Pregnant nurse working with isolation patients

[Tiffado]

I was wondering what everyone thinks about this situation. I am 31 weeks pregnant and work on a med/surg floor as an RN. For at least the last 8 years, general conscensus amoung co-workers on my floor has been once a female nurse is pregnant she no longer will take patients on pre-cautions....MRSA, VRE, CDiff etc. We also ensure that these nurses dont take patients with chicken pox, shingles, necrotizing facitis, head lice, scabies. Basically nothing too contagious or too nasty.

Things have been going fine with this during my entire pregnancy-as well as for a few of my pregnant co-workers until recently I was floated to another unit (the icu). Here I was expected to take on two isolation patients. They presently have a pregnant nurse who will take any and all patients regardless of their diagnosis. But I refused as my floor had already let them know 3 hours before my shift began that a pregnant nurse would be floating and therefore the assignment needed to be 'clean'.

Well my refusal created a big stink I guess and now infection control is saying that there is NO reason why we cant care for any patient including shingles, chicken pox, menigitis and CMV. Im just upset and with so little time being left for my pregnancy (9 weeks) i hate to expose myself and my baby to something now. Am I being too cautious? Do you think my OBGYN would give me a doctors note to avoid isolation patients?

[leslie :-D]

i would get that ob note asap.

definitive restrictions will protect you and your baby...

"gen'l consensus" will not.

best of everything.

leslie

[Otessa, BSN, RN]

I was preganant with twins working 3-11 in a critical care float pool too. EVERYONE that I worked with on every unit was very cautious about the patient load I recieved. I was never given an isolation patient or an extrememly large patient either-I think they were afraid that I would go into labor and they would have to deliver my babies on their shift. I worked until 34 weeks-no shoes besides flip flops fit

[RNGrammie]

when i was pregnant i was exposed three times to meningitis...all three presented with atypical symptoms. all three times the staff freaked out on my behalf when it was announced. on another occasion i was about to walk into a room that, unbeknownst to me, held a child with possible measles. a coworker practically screamed at me to get a mask on before going in there. i don't know if it's a written thing or not, but pregnant nurses should never be expected to care for isolation pts.

i really can't believe i am reading this correctly.....never be expected to care for isolation pts. when pregnant? imho, take a leave of absence then. as a nurse, i would never refuse care to someone in any circumstance. of course it would be wonderful if the assignment could be given to the non-pregnant nurse, that's not always possible. standard precautions, contact precautions etc. it's what we signed up for when we signed on the dotted line. i work in ltc and just today had a positive influenza come back.....do i refuse to work w/ that resident because i am currently receiving radiation for a malignancy???? nope....gotta take the precautions or take a loa till txs are done. i think the same goes for pregnancy. both times i was pregnant, i would never have even thought to request special assingments let alone "hope" someone would step up and offer to to take the isolations.

in today's society, we have probably come in contact with more "stuff" than we can even imagine.

[weesyanne]

I wanted to comment on whether pregnant nurses/techs should be given isolation patients. I think it all depends on what the isolation is for. I can see not giving a pregnant nurse a patient who you know has CMV or shingles/chicken pox. But as far as patients who are isolation for other diseases, I don't see a reason to restrict who their nurse can be. Granted, if there is an option to give a pregnant nurse an assignment without isolation patients, it should be done in the interest of putting her mind at ease.

I happen to work on a unit where a majority of the patients are MRSA positive and some have VRE, acinobacter, pseudomonas, ESBL, Klebsiella, etc. It would be impossible to give a pregnant nurse an assignment without an isolation patient.

I have two kids and worked during both pregnancies. With the first pregnancy, I was on a cardiac stepdown unit and most of my patients were not on any type of isolation. During the second pregnancy, I sporadically had to take care of isolation patients on a general surgical unit. I had a guy with full blown AIDS that I got a needle stick from when I tried to place a used syringe into a needle box that someone had left jammed. I found out the next day that he also had active Hepatitis B. When they checked my titers, it was found that I didn't have antibodies, despite getting the shot series several years before. They gave me immunoglobulin and I showed antibodies at that point. I tested HIV negative for all the tests that they gave me after the needlestick. I panicked when that happened in 1993. I took care of TB patients during the pregnancy as well.

I guess what I'm saying is that if there is a feasible way to prevent a pregnant nurse from having a patient on isolation that it probably should be done, but on some units, that would not be possible. Also, there are many patients that you do not know have a disease for which they need isolation until several days after being admitted, so you are assuming some risk by working as a nurse. As for the statement from the nursing instructor to the pregnant student nurse, I would not rely on not being given isolation patients if you are pregnant after getting out of school. It depends on the unit, the patient mix, the level of staffing, whether you are required to float, etc. lots of factors.

[RNsRWe, ASN, RN]

Guess I'm in the minority here, but my facility has a policy that states that universal precautions are for the protection of everyone, not just the non-pregnant ones. Pregnant nurses take isolation patients. The ONLY exception to be made is in the case of shingles/chicken pox; they're rather a rarity for us and can therefore be avoided in assignments.

Otherwise, if you're pregnant, expect to use the same set of precautions everyone else uses to avoid contracting the disease your patient has.

Personally, I'm fine with this. We get alot of isolations, and I have worked with quite a number of pregnant ladies (nurses, aides, etc). If I had to take on every patient that a pregnant staffer decided to refuse, I don't think I'd be taking it for long!

We all follow the same protocols for handwashing, gowns and gloves. The pregnant woman is therefore just as protected as I am.

[RNsRWe, ASN, RN]

I guess what I'm saying is that if there is a feasible way to prevent a pregnant nurse from having a patient on isolation that it probably should be done, but on some units, that would not be possible. Also, there are many patients that you do not know have a disease for which they need isolation until several days after being admitted, so you are assuming some risk by working as a nurse.

