Ebola - My Right to Accept or Refuse an Assignment
Ebola has been the dominant topic on the news for a few weeks now. Nurses have been making the front page, insisting on their rights to be adequately protected from this deadly virus. Nurses everywhere are wondering what their rights and responsibilities are when it comes to accepting or refusing an assignment to care for a patient with a contagious illness, such as Ebola. Do you know what you will do?
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Ebola. The very name of this evil virus is striking anxiety in the bravest of nurses. Nurses everywhere are facing the question of "what will I do when it comes here?" We ask ourselves if we would accept the assignment of caring for the patient, or refuse it. We consider the cost of risking our lives to care for the sick - and - what about my children? What about my loved ones? If I accept this assignment, am I putting my family at risk?
I have heard an array of comments on the subject from nurses - and all of their concerns are valid. I have heard more than a handful of nurses' state they would ask for a new assignment - or quit. I have heard the opposite end of the spectrum as well, where nurses will accept the assignment IF. The 'IF' is a pretty big IF.
IF the nurse is properly trained, IF the hospital has the PROPER PPE, IF the nurse will receive hazard pay, IF the nurse will be given a room on the floor with the patient for the next month - because they certainly do not want to take anything home to the family. All very valid requests. If you are given an assignment to care for a patient, but do not have the proper PPE, have not been properly TRAINED in donning and doffing the CDC PPE, or if you have an underlying issue - such as pregnancy or decreased immune system, you may consider Safe Harbor as your reason to refuse the assignment.
So, what are our rights on refusing an assignment? What are our responsibilities to care for a patient? The Nurse Practice Act (NPA) relates to safe practice of nursing through regulations as determined by the Board of Nursing. When a nurse is given a license, the nurse must clearly understand her/his own competencies. If a nurse is not competent to care for a certain type of patient, the nurse then has the responsibility to obtain training/education for assignments in the field where they are working. The nurse must realize that working in an area they are not competent in can put the patient at risk for harm, and the nurse places his/her license on the line. If the nurse has not been properly trained in donning and doffing the APPROPRIATE PPE the CDC recommends in caring for a patient with Ebola, you may have a case to refuse your assignment. If your hospital does not HAVE the proper PPE, equipment, isolation room, etc., to care for your patient in a safe environment, you may have justifiable cause to refuse your assignment.
When is refusing to care for a patient considered abandonment? This is AFTER you have made contact with a patient, or after you have accepted an assignment. For instance, if you are an ED RN and a patient comes in and you begin caring for the patient only to find out the patient has Ebola, and then you refuse to care for the patient any longer - this is abandonment. If you abandon your patient, you can lose your license to practice nursing.
Most hospitals are asking for volunteers to care for any patient who may present with Ebola. A core group is properly trained in PPE donning/doffing. Most hospitals are utilizing ED and ICU RNs for their 'Ebola Task Force'. The hospital I work for also will allow the trained volunteers to live at the hospital in the same unit that has the patient in isolation, and will provide meals and scrubs.
Many nurses I talk to are worried about caring for these types of patients, and I completely understand their concerns. However, I have also found that there are nurses who are ready to face the challenges that are ahead of us and do all they can to care for the patient. I personally believe that caring for any patient with any illness is my responsibility and part of the oath I took when I dedicated my life to caring for people. I know I am not alone when I say I will do whatever it takes to save a life.
