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Dealing with Difficult Patients: Suicidal behavior

By Joan Monchak Lorenz, MSN, RN, PMHCNS-BC

Many nurses don’t feel comfortable completing a suicide assessment. Some nurses can’t imagine anyone thinking that killing him or herself is the best solution to any problem. However, many of the patients we serve have thought that way and some are actively suicidal, and we are not even aware of it. Being aware of the signs of suicide, and making a suicide assessment, can save your patient’s life. As with many other assessments, practice facilitates mastery. This chapter will give you lots of guidelines and tips to help.

It is important to remember that most suicide attempts are expressions of extreme distress, not harmless bids for attention. Also, any person who has expressed suicidal ideation should not be left alone and needs immediate treatment.

What if I think someone is suicidal?

One way to determine whether a person is thinking about suicide is to ask directly: “Are you thinking about suicide? Are you planning to kill yourself?” Doing this will not plant thoughts in the person’s head. Doing this will not cause the person to consider suicide if he or she was not thinking about it. Doing this will not cause the person to try suicide. By asking directly, you show you are not afraid to tackle the hardest of situations, and it is a way to show the patient that you can be trusted. Suicidal individuals seek out those whom they trust and feel connected to in some way. One of the most important factors in preventing a suicide is the presence of a supportive person.

Don’t panic: If a person does tell you that he or she is suicidal, here’s what you can do:

  • Stay calm and listen.
  • Let the person talk about his or her feelings.
  • Be accepting, and do not judge.
  • Ask whether the person has a plan, and if so, what it is.
  • Don’t swear secrecy.
  • Do not leave the patient alone. Take him or her with you if you must, so you can get help.

Don’t ignore the warning signs

All mentions of suicide must be taken seriously. Warning signs include:

  • Thoughts or talk of death or suicide.
  • Thoughts or talk of self-harm or harm to others.
  • Aggressive behavior or impulsiveness.
  • Previous suicide attempts, which increases the risk for future suicide attempts and completed suicide.

Assessing the possibility of suicidal thoughts

Ask the patient the following questions to assess the possibility of suicidal thoughts:

  • You have been through a lot lately: How has that affected your energy (appetite, ability to sleep)?
  • Many people in your situation may feel sad and blue or depressed: Do you feel that way?
  • Have you ever felt so sad and blue that you thought that maybe life was not worth living?
  • You have been in a lot of pain lately: Have you ever wished you could go to sleep and just not wake up?
  • Have you been thinking a lot about death recently?
  • Have you recently thought about harming yourself or killing yourself?
  • Have things ever reached the point that you’ve thought of harming yourself?

If the person says that he or she has thought about self-harm or suicide, the next step is to assess whether the person has a plan and the ability to carry out the plan. Ask questions such as these:

  • Have you made a specific plan to harm (kill) yourself? If so, what is it?
  • Do you have a gun (knife) available for your use? (Find out if the person has access to accomplish the plan.)
  • What preparations have you made? (This might include purchasing specific items, writing a note or a will, making financial arrangements, taking steps to avoid being found, and/or practicing the plan.)
  • Have you spoken to anyone about your plans?
  • Would you be able to tell someone if you were about to harm yourself?

Keeping the patient safe

Your next step is to make sure the patient is safe. Most facilities have policies about levels of observation or supervision for patients who are a suicidal risk. There is also a process for further assessment of the patient. Again, never leave a person who has expressed suicidal thoughts alone. Take him or her with you to get help. Always read and follow your facility’s policies.

In general, there are some universal safety measures to take with a person who is suicidal:

  • Keep the person on continuous observation, such as 1:1 or in your line of sight.
  • Restrict the person’s environment for safety. Ask the person to remain in a certain area where staff members can see him or her at all times.
  • Do not allow the person to be alone in a room.
  • Check the person at intervals of five, 15, or 30 minutes.

Staff supervision is necessary when a patient uses items such as sharps (nail cutters, razors, or scissors), cigarettes, and/or matches; is around potential poisons, such as cleaning supplies; uses the bathroom or kitchen; and/or goes off the unit for treatments, therapies, or tests.

Joan Monchak Lorenz, MSN, RN, PMHCNS-BC is an HCPro author and contributed to the book Stressed Out About Difficult Patients.

