Patient Refusing Unvaccinated RN

[Delia37, MSN]

Just as the tittle implies, we recently had a patient's family refusing a nurse who is not vaccinated. As of now, vaccination at my facility is still voluntary; becoming mandatory after September 1st (we still have several staff on the fence about it). My understanding is that the patient happened to come in as a stroke, with a prior  hx of prostate CA. Not sure what was the context of the conversation, but the patient's wife asked the nurse at the time if she was vaccinated (she was not and answered honestly...she could had refused); prompting the wife to request a different nurse due her fear of exposing her possible immunocompromised husband...the assignment was changed. The feeling of some of my co-workers is that we shouldn't had accommodated the request in support of the staff; however, many feel the wife had the right to advocate for her husband and had a valid concern. This has become a hot topic of conversation in the unit during downtime. 

Have anyone come across to anything similar?? If so, how was it handled?

[DesiDani]

That is a false sense of security.  Just because someone is vaccinated does not mean they cannot catch and then spread Covid. So her guard is naively down when her spouse has a nurse who says she is vaccinated? 

[Delia37, MSN]

2 minutes ago, DesiDani said:

That is a false sense of security.  Just because someone is vaccinated does not mean they cannot catch and then spread Covid. So her guard is naively down when her spouse has a nurse who says she is vaccinated? 

I hear you. In fact, there are some report of vaccinated individuals becoming infected with the new Delta strain. I don't think it has to do being naïve, but with the public assumption that we, as health care providers would already be vaccinated.  I was not present when this happened, so sure what was the wife's mindset (...or honestly, how they even got into that conversation). How would you had addressed the wife's concerns??

[macawake, MSN]

On 7/21/2021 at 3:41 AM, Delia37 said:

Just as the tittle implies, we recently had a patient's family refusing a nurse who is not vaccinated. As of now, vaccination at my facility is still voluntary; becoming mandatory after September 1st (we still have several staff on the fence about it). My understanding is that the patient happened to come in as a stroke, with a prior  hx of prostate CA. Not sure what was the context of the conversation, but the patient's wife asked the nurse at the time if she was vaccinated (she was not and answered honestly...she could had refused); prompting the wife to request a different nurse due her fear of exposing her possible immunocompromised husband...the assignment was changed. The feeling of some of my co-workers is that we shouldn't had accommodated the request in support of the staff; however, many feel the wife had the right to advocate for her husband and had a valid concern. This has become a hot topic of conversation in the unit during downtime. 

Have anyone come across to anything similar?? If so, how was it handled?

I haven’t experienced anything similar, probably because more than 98% of my coworkers are fully vaccinated. So, I can’t offer any helpful suggestions. 
 

I can definitely understand the wife. If I came in with a stroke and a history of cancer, I sure as heck would not want an unvaccinated nurse in my face. Actually, I’m mid-forties and a health nut in great shape, and I still wouldn’t want an unvaccinated healthcare provider up in my face. PPE, or not. With strangers it’s pretty easy to stay more than six feet away, not so with your nurse, physician or CNA when hospitalized.

For me personally, I would also have a problem trusting the professional judgement of a nurse who has chosen not to vaccinate. (Unless they had an absolute medical contraindication).

I think that those of your coworkers who don’t think that you should have accomodated the patient’s or wife’s wish are simply being selfish and displaying disregard for the vulnerable position the patient is in. They are in my opinion acting entitled. As far as I’m concerned, the wilfully unvaccinated are not a protected class. 

On 7/21/2021 at 4:55 AM, DesiDani said:

That is a false sense of security.  Just because someone is vaccinated does not mean they cannot catch and then spread Covid. So her guard is naively down when her spouse has a nurse who says she is vaccinated? 

It’s only false security if the wife or patient thinks that it’s okay for a vaccinated nurse to skip wearing a mask, washing hands etc. just because the nurse is vaccinated. Or are you thinking that vaccines don’t reduce the risk of infection and transmission at all?