Bingo! I was thinking this, but forgot to type it myself. I wish I had a buck for every time a culture came back positive for this ick or that, after the patient had been with us for a week or more, going through every possible service person, and traveling to practically every area of the hospital for tests, etc.

If you're pregnant or not, you'd better be darned careful about hygiene in the hospital, as you NEVER know what you're gonna pick up where!

[elizabells, BSN, RN]

But things happen, even when strictly observing universal and even special precautions. If *I* get CMV from a patient, I might get a little flu-y. If my pregnant coworker gets it, her baby could end up deaf, on ECMO, or dead. I would never, ever be able to forgive myself if I refused to switch with someone and her baby died because of it.

[jessiern, BSN, RN]

Aside from obvious CMV/shingles we do not make exceptions in our facility. It has been discussed, because someone is always pregant at our facility. Most of us feel like it would be pointless. How often do you find out halfway through a shift that a patient is MRSA postive? Wash you hands, follow precautions and you should be fine.

BTW, my friend that is 16 weeks took an MRSA patient yesterday, and never heard a complaint.

[RNGrammie]

i see so many posters on this thread making comments about cmv....according to the nys dept. of health's information regarding cmv......

what precautions should pregnant women take when performing patient care or child care?

pregnant women should practice good hygiene and carefully wash their hands after caring for patients or children. this is particularly important when handling diapers or having contact with the child's urine or saliva.

the risk of cmv infection in hospital workers is not greater than it is in others in the community and is probably low because of careful hand washing practices. in daycare centers, where hand washing practices may not be as good, there may be a greater risk of infection. in both settings, good hygiene and careful hand washing are the most important control measures. pregnant women working in child care facilities should minimize direct exposure to saliva and avoid kissing babies or young children on the mouth. hugging is fine and is not a risk factor.

routine blood testing during pregnancy for cmv antibody is not generally recommended. pregnant women should consult their physician on an individual basis regarding this issue.

again, precautions need to be taken. as a nurse, you should not be allowed to refuse an assignment.

[lindskay0]

I currently work in the er I am 17 weeks pregnant. I just had two patients with shingles last night. I have no precautions, my charge nurse doesn't change my assignment just because I an pregnant. I even got in called to the carpet once because I refused to help another nurse hold down a combative patient and put in a catheter. I hate this job. For the most part my coworkers just ignore that I'm pregnant. I still lift and pull. I don't want to jeopardize my job, I just hope I can get out on leave early.

[MrsCaseyRN]

First, this thread is OLD! lol! I got an email saying there was a reply. But look at the post before you, 2008, I think.

Anyway, as long as you have had chicken pox, I'm pretty sure you're ok. That's what my OB told me. I've been through 2 pregnancies as a nurse. As long as you take proper precautions/ handwashing ect, it should be ok. With my first pregnancy I was very worried about this. Still, if I work with a pregnant nurse, I will take isolation pts, combative pts, not let her lift...why? Because to me its as courtesous as holding the door for someone, or allowing an elderly person to have your seat on the bus kind of thing.

There are people out there that are angery. They have this attitude like "Just because she's pregnant..." and don't want to budge to give a pregnant woman a break. I don't get that kind of sour attitude especially among nurses! But what can you do?

Personally, I noticed the most unhelpful coworkers were those that either didn't (or couldn't) have kids or people that felt like they had to work during their pregnancy. In otherwords if they felt over worked during their pregnancy then, they'll be damned if any other women be given a break while pregnant.

Check with your OB, but lifting at this point should still be ok. Regardless, I still don't let pregnant coworkers lift if I can help it. And if someone is combative, I don't let the pregnant coworker be where swinging limbs might be. I suppose if you were on a very small unit, that the extra staff might not be available, but generally speaking.

I just see nothing wrong with cutting a pregnant woman some slack. I mena you are out there working! I knew a girl that quit her desk job when she found out she was pregnant, at like 8 weeks! lol Because she truly believed that being pregnant meant sitting for 9 months. Meanwhile there is a girl in my spin class that's like 7 months pregnant and she spins better and harder than I do!

There's always going to be some bitter crows that will not allow you to have any special treatment just because you are pregnant (granted the staff is available, thats a different story). I wonder if they do not hold doors for elderly people because they do not want them thinking that just because they are old doesn't mean they can't hold their own doors! haha.

Ah, I'm sure I'll get flamed for this. Also, I probably should have reread this thread before posting.

All and all, it is scary being around isolation pts while pregnant, and I believe it that whenever possible pregnant nurses should not be given iso pts, but if you have no choice, check with your OB on the specifics, use appropriate precautions, and if you truly, truly feel that you are putting your baby at risk, especially if your OB has warned against certain things and your job still asks you to do said tasks, then don't do it. But if you are going to refuse to do something or takea pt at the recommendation of your OB, I'd get that in writing, so you have proof, should they disapline you for refusing to do your job. HTH

P.S. Please excuse typos!!!

[nurseprnRN, BSN, RN]

also remember that if you are so immunoincompetent that you can't be around someone with an infection, you shouldn't be going to the grocery store, riding the bus, going to church, rooting for your kid's soccer team on the sidelines, or voting. and since many people with infectious disease are not diagnosed until well after they are infectious, you are fooling yourself if you think avoiding identified cases makes you safe. that's why we have standard (originally called universal) precautions.

so. not immunoincompetent? using standard precautions for everyone and special precautions as indicated? you have no scientifically-defensible reason to avoid isolation cases merely on the basis of pregnancy. this is ignorant, or lazy, or both, no matter how well-meant. it's not defensible.

here's a good summary, with more links.

http://www.uptodate.com/contents/topic.do?topickey=pi/6717