Ebola - do you have the right to walk away?

[rnnina19]

I just want your insight... would you or would you not accept the assignment if they gave you a patient positive for Ebola. Can you or do you have the right to walk away?

[eaus]

A nurse may refuse to care for an Ebola-infected patient but should be prepared to accept

the consequences including termination of employment. Having proper PPE and training is key.

If there is not proper protective gear available and nurses are not trained, the hospital must not

accept the patient. If your loved one had Ebola and was admitted to an unprepared hospital, would you want

the staff to give their lives so your loved one could possibly live? It is a dilemma no matter how you look at it.

[SweetSong]

I would say I'd stay and help care for the Ebola patient. However, demands should be made of the hospital to provide the best, most adequate and safest equipment, training and PPE available. I heard that in the case of the gentleman who recently died in Texas, that a nursing supervisor demanded that he be placed in isolation but received push-back by someone in the hospital administration. Eventually he was placed in isolation but most definitely not fast enough. Hospitals talk the talk about protecting staff and maintaining a safe facility but it has been my experience that not very many walk the walk... sad but true.

[brandy1017, ASN, RN]

I agree with Esme. There are a LOT of things being said that aren't true and there is a lot of info the media is not privy to, so they make things up. There is a definite spin going on here. The CDC has an agenda or a heavy dose of hubris in my own opinion. I can tell you this hospital is a world class organization and the employees are loyal and heartbroken. I can tell you the things the hospital are doing internally to take care of both patients and employees would amaze you and the media is not privy to those things either. I will never again trust what I hear or see in the media. The half truths, blatant lies and sensationalism are astounding. Take everything you hear and read with a heavy dose of skepticism.

- n.d.y.

The viewpoints and opinions expressed here are my own and not representative of any entity other than myself

If you have inside knowledge is it true that nurses wore gowns and were told to cover their necks with medical tape and that waste piled to the ceiling? That doesn't sound world class to me! Also why were the nurses expected to care for other patients as well, potentially exposing them to Ebola as well as themselves?

There have been a lot of false alarms in NY, Boston, FL and LA so it is high time the hospitals across the nation, esp the major cities should have an Ebola plan ready with the necessary equipment, preparations and obviously this is not the case.

Also why the need to destroy all the patient's belongings? If that is the case then there should be a national policy that you don't go home but stay at the hospital or hotel. Why should you have to worry about losing all your belongings to care for an Ebola patient.

There are just so many reasons to want to run away. I don't blame anyone that walks out rather than put their life, family, pets and home at risk! Basically if you live you will find yourself forced to start over without any clothes, furniture, family keepsakes, everything destroyed! That is just too much for me!

[brandy1017, ASN, RN]

I would say I'd stay and help care for the Ebola patient. However, demands should be made of the hospital to provide the best, most adequate and safest equipment, training and PPE available. I heard that in the case of the gentleman who recently died in Texas, that a nursing supervisor demanded that he be placed in isolation but received push-back by someone in the hospital administration. Eventually he was placed in isolation but most definitely not fast enough. Hospitals talk the talk about protecting staff and maintaining a safe facility but it has been my experience that not very many walk the walk... sad but true.

But you are stuck with the equipment the hospital has. If it doesn't offer you hazmat suit or respirator you are still forced to endanger yourself. I don't care what they say they must be concerned of it being airborne when they have a positive pressure hazmat suit with a respirator and HEPA filter to protect you from the air in the patients room! Look at the safety measures taken at Emory and compare them to the rest of the hospitals. There is no comparison!

[diosa78]

I would walk away very fast and refuse it based on - 1. It is outside my scope of practice (I am not trained to handle Level 4 biosafety hazards) and 2. I do not have the adequate PPE to do the job thus putting my family and others at risk of me getting the disease and transferring it to someone else. However, if I get the training that those who work for NGOs in Africa and those that work with Level 4 biosafety hazards get than yes. I want a positive pressure suit, a respirator, the proper footwear, the proper gloves, disinfectant sprayed on me when I'm done, and ultraviolet lights. I also want a buddy and a hygiene team coming behind me to clean. That is how it's done in Africa - why aren't we, as a "more developed" nation doing the same. I think the teams in Africa are handling this much better than we are here as far as with healthcare workers. I encourage all of us to research how the Ebola teams put on and take off PPE in Africa as well as how the CDC handles Ebola in biocontainment units and then ask yourself if you have the same safeguards. These patients should be treated in the most appropriate facility - which is a biocontainment unit.

[herring_RN, ASN, BSN]

I urge everyone in the Nursing Community to donate to National Nurses United:

National Nurses United

They have shown up in a major way to advocate for appropriate occupational safety for healthcare workers in this situation!