 

Dealing with Difficult Patients: Behaviors that drive you bananas

By Joan Monchak Lorenz, MSN, RN, PMHCNS-BC

Does a certain group of patients simply drive you bananas? Sometimes you can’t put your finger on it. Something just doesn’t fit for you. Then, someone points it out to you by saying, “Don’t you see how he or she is manipulating you?” Oh, that’s it! He or she is a manipulator and the problem is solved. Or is it? What is manipulation? How does it get in the way? Can it ever be a good thing?

Persuasion, influence, and manipulation: What’s the difference?
Persuasion and influence are often seen as positive traits. We look at people who seem to be able to encourage others to get things done and wish we could be more like them. Indeed, very popular books have been written that teach others how to persuade or influence others. For example, there is a famous book by Dr. Jerome Frank—now updated by his daughter Julia—called Persuasion and Healing. It elucidates the positive influence of therapeutic relationships and other psychological healing  techniques. In addition to this classic for healthcare providers, numerous pop books on the market give lots of hints on how to stop arguments by persuasion, get projects completed by influence and persuasion, and further your career by using your influence and persuasion.

Bothersome behaviors
Rather than using the label “manipulation,” let’s refine the definition and talk about the specific behaviors that drive us bananas. Then, let’s look at ways to handle these behaviors in our work situations.

Whether we see them in patients or our peers, the following are some behaviors that cause distress in the workplace.

First, we have the overt types of behavior that come across as verbal violence. These are often easier to handle because they are so overt. It is hard to miss them. They include:

Making demands: “I must have this weekend off to attend my cousin’s graduation,” or “I can’t go to x-ray until after I have my shower and shave.”

Violating rules and routines: A staff member consistently comes back from break or lunch late. A patient’s family member brings in food from home, even after being told that the patient is presently on a very restricted diet.

Making threats:
“I’ll throw this food tray at you if you come any closer.”

Then, we have the more passive types of behavior that are meant to persuade you to do what the person wants. These might be harder to spot. If you grew up with adults who used these, you may even think they are healthy behaviors. Once pointed out to you, however, they may become more obvious.

Eliciting pity:
The staff member who says, “You just don’t understand how hard it is for me to take care of that patient . . . ,” but says this often about all kinds of patients. Or the person who is abusing drugs: “If you had my horrible upbringing you would take drugs to numb your pain, too. Can’t you see how tough my life has been?”

Ingratiating and flattering:
The person who is always commenting on your clothes, your jewelry, and how good you look. Or the patient who says, “You are the best nurse on this floor. I don’t know what I would do if you took a day off.”

Evoking guilt feelings: When people say, “If you had called me over the weekend like you said you were going to, this would never have happened,” or “If you had made your rounds earlier like you usually do, I wouldn’t be in this mess.”

Abusing compassion: When patients say, “You acted like you were a caring person and said that you would have a hard time on a restricted diet, so why are you making such a fuss over my wife bringing me food from home?”

Attempting to exchange roles: When someone says, “I see that you have a problem with your weight. I am a fitness trainer and can help you with a personal plan to get you in shape. When you get a chance, come back and we’ll start on it.”

Pitting people against each other: When a peer says, “That night shift is something else. I don’t see them making rounds or doing any of the things I know they should be doing at night. You guys and gals on the day shift are top-notch.” Or when a patient says, “Who is that young doctor who came in here yesterday anyway? I bet you know a heck of a lot more about my condition than he does.”

Questioning competence or authority: When a patient says, “Now, honey, you just go take care of your other patients, and send in the charge nurse. I need a real nurse in here to answer my questions.”
Being overly dependent: People who allow others to do for them, do not accept self-responsibility, and then skirt responsibility if things go wrong. They say things such as “I am sure you know best. Just take care of that for me. I rely on all you nurses to make sure I get better.”

Using avoidance: People who change the subject when it comes up, avoid being around people they dislike, or are silent rather than open with their opinions. When they do speak, it is in order to avoid: “I can’t be on the same team as Susan. We don’t work well together.”

Joan Monchak Lorenz, MSN, RN, PMHCNS-BC is an HCPro author and contributed to the book Stressed Out About Difficult Patients.

Why Do Healthcare Workers Report to Work When Sick?

By John Palmer
This article originally appeared in PSQH.

It’s no secret that that healthcare can be a dirty profession. So why is it that despite the warnings about the dangers of not wearing appropriate protection around hazardous drugs and infectious diseases, workers still choose to put themselves in danger?

It’s an interesting conundrum, and wearing the proper Personal Protective Equipment (PPE) is just as much for the protection of the patient as it is for the worker. In fact, a report published in the November 2017 issue of the American Journal of Infection Control found that as many as 4 out of 10 healthcare professionals show up at work even when they are sick with flu-like illnesses.