We’re seeing more and more evidence that breakthrough infections in vaccinated individuals are associated with lower viral loads and that the virus is detectable for a shorter amount of time than in the unvaccinated. We’re still gathering evidence and learning, but I would be very surprised if vaccines don’t offer advantages beyond protecting the vaccinated individuals themselves.

https://www.nejm.org/doi/full/10.1056/NEJMoa2107058

[DesiDani]

47 minutes ago, macawake said:

Or are you thinking that vaccines don’t reduce the risk of infection and transmission at all?

Nope. If she is concerned about her immune compromised husband having a nurse be vaccinated is giving her a false sense of security. Remember her concern was the RN not having the shot. Even that excerpt of yours said that 5% of the people who were fully vaccinated tested positive. Small, but I assume big for her husband.  That RN could be the only wearing a N95 and a face mask, while the other will only wear a face mask.

[macawake, MSN]

On 7/21/2021 at 6:52 AM, DesiDani said:

Nope. If she is concerned about her immune compromised husband having a nurse be vaccinated is giving her a false sense of security. Remember her concern was the RN not having the shot. Even that excerpt of yours said that 5% of the people who were fully vaccinated tested positive. Small, but I assume big for her husband.  That RN could be the only wearing a N95 and a face mask, while the other will only wear a face mask.

No, that is incorrect. You need to read the study again.

It’s a prospective cohort study involving 3,975 healthcare personnel. Study time period = 17 weeks (December 2020  - April 2021).

3,179 had received at least one dose of an mRNA vaccine.

Of the 3,179 vaccinated, 2,686 had received both doses and were fully vaccinated. 
204 participants (which is 5.1% of the TOTAL number of study participants (3,975)) were diagnosed with a Covid infection during the study time period. 

Of the 204 participants who were diagnosed with Covid-19:

5 were fully vaccinated.

11 were partially vaccinated.

156 were unvaccinated.

(The reason the above three numbers don’t total 204 is because 32 participants were excluded due to indeterminate vaccination status. Read the study). 

Seeing as 80% of the participants in this study were partially or fully vaccinated, the fact that ”their share” of the infections is only 16 (5+11) and the much smaller unvaccinated group a whopping 156 infected participants, what conclusions, if any, can we draw? 

Five infections in a group of 2.686 fully vaccinated participants ≈ 0.19% 

Why are you attempting to muddy the waters by speculating that the two nurses wear different face coverings? We have no idea what they wear or don’t wear or what their facility’s rules are on PPE. We don’t even know if one of them is a raving lunatic who habitually spits her patients in the face (but I find that scenario kind of unlikely..) Maybe one of them always stays at home and isolates with even the slightest cold symptoms, and the other one doesn’t. But that hasn’t have anything to do with whether or not preferring vaccinated healthcare providers over unvaccinated ones, is a scientifically rational preference. I happen to think it is. 

You seem hell-bent on labelling the wife as naive and convince us that having a preference for a vaccinated healthcare professional is just fooling oneself into thinking that one is somehow safer. Why?

Do you yourself believe in the efficacy of vaccines and their public health benefits? 

[Delia37, MSN]

Ladies, thank you for your input. Unfortunately, this is exactly the type of conversations going on in my unit, at this time. As mentioned previously, (regardless of how you feel about the vaccine) the reality is that the general public comes into the hospital with a certain expectation that the person caring for them and their loved one is vaccinated. As much as I want to respect and support my co-workers in their personal choices; as a nurse, I also have a duty to provide the safest environment for my patients, based on science. I hope this is an isolated incident, but thanks to the internet...I doubt  it. I honestly wish the nurse would had just refused to answer the wife inquire, since these discussions has made many staff self disclose their own  vaccination status and is creating a divisive work environment of 'us" against "them".