The MSDS states that persons working in a laboratory with a vial of Ebola should don Haz-Mat suits for protection, while in the clinical setting healthcare workers who are working with confirmed, contagious individuals with limited control of their own secretions-ie. cough, projectile vomit, and other bodily fluids, are not required to wear Haz-Mat suits per the current CDC protocol.

I suggest patients with this illness be transported to one of the 4 bio-containment units in the US with equipped and trained staff with Haz-Mats suits to prevent the spread of this illness. If this transportation is not possible and we are required to treat these patients in our community hospitals, then we should be fitted and trained with Haz-Mat suits in order to responsibly care for these patients. Based on the the high rate of mortality among infected patients, the risk of human-to-human transmission, and the lack of FDA-approved vaccine and therapeutics the highest and most conservative level of protection is necessary.

You can join NNU for $50.00 a year:

https://donate.nationalnursesunited.org/page/contribute/joinnnu

The NNU charitable organization is the Registered Nurse Response Network (RNRN):

RNRN Home | National Nurses United

[edmia, BSN, RN]

This case is a perfect example of why we need a national nursing union. Had the union been in place from the start, all these reports of unsafe working conditions would have been brought to light early on in the management of this first patient.

[naijanurse]

I remember a few years ago during the H1N1 epidemic, we had a patient on our unit who was suspected to have it. We were provided with PAPRs (Infectious Disease PAPRs >> ILC Dover), and rotated that patient out so that it was fair for all staff involved. Obviously staff members that were pregnant, or had young children at home were excluded, but it worked out nicely. Before taking care of the patient, you had to be inserviced on how to use the PAPR, and signed off on a competency. I never felt unsafe, or unsupported as these poor nurses at Texas Health Presbyterian did. I guess my point is that with proper training, I would take care of the patient. However, I would never judge another staff member for refusing the assignment.

[dudette10, MSN, RN]

If your loved one had Ebola and was admitted to an unprepared hospital, would you want

the staff to give their lives so your loved one could possibly live?

No, I wouldn't. But that wasn't the question posed to all of us, and which I answered. You're mixing scenarios and variables.

You cannot mandate that the loved ones of nurses should be excluded from Ebola treatment from those with proper protection because the nurses refused to care for patients without proper protection. That is clearly unethical.

Really, people, y'all would do basic care on an Ebola patient with just contact/droplet PPE that we have all used? I don't believe ANYONE who would say yes to that. You might as well walk in wearing your birthday suit.

From what I understand, the Presby Dallas nurses were wearing hazmat-type gear, but I am unsure what respirators they used. The difference with Duncan is that he was intubated and dialyzed, something that has NOT been done on any Ebola patient in the US (and I doubt in the world, given the conditions and equipment in West Africa).

In fact, our protocol states that we are not to intubate or dialyze a patient. Why? Because the risks to other healthcare personnel outweigh the benefits to the patient. In other words, if an Ebola patient gets to the point of needing dialysis or intubation, he/she won't live anyway.

[calivianya, BSN, RN]

One cannot ask someone else to do for them what they themselves are unwilling to do for another. It is that simple.

Well, your logic would certainly cut costs tremendously. If one can't ask someone else to do for them what they themselves are unwilling to do for another, we should be asking patients in the ER if they would be willing to take care of a hospital nurse if that nurse became sick. If not, we could refuse to admit the patient. Boom! It sounds like a pretty good cost-containment strategy to me.

I don't want to take care of an Ebola patient if I don't have proper PPE (which my hospital does not, even though they just got named as an Ebola treatment center in my state). If I was in the bed with Ebola, I also wouldn't judge anyone for refusing to take care of me. I won't risk my life for my job and I don't expect other people to risk their lives either. If another nurse volunteers to risk her life to take care of mine with improper PPE - well, I would think she's insane, but she's allowed to risk her life if she wants to.

[Thimbalina]

I was thinking also about the other people involved indirectly specifically HOUSEKEEPING! How scary for the poor housekeepers who had to clean… Did they use a separate mop? How did they dispose of the mop water? did they use the mop in other patients rooms? If they use Bleach would that kill the Ebola virus?

What about the laundry? Was it burned? Washed with other hospital laundry?

[dedicatednurse092b]

I'm a student taking pre-reqs for nursing school. I have no hospital or critical care experience being that I'm just in school. I wouldn't dare refuse treatment to patient with any disease, all I could think about is what if it was me or one of my family members and someone refuses treatment. I feel that everyone deserves the proper treatment. That's why I'm coming into the nursing field .