The study makes the assertion that illness transmission by healthcare employees represents a grave public health hazard.

Lead researcher Dr. Sophia Chiu called the findings “alarming” and cited an earlier study that showed patients exposed to a medical worker who is sick are five times more likely to get a healthcare-associated infection. “We recommend all healthcare facilities take steps to support and encourage their staff to not work while they are sick,” she added.

The survey of nearly 2,000 health workers during the 2014-2015 flu season interviewed doctors, nurses, nurse practitioners, physician assistants, aides, and others who self-reported flu-like symptoms at work such as fever and cough or sore throat.

“Healthcare personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in healthcare settings,” the report’s authors wrote. “Influenza infections are associated with thousands of deaths in the United States each year. Transmission in healthcare settings, where there is a higher concentration of elderly persons and individuals with immunosuppression or severe chronic disease, is a major concern.”

According to the report’s findings, of the people surveyed 414 (21.6%) of the workers reported flu-like symptoms, and 183 (41.4%) reported working with the symptoms for at least three days at a time. Pharmacists (67.2%) and physicians (63.2%) had the highest frequency of working with symptoms suspected to be the flu.

By work setting, hospital-based workers had the highest frequency of working with flu symptoms—more than 49%. The most common reasons given for working while sick included still being able to perform job duties and not feeling bad enough to miss work. Among workers at long-term care facilities, the most common reason was inability to afford lost pay.

Suggested solutions

So, what does this mean? Well, perhaps most revealing about the study is the prevalence of healthcare workers who think it’s acceptable to show up for work when they aren’t feeling well.

“Training to change social and cultural norms of HCP, such as the expectation to work unless experiencing severe symptoms among clinicians, might address these misconceptions,” the authors wrote. “Different strategies for modifying norms might be needed for different healthcare occupations. For example, physicians develop their sense of professional identity and adopt professional norms and values over a long period of training, which may differ from the experience of nonclinical HCP.”

In addition, the authors of the study came up with several suggestions that healthcare facilities can use to try to fight the problem of workers coming to work sick.

Make workplace policies clear. After listening to the reasons workers gave about why they came to work sick, including the ubiquitous “I could still perform my job duties,” and “I wasn’t feeling bad enough to miss work,” it became clear that individuals may not be the best ones to make the decision about whether they should work. For that reason, the authors stressed that there should be a clear policy and culture that stresses the importance of infection control in the healthcare workplace.

“Employers can convey that the perspective of infection control at the institutional level is important for HCP to consider when deciding whether to work during (an illness),” according to the report. “For example, one academic medical center instituted a triage system requiring HCP with fever or upper respiratory symptoms to undergo evaluation and viral testing. This system provided symptomatic HCP with more information regarding their risk to others. This institution also instituted mandatory absence from work for at least 7 days if testing was positive for influenza.”

Make it easier to take sick time. Many healthcare workers interviewed in the survey said did not take time off from work when they were sick because they were could not afford to lose pay for time off. This may mean that you need to consider a change in policy for sick time. The reports authors suggested institution-level resources to accommodate sick leave, including a “jeopardy system” in which some workers are held in reserve to back up sick colleagues.

This “may help reduce common perceived barriers to taking sick leave when the risk of transmission to others is taken into account,” the report said. “Such barriers include difficulty in finding coverage and desire to not burden colleagues.”

Make the flu shot mandatory, but remember that it isn’t a guarantee. Many facilities encourage their workers to get the flu shot every year, and in fact some make it mandatory. The report’s authors claimed that the fact that a worker received the flu vaccination at any time during the 2014-2015 influenza season may have contributed to the decision to come to work, even with symptoms. In other words, their perception is that there is no way they could have the flu if they’ve gotten the shot, which of course is not the case. Workers should be educated about the flu vaccine, and again, should be encouraged not to come to work if they feel sick.

In many places, it’s still not legal to require flu shots for employees, and if unions get involved it’s a much more complicated issue. Many people still have religious requirements, or moral protests against required flu shots. But the truth is that the flu shot has been proven to be safe and extremely effective.

Therefore, employees who work with patients should be encouraged to get a flu shot each year. In most cases, the flu vaccinations are free, and they really will make things healthier in your facility. Statistics show that those who get the shot stay healthier with very little risk of side effects. That translates to healthier workers who can come to work and not get patients sick. At the very least, there must be a very strict policy in place preventing patient contact when workers are sick, and in all cases, they must wear face masks when working anywhere around patients with compromised immune systems.

