As an occupational nurse am I responsible if an employee refuses an ambulance?

[Nurse Beth, MSN]

As an occupational nurse, your primary responsibility is to ensure employees' safety and well-being while upholding ethical and legal standards to provide the best care possible. 

Your protection in a case like this lies in following policy and thorough documentation. By following standard procedures, including calling for additional help when necessary, you protect yourself, the employee, and the employer from potential liability. 

If you follow the proper procedures and document everything, your professional responsibility can be limited.

Employee's Right to Refuse Care 

While you can recommend medical intervention (such as calling an ambulance), ultimately, the decision to accept or refuse care lies with the employee, as long as they are legally capable of making an informed medical refusal.

Policies

It's crucial for nurses to know and understand their employer's policies governing their practice because that is what protects them.

Ensure you follow your employer's policies on medical emergencies and employee refusal of care.

If your employer does not have a refusal of care form, recommend these to your supervisor.

Document, Document, Document

• Your assessment and recommendation for an ambulance
• Employee's refusal of an ambulance in detail, including that they were assessed, appeared stable and declined further care or transport
• Efforts to inform employee of  the potential risks of refusing care
• Employee's understanding of the risks
• Any follow-up care recommendations
• Discharge status, including your assessment of stability
• Any conversations had with a supervisor
• Follow-up care recommendations

Follow-Up

If the employee refuses an ambulance, you should make sure they have a follow-up plan, which includes monitoring their condition or encouraging them to seek care later. For instance, they may be asked to check in after a certain period or to be re-evaluated by another healthcare professional.

When to Escalate

In situations with ambiguity or uncertainty, you should always err on the side of safety. You could be held accountable if something goes wrong and you don't take the necessary precautions or escalate care.

If you believe the employee's health is at significant risk, or there are concerns about their mental capacity and ability to make an informed decision, you have an ethical obligation to escalate the matter, even if they refuse.  Contact your supervisor. It may be necessary to involve HR, Risk Management, or a physician. 

Involving your supervisor also shifts the responsibility upward, which further protects you. 

Summary

In summary, while employees can refuse an ambulance, you must provide recommendations, ensure the employee understands the risks, and document everything carefully. If there's any doubt or concern, it's important to err on the side of caution and escalate the situation to ensure the employee receives the care they need.

Keep notes for your future reference, and the names of any witnesses to the situation. Also, make sure you carry  professional Liability Insurance and consider joining your professional organization, The American Association of Occupational Health Nurses.

Best wishes,

Nurse Beth