[DesiDani]

2 hours ago, macawake said:

You seem hell-bent on labelling the wife as naive and convince us that having a preference for a vaccinated healthcare professional is just fooling oneself into thinking that one is somehow safer. Why?

Do you yourself believe in the efficacy of vaccines and their public health benefits? 

My mistake 5 not 5% and I already answered that question. I point is that if she is so concerned BECAUSE her husband is immune compromised why would it matter to her if the RN was vaccinated or not? A vaccinated person, yes is better off if they get the virus, but they still can get and transmit the virus.  Just because I am FULLY VACCINATED I still know that there are some out there who choice not to and CANNOT get the vaccine. I am not going to throw caution to the wind just because I am fully vaccinated?

Yes she is naïve many people come in and out of a hospital room and who knows maybe they all might be vaccinated, but there is no guarantee her immune compromised husband is not at risk of getting it just because she doesn't want one nurse to take care of him.

[DesiDani]

2 hours ago, macawake said:

Five infections in a group of 2.686 fully vaccinated participants ≈ 0.19% 

Yeah and that one is all it takes to infect someone who can't get the shots

[macawake, MSN]

On 7/21/2021 at 9:41 AM, DesiDani said:

My mistake 5 not 5% and I already answered that question. I point is that if she is so concerned BECAUSE her husband is immune compromised why would it matter to her if the RN was vaccinated or not? A vaccinated person, yes is better off if they get the virus, but they still can get and transmit the virus.  Just because I am FULLY VACCINATED I still know that there are some out there who choice not to and CANNOT get the vaccine. I am not going to throw caution to the wind just because I am fully vaccinated?

Yes she is naïve many people come in and out of a hospital room and who knows maybe they all might be vaccinated, but there is no guarantee her immune compromised husband is not at risk of getting it just because she doesn't want one nurse to take care of him.

On 7/21/2021 at 9:47 AM, DesiDani said:

Yeah and that one is all it takes to infect someone who can't get the shots

Honestly, I think you’re being quite stubborn about this. 

No one’s said that you or anyone else, should throw caution to the wind just because you or they are vaccinated. 

Let’s try something else…

If a patient (or a patient’s wife) knows that nurses wearing a green scrub have a statistical likelihood of 1 in 580 of being infected with an infectious disease, and that all nurses wearing blue scrubs have a statistical likelihood of being infected with the same disease of 1 in 20. Do you still think that it’s irrational for the patient or loved one to prefer a nurse in green? 

You are just reading things into OP’s post. Nowhere does it say that the patient’s wife feels 100% secure with a vaccinated nurse. That’s your interpretation and it made you say that she’s feeling a false sense of security. I’m thinking that she and many others are smart enough to know that the risk isn’t zero, but it’s much lower if the people who have to invade their personal space are at least vaccinated. 

A stroke patient doesn’t have much of a choice about going to the hospital if they want to survive. They might not want to be there, but they have to. And I sure don’t blame them for wanting the nurse in green scrubs. 

[AnLe, ASN, RN]

I haven't had many patients ask if we're vaccinated, especially in our new growing covid section of the hospital. It's almost confession time, if you do. Most of them are unvaccinated for one reason or another. Less than a handful are vaccinated.

Back to the topic at hand. I would address the wife's concern by educating her that the vaccine does not prevent you from getting the virus, it decreases your severity. "A small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it... no vaccine prevents illness 100% of the time" (CDC, 2021). Just like with flu shots, you can still get the flu. If she feels uncomfortable with her nurse if they don't wish to disclose their status, the nurse is not required to answer due to privacy. Vaccinated or not, the hospital staff will wear face masks and perform hand hygiene as dictated by hospital policy. If they see someone who is not adhering to it, she is free to speak to our charge/director.... is how I would handle it.

https://www.CDC.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html

[toomuchbaloney]

Nurses should be advocating for patient safety, not rallying behind Nurses whose personal choices put the patients at increased risk.