During the winter months, you should encourage workers to stay healthy. Your staff cannot help patients when they are not well, so encourage them to keep healthy by living a healthy lifestyle. They should be washing their hands regularly, eating well, and getting plenty of sleep—and staying home when they are sick. They should be getting plenty of exercise, downtime, and time to spend with their families and pursuing hobbies.

Make PPE mandatory, and train more. It should be common sense, and common practice, for anyone who works in healthcare that PPE is part of the job. Yet for some reason, workers still come up with every excuse not to use it.

Over the years, PPE—and standards from OSHA and other regulators—have been developed to help reduce and prevent workers from getting hurt or sick on the job. Yet, every year, we hear more about how healthcare workers have some of the highest workplace injury rates in any industry in the United States. To make things worse, every so often an illness rarely, if ever, seen in the U.S. makes its way into the country’s healthcare facilities (think MERS in 2012 or Ebola in 2014) and changes the way the healthcare community looks at PPE. In addition, training often takes a back seat because of shrinking budgets and lack of time.

“PPE does not remove the hazards; it protects the individual,” says Marjorie Quint-Bouzid, MPA, RN, NEA-BC, who currently serves as vice president of nursing at Parkland Hospital and Health System in Dallas. “Healthcare organizations must continue to attempt to mitigate potential hazardous situations or practices as the first line of defense.”

The trouble doesn’t stop with infection control. Pharmacists who handle hazardous drugs, and the nurses who then administer them, are at high risk of occupational exposure. These exposures can cause acute health effects, from sore throats to hair loss; allergic reactions; cancer; and reproductive toxicity—including an increased risk of miscarriage.

A 2011 National Institute for Occupational Safety and Health (NIOSH) survey reported that the most common reason given for failing to wear gloves was that “skin exposure was minimal”—an opinion at odds with various biological measures of worker exposures.

In 2011, NIOSH surveyed 2,069 healthcare workers—most of them nurses—who had administered one of more than 90 specific antineoplastic drugs in the previous week about their adherence to safe work practices. According to the survey, which was published in the Journal of Occupational and Environmental Hygiene in 2014, workers reported that they had engaged in risky activities or been exposed to hazardous drugs by incidents that included:

 

  • Failing to wear a nonabsorbent gown with closed front and tight cuffs (42%);
  • Priming intravenous (IV) tubing with the antineoplastic drug (6% had done this themselves; another 12% reported that this was done by the pharmacy);
  • Taking potentially contaminated clothing home (12%);
  • Spills or leaks of antineoplastic drugs during administration (12%);
  • Failing to wear chemotherapy gloves (12%); and
  • Lack of hazard awareness training (4%).

When NIOSH asked healthcare workers why they did not wear their personal protective equipment (PPE), including double gloves and gowns, while compounding or administering hazardous drugs, it found that workers were essentially shrugging off the risk. “Skin exposure is minimal” was the most common answer to the question, followed by “not part of our protocol” and “not provided by employer.” The researchers concluded that “there is a perception among respondents that chemotherapy drugs pose a minimal exposure risk.” In addition, workers reported that employers failed to implement safe work practices and provide PPE in many cases.

 

What providers can do this National Suicide Prevention Week

National Suicide Prevention Week is September 10-16, bringing awareness to the 10th leading cause of death in the United States. This week is a time for physicians, nurses, and other providers to learn more about how their healthcare organizations can help suicidal patients.

In 2013, 9.3 million adults had suicidal thoughts, 1.3 million attempted suicide, and 41,149 died. Even more worrying is that the rate of suicides has increased 24% between 1999 and 2014. And as of March 2017, Joint Commission surveyors have been putting special focus on suicide, self-harm, and ligature observations in psychiatric units and hospitals. Surveyors are documenting all observations of self-harm risks, and evaluating whether the facility has:

  • Identified these risks before
    •    Has plans to deal with these risks
    •    Conducted an effective environmental risk assessment process

To learn more about suicide prevention in healthcare, check out the following websites and articles.

Resources

Clinical Nurse Leaders, partners in quality improvement

Quality within any healthcare system depends on improving patient outcomes, which rely on continual nursing professional development and overall improvements in system performance. One of your most important resources for managing such improvements is the Clinical Nurse Leader (CNL). This clinician is a Master’s prepared Advanced Generalist nurse who builds quality measures in patient care outcomes and implements evidence-based practice principles at the clinical point of care and service. These outcomes align with the facility’s goals and strategic plan and can positively impact patient care processes.

