I haven't posted here in a really long time, but happened to be browsing today, and how perfect that your post was at the top of the list! I have a similar story to tell from last Fall. Please feel free to PM me if you want to correspond more about this, as I probably won't be checking the board again. Hopefully some of my story will provide you emotional support and concrete ideas for dealing with you own situation.
I am an RN working in newborn nursery and NICU for the past 11+ years. I have twice been threatened with termination for refusing to assist in circumcisions and getting reported by several docs involved who took offense to it (others were perfectly fine with asking someone else to help). The first time it happened years back, I was taken by surprise on the disciplinary action they undertook against me, and I didn't know how to defend myself. So I ended up walking on eggshells and feeling very disempowered for a long time. Then last Fall, I had to defend myself again, over a very stressful 3 month period, in which they really were on the verge of firing me if I didn't agree to their conditions. But this time I wasn't going to let them walk all over me. I negotiated my way through 3 difficult meetings with my supervisors and HR all by myself, wrote position statements and policy proposals, met with the head of the Ethics Committee, consulted with lawyers, looked up JCAHO and federal healthcare conscience protection regs, and also sought out support and advice from others who had been down the same path - Marilyn Milos, Mary Conant, and Betty Sperlich (of Nurses for the Rights of the Child) among them. It very scary, very stressful, and very exhausting, but the short story is, I am still employed, and no I still don't assist with circumcisions.
They felt they were being accomodating by saying that, OK, I didn't have to assist myself in circumcisions, but that if asked to assist, I at least needed to get someone else to assist. This was where we could not find common ground. Although I told them I would assist if there were a medical emergency during the circumcision, and that I would do whatever after care and teaching was needed, I maintained that I would not get someone else to assist with the performance of the regular circumcision itself, since that to me was being complicit with an unethical practice and system as much as doing it myself.
JCAHO regs support the principle of health care conscientious objection, with the stipulation that it must not delay, interrupt, or compromise patient care, and each hospital must have a policy on this. (Of course, circumcision does not constitute any kind of medically valid "care", but they didn't buy that argument.) My hospital's policy included in three places that care must not be interrupted, and while it listed multiple factors that were to be taken into consideration in responding to employees' objections to participation (e.g. the ethical issue itself, alternative means of providing staffing, avoiding future problems with the same issue), all of these were ignored. All they cared about was that the provision of circumcisions must not be interrupted. Bleah! When I countered that federal policy allowed for healthcare professionals not to have to participate, they said that they had checked with "corporate legal" which had said that my contract states that I have to do whatever they tell me to do ("other tasks as assigned").
If we had failed to come to agreement on this point, they were going to terminate me, with my only recourse being appealing to the Ethics Committee, part of the HR conscientious objection policy. The chaplain who was the head of the ethics committee had been intrigued by the information I had given him, but he did not seem like he was going to stick his neck out to fight for me. I was told I could present to the Ethics Committee, but I could not talk about the ethics of circumcision, only my case for why I should not have to participate in getting someone to assist, and only for about 15 minutes. Plus they wanted the Ethics Committee to meet within the next few days (the week before Christmas!), and come to an immediate decision, because the negotiations had dragged on long enough in their opinion. If the Ethics Committee approach had failed (which I'm sure it would have under the conditions), I believe I would in fact have been terminated, and my only other recourse would have been to undertake an expensive, ugly, and hugely stressful lawsuit, which I believe also probably would have failed.
But at the last moment, they batted an eye. In wrapping up my final meeting with them, I said that I valued my job at the hospital, and I had considered every way I could think of to make this situation work. The only options I could see for myself were to either 1) make myself unavailable everytime a doc came into the nursery to do a circ (thus taking away from care of my other patients), 2) doing what I was asked to do (assist) and feeling I was compromising my conscience, or 2) having a conversation about my ethical stance with any doc that asked for help (right in the middle of them doing the circ), asking that they get someone else to help them, and hoping for the best. My supervisor then got the aha! idea that I could write a letter on hospital letter head and with her express support to communicate to all the docs that did circumcisions that I had ethical objections to circumcision, and respectfully asking them not to ask me to assist, also listing the situations under which I would assist (eg. emergency). To make a long story short, that's what we did, and the episode was over. Not an ideal solution, but a shift on their part, and the best communication to doctors and the best support I had gotten from them in the 11 years I had worked there.
