Can I Refuse to Work If My Facility Does Not Have Proper Personal Protective Equipment?

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Can I Refuse to Work If My Facility Does Not Have Proper Personal Protective Equipment?

The number 1 question that I have been asked during this time of COVID-19 is, “Do I have to work if my facility does not have personal protective equipment?”

Unfortunately, my response is not going to be popular. The truth is that the Oregon State Board of Nursing issued a position statement declaring that, “The Board has determined that nurses cannot refuse a patient care assignment because the organization is following Oregon Health Authority Public Health Division recommendations regarding PPE and other infection control practices rather guidelines of the World Health Organization or Centers for Disease Control and Prevention." This statement has been updated by the Board to read

"Nurses cannot refuse an assignment solely because the employer is utilizing OHA guidelines rather than WHO or CDC guidelines."

After conversations with other nurse attorneys, I believe that other states feel the same way as does Oregon. They consider a refusal to work to be patient abandonment or job abandonment.

At this difficult time, nurses are the epicenter of this pandemic crisis. You do have a choice. If you believe the facility does not have proper equipment, you can give proper notice and resign. However, if you leave and abandon your job without notice, you can face disciplinary action with the Board.

It is unfortunate that our country was not prepared and placed nurses in these vulnerable positions, but you can decide for yourself what is best for you in protecting yourself and your family as well as your license.

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WOW!, Oregon must certainly not value their nurses as a whole. I am extremely displeased at the lack of support I have been given.

I work for a dermatologist in Washington state. The MD has not stopped surgeries, and this would be appropriate if we were treating melanoma and advanced SCC. This however is not what has occurred. We are still doing all surgeries ( a cyst that the person has had for 15 yrs and is not causing problems, mild atypia). I was provided with a hiking windbreaker mask to be used, not medical grade. I have been asked to not use gloves to apply a dressing after surgery, so that supplies can be conserved. Now I work for a Dermatologist, this is not even the level of disregard that some of those in my industry have been exposed to.

What will happen like it always does for nurses, is they will tell us just get through this. Guilt us with the risk to pts (this is really manipulation), and they will make sure we are never put in this situation again.

I really dislike that the advise is to move on. We are always moving on, and not being given the support to make the correct changes that need to be made for pt and nurse safety.

To the original post, I am so sorry that you are in this position. I hope you find some nurses near you to rally around you.

Stay safe and sound

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Could you expand to whatever degree possible on 'job abandonment' and 'proper notice'? Obviously this will be state-by-state, but what should nurses know about quitting their jobs during this pandemic?

Could the time frame that constitutes proper notice be dependent upon other factors from the nurses personal life? I.e. sudden sickness in the family, new diagnosis of htn, auto-immune disease, copd, etc?

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Washington state is an at will state.

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Ms. Brown,

I am an RN in Oregon working in direct client contact without proper PPE.

I dont understand some portions of what you wrote. The OSBON Covid-19 PPE statement currently on their website says:

"All nurses and nursing assistants are entitled to keep themselves safe through appropriate use of PPE. The Board of Nursing does not expect nurses to work without PPE. The Nurse Practice Act will always support the ability of a nurse to refuse an assignment when they do not have the knowledge, skills, competencies, and abilities to safely accept it. Having PPE, or not having PPE, comes under the “abilities” section of the practice act."

So my question is, is your professional legal perspective to mean that nurses are legally bound to work without PPE? I dont understand how you and other attorneys have arrived at the legal determination that the Practice Act can result in disciplinary action with the board, when their statement above says something else.

Also, I take umbrage with your statement, "You do have a choice. If you believe the facility does not have proper equipment, you can give proper notice and resign."

Ms Brown, we have lots of other choices, which you failed to mention. Make OSHA complaints. Are you unionized? Accept the patient assignment under protest & notify your union immediately. Ask questions of leadership, in report, in meetings, when everyone is listening. You are protecting yourself and your patients. Not unionized? Now's the time to get that rolling.

Ms. Brown, I find the legal perspective information you provided in the above article/response is vague and unhelpful. To me your tone reads as helpless, hopeless, lacking in advocacy, and rich in fear-mongering. I am very disappointed in your article.

I hope that you understand that with your credentials as an attorney and a nurse it is a grave responsibility when you offer statements based on your legal background to front line staff.

TO ALL PATIENT-FACING STAFF IN THIS CRISIS: IN SOLIDARITY.

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Well said, thank you.

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I don't really see the issue with the OP's statement. She is an attorney and is warning that BON's across the country might look unfavorably upon nurses who refuse an assignment or quit their job.

Nurses should not look to attorneys for emotional support or kind words. We should be look for black and white legal perspective on a topic that is not crystal clear.

Any human being has the free will to not do something (take an assignment), regardless of the repercussions. Attorneys can comment on what those repercussions might include.

The talk and issue of job abandonment is the most pressing issue imho. The idea that you can be disciplined for quitting a job without notice is alarming. Whereas, the issue of what constitutes patient abandonment is quite clear.

I AM NOT AN ATTORNEY AND THIS IS NOT LEGAL ADVICE. In looking over the MASSACHUSETTS regulations, I don't see anything about 'job abandonment'. Anything related to abandonment is dependent upon an existing nurse/patient relationship. Correct me if I am wrong or if I overlooked a section of the legal code.

Two conflicting sections of Massachusetts laws pertaining to nursing practice and COVID-19 are as follow;

(13) Discrimination. A nurse licensed by the Board shall not withhold or deny nursing care based on age, ancestry, marital status, sex, sexual orientation, race, color, religious creed, national origin, diagnosis, or mental or physical disability.

