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Patient preference does not justify hiring practices
The experts research
Patient preference does not justify hiring practices
Q
It is our hospital's practice to shave patients the evening prior to their scheduled surgery. We employ a male and a female nursing assistant to do this. Recently, the male nursing assistant resigned, and several women have applied for this position. As the OR supervisor, am I justified in requiring that a man be employed to prepare male patients?
A
There are actually two questions to be addressed here. One is whether sex is a bona fide occupational qualification for this ancillary position, and the other is when patients should be shaved if preoperative shaving is necessary. The answer to the first question is found in federal and many state laws. According to the Civil Rights Act of 1964 and the Equal Employment Opportunity Act of 1972, an applicant's sex is rarely, if ever, a justifiable reason for offering or denying employment. Therefore, jobs cannot be designed and advertised specifically to exclude one sex. Performing shave preparations on patients requires a certain amount of skill, but this skill is in no way related to the sex of the person performing the shave or the patient who is being shaved. Of course, when the pubic area is involved, most patients would prefer someone of the same sex to perform the shave. However, federal court decisions have strongly upheld the principle that client prefer-
266
a:
ence is not a justifiable reason for hiring a person from one sex, race, religion, or ethnic group over another. Physicians and nurses, regardless of sex, examine and care for patients of both sexes. It is unreasonable to place artificial constraints on the sex of workers in ancillary positions when they are performing similar duties. Furthermore, it is illegal to do so.' You may also want to examine your hospital's policy in regard to shaving. Several authorities have questioned the efficacy of shaving patients preoperatively.2 In one study, the infection rate was 2.3% in patients whose operative site was shaved. Unshaven patients in the same study had an infection rate of 0.9%. The timing of the shave is more significant than the shave itself. According to Seropian and Reynolds, the infection rate more than doubles if the shave is not done immediately prior to surgery but is done within 24 hours. If the shave is done more than 24 hours preoperatively, the infection rate is six times that occurring in patients shaved just before surgery. Hair removal with chemical depilatories results in infection rates comparable to leaving the operative site unshaven, but many people are sensitive to depilatories and careful skin patch testing must be done prior to use.4 Based on these data, preoperative shaves should be done only when absolutely necessary and as close to the time of incision as possible. Shaves should not be done in the actual operating r 0 0 m . ~
Q
We are planning to implement instrument counts in the near future. Is it necessary to account for each type of instrument in the
AORN Journal, August 1979, Vol30, No 2
set, such as hemostats, needle holders, and scalpel handles? Or is it satisfactory to account only for the total number of instruments in the set, regardless of type?
A
The "AORN standards for sponge, needle and instrument procedures" do not address this specific issue.6 However, a possible source of human error is introduced when a count procedure tallies only the number of pieces in a set without regard to type. Therefore, it seems prudent to include the type of instrument as part of the count. This is especially true if some of the instruments can be disassembled into two or more parts. Many institutions do not include large retractors, pin cutters, or other such pieces in their counts because it is improbable that they would be left in the wound. However, removable retractor blades and wing nuts are counted. Accounting for sponges and sharps by type is an aid in knowing where to look for a missing item. It may also help in a decision to delay closure for a search, especially if a very small needle is missing, which might happen during a cardiovascular procedure. These reasons can apply to instrument counts as well. Documenting the instrument count as well as sponge and sharp counts on the patient's medical record is another matter. It is not necessary to list the items being counted by type or gross number. It is sufficient to indicate that the count was correct or incorrect. If it is incorrect, it will be necessary to state what corrective action was taken. Either notation should include the names of the persons who did the count.7
tions," American Journal of Surgery 121 (March 1971) 252; Doris MacClelland, "Are current skin preparations valid?" AORN Journal 21 (January 1975) 59; "Standards for preoperative preparation of patients" in AORN Standards of Practice (Denver: Association of Operating Room Nurses. Inc. 1978) 3-17. 3. Cruse and Foord, "A five-year prospective study," 207. 4. Seropian and Reynolds, "Wound infection," 252. 5. "Standards for preoperative preparation," 3-17, 3-18. 6. "Standards for sponge, needle and instrument procedures" in AORN Standards of Practice (Denver: Association of Operating Room Nurses, Inc, 1978) 3-22. 7. William Andrew Regan. "Incident reports are administrative, not medical record," AORN Journal 25 (June 1977) 1244; William Andrew Regan, "Is staffing RR with unit nurses legally dangerous?" AORN Journal 28 (September 1978) 528. Suggested media Hospers, Colee. Preoperative Skin Preparation of the Patient. AORN Film Series. 1978. Davis + Geck Surgical Film Library Number DG 1302, Danbury, Conn. Lange, Katherine. Sponge, Needle and Instrument Counts. AORN Film Series, 1977. Davis + Geck Surgical Film Library Number DG 1268, Danbury, Conn.
Janet K Schultz, RN and the Professional Advisory Committee Notes 1. Know Your Rights: What You Should Know About Equal Employment Opportunity (Washington, DC: US Equal Employment Opportunity Commission, Government Printing Office, 1977) pamphlet number 918-136, 1. 2. Peter Cruse, Rosemary Foord, "A five-year prospective study of 23,649 surgical wounds," Archives of Surgery 107 (August 1973) 207; Richard Seropian, Benedict Reynolds, "Wound infection after preoperative depilatory versus razor prepara-
268
AORN Journal, August 1979, Vol30, No 2
Patient preference does not justify hiring practices
Q
It is our hospital's practice to shave patients the evening prior to their scheduled surgery. We employ a male and a female nursing assistant to do this. Recently, the male nursing assistant resigned, and several women have applied for this position. As the OR supervisor, am I justified in requiring that a man be employed to prepare male patients?
