If there was a SARS case in USA?

. . . The masks are horrible. Your eyeglasses steam up and you long for the coolness of fresh air. The fibres quickly clog your nose, and after a few hours everyone has a sore throat. Fatigue sets in as you re-breathe your own stale air. Eventually, you forget the darn thing is on. I remember being doubled over in laughter at a colleague whose coffee spilled all over him when the cup hit his mask . . .

. . . Later the same day I was informed that three family doctors in a four-man community practice just down the road - colleagues I would see at educational events or medical dinners - had become ill with Sars after treating a patient with the disease who came to their office. The patient had broken quarantine. Two of the doctors have young children. Unfortunately, we have learned that with Sars almost 100% of household contacts become infected themselves. Only one of the doctors treated the Sars patient, the other two simply worked in the same office. We have learned that the virus is highly virulent and some patients are "super shedders". The three doctors remain critically ill and on respirators in intensive care. Sars is challenging all of us, asking something new of us. It is asking us to put the needs of others ahead of our own. It is reminding us that this is what we signed up for, even if we never imagined it could really happen . . .

. . . The week of April 21 started with a setback for the city, and our department of family medicine. A patient with Sars infected up to 15 doctors and nurses at one hospital. I emailed a colleague at the hospital to ask how this could happen. His email back described how the Sars patient was seriously ill and confused. He was strong and struggled to resist being intubated (having a tube inserted into his larynx) and ventilated by the doctors and nurses. He pulled out the ventilating tube several times. By the end of the ordeal, which lasted several hours, there were masks and gloves strewn everywhere. It had been impossible to preserve isolation, yet none of the staff left until their patient was stabilised. The world owes these professionals an unbelievable debt of gratitude. They knew the risk that was evolving, and they did not flinch. My friend told me that those watching from outside were in tears. As I read about it, I was too.

nursenoelle · May 25, 2003

I am currently on suspension for not coming in to help ICU, while I was on call for my dept. (OB). I refused because I was not comfortable floating there, and risking possibly infecting a mother or infant.

I had to call this morning to find out my status, which was suspension. I assumed that I was terminated, because it was said come in or be fired. If I had cold feet about changing jobs before, they are nice and warm now.

P.S.- I am not a Germaphobe, our ICU does not have an isolation room with an anteroom nor negative pressure ventilation.

oramar · May 25, 2003

Congradulations Nursenoelle on taking a stand. OB nurses absolutely should not be caring for suspected SARS cases. Even the thought of it is to horrible to contemplate. Instead of a suspension you should be getting a medal. PS I have serious problems with OB nurses even being pulled to other units period.

nursenoelle · May 25, 2003

Thanks Oramar. I feel better about it today after talking to some of my coworkers, last night was horrible. I had the backing of my Dept. manager, but the House supervisor and CNO overrode her I am thinking of contacting a lawer on tues. This is all like a really bad dream.

toronto rn · May 26, 2003

I agree with you to a point Nursenoelle, given your position in OBS. It doesn't make sense to float someone into a SARS area. But if you are protected well enough, it shouldn't be an issue. Were you going to be responsible for taking care of a patient with SARS or just be located on that floor? I don't want to instigate any bad feelings but frankly most of us here have not had a choice about who we take care of, and we risk losing our license to nurse if we refuse to take care of a SARS patient.

The following information is from the College of Nurses of Ontario, I am aware this doesn't apply for the USA, but I'm sure you have your own Professional licensing body and disciplinary commitee which may have addressed these issues.

Frequently Asked Questions: Severe Acute Respiratory Syndrome (SARS)

(http://www.cdc.gov/ncidod/sars/faq.htm)

For the latest information on SARS visit the following sites:

Health Canada at: http://www.hc-sc.gc.ca.

Ontario Ministry of Health and Long Term Care at: http://www.health.gov.on.ca/english/public/pub/disease/sars.html.

Toronto Public Health at: http://www.toronto.ca

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SARS Information for Nurses

In light of the current outbreak of Severe Acute Respiratory Syndrome (SARS) nurses are questioning how to provide care for clients while protecting both themselves and their families. The College of Nurses of Ontario (CNO) has developed the following statement to guide nurses who are concerned about this issue, and who may be questioning whether they can refuse to provide care to clients with SARS or work a scheduled shift.