 

For example, when working with a CNL, you can align the care team with strategic performance goals. CNLs and the Quality Systems team are important resources for strategic planning for quality and performance improvement (objectives, priorities, expectations, deliverables, and timelines). Working together, you can establish an infrastructure for engaging and motivating staff and other team members to work toward achieving improved patient care outcomes within the organization’s measures of performance. CPI only happens when everyone engages to improve management of operations and care delivery.

 

As the context of healthcare environments continually evolves and changes, your role becomes more complex and demanding. However, these growing challenges offer expanding opportunities for developing partnerships with your nurse manager, CNLs, and interprofessional team members to improve quality, practice, and competency in managing unit operations and coordinating patient care. By taking of advantage of these opportunities, you can help create a unit culture of safety, quality, and practice excellence.

Source: The Effective Charge Nurse Handbook

Four easy ways to provide patient education

The responsibility of educating patients and their families often falls to nurses, from explaining procedures to providing discharge instructions. This can be one of the most difficult parts of the job, and your staff may have limited time due to staffing issues or an emergency situation. Here are some tips to help educate patients quickly and effectively:

Handouts are your friend: Patients are often given a lot of information all at once, and it can be hard for them to remember every detail, especially in a stressful hospital setting. Having notes and props ready for them can save time and prevent miscommunication, especially when discharging patients. Have your nurses write up the specific instructions and go over them with the patient; use highlighters to mark the most important information. There are a lot of resources and tools available (we have some here) about common procedures and practices that you can use as handouts for patients as well.

Stay concise but informative: Patients are probably only going to remember one or two learning points, so try to emphasize the most important takeaways and leave the rest for your handouts.

Test understanding: It’s important not to assume that your patient is well-informed about their own condition. Even if you think something is obvious, say it anyway! Once you go over the key points, make the patient repeat them back to you; it’s one thing to listen to an explanation, but quite another to have to explain it yourself.

Encourage questions: Even if a patient seems to understand, it’s important to leave time for questions. Ask if they have any concerns about medications or follow-up care; this will help prevent confusion going forward and negative health outcomes.

You can go here for more advice about patient education.

House calls can benefit patients and cut costs

Two of the lasting images of early healthcare professionals is the doctor with their big bag making house calls and a midwife rushing to a family home to facilitate a birth. As healthcare has advanced, we’ve moved away from this home-based model toward the consolidated approach of the modern hospital. However, some practices have returned to house calls, with some positive results.

Independence at Home, a program created by the Centers for Medicare and Medicaid Services (CMS), seeks to identify patients that would benefit from homecare or cannot be helped in a hospital setting. The project sends mobile interdisciplinary healthcare teams, lead by physicians and nurse practitioner, out to the homes of these patients and provide care.

According to a recent Medscape article, the program reports a few different benefits. The patients receive more attention and care from providers, and the setting can foster trust between patient and provider. Hospitals and nursing homes can be difficult places for many patients, and they would prefer to get treatment in their homes. Terminal patients particularly benefit from this; as one provider notes, hospitals are not where people want to die.

The providers benefit from the more personalized patient relationship as well, but there are also financial incentives for homecare. CMS reports that they saved $25 million by using this system and $11.7 million of that went back to the providers. Because the system targets some of the most expensive Medicare patients, hospitals can save a lot by providing in-home care in this system. In addition to the CMS program, Veterans Affairs Medical Centers report that providing home care for some of their patients cost 12% less than standard care.

CMS adopts 2012 Life Safety Code®

Editor’s Note: This originally appeared in the OSHA Healthcare Advisor.

In a highly-anticipated move expected to significantly affect the regulatory rules that hospitals and other healthcare facilities are held to, the Centers for Medicare & Medicaid Services (CMS) has officially adopted the 2012 edition of the Life Safety Code® (LSC).

CMS has confirmed that the final rule adopts updated provisions of the National Fire Protection Association’s (NFPA) 2012 edition of the LSC as well as provisions of the NFPA’s 2012 edition of the Health Care Facilities Code.

Healthcare providers affected by this rule must comply with all regulations by July 4—60 days from the publication date of the rule in the Federal Register.

The adoption of the rule has long been anticipated, as the LSC, which governs fire safety regulations in U.S. hospitals, is updated every three years, and CMS has not formally adopted a new update since 2003, when it adopted the 2000 edition. As a result, CMS surveyors have been holding healthcare facilities to different standards to other regulatory agencies that have gradually adopted provisions of the new LSC in their survey requirements.

