refusing to care for clients - page 2

Hi! I am a senior nursing student doing a theory paper on the ethical considerations regarding refusing to care for a client with a communicable disease. It amazes me to see how many people have... Read More

  1. by   ecb
    I was informed by my Unit manager (yesterday in fact) that I, as an RN, can give an inservice any time just get the sheet, collect my staff, and explain why a patient needs special care, and exacly WHAT that care need is, and hand in the sheet. I have been ding this informally for MONTHS, and none of them got credit for the education

    I have a CNA who is from an agency who will do the whole gown/glove/goggles mask w shield routine whenever she cares for someone with ANY infection at all, even just to give them fresh water. This is her right, if she needs to protect herself (under the argument that she will not bring this home to her child if she is careful enough) but it is demeaning to the patients with urinary mrsa infections, or a history of + PPD but no active disease, or healed shingles.
    Her biggest problem (that I see) is she is sloppy with most of her other residents, and she realises that if she is not VERY careful with the infected ones her actions WILL spread infection.

    Before you remind me to orient her, I have, and she has NOT changed, and the nsg supervisor will NOT write her up because they NEED her to be willing to come back.
    I try to pint out how she is SO inapropriate but she has not improved yet.

    I try to keep her with only the residents who will not take offence at her antics (?) but I get little or no support about her (I think she needs to go into burger flipping personally), other people tend to become more realistic about patient care with a little education
    that is all

    *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***
  2. by   vawoman123
    i feel someone should not get away with not wanting to care for someone with a disease. if your in nursing, then that is your job. i can understand if the patient doesnt want a certain nurse to care for him, cause of her attitude, etc.other then this, you have to care for all ill would they like it ifsomeone didn't want to care for them cause of what they had.
  3. by   alaskanRNx2
    above all, consider what is in the best interest of the patient


  4. by   JOY, RN
  5. by   JillR
    I do not think that it is the nurses right to refuse to care for patients with communicable diseased, unless the nurse is pregant and there is a high risk for the disease to be passed on to the fetus and cause harm.

    Should a nurse be allowed to refuse to care for a patient based on a moral decision, well the nurse can choose not to work in that facility, but if the nurse does choose to work in a capacity that may have him/her faced with this delemma, then I say no to that also.

    We all have the ability to choose if we will take a job or not. Not all patients have a choice about where they will recieve their health care.

    Every person has a right to good nursing care and has the right to not have anothers views pushed on them and to be treated respectfully, regardless of whether or not we agee with thier choices.
  6. by   hollykate
    I have never refused to care for pts with communicable diseases. One thing I always point out when someone complains aboutt aking care of someone with TB or AIDS: is that we know this person has this disease. So many times we treat people and have no idea if they have HIV, Herpes, hepatitis C, etc. We don't know, which is why universal precautions exist. I would rather take care of a known HIV patient than find out later- after the pt had hemmorhaged all over the floor and we "exposed" ouselves, the cleaning staff etc. (Although under universal precautions no one should be exposed anyway.)
    I agree with Willis above, though his presentation was a little passionate. I don't think you can make an entire floor overcome fear, but sometimes those that show the most fear, give it up, when they see that the majority are just doing their job (in those sunny yellow isolation gowns we all love so much). I will admit, when our entire bed area in our unit was ORSA or MRSA, I got a little tired of the yellow look, but I never would have refused care to any of those Mothers, Son's.and Wives lying sick in those rooms.
  7. by   penny0314
    OK, as an RN and a lesbian, some of the concern from my community comes with the Michigan law, which can potentially leave a gay person without care solely because of their orientation. The new Mich. law makes this a possibility, which is very frightening for the gay and lesbian community. I think if we had not been so battered already, especially by GW Bush and the religious right, it might not be such a big thing, because I don't think that was the real thrust of the law, just some of the backwash. I cannot imagine any caring nurse refusing to care for someone on that basis, but when parents abandon their children for being gay (cf. Alan Keyes and wife, who have turned their backs on their 19 year old daughter and refused to allow her in their house), you sometimes have to wonder. Also, MDs seem to be far less bound to an ethical sense than nurses. So, if under the Michigan law a health care worker can refuse to care for someone on moral grounds because of who they are (as opposed to assisting in an abortion, e.g.), where does that go? I haven't read the law itself, but it has worried a community already more medically underserved than almost any in the US.
  8. by   angie1982
    penny, I am not sure what law you are talking about i live in michigan and have all my life, and have never heard of being allowed to refuse to give care to someone based on their sexual orientation. please enlighten me.
  9. by   mommatrauma
    I got into nursing to take care of sick people...not healthy ones...I knew what I was getting myself into when I started...It sounds like these people who try to refuse patients with communicable diseases chose the wrong profession and need to move on...
  10. by   pebbles
    ... the other side: remember SARS?

    Out of the 144 cases of SARS that occurred in Toronto, Ontario, 73, or 51% were health care workers. It took the experts a long time before they knew HOW to protect the staff, and even health care staff that took the initial reccomended precautions ended up getting sick with SARS. Some nurses refused to go to work, or refused to take care of the SARS patients. I don't blame them for that, because nobody knew much about it, and it was a killer disease.

    Not sure about the on-paper "ethics debate" over refusing to take care of these patients and selective refusal to care for them, etc. But if I believed my life or the life of my family was at stake, I wouldn't have much difficulty refusing.

    That being said, people who refuse to care for someone who has a disease which medical science is knowledgable about - that offends me. We try to portray ourselves as professional and educated and knowledgaeable. Well to me, that means we have a duty to learn about a disease. If that was really happening, the staff member would KNOW that the disease would not harm herself or her family. Especially whem education and info about diseases like MRSA or HIV is so readilly available, I think refusal to care is just plain ignorant.