The College of Nurses understands the challenges that nurses face in such situations. While nurses are committed to meeting the needs of clients, provision of professional nursing services does not include working in situations where nurses' health is at risk and no precautions have been taken. CNO believes that nurses can protect themselves from risk of exposure to SARS by using appropriate infection control measures. Nurses need to be aware of these measures, and use their knowledge and judgement to determine how to best protect themselves and clients from SARS.

Health Canada has issued infection control guidelines to help prevent the spread of SARS. Up-to-date information is available from Health Canada at http://www.hc-sc.gc.ca. In addition, the Ontario Ministry of Health and Long Term Care has created a fact sheet, which is available at http://www.health.gov.on.ca/english/public/pub/disease/sars.html. This site also has a link to Toronto Public Health.

As self-regulated professionals, nurses have implicitly promised to provide health care services to the public. Nurses are accountable for meeting the needs of all clients, including those with SARS. In fulfilling this obligation, nurses must not abandon or neglect clients for whom they have made a commitment to provide care.

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Frequently Asked Questions about SARS for Ontario Nurses

The College of Nurses of Ontario is receiving many calls related to SARS. The following are some of the more frequently asked questions and the CNO response. Check this site regularly for further updates.

My clinical placement has been cancelled because of the SARS situation. Can I still write my exam in June?

Because of the SARS situation at the hospital where I work, my colleagues and I are being asked to work extra shifts. What is CNO's position on nurses working extra shifts, and what should nurses do should this situation continue and they become fatigued?

What is my accountability when I feel that my workplace is unsafe because of the risk of SARS.

Q: My clinical placement has been cancelled because of the SARS situation. Can I still write my exam in June?

A: The College of Nurses is aware of this situation and is monitoring it daily. The definition of what constitutes "clinical placement" and the requirement that students complete it are determined by the nursing schools and the Ontario Ministry of Training, Colleges and Universities. CNO requires that students have successfully completed an approved nursing program.

The requirement that Ontario applicants successfully graduate from an approved nursing program before writing the exam is legislated in the Nursing Act. CNO does not have the authority to waive this requirement.

At this time, the Nursing Act requires all applicants to complete their program before writing. CNO will accommodate applicants who cannot write the May (RPN) and/or June (RN) exams due to the SARS situation, by transferring them to the next available exam that they are eligible to write, at no extra charge.

Applicants who have successfully graduated from their nursing program and are waiting to write the exam may apply for Temporary Registration. This will allow them to work in approved employers until they write the exam. For more on Temporary Registration see the Temporary Registration - Fact Sheet (#45029) .

The exam is a national examination and the dates are set two years in advance.

Please check this Web site regularly for updates. Also, consult with your nursing program leaders for further updates on the clinical placement issue.

Q: Because of the SARS situation at the hospital where I work, my colleagues and I are being asked to work extra shifts. What is CNO's position on nurses working extra shifts, and what should nurses do should this situation continue and they become fatigued?

A: It is acceptable to work overtime when you feel competent to provide safe, effective and ethical care. But when continued overtime leads to exhaustion or fatigue, it is expected that you will use your judgement to determine if you should accept the assignment. If you feel you cannot practise safely because of exhaustion from overtime, then you must refuse the extra hours. Situations such as this would not be considered client abandonment or professional misconduct.

In the current SARS situation, nurses are promoting client safety and supporting their colleagues by working longer hours and more shifts to cover for staff who are unavailable. However, it is important that nurses recognize when fatigue is affecting their practice and take steps to address this concern.

Q: What is my accountability when I feel that my workplace is unsafe because of the risk of SARS.

A: Nurses have the right to refuse to work where unsafe conditions exist and they cannot be adequately protected through infection control procedures. That said, there are procedures and equipment that will protect nurses so they can continue to provide safe care for their clients.

Individual circumstances such as lack of equipment need to be addressed at the institutional level, and nurses need to make a judgement call, realistically weighing the risks of harm against clients' need for care.

Cases where nurses withhold their services would need to be considered individually. It is important that nurses have an appropriate rationale for refusing to work because of unsafe conditions, and make every effort to ensure care is provided to clients.

