Have you/would you refuse certain patients while pregnant

  1. With my last pregnancy I refused patients with shingles and CMV, but usually no one would assign them to me. I worked with a woman that refused everyone with anything infectious. HIV, Hep C, MERSA, VRE, TB, you name it. This made it difficult as many patients in our city hospital had something or ended up with something. But we let her do it and grumbled under our breath about her being overly cautious.
    Have you refused patients while pregnant? For what? Were you supported? Lastly, do you think a pregnant nurse should accept assignments of infectious/isolated patients? (excluding varicella and CMV)
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  2. 17 Comments

  3. by   ClariceS
    We actually have a policy in our hospital about what patients should be avoided by pregnant nurses. It also kind of sets the line what a pregnant nurse can refuse. Any immunosupressed pregnant nurses shouldn't be in any patient contact. For other pregnant nurses the restrictions are varicella, parvovirus and RSV using ribovirin. Otherwise there are no specifics. We usually don't assign a pregnant nurse if there is CMV either.
  4. by   dawngloves
    Originally posted by ClariceS:
    restrictions are varicella, parvovirus and RSV using ribovirin.
    Thanks for the info! I fogot about parvovirus, but I don't work peds and I've never seen it. I never been in an RSV situation either.
  5. by   ajessee
    I am not currently pregnant, but plan to in the future so i am trying to educate myself as much as i can ahead of time.

    I work on a med-surg unit. I know that we recently had an RN working while pregnant (she has since given birth and come back part time) and i believe I recall them giving her patients in isolation with MRSA for sure. I do know that we absolutely do not give pregnant nurses or CP's patients who have active shingles, and pretty much inactive as well. Basically anyone with a suspicious looking rash is avoided. We really have too many patients on isolation for MRSA, VRE, or C-diff to not give them to pregnant nurses or CP's all the time, but generally it is avoided if possible. I never heard the nurse complain about her isolation patients, just her load in general was tough i think during pregnancy. She did work a very difficult shift. evenings. so I think a big challenge was getting time to eat and all the chaos going on. She did some lifting as well, but not without help.

    But currently we have a CP who is refusing to take patients on any kind of isolation. at first it just started out with respiratory isolation patients and shingles of course, which i totally agree with those patients. But recently she has changed it to all isolation it seems. I think it is because she is getting mixed opinions from everyone and isn't sure what to do. I know it took her a while to get pregnant and so I think she wants to be extra careful. I have a feeling though it is going to get a little hairy at times as sometimes we only have one CP on night shift.

    As I am not pregnant yet and not yet really trying, I think my plan will be to talk to my nurse manager when i am pregnant about it and see what her take is on what patients I should and should not care for. And just ask that they avoid giving me isolation if at all possible, but I do not want to make a big deal about it and will not ask them to switch my assignment unless it is for someone with respiratory isolation or shingles. I do think that my co-workers will respect my wish to be somewhat cautious, but also will respect me not all out refusing patients and making things more difficult for them.
  6. by   CuriousMe
    Quote from ajessee
    <snip>

    As I am not pregnant yet and not yet really trying, I think my plan will be to talk to my nurse manager when i am pregnant about it and see what her take is on what patients I should and should not care for. And just ask that they avoid giving me isolation if at all possible, but I do not want to make a big deal about it and will not ask them to switch my assignment unless it is for someone with respiratory isolation or shingles. I do think that my co-workers will respect my wish to be somewhat cautious, but also will respect me not all out refusing patients and making things more difficult for them.

    With all due respect to your Nurse Manager I'd talk to my OB about which infections I should avoid. The NM's responsibility is for the unit to run smoothly, your OB's responsibility is to you and your baby. Once you and your OB are clear on what to avoid and why....then chat with your NM.

    Just .02 from a nursing student....
  7. by   RNperdiem
    I did once request not to be assigned a patient who was in ICU for labor complications. Her 33wk baby did not survive.
    I was 33wks pregnant at the time and thought it best to take a different patient.
    I never worried about infections, I just made sure to use good use of gloves and gowns.
  8. by   fibro2003
    Quote from dawngloves
    With my last pregnancy I refused patients with shingles and CMV, but usually no one would assign them to me. I worked with a woman that refused everyone with anything infectious. HIV, Hep C, MERSA, VRE, TB, you name it. This made it difficult as many patients in our city hospital had something or ended up with something. But we let her do it and grumbled under our breath about her being overly cautious.
    Have you refused patients while pregnant? For what? Were you supported? Lastly, do you think a pregnant nurse should accept assignments of infectious/isolated patients? (excluding varicella and CMV)
    I think a RN/LPN/NA who is pregnant knows the risk she is involved with working with sick people. with the nurse shortage I say if you are on the clock then gown and mask up and do your job or go home.
  9. by   Susan9608
    I'm currently pregnant (32 weeks), and I work in pediatric intensive care. It's been very difficult to find appropriate patient assignments without effecting the workings of my unit.

    I spoke to my OB first and foremost about what patients are appropriate for me. In the very beginning, I had no weight limit, so that wasn't an issue. However, H1N1 was a big concern, as we had an abundance of it in my unit, and as the CDC was reporting it to be very dangerous to pregnant women. My OB wrote me a medical excuse, saying "NO H1N1 patients."

    As far as CMV, my ob tested me for it - I thought for sure I'd have antibodies already and have nothing to worry about, but surprisingly, I don't. So I am excused from taking CMV patients as well. CMV is one of the TORCH diseases, so it's really not worth the risk to care for them when you have no immunity.

