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Mask refusal

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by Sherrie Smith Sherrie Smith (New) New

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?

Mywords1

Specializes in nursing ethics.

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

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.

Edited by JKL33

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.

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.

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.

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.

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

Specializes in ER. Has 28 years experience.

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

Specializes in anesthesiology.

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.

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?

Edited by Kooky Korky

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. 🤬🤣

I don’t think it’s legal or ethical.

I quit a job because my (former) employer did the same thing - “required” patients to wear masks, unless they didn’t want to wear a mask.

In that role, it wasn’t just me getting exposed involuntarily- there were up to eighteen other patients in the same room getting exposed. And the other patients were all considered immune compromised.

If anything, I felt it was unethical to accept care of an unmasked patient who had no medical need to skip the mask. I had to quit. No unemployment & lost my health insurance for a couple of months during this pandemic.

I ended up getting a raise at my new job. A few of my former patients are dead of covid.

This is, no doubt, why certain people in government want “liability protection” as part of any future stimulus package.. So healthcare employers can intentionally do the wrong things for profit.

Mywords1

Specializes in nursing ethics.

In most units and situations, all patients need to wear a mask. . In other situations and hospitals, exceptions can be made. Standing 6 feet away is not enough for you? Are all the Covid-related rules in writing for patients?

What if someone needed CPR, breathing close to you, will you refuse and let her die? You realize that statistically chances of infection are very tiny. Risk is a matter of degree from none to big-- depending on your state, health, and your particular job.. The nurse's career and duty is treating all patients-- unless the situation is so strange that it is impossible. All ethicists I know of agree. If you feel strongly against caring for a maskless patient, then by all means arrange for another nurse to handle him, if possible.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

12 minutes ago, Mywords1 said:

What if someone needed CPR, breathing close to you, will you refuse and let her die?

Actually, AHA has come out with guidelines and in fact state to put on PPE to guard against both airborne and droplet particles before entering the scene. So yes, there may indeed be adverse effects to the patient when the rescuer needs to protect themselves. Scene safety is after all the first thing to check- not even responsiveness.

OP, what guidance has your administration put out for care of patients refusing a mask? Mine flat out states that if the patient refuses to wear a mask for anything other than a health reason, they may not enter the building unless emergency treatment is needed. Anyone besides a patient refusing to wear a mask for any reason may not enter the building.

macawake, MSN

Has 13 years experience.

1 hour ago, Mywords1 said:

In most units and situations, all patients need to wear a mask. . In other situations and hospitals, exceptions can be made. Standing 6 feet away is not enough for you? Are all the Covid-related rules in writing for patients?

What if someone needed CPR, breathing close to you, will you refuse and let her die? You realize that statistically chances of infection are very tiny. Risk is a matter of degree from none to big-- depending on your state, health, and your particular job.. The nurse's career and duty is treating all patients-- unless the situation is so strange that it is impossible. All ethicists I know of agree. If you feel strongly against caring for a maskless patient, then by all means arrange for another nurse to handle him, if possible.

If the patient was wearing a mask it would be removed anyway in order to perform CPR. So why is this a question? It’s not really relevant to OP’s post as far as I can tell. I’d of course use PPE for myself, but I wouldn’t demand that the patient did in the CPR scenario..

Also, it’d be very hard for OP to stand six feet away while administering a vaccine. If you ask me personally what my pick would be if I could choose only one, distance or mask, I’d choose distance every time. But the mask is useful for those occasions when you can’t stay at a safe distance.

Edited by macawake

This demonstrates nicely why I left the BS of nursing behind forever.

1 hour ago, Mywords1 said:

In most units and situations, all patients need to wear a mask. . In other situations and hospitals, exceptions can be made. Standing 6 feet away is not enough for you? Are all the Covid-related rules in writing for patients?

What if someone needed CPR, breathing close to you, will you refuse and let her die? You realize that statistically chances of infection are very tiny. Risk is a matter of degree from none to big-- depending on your state, health, and your particular job.. The nurse's career and duty is treating all patients-- unless the situation is so strange that it is impossible. All ethicists I know of agree. If you feel strongly against caring for a maskless patient, then by all means arrange for another nurse to handle him, if possible.

And what about the immune-compromised patients being exposed to unmasked patients while under a nurse’s care? At some point the nurse assumes responsibility for allowing an unsafe and unnecessary “exception” endangering the other patients under their care, regardless of what the corporate overlords say.

My former employer required me to allow unmasked patients onto a common treatment floor with vulnerable patients - and distancing was/is impossible in that situation.

The situation I experienced should *rightly* expose the corporation to civil liability for knowingly endangering vulnerable patients (and staff) without a good medical excuse.

The policy was written to require masks on patients in the beginning of the pandemic, and revised to allow grumpy unmasked patients (without a medical need to skip the mask) after at least one grumpy patient was escorted out of the building by the local police - for refusing to mask up, then refusing to leave the treatment floor. No one needed “CPR”, this was not “emergency” care.