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

[BiscuitStripes]

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.

[2BS Nurse, BSN]

On 3/23/2020 at 11:41 AM, Walti said:

Your patient has Covid-19, He has just stopped breathing. There is no cart or bag available. You are a 70 year old retired nurse that has answered the call of the BRN to come back. You had lung surgery and a lobe removed a few years ago. Should you do mouth to mouth respiration? Yeah I know it is no longer recommended but there is going to be a prolonged time for code equipment to get to you. You are working a SNF and the one cart is in use at the other end of the facility. Nobody gets paid enough to die for the patient.

No, you don't give mouth to mouth. In a SNF, the odds of surviving are very low after mouth to mouth anyway.

[2BS Nurse, BSN]

2 hours ago, Workitinurfava said:

I don't work on a med-surg floor. We had enough mask to go around prior to COVID but now all of a sudden we can't find any and none are becoming accessible. There is something off about this and it leads me to believe that this is being done on purpose. I hear what you are saying about the government but for mask to disappear in a matter of a week......hmm.

In the outpatient setting, masks were still kept out for patients to take as late as the end of February. Patients were taking them home by the handfuls. We alerted supervisors who didn't listen.

[Stellar88]

1 hour ago, brittnie89 said:

I’m so tired of y’all “do gooder” nurses. Everyone is always throwing around how hard you worked for your license and don’t want to put that in jeopardy but you’re ready to place your life in jeopardy? This is an infectious disease that healthcare workers are catching, could potentially pass to other patients, co workers, and family. That would result in more hospitalized in an already overwhelmed healthcare system and possibly higher mortality rates. I’m so tired of hearing that BS. The military, police officers, firefighters all have adequate equipment. They have no control over the actions of others or a house falling on them. The hospitals are not providing us with the tools we need to safely perform our jobs and we are no wrong for thinking about our lives! You all should be the first to volunteer to quarantine at the hospital with no PPE and be the designated Covid Nurses since you’re willing to die. Smh

OMG thank you for saying this! It is so annoying how sanctimonious nurses try to act. Like this license wasn’t bestowed upon me like some sort of gift. I earned it myself and paid for it myself, in fact I’m still paying for the damn expensive thing. I put up with all kinds of BS and training and attitudes and studying to get it. The healthcare system did not give it to me with the expectation that I now belong to them. It is a degree like any other degree and a job like any other job. And I can walk away at any time if proper precautions are not in place. They drilled these precautions into us for years and years and now we are expected to forget them completely and sacrifice ourselves because we’re nurses. No thank you.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

10 minutes ago, Stellar88 said:

...The healthcare system did not give it to me with the expectation that I now belong to them.

Some agencies seem to be behaving this way...not only that they own your license, but that they own YOU. I'm prepared to refuse to work if I'm not provided with proper PPE. I have the same human rights as those lovely non-compliance types who are refusing to wash their hands or practise physical distancing. If the hospital wants me to risk my safety, they can provide PPE. Otherwise, they will have to physically drag me into work, like this:

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

2 hours ago, irvine123 said:

LOL....sigh...I assume you think its another flu and dont use social distancing

...And, probably thinks the earth is flat too?

[ReflectiveRN]

I worry about all the nurses who feel like they have no way out and have to accept unsafe working conditions without proper PPE given the amount of "untested" potentials... I hope we don't lose too many. Praying for them and hoping that if they feel unsafe they also can know there are enough of us who will back them and support all RNs who choose not to work in unsafe conditions!! Even non-union hospitals have a responsibility to their workers to not put them in unsafe working conditions.

I am going to join this organization today. Any other thoughts on how we can help those overwhelmed RNs who aren't thinking straight?

https://www.nationalnursesunited.org

[L.RileyRN]

On 3/19/2020 at 6:41 PM, 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.

Not having proper PPE, is not just about you. It is about every person you come in contact with, after you have treated a patient with COