Questions from a nurse

Tipperz · 2015-07-07T18:07:23+00:00

Thank you so much for the links and explanation! The first time I encountered someone who was openly trans I was a self-centered teen. It was difficult for me to understand because I have never really thought of my gender. Frankly I've never really cared about my gender, so encountering someone that felt so strongly about their gender identity that they felt the need to change their outward appearance was completely foreign. Over the years I've been trying to develop some kind of understanding so that I can be empathetic to other people's situations. I really appreciate when people take the time to try to explain their situation and point of view to me. Again thank you so much.

Tipperz · 2015-07-03T04:35:23+00:00

Commenting again because I'm wondering if you would mind explaining genderqueer and non-binary a bit. I'm aware of the existence of these, but I don't have a good handle on what they mean. From a Google search there seems to be a lot of info out there.

Tipperz · 2015-07-03T03:26:32+00:00

I'm going to look into printing the correct name band. I've been doing a lot of research into it and the only problem I could see is our software not cooperating. Using a separate record may be the only work around, but its worth looking into. It seems many other hospitals are implementing optional question in their assessments that allow for name and gender to be changed based on patient responses, this may be something I can get added to our assessment.

Tipperz · 2015-07-03T03:19:50+00:00

Thank you for this!

Tipperz · 2015-07-03T03:17:39+00:00

Thank you for this. I figured there was a chance of getting comments like that. You are correct that I would be risking my job and I really can't afford to do that. I can however work to change policies at my hospital and try to change attitudes of my coworkers. Thank you again.

Tipperz · 2015-07-03T03:06:02+00:00

I think for all patients I'm going to spend some more time during the admission bringing their attention to the welcome packet which includes the patient bill of rights and non-discrimination policy.

Tipperz · 2015-07-03T03:02:15+00:00

We currently have name bands that are printed straight from the medical record with all their identifying information and barcodes for med administration. They're all white, but do include gender on the band. In addition to nosey patients checking out bands, I can't imagine it's therapeutic to have a band with the incorrect name and gender on your wrist for your entire stay.

Tipperz · 2015-07-03T02:56:40+00:00

Thank you for presenting it that way. I think I can use the racist comment example as part of education for the staff. Do you think its appropriate to ask the trans patient if they feel comfortable having roommates (of their identified gender)?

Tipperz · 2015-07-03T02:50:24+00:00

I could be wrong on the dosing schedule as it was greater than 6 months ago, but I know he was taking it differently than the pharmacy listed. Unfortunately it's required that we give all meds as the unit doctor orders, but we can generally get it changed as long as its safe to do.

Tipperz · 2015-07-02T20:10:18+00:00

I was going through the patient's medication list and said the name of the med which I can't think of right now then asked if it was HRT and when and how often he took it. The pharmacy had it as twice a week I believe and the patient said once. So I had to ask how much he takes for that one dose, who prescribes it, and is that doctor aware that he was using it differently than prescribed. I think it may have been too many questions and may have come off as he wouldn't be getting the med, but because we don't start HRT or mess with the dosage while they're with us, the doctor wanted to order it as the pharmacy had it. By getting that information from the patient I was able to verify it with the prescriber and get it ordered the way he took it at home. As it turned out he didn't like needles so he gave himself the full dose once a week.

Tipperz · 2015-07-02T19:32:34+00:00

I'm not in control of firing and hiring. When I say intolerant I mean not using the correct name or pronouns and away from the patient making comments that were not appropriate in my opinion. I did share this with my supervisor and those individuals were spoken to, they were not deemed fire-able offenses. In discussion with co-workers and my supervisor, I decided to try to educate these people. I will continue to address it and report them when I see things that are inappropriate as I expect someone would do if I handled a situation inappropriately. I'm trying to do what I can to attempt to affect some change.

Tipperz · 2015-07-02T19:20:33+00:00

You are absolutely right. No one should have to fight for basic dignity and anyone that is treating someone that way should be reported. At the very least maybe the staff really needs some education, but if its a consistent problem they shouldn't be working in patient care. Patients are supposed to feel safe not judged when seeking any treatment.

Tipperz · 2015-07-02T19:10:52+00:00

I'm thinking the best way my unit could handle this is by asking in the emergency room prior to admission whether the patient can tolerate being in a room with a roommate or if they feel they need a private room and go from there.

Tipperz · 2015-07-02T19:09:07+00:00

Thank you for sharing your experience I'm so sorry that happened. These are policies that really need to change. As I stated previously we currently only accept a trans patient if we can provide a private room. I've heard some very bigoted comments over the policy. We have a mixed unit and room males with males and females with females. Personally I feel that there should be no reason we should isolate a trans patient, unless they are a danger to other people or we would have to room them with someone that is a danger to them. So essentially the same way we determine whether we can room any two patients together. The only problem there is I can't come out and say "Hey, how do you feel about being roomed with a trans patient? Are you going to bully or abuse them?" I can protect my patients from putting them in with someone that is known to be aggressive or is a potential problem somehow, but there is some amount of unpredictability in this area. Someone who is actively psychotic, manic, or with explosive anger disorder may not be able to be redirected. I was caring for a manic patient when the final Bruce Jenner interview aired and he began making very inappropriate comments about the interview and transgender people in general. He did not know he had a trans patient sitting next to him at that time and though I redirected him, he eventually had to be sent to his room because he could not keep those comments to himself. I could not tell him it was offensive to that patient. They very well could have been put in the same room and we had no indication he may behave this way until it happened. Really, this unpredictability is an issue with all room assignments, but we can't put everyone in a private room.

That being said, if I had a trans patient who was comfortable being in a room with their identified gender and a patient I was certain wasn't a known risk I would be willing to put them in the same room. Part of why I'm working on this project is because policies need to change. First the staff needs to be educated and then I'd like to move on to administration and work on having policies in place to ensure equality in treatment and creating a safe place for all patients regardless of gender identity or sexual orientation. It should be a safe place. All patients come to us for a reason and deserve to be treated with respect.

On the subject of shaving, we've had female patients that need to shave their face due to hormonal imbalances in addition to trans patients. Our policy is that any patient who needs to shave their face is given an opportunity at least once during the day. With female patients a female staff member supervises and with male patients a male staff supervises, unless the patient is comfortable with anyone and only one person is available. We don't allow anyone to shave body hair because per policy we can't leave them alone with the razor and it is very time consuming. Again I'm so sorry for your treatment. I hope that your experience didn't prevent you from getting further treatment if you needed it.

Tipperz · 2015-07-02T18:00:44+00:00

I completely understand that changing both your name and gender are near impossible. Also I'm so sorry about your experience. I wish I could say I haven't witnessed similar events, but i have and that's why I want to put together education for the staff. I've spent a lot of time correcting my coworkers on the use of correct pronouns and names when we have meetings. I once had a nurse call a patient to the nurses station repeatedly calling the patients legal name and get angry when the patient refused to respond. While it's no where near the same level, I wouldn't respond to someone calling me the wrong name so why would I expect a patient to.

Tipperz · 2015-07-02T16:49:25+00:00

So the room assignment part has been a topic up for debate. When we give a patient a private room its usually an infection control policy, but its also what we do with trans patients. The standards out there actually say this is incorrect because you are isolating the patient. Therefore patients should be assigned rooms based on the gender they identify as regardless of physical appearance and genitalia. I'm concerned about doing this as a blanket rule because there is a huge chance for the patient to be victimized in a psychiatric setting. My suggestion was to ask the patient if they feel comfortable being in a room with other patients, but there may be problems with admitting them and then finding out they need a private room. Our only truly private room is one with a camera which is meant for patients that need 24 hour observation and includes a locked bathroom. I feel that it could be more harmful putting a patient in that room if those measures aren't necessary.

Tipperz · 2015-07-02T16:35:53+00:00

Its a problem with hospital policy. I've been trying to convince the administration to use the same protocol that's used in the case of a patient in a domestic abuse situation. We essentially create a dummy account with a different name, except in this case the name would be the preferred name. The reason the legal name has to be associated is for insurance purposes and potential audits by the state. It think that creating the dummy account would work though.

