prefer females in the OR." Although I don't agree, I could see "We prefer females in OB-GYN." But in the OR in general? One gender will push special preferences as far as they can until the other fights it.
Doug

Joel Sherman MD said...

Doug, the hospital has already hinted at its likely defense, it will deny that they give preferences to women.
But the EEOC obviously believed the man's complaint.

Joel Sherman MD said...

Here's a new thread on allnurses, a 50 year old male is asking if he would face any discrimination or employment problems if he became a nurse.
Most of the answers so far are positive, that is he would not have any problems as a man. Some seem to think men get hired preferentially. Most note that overall hiring is down right now though.
It is my impression that male nurses have no trouble getting hired in general. I have talked to many male nurses in my hospital and most are quite satisfied relating no discrimination. Now I'm referring to job discrimination. That does not mean that an occasional female patient refuses their care, but it is uncommon.

Joel Sherman MD said...

Here's an interesting and complex story from Dearborn MI where there is a large Muslim population. A male nurse working in a public clinic was given conflicting orders about dealing with Muslim women, then fired. One supervisor told him not to deal with any Muslim women because their husbands objected; another countermanded the order.

He is suing for damages. The question is whether public agencies have the right to discriminate against their employees by gender.

Anonymous said...

Doug:
Why do you not agree with "we prefer female nurses in OB-GYN"? You state that you understand this but do not necessarily agree with it. It seems that goes against everything we have talked about on these blogs; i.e. same gender preferences for intimate care. Also, Dr. Sherman: you state that male nurses may have the "occasional" female refuse their care. I do not have a problem with male nurses for general care but would not want one for intimate care. Do you think only the "occasional" female patient feels this way? Do you think most females accept male nurses for all types of care or do you think perhaps they just do not feel able to protest? I still think that we should have an equal mix of male and female nurses because that would allow patients to have a greater chance of getting same gender care if that is what they prefer. I do not think we should have an equal mix if it only means both male and female patients would be exposed to care from both genders regardless of the nature of their care or preferences. I don't really see why it would be a problem to patients or nurses if intimate care could/would be provided by same sex nurses. After all there are both male and female patients. Nurses would have equal opportunity for providing care. Why would it matter to them whether or not they were providing that care to a male or a female? And for patients that don't have a gender preference, why would it matter to them if they received their care from a same gender nurse?

Joel Sherman MD said...

Here's a follow up story on the above with fuller details.

Doug Capra said...

"Doug:
Why do you not agree with "we prefer female nurses in OB-GYN"? You state that you understand this but do not necessarily agree with it. It seems that goes against everything we have talked about on these blogs; i.e. same gender preferences for intimate care."

I'm not clear what comment of mine you're referring to. I've always made my position clear. I'm for patient choice of provider gender, both genders. I am not against opposite gender care in all cases, i.e. where it doesn't matter to the patient or is the preference of the patient. The case here under discussion is different -- it's about poor judgment on everyone's part. The female nurse who told the male nurse not to treat female Muslim patients was out of line. The male nurse should be sensitive to Muslim culture and ask and follow the patient's request. The doctor who ordered the male nurse to treat female Muslim patients as any other patient was also out of line. And the male nurse should know better. This case is about poor judgment on everyone's part.

I'm concerned with gender discrimination and double standards, like what we sometimes in OB-GYN -- where male nurses are just refused jobs there. Some women don't mind having a male nurse in OB-GYN; others might prefer a male nurses. What I'm against, is not even giving these women a choice by banning all male nurses from OB-GYN. That's just plain gender discrimination. Period. Male nurses have a place in all medical departments. Patients also should have choice of gender, esp. for intimate procedures. Of course, if a Muslim woman, or any woman, doesn't want a male nurse, that's her choice. Same for men and female nurses. That's my position.
Does that clarify things? If not, please let me know specific what your comment above refers to.

Anonymous said...

Doug:
Yes, that does clarify your position/point and I agree 100%. So, yes, I suppose male nurses should be allowed in ob/gyn care as there are undoubtly some women who would not object to their care (although not necessarily prefer it). It still seems to me that most people that do not have a preference for same gender care would accept care from either gender, so it would not matter to them if there were not any choices. In other words, if only female nurses were available in ob/gyn I don't think patients would have a problem with it. I guess the only problem that would come up would be if male nurses felt it was discriminatory to be denied positions in those areas if they had that preference. In that case, then, it would be more about the hospital staff's feelings/rights and less about the patients'. Does that make sense? Jean

Doug Capra said...

"In other words, if only female nurses were available in ob/gyn I don't think patients would have a problem with it."

True, perhaps, but then -- if only male sailors were allowed on submarines, the other male sailors probably wouldn't have a problem with that, either. Etc. Etc. You might get away with only hiring female nurses in OB-GYN if you could demonstrate to the courts the requirements of the BFOQ laws -- but that's not easy. You'd have to demonstrate that you'd go out of business if you hired males because all the females would refuse them. On these blogs, we need to realize that the case may be that most patients don't mind opposite gender care -- and that may go for, if not most, certainly a significantly number in OB-GYN. What I've read about this, from women, is that, once that have an empathetic, caring male nurse, they accept him. But if they never have the opportunity to even see a male nurse, what then?
It's about choice. Choice implies more than one option. There are two genders. Both need to be available for patients to have a choice.

Joel Sherman MD said...

Here's an interesting article quoted on allnurses about the status of men in nursing. It is based on a federal study.
A brief summary, the number of men in nursing has tripled since 1970 and they now represent nearly 10% of nurses. On the average they also earn more than female nurses.

Joel Sherman MD said...

The full government study can be found here.

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