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Refusing Care of a COVID-19 Patient Due to Inappropriate PPE

Disasters   (253,069 Views | 291 Replies)

EDboundSN has 5 years experience as a EMT-B and specializes in the Emergency Department.

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I'm a senior nursing student and this debate arose with a couple of my classmates and me.  I work as an ER tech and they work as patient care techs on the floor.  As of right now, CDC guidelines state for PPE:

Quote

Updated PPE recommendations for the care of patients with known or suspected COVID-19:

Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand.  During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP.

Facemasks protect the wearer from splashes and sprays.

Respirators, which filter inspired air, offer respiratory protection.

When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.

Eye protection, gown, and gloves continue to be recommended

So basically CDC is saying wear an N95 if you have it, but if you don't, wear a surgical mask until you can get an N95.

So if you have a suspected or confirmed COVID-19 patient, and all you have is a surgical mask and no N95, can you refuse to take care of that patient?  Do you face any legal repercussions or potential fallout from your employer if you do refuse?  Asking not only about tech positions, but RN positions as well.

n95-mask.jpg.948ffc9ddec77bfd24a6a81472029d5d.jpg

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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My state has addressed the issue of whether nurses can refuse to care for these patients, the response was that you're free to permanently surrender your license, but that's the only option.

I would argue that older and immunocompromised nurses should be more of a last choice for caring for COVID patients, although we might already be to that point.

Edited by MunoRN

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No, you don’t refuse care.  These people didn’t ask for this and they are entitled to care.  I will end up at some point with COVID.  I’m healthy enough to handle it.

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EDboundSN has 5 years experience as a EMT-B and specializes in the Emergency Department.

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Just now, LovingLife123 said:

No, you don’t refuse care.  These people didn’t ask for this and they are entitled to care.  I will end up at some point with COVID.  I’m healthy enough to handle it.

I agree.  I have a background in military and law enforcement though, so putting myself at risk to help others has always been in my character.  But other's don't necessarily agree, so I was curious others opinions and legality of it all.

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JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

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1 hour ago, EDboundSN said:

So if you have a suspected or confirmed COVID-19 patient, and all you have is a surgical mask and no N95, can you refuse to take care of that patient?  Do you face any legal repercussions or potential fallout from your employer if you do refuse?  Asking not only about tech positions, but RN positions as well.

What basis would you have to refuse the patient if you are still technically following the CDC recommendations and guidelines?

Potential fallout from your employer if you refuse could be termination. Depending on when refusal happened, they could go the route of threatening patient abandonment.

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EDboundSN has 5 years experience as a EMT-B and specializes in the Emergency Department.

305 Posts; 5,719 Profile Views

Just now, JadedCPN said:

What basis would you have to refuse the patient if you are still technically following the CDC recommendations and guidelines?

Potential fallout from your employer if you refuse could be termination. Depending on when refusal happened, they could go the route of threatening patient abandonment.

I guess people were trying to tell me that using lesser PPE (masks) simply because the appropriate PPE (N95) isn't available doesn't justify putting your health and safety as risk, especially if the hospital does have N95's available but is not giving them out.  Again - not my opinion, that's why I was seeking other opinions.

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But there are different levels as to what requires the N95 mask at this time.  In certain cases a surgical mask is appropriate and others a N95 is.

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JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

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4 minutes ago, EDboundSN said:

I guess people were trying to tell me that using lesser PPE (masks) simply because the appropriate PPE (N95) isn't available doesn't justify putting your health and safety as risk, especially if the hospital does have N95's available but is not giving them out.  Again - not my opinion, that's why I was seeking other opinions.

I would understand that concern more if it were coming from the recommendation of the hospital - I wouldn't trust them and would likely assume they were just being cheap. But overall I believe the CDC to be a reliable source and don't believe they would put out a recommendation like that if it were not sound advice.

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27 minutes ago, MunoRN said:

My state has addressed the issue of whether nurses can refuse to care for these patients, the response was that you're free to permanently surrender your license, but that's the only option.

I would argue that older and immunocompromised nurses should be more of a last choice for caring for COVID patients, although we might already be to that point.

Young caregivers have died from Covid-19. I would not automatically assume that "older" nurses ought not to care for Covid-19 pts.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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21 hours ago, LovingLife123 said:

But there are different levels as to what requires the N95 mask at this time.  In certain cases a surgical mask is appropriate and others a N95 is.

21 hours ago, JadedCPN said:

I would understand that concern more if it were coming from the recommendation of the hospital - I wouldn't trust them and would likely assume they were just being cheap. But overall I believe the CDC to be a reliable source and don't believe they would put out a recommendation like that if it were not sound advice.

To clarify, the CDC has not said that procedure / surgical masks are just as safe as an N95 or other respirator, they specifically state this is not true.  They have also not said that there are certain circumstances when caring for a COVID patient where a procedure or surgical mask provides reliable protection.  

What they've said is that when the appropriate level of respiratory protection is not available, then procedure / surgical masks are better than nothing at all, and actually now they're saying when those run out then use a scarf or bandana.  That doesn't mean they're saying a scarf or bandana is as effective at stopping 5 micron droplet nuclei as well as an N95 mask.  

21 hours ago, NormaSaline said:

Young caregivers have died from Covid-19. I would not automatically assume that "older" nurses ought not to care for Covid-19 pts.

Younger people are certainly not immune from COVID-19, but there is a clear increase in mortality risk with an increase in age with this virus.  

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