A
There are actually two questions to be addressed here. One is whether sex is a bona fide occupational qualification for this ancillary position, and the other is when patients should be shaved if preoperative shaving is necessary. The answer to the first question is found in federal and many state laws. According to the Civil Rights Act of 1964 and the Equal Employment Opportunity Act of 1972, an applicant's sex is rarely, if ever, a justifiable reason for offering or denying employment. Therefore, jobs cannot be designed and advertised specifically to exclude one sex. Performing shave preparations on patients requires a certain amount of skill, but this skill is in no way related to the sex of the person performing the shave or the patient who is being shaved. Of course, when the pubic area is involved, most patients would prefer someone of the same sex to perform the shave. However, federal court decisions have strongly upheld the principle that client prefer-
266
a:
ence is not a justifiable reason for hiring a person from one sex, race, religion, or ethnic group over another. Physicians and nurses, regardless of sex, examine and care for patients of both sexes. It is unreasonable to place artificial constraints on the sex of workers in ancillary positions when they are performing similar duties. Furthermore, it is illegal to do so.' You may also want to examine your hospital's policy in regard to shaving. Several authorities have questioned the efficacy of shaving patients preoperatively.2 In one study, the infection rate was 2.3% in patients whose operative site was shaved. Unshaven patients in the same study had an infection rate of 0.9%. The timing of the shave is more significant than the shave itself. According to Seropian and Reynolds, the infection rate more than doubles if the shave is not done immediately prior to surgery but is done within 24 hours. If the shave is done more than 24 hours preoperatively, the infection rate is six times that occurring in patients shaved just before surgery. Hair removal with chemical depilatories results in infection rates comparable to leaving the operative site unshaven, but many people are sensitive to depilatories and careful skin patch testing must be done prior to use.4 Based on these data, preoperative shaves should be done only when absolutely necessary and as close to the time of incision as possible. Shaves should not be done in the actual operating r 0 0 m . ~
Q
We are planning to implement instrument counts in the near future. Is it necessary to account for each type of instrument in the
AORN Journal, August 1979, Vol30, No 2
set, such as hemostats, needle holders, and scalpel handles? Or is it satisfactory to account only for the total number of instruments in the set, regardless of type?
A
The "AORN standards for sponge, needle and instrument procedures" do not address this specific issue.6 However, a possible source of human error is introduced when a count procedure tallies only the number of pieces in a set without regard to type. Therefore, it seems prudent to include the type of instrument as part of the count. This is especially true if some of the instruments can be disassembled into two or more parts. Many institutions do not include large retractors, pin cutters, or other such pieces in their counts because it is improbable that they would be left in the wound. However, removable retractor blades and wing nuts are counted. Accounting for sponges and sharps by type is an aid in knowing where to look for a missing item. It may also help in a decision to delay closure for a search, especially if a very small needle is missing, which might happen during a cardiovascular procedure. These reasons can apply to instrument counts as well. Documenting the instrument count as well as sponge and sharp counts on the patient's medical record is another matter. It is not necessary to list the items being counted by type or gross number. It is sufficient to indicate that the count was correct or incorrect. If it is incorrect, it will be necessary to state what corrective action was taken. Either notation should include the names of the persons who did the count.7
tions," American Journal of Surgery 121 (March 1971) 252; Doris MacClelland, "Are current skin preparations valid?" AORN Journal 21 (January 1975) 59; "Standards for preoperative preparation of patients" in AORN Standards of Practice (Denver: Association of Operating Room Nurses. Inc. 1978) 3-17. 3. Cruse and Foord, "A five-year prospective study," 207. 4. Seropian and Reynolds, "Wound infection," 252. 5. "Standards for preoperative preparation," 3-17, 3-18. 6. "Standards for sponge, needle and instrument procedures" in AORN Standards of Practice (Denver: Association of Operating Room Nurses, Inc, 1978) 3-22. 7. William Andrew Regan. "Incident reports are administrative, not medical record," AORN Journal 25 (June 1977) 1244; William Andrew Regan, "Is staffing RR with unit nurses legally dangerous?" AORN Journal 28 (September 1978) 528. Suggested media Hospers, Colee. Preoperative Skin Preparation of the Patient. AORN Film Series. 1978. Davis + Geck Surgical Film Library Number DG 1302, Danbury, Conn. Lange, Katherine. Sponge, Needle and Instrument Counts. AORN Film Series, 1977. Davis + Geck Surgical Film Library Number DG 1268, Danbury, Conn.
Janet K Schultz, RN and the Professional Advisory Committee Notes 1. Know Your Rights: What You Should Know About Equal Employment Opportunity (Washington, DC: US Equal Employment Opportunity Commission, Government Printing Office, 1977) pamphlet number 918-136, 1. 2. Peter Cruse, Rosemary Foord, "A five-year prospective study of 23,649 surgical wounds," Archives of Surgery 107 (August 1973) 207; Richard Seropian, Benedict Reynolds, "Wound infection after preoperative depilatory versus razor prepara-
268
AORN Journal, August 1979, Vol30, No 2