Some of the main changes required under the final rule include:

  • Healthcare facilities located in buildings that are taller than 75 feet are required to install automatic sprinkler systems within 12 years. after the rule’s effective date.
  • Healthcare facilities are required to have a fire watch or building evacuation if their sprinkler systems is out of service for more than 10 hours.
  • The provisions offer long-term care facilities greater flexibility in what they can place in corridors. Currently, they cannot include benches or other seating areas because of fire code requirements limiting potential barriers to firefighters. Moving forward, LTC facilities will be able to include more home-like items such as fixed seating in the corridor for resting and certain decorations in patient rooms.
  • Fireplaces will be permitted in smoke compartments without a one-hour fire wall rating, which makes a facility more home-like for residents.
  • For ASCs, alcohol-based hand rub dispensers now may be placed in corridors to allow for easier access.

Visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10043.pdf to read the full final rule.

View the CMS press release here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-05-03.html

California nurses seven-day strike ends in stalemate

On March 15, the newly unionized nurses of Kaiser Permanente Los Angeles Medical Center arranged a seven-day strike in hopes of getting their first collectively-bargained contract.

Last summer, 1,200 nurses voted to join the California Nurses Association (CNA), and the walkout was their first major action since joining the union. Negotiations for a new contract have been taking place since September, and this timed strike is part of the negotiation process. The union hopes to improve the conditions both for the RNs and their patients; the nurses report being understaffed, often having to cover units outside of their specialties, and seek economic improvements to attract and retain qualified nurses. Another concern brought up by the union is the hospital’s plans to open a medical school in the next few years, which will put additional strain on the hospital and its staff. The combination of factors led to the strike.

Kaiser Permanente expressed disappointment at the nurse’s tactic, and claims that they made a fair offer last month that went without a response. Additionally, Kaiser notes that their nurses are among the highest paid in the region, and their new offer would keep them there.

All of this is happening among growing concerns about healthcare coverage, as demand has spiked over the past few years.

The striking RNs have gone back to work after seven days of picketing, and negotiations between the two sides are still ongoing.

Creating a transgender-friendly healthcare environment starts with nurses

Nurses are often the face of their hospital; they are typically the first staff member to interact with the patient, and nurses are integral to providing a positive patient experience. In the ever-shifting landscape of culture, healthcare providers need to avoid discrimination and work to make sure patients feel at ease. While we have many resources that address cross-cultural competency (like this article from our Strategies for Nurse Manager’s reading room or the Health and Human Services’ guide), the medical community is just beginning to address how to effectively treat transgender patients. The Association of American Medical Colleges (AAMC) recently released treatment guidelines for transgender patients, and it is vital that nursing staffs help battle unconscious bias and create a safe climate for all of their patients.

In 2010, Lambda Legal found that a staggering 70 percent of transgender people had experienced discrimination in a hospital setting, and a 2011 study by the National Center for Transgender Equality and the National LGBTQ Task Force reported that 19 percent of patients were denied healthcare because of their status (via the New York Times). Because of this, 28 percent of the respondents have postponed medical care when sick and 33 percent don’t pursue preventive care because of their past experiences with medical professionals.

Better nurse education would be a great start to counteract this trend of discrimination and improve the climate for transgender patients; and when it comes to educating your staff, a little can go a long way. Part of the problem is treatment knowledge, but many of the issues could be solved with improved sensitivity training. Basic language education, such as what pronouns to use and asking the patient how they’d like to be addressed, can make a transgender patient feel at ease. Adding a gender and preferred name component to medical records and ensuring that they are up to date can greatly improve the consistency and quality of care as well.

Janis Booth, RN, shares a great example of how hospital staff can help a transgender person feel at ease from one of her readers:

“My new doctor saw my list of meds and knew immediately and opened with, ‘You look great…how long ago did you begin your transition?’ Put me right at ease, immediately, even though my name change had not caught up with their record keeping. I presented new IDs and they updated my info.”

Small things like asking the right questions in a gentle way can open up the patient and make them more comfortable, which will make your job much easier as well. Nurses get to set the tone of the patient’s experience, so properly training your staff on gender issues can make all the difference for a transgender patient in need.

Here are some great training resources on the topic:

  • You can download the full AAMC guide here.
  • WBUR has a list of tips to get you started.
  • Janis Booth’s full article has a lot of great information as well.
  • TransRecord and RAD Remedy are sites dedicated to gathering and sharing data on trans-friendly providers.