(14) Asepsis and Infection Control. A nurse licensed by the Board shall adhere to standard precautions and to principles of asepsis and infection control, and shall not place a patient, himself or herself, or others at risk for the transmission of infectious diseases.

Irregardless of your decision in the setting of improper PPE; refusing to care for covid+ patients in Massachusetts would result in violating two sections of the law. You'd either be refusing care based upon a diagnosis, or putting yourself at risk?

Another concerning section of the law is as follows;

Other Prohibited Conduct. A nurse licensed by the Board shall not engage in any other conduct that fails to conform to accepted standards of nursing practice or in any behavior that is likely to have an adverse effect upon the health, safety, or welfare of the public.

Does resignation without proper notice constitute conduct that fails to conform to accepted standards or behavior that has adverse effect upon public health?

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On 4/1/2020 at 2:40 PM, Lorie Brown RN, MN, JD said:

At this difficult time, nurses are the epicenter of this pandemic crisis. You do have a choice. If you believe the facility does not have proper equipment, you can give proper notice and resign. However, if you leave and abandon your job without notice, you can face disciplinary action with the Board.

It is professional to give 2 weeks notice to resign. However, NO ONE faces DISCIPLINARY ACTION WITH BON if leaving the job without notice no matter it is at will employment or contract employment.

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DannyBoy8,

Ms. Brown is per her listed credentials, both an attorney and an RN.

Based on her credentials as an attorney, I take issue with the, in my opinion, professionally lacking legal perspective that she provided, on a public forum, for nurses in my state, when based upon the actual statement posted by Oregon's BON. I look forward, hopefully, to her clarification, as you said, in black and white.

Based on her credentials as an RN I am offended, as a fellow RN, from an advocacy perspective, that she failed to identify many of the powerful tools we have available to protect ourselves, as a group. I am not looking for kind words or emotional support.

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10 minutes ago, ashagreyjoy said:

DannyBoy8,

Ms. Brown is per her listed credentials, both an attorney and an RN.

Based on her credentials as an attorney, I take issue with the, in my opinion, professionally lacking legal perspective that she provided, on a public forum, for nurses in my state, when based upon the actual statement posted by Oregon's BON. I look forward, hopefully, to her clarification, as you said, in black and white.

Based on her credentials as an RN I am offended, as a fellow RN, from an advocacy perspective, that she failed to identify many of the powerful tools we have available to protect ourselves, as a group. I am not looking for kind words or emotional support.

I'm on your side. The idea that nurses can face repercussions for exercising their free will to work or not work is infuriating.

Ms. Brown stated that "nurses can face" action from the board if they quite their job, not that they 'absolutely' will face action. Don't take this the wrong way, but you need to focus on logic and true meaning of a statement given its syntax. Given the unknown territory we are in, this hardly a perspective that lacks professionalism. Lawyers can't predict case law that will result from this mess, after all, every lawsuit is dependent upon two lawyers arguing opposing viewpoint until a judge or jury makes a judgement or ruling.

And to your point about not looking for emotional support or kind words....you criticized her tone as sounding helpless and hopeless.

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On 4/1/2020 at 4:20 PM, ashagreyjoy said:

Ms. Brown,

I am an RN in Oregon working in direct client contact without proper PPE.

I dont understand some portions of what you wrote. The OSBON Covid-19 PPE statement currently on their website says:

"All nurses and nursing assistants are entitled to keep themselves safe through appropriate use of PPE. The Board of Nursing does not expect nurses to work without PPE. The Nurse Practice Act will always support the ability of a nurse to refuse an assignment when they do not have the knowledge, skills, competencies, and abilities to safely accept it. Having PPE, or not having PPE, comes under the “abilities” section of the practice act."

So my question is, is your professional legal perspective to mean that nurses are legally bound to work without PPE? I dont understand how you and other attorneys have arrived at the legal determination that the Practice Act can result in disciplinary action with the board, when their statement above says something else.

Also, I take umbrage with your statement, "You do have a choice. If you believe the facility does not have proper equipment, you can give proper notice and resign."

Ms Brown, we have lots of other choices, which you failed to mention. Make OSHA complaints. Are you unionized? Accept the patient assignment under protest & notify your union immediately. Ask questions of leadership, in report, in meetings, when everyone is listening. You are protecting yourself and your patients. Not unionized? Now's the time to get that rolling.

Ms. Brown, I find the legal perspective information you provided in the above article/response is vague and unhelpful. To me your tone reads as helpless, hopeless, lacking in advocacy, and rich in fear-mongering. I am very disappointed in your article.

I hope that you understand that with your credentials as an attorney and a nurse it is a grave responsibility when you offer statements based on your legal background to front line staff.

TO ALL PATIENT-FACING STAFF IN THIS CRISIS: IN SOLIDARITY.

Well said in a professional and Evidence-Based Practice way. Thank you.

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Specializes in Critical Care.
On 4/1/2020 at 2:40 PM, Lorie Brown RN, MN, JD said:

Can I Refuse to Work If My Facility Does Not Have Proper Personal Protective Equipment?

The number 1 question that I have been asked during this time of COVID-19 is, “Do I have to work if my facility does not have personal protective equipment?”

Unfortunately, my response is not going to be popular. The truth is that the Oregon State Board of Nursing issued a position statement declaring that, “The Board has determined that nurses cannot refuse a patient care assignment because the organization is following Oregon Health Authority Public Health Division recommendations regarding PPE and other infection control practices rather guidelines of the World Health Organization or Centers for Disease Control and Prevention.

The OSBN's answer to the question you pose in the beginning is quite clear from their statements, they do not expect nurses to work without the PPE recommended by the OHA.

I don't know who these "other nurse attorneys" are that you're having conversations with, but I would suggest finding a more informed peer group.

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