Of course, now they have changed to a new staffing model recommended by AWHONN in which a nurse has to be present for every circumcision. So now instead of random occasions of request for assistance, ALL nurses are in a position of being expected to assist, including all the postpartum nurses who never had to do it before. Besides making me sick to see all the nurses being inculcated into taking on this role in sheep-like manner, it leaves me again in an unsupported position, as so far no alternative system of staffing when a nurse objects to participation has been put in place. If I had a patient who was going to get circumcised on a given day, I would again be put in a position of having to get someone to take my place. As far as I know, the charge nurses all understand my position and basically respect it, but there is no directive from management for what they should do if I refuse to assist. So for now, I just try to ask for assignments in the morning of boys that are known to not be getting discharged (or circumcised) that day so as to avoid the problem. Back to having to be a rat trying to stay out of the streetlight. Having just gone through all this in the Fall, I don't have the stomach to go in and rabblerouse for a conscinetious objection policy all over again now for this new staffing arrangement, especially since I am already a persona non grata in their eyes in this regard, and they are swamped with lots of snags and annoyed employees with the new staffing system, for other reasons. I guess that's part of their strategy, to wear you down.
Although my supervisors were not nasty to me throughout this episode, they did lay some trips on me like "you're imposing on your fellow nurses when you refuse to assist" "other nurses resent when you do this" "if you care about babies, why won't you do everything you can to relieve their pain?" (i.e. stand there an hold a pacifier in their mouth!!) "you're not a team player", "you have to make a decision whether you want to work here or not," and pulling out the big guns like "corporate legal" etc. Still, in honesty, they were mostly sympathetic, good listeners, and patient mediators. It could have been much worse.
I think there were some things that helped this work out as positively as it did (at least before the change to the AWHONN staffing), which might give some indicators to help you. First, I had already been there for 11 years, and we were all familiar with each other, and I was a valued part of the staff there. I really don't think they wanted to fire me, but they had boxed themselves into a position, so I think they were happy to jump at a solution that seemed to bridge our two positions (the letter to the docs). Since you've only been there a month, I think you will have to show a lot of professionalism and good will in negotiating this with them, since the rapport and trust is not already in place. Second, I think the fact that this played out over several meetings over several months (I asked for time to work up responses, and then there were interruptions in my supervisor's availability) gave them time to do some internal processing on this, rather than force a hard-line solution immediately. Hopefully, you can use this to your advantage in this situation too.
Also, I would show your willingness to contribute solutions to the situation, not just refusing, such as suggesting alternate staffing arrangements, or communications processes. I would also suggest you write up this recent interaction with the doctor in detail to refer to later if other accusations or episodes come up later. (The same doctor became involved in both of my disciplinary actions, and I should have recorded all the details of our original interaction to prove that he was being an a**hole the first time around). Also, I would write up some kind of position statement that describes your ethical stance, what you are or are not willing to do, expresses a good faith desire to collaborate with them to find a solution. Also, I would become familiar with the language of the hospital policy on staff rights to refusal to participate in procedures to which they have ethical, religious, or cultural objections. Also, try to find other literature and policy statements that relate to conscientious objection in heatlh care settings.
I hope you will send me a PM. I am very happy to correspond with you on this. You are not alone, and each one of us that goes through this is educating our colleagues and paving the way for making it easier for those that come after us. One big thing that will lead to the end of circumcision, is when health professionals are educated enough, and feel supported in standing up and saying "I will not participate in this." Good luck. Gillian RN