Mask refusal

[Sherrie Smith]

At Virginia Department of Health, RN's are being told that we must serve clients who refuse to wear masks. Ironically, it is VDH that is supposed to be enforcing the mask requirement in public buildings in Virginia. How is this ethical or even legal?

[MarkMyWords]

The primary duty, as we know, is to treat all patients toward recovery. The mask law or rule is secondary and does not and should not override the nurse-doctors primary mission. It is unethical not to care for a patient with no mask. However, depending on the patient, maybe a thin inconspicuous facial covering will suffice. don't call it a mask. Doesnt have to look like a mask, such as a towel or something you create.

Of course, Covid patients or anyone tested positive should wear some mask

[JKL33]

25 minutes ago, Mywords1 said:

The primary duty, as we know, is to treat all patients toward recovery. The mask law or rule is secondary and does not and should not override the nurse-doctors primary mission. It is unethical not to care for a patient with no mask.

You know, our Code of Ethics (though not perfect in my opinion) is a little more nuanced than this.

Provision 2 clearly describes "patient" as being an individual, family, group, community or population.

The argument could thus be made that a DOH's work involves a primary responsibility for/to entire communities and populations.

You're making this out to be a personal ethical-professional issue, when in fact the argument could also be made that upholding a duty to the community (who is the "patient" of the DOH) involves protecting the interests of the whole.

In my reading of the CoE, it would seem ethically reasonable to:

1) Seek understanding of the individuals' reasons for not wearing a mask

2) Collaborate to offer an alternative that upholds the duty to both the individual and the rest of the community and

3) Acknowledge these individuals' autonomy/right to refuse care if reasonable alternatives are not acceptable to them

So...not doing the above would be the dereliction of duty. If the OP's employer plans to serve healthcare clients who cannot or will not wear a mask, they have a duty to come up with a reasonable alternative plan.

[Sherrie Smith]

This particular client seemed to enjoy seeing my frustration at his refusal to wear a mask. He came for a routine vaccination. I would like to be able to say, "You may return on another day when you feel up to wearing a mask for the few minutes that you need to be in the building."

I care about the public health of my community or I wouldn't have chosen this job, but my own health matters too. I am a nurse, not a martyr.

[Sherrie Smith]

I also feel the Department of Health has a responsibility to educate citizens during this public health crisis how imperative it is that we all wear masks. The message needs to be clear and consistent.

[Guest219794]

11 hours ago, Mywords1 said:

The primary duty, as we know, is to treat all patients toward recovery. The mask law or rule is secondary and does not and should not override the nurse-doctors primary mission. It is unethical not to care for a patient with no mask. However, depending on the patient, maybe a thin inconspicuous facial covering will suffice. don't call it a mask. Doesnt have to look like a mask, such as a towel or something you create.

Of course, Covid patients or anyone tested positive should wear some mask

I disagree.

It is absolutely not unethical to care for somebody who refuses to comply with simple safety guidelines.

Patients do not get to pick and choose which safety regulations they can follow. I live in an open carry state. Come in with a gun, and you are not getting treated until the situation gets resolved. If you have TB, and refuse a negative pressure room because the TV doesn't work, you won't be getting treated until you comply.

There are countless safety rules in place. There is nothing unethical about refusing to go into an unsafe situation.

The fact that masks have become a political hot button has no impact on this principle.

[Guest219794]

On 8/7/2020 at 6:42 AM, Norm smith said:

At Virginia Department of Health, RN's are being told that we must serve clients who refuse to wear masks. Ironically, it is VDH that is supposed to be enforcing the mask requirement in public buildings in Virginia. How is this ethical or even legal?

What about pants?

Do they allow folks to come in stark naked, wait in the waiting room with nothing on? What about if they start ranting about tyranny and freedom? Would that get them a pass for waiting around naked with others there? Nobody has ever died from seeing somebody's privates, yet we enforce that rule all the time.

Requiring masks is a public health issue based on the best available science.

Accommodating those that refuse, while enforcing numerous other requirements is a political decision. There are any number of actions a patient could take that would result in deferring care.

Wearing a mask at your institution is not, in fact, a requirement. It is a recommendation.

[JKL33]

I don't even know why it should be referred to as refusing to care for someone...it can just as easily be viewed as the patient refusing the to receive care under the circumstances.

With regard to my previous post, though, it would be pretty much open and shut especially if the site had an actual protocol for handling refusals instead of just putting staff and others at risk. Such as, why not ask these refusers to make a separate appointment at hours where they are separated from other clients and the staff is prepared and in full PPE gear? Or some such alternative plan? Give them their option (put on a mask now or make a different appointment) and allow them to make the decision about whether they want care.

[Emergent, RN]

On 8/8/2020 at 7:22 PM, Norm smith said:

This particular client seemed to enjoy seeing my frustration at his refusal to wear a mask. He came for a routine vaccination. I would like to be able to say, "You may return on another day when you feel up to wearing a mask for the few minutes that you need to be in the building."

I care about the public health of my community or I wouldn't have chosen this job, but my own health matters too. I am a nurse, not a martyr.

Interesting. Anxious for a vaccine, but couldn't be bothered with a mask. Fascinating.

[murseman24, MSN, CRNA]

sorry to hear about the poor leadership at your facility that is putting its employees in danger. Only way to win this battle is through sheer numbers and unity, if enough people stand together something may change, it's difficult at the nursing level to get these things done, I'm sorry. Case in point, a pt tried to refuse her COVID swab before elective Sx, the surgeon who is CMO states she either takes her test or goes home AMA. On the flip side there are surgeons who try to label everything as "urgent" in order to bypass the rule. These people have pull with the hospital, it's up to those in leadership positions to be responsible and care for their employees.

[Kooky Korky, BSN, RN]

On 8/8/2020 at 8:34 AM, Mywords1 said:

The primary duty, as we know, is to treat all patients toward recovery. The mask law or rule is secondary and does not and should not override the nurse-doctors primary mission. It is unethical not to care for a patient with no mask. However, depending on the patient, maybe a thin inconspicuous facial covering will suffice. don't call it a mask. Doesnt have to look like a mask, such as a towel or something you create.

Of course, Covid patients or anyone tested positive should wear some mask

How about the nurses' duty to remain healthy so he or she can be able to treat lots of other patients and be there for one's own family and protect one's own health?

[Kooky Korky, BSN, RN]

On 8/7/2020 at 5:42 AM, Norm smith said:

At Virginia Department of Health, RN's are being told that we must serve clients who refuse to wear masks. Ironically, it is VDH that is supposed to be enforcing the mask requirement in public buildings in Virginia. How is this ethical or even legal?

This is when those making the rules need to come live them. You know - lead the way for their workers. ??