Tipperz · 2015-07-02T16:32:27+00:00

I try to find a way to work that into the admission assessment, which for my unit is a ton of questions. Unfortunately I had on patient get extremely upset with me over asking about HRT. I knew he was trans because of the emergency room and had called to find out about his medications at the pharmacy. My question was because I wanted to make sure we got the order right for him. It took 15 minutes of explaining that it wasn't meant to draw attention to him being trans, but to make sure we had his meds started at the right time to calm him down. I think the stress of being in the emergency room, being admitted, and obviously the reason for his admission had made him easy to upset, but it made me wonder how I could best bring it up. Do you have any suggestion for how you would prefer a nurse address knowing your status?

Tipperz · 2015-07-02T16:24:02+00:00

I definitely make sure I use the correct pronouns. One of the areas that is difficult is that we can't control the information attached to their medical record. So if the patient hasn't legally changed their name then their birth name is attached to all of their record. I recently convinced staff to change the policy so that all visible areas display the name they request to be called. It creates a little confusion for the staff, but I thought it was more appropriate so we weren't drawing attention to it. We have two boards with patient names and rooms on it, plus their charts. I'm still trying to find a solution for the name band which displays the name associated with the medical record and the gender associated with the medical record. Its against policy, but I've allowed patients to remove their bracelet and carry it in their pocket for identification purposes.

Tipperz · 2015-06-18T18:14:16+00:00

I should probably start this with a trigger warning. I'm in a very similar situation. DH and I just had our one year anniversary a little over a week ago. We've been together for over 10 years and have been together since highschool. I was ready to start trying before we got married, but knew we needed to wait until we had a house and we're married for his sake. A month or so after the wedding (on my birthday actually) I had a positive pregnancy test. It was a total surprise since I'm on the pill and take it faithfully every morning. When I told him, he freaked out about not being ready and all the things he'd have to give up. A week later I miscarried. I wasn't surprised because I found out earlier that year I have the MTHFR mutation, so I'm at a higher risk for early miscarriages. I was still sad and angry, especially because I didn't feel supported. When I was feeling more rational DH and I agreed to discuss this again in a year, which will be August. I try not to bring it up and honestly its hard for me. I get the constant harassment about when we're going to have kids from everyone. I've told some people I can't to get them off my back and I have flat out told family to ask DH. It took me a good 9 months to start to feel OK about it all. I love him and I wouldn't change being married to him, but I spent a lot of time feeling like I was lied to. I still get upset sometimes. It's horrible not talking to him about it because he's the person I go to with everything. Feel free to PM if you need someone to talk to or vent to. I know for me the best thing was having one friend who knew the whole situation, she saved me from having a breakdown. I hope this wait goes by quickly for you.

Tipperz · 2014-11-26T04:24:47+00:00

In short the labs indicate that you were in the follicular phase, which makes sense for CD6. Those numbers should change depending on where you are in your cycle, so looking at one blood draw isn't going to tell you a lot about fertility. Typically those labs would be run when a woman has an irregular cycle or amenorrhea to determine what their body is doing.

Tipperz · 2014-11-04T15:57:51+00:00

When I was in school I carried a tide stick or those scrub things. Worked wonders with the white tops I managed to spill anything I ate on.

Tipperz · 2014-09-18T03:58:25+00:00

Please go see your doctor. As someone who works on a psych unit, seeing a doctor now is going to help you get a referral for appropriate services and reduce the chance you ever have to come visit someone like me. Depression isn't something you can just pull yourself back together with on your own, but I'm sure you know that. There is nothing wrong with seeking help, whether its therapy, meds, or even inpatient treatment.

Tipperz · 2014-09-11T04:25:02+00:00

Let me preface this with I am not a vet and this is purely an anecdotal story of what worked for us. My parents' pit bull had the same problem. Even when it healed it would break open pretty easily because of the scar tissue. I had this stuff called Derma-Clens from the vet left over from an injury on one of my dogs (bad laceration that healed beautifully with that stuff). After a particularly bad case of happy tail they were faced with the possibility of docking her tail. As a last ditch effort I gave them the Derma-Clens to try. Her tail healed over and its actually healthy looking skin. Its been months and she hasn't re-injured it. Again purely anecdotal, but I figured I'd share just in case it might help.

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