As the charge nurse, which assignment should be reassessed due to potential gender-age matching concerns on an acute psychiatric unit?

• A. Older female RN with medical-surgical experience assigned to a male patient with Alzheimer disease.
• B. Male LVN assigned to a male patient with chronic depression.
• C. Young male mental health assistant assigned to a female adolescent with anorexia nervosa.
• D. Female RN assigned to a newly admitted female patient who has command hallucinations and delusions of persecution.

Answer: (C)

Maintaining boundaries and protecting vulnerable patients is a key safety focus in psychiatric care. When staffing assignments, consider how the patient’s age and condition interact with the staff member’s gender and level of experience. A female adolescent with anorexia nervosa is a highly vulnerable patient, and having a young male staff member as her caregiver increases the risk of boundary violations or exploitation. This is precisely the kind of scenario that should prompt reassessment of the assignment to align with safeguarding policies—preferably assigning a staff member of the same gender or ensuring strict supervision and clear boundary adherence.

Other assignments here carry less of an inherent boundary risk for this particular patient population. For instance, pairing an older female nurse with an elderly male patient with dementia is common practice when clinical needs dictate care, and a male clinician with a male patient with depression avoids gender-related boundary concerns. A female nurse caring for a newly admitted female patient with severe psychiatric symptoms focuses on symptom management and safety within an appropriate female-on-female care plan.