    The only other things I avoid are patients receiving chemo and patients who need to be taken to radiology procedures (CTs, extensive x-rays, etc.) Also, since my uterus is now out of my pelvis, I am not to solely lift more than 30 pounds, so they try to assign me lighter patients.

    The end result is that I have to be very flexible about everything else - I have to take up the slack some how, and that usually occurs by me taking more admits, taking more of the chronic patients, etc - those things that aren't the most fabulous assignments, but are safe and free up everyone else to do what I can't.
  10. by   cjcsoon2bnp
    Quote from CuriousMe
    With all due respect to your Nurse Manager I'd talk to my OB about which infections I should avoid. The NM's responsibility is for the unit to run smoothly, your OB's responsibility is to you and your baby. Once you and your OB are clear on what to avoid and why....then chat with your NM.

    Just .02 from a nursing student....
    Ditto! I think it wouldn't hurt to talk to the OB and then present your findings from the OB to your Nurse Manager. Another thing I didn't see mentioned (maybe it was, I'm not sure) is about medication administration. I would just be careful when handling medications because some medications can be absorbed through the skin so if I were you I would just make sure that I wore gloves while giving meds (especially while your pregnant.) I know that many nurses wear gloves while giving meds already and I have seen many that do not I just think its better to be safe than sorry.

    !Chris
  11. by   RhiaRN75
    I was very fortunate to have protective co-workers when I was pregnant. I stayed away from CMV, parvo, and shingles/chickenpox- but we did a lot of woundcare so I was very careful about infections like MRSA and VRE w/ regards to PPE. I never thought about it at the time- and I don't think I had any pts with it- but I guess in theory you should be careful with group B strep. Ask your OB what to worry about to be sure.
    I also wore gloves while getting medications to be extra safe. My coworkers worried more then I did, bless them. I'll always be grateful for their concern.
    When my OB didn't want me working more then three 12's in a row, I went to weekends only. That made everyone happy. I was also not 'allowed' to take a few ETOH DT-ers and other pts that may hit/kick me, my co-workers really were protective.
    My last month I walked the halls- they fussed at me but between the restless legs and the desire to just go into labor already- I kept walking.
    I really appreciated their efforts on my part. I've always made sure to look out for my pregnant coworkers in return.
  12. by   ajessee
    very cool to see all the info from people who have experienced pregnancy and working the floor. there are definately many things to consider and know about. as i have said before i am not pregnant, and looked up this blog in order to get information to better prepare myself when i do decide to start trying. there are a few co-workers who have also had experiences and so i plan to pick their brains as well as to tips and info. one thing is for sure, PPE is a must, and I had never thought about wearing gloves when giving meds, but I do know there are certain meds that pregnant women should not handle, so it is probably better safe than sorry and i will wear them all the time when prego.

    i actually thought i was all ready to go for it and start trying to get pregnant right after getting married in september, but have since decided to wait a little longer. we have been together 9 years already so time isn't holding me back, just feel i need to get more info in regards to working while pregnant and would love to go on a real vacation sans belly or kids first etc...we've never been on a real vaca together. also i think i need to educate myself on whatever hospital policies are in place at my work regarding pregnant staff, as well as address my concerns with my doctor, and after all that and once i am pregnant it will be time to talk with my nurse manager as well so that she is aware and pick her brain too for any extra info she may have insight into.

    But from what I have seen so far from postings here and what happens on my floor with pregnant workers, there are only a few things that will absolutely not be given to me in an assignment and the rest is up to me to decide and stick up for myself as i see fit after gathering more info. as well as any restrictions that may come up. I am young and healthy so i do not forsee any special restrictions but you never know how any one persons body will respond to pregnancy. lots to consider and i am grateful for sites like this. much better than just reading it in an article or book as those things do not always reflect real life situations.

    Thanks everyone.
  13. by   littleneoRN
    Quote from fibro2003
    I think a RN/LPN/NA who is pregnant knows the risk she is involved with working with sick people. with the nurse shortage I say if you are on the clock then gown and mask up and do your job or go home.

    First of all, where do you live that there is a nursing shortage?

    Second, this is a dangerous attitude toward the health of the baby. Some of the exposures can be devastating, leading to significant illness after birth, disabilities, premature labor, death, or miscarriage. I think we are obligated to provide reasonable accommodations to our pregnant co-workers.
  14. by   Moogie
    When I was pregnant with my first child, I worked on a floor that sometimes got radiation implant patients. There was a hospital policy that pregnant workers could NOT take care of implant patients; still, one night the charge nurse insisted that I could not refuse the assignment because there had been so many implant patients as of late that she didn't want to risk any additional exposure to herself. She was not pregnant at the time. I got no support from the shift supervisor; she used to administer chemo when she was pregnant. So I took the patient, limited my contact, stayed behind the lead shield---but I also called in the next several shifts because the same charge nurse was on and I did not want to risk any harm to my unborn child. I had already put in my notice, so it was all moot by that point.

    My son ended up being fine but, twenty-three years after this happened, the selfishness of that particular charge nurse still makes me very angry. (BTW, this particular nurse always panicked when we had AIDS patients. She was so paranoid and uninformed about AIDS---and homophobic----she was afraid to even touch someone with AIDS and tried to weasel out of any assignments would have required her taking care of anyone with AIDS.) :angryfire

    That incident has made me very protective of my pregnant co-workers, even to the point of telling a CNA to not toilet a particular patient because he/she had recently had chemo and I did not want her handling the person's bodily waste. I told her I'd do it myself rather than risk her getting exposed. Just the right thing to do, IMHO.

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