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nursenoelle · May 26, 2003

I want to clarify that I in no way would refuse to care for a SARS infected pt. My issue was that due to low census, I was to take call from home, for my dept. If a laboring pt. was to come in, then the acuity would go up and I would be called in.

We have had Supervisors cancel ICU and MS staff and think that they can just use the OB staff. This was OK at first, but became abusive. This case was the last straw, if you will.

I have no problem floating to help someone if my dept. is not busy. I will not take pts., as I may have to leave immediately for a pt. I do not believe that an OB nurse should be around pts. in respiratory isolation, only to attend deliveries or C/S later.

My biggest beef was that the pt. was not in adequate isolation. From what I had read , negative pressure and anterooms are recommended. I would also be in contact with nurses that now have to check their temps BID because they had been exposed. Our ICU is very tiny, 7 rooms I think. And the whole lack of education of SARS in our hospital, frankly scares the crap out of me.

It is a really long story, and an ongoing battle between our dept. and the others.

Would I have taken that pt. had I not been on OB call ? Heck yeah, I am a nurse, and ain't skeerd of bugs. I have thought this out alot. I cannot, even with protection, put laboring mothers and infants in that positon.

Are they isolating without negative pressure up there? I can't understand why that is not happening here. I can't believe our podunk hospital is handling this. We only have ONE airborne iso. rm. What happens if it spreads?

toronto rn · May 26, 2003

It sounds like you have much to be frightened of nursenoelle. I would definately get a lawyer's input into your situation. If you are having to work with staff who are already exposed, they should be quarantined as well as taking their temps.

Not all hospitals have had the luxury of using negative pressure isolation rooms. There just are not enough of them, but usually the patients with SARS are segregated if possible and the staff working with them are segregated as well. This limits exposure to other patients and staff. Although SARS is not proven to be airborne, negative pressure isolation is recommended.

Because of the reoccurance here all hospitals are back to full precautions again. Everyone in the hospital wears an N-95 mask and areas with SARS cases wear gown and gloves and caps in the general floor area and then double gown, glove, sheilds and goggles in patient rooms. We now even use Stryker suits (positive pressure space suits) when intubating or doing invasive procedures. If the hospital doesn't follow the safest protocol your health is at risk, and you have the right to demand a safe environment for working in. The other patients in that area are also entitled to a safe environment. We know this bug spreads well in hospital environments and health care workers get ill from it. Your hospital needs to be accountable for safety. You go girl - best of luck with your job.

nursenoelle · May 27, 2003

Thank you for your imput. I have decided not to speak directly to any adm. official until I have contacted a lawer. It was said today after the HR manager found out what happened to me over the weekend that I should not have been disciplined. Too little too late , IMO. They want to call a meeting tomorrow, and my coworkers and I seem to think that they may try to woo me. The could not see the forest for the trees, and decided that that was the time to make an example out of me.

I was trying to be a pt. advocate. What is really sad, is that I had interviewed somewhere else just last week, but the RN that does the sced. agreed to work with me so that I will stay. I just rec'd a customer service citation for exceptional care 2 weeks ago. None of this makes any sense. I am so disappionted in our local hospital, for the way they have handled this situation. I worry about my coworkers and thier families. One nurse is already on home quarantine. It is a huge mess, to put it mildly.

Thanks for letting me vent, it has been one helluva holiday weekend.

- Noelle

fergus51 · May 27, 2003

I wouldn't work there with a patient assignment (cause I don't do med-surg/icu either), but I did do deliveries to our SARS unit and help out with supplies and stuff. I think the risk of SARS has been GREATLY overexaggerated in the media. We had litterally hundreds of staff care for SARS patients without getting SARS because they used proper precautions.

Nurse Ratched, RN · May 27, 2003

I would not refuse to care for a SARS patient. Nursenoelle, your situation clearly is a little different - another case of abusive floating practices. IMO, floating should happen when there is no other choice - not to purposely call off qualified staff to move less familiar staff in to the area. And to have potentially exposed nurses possibly further spreading it to their patients with the only precaution being to take the temps regularly?? Sheesh. Yeah - I think you had cause to say "bite me" and refuse to possibly expose your helpless patient population given the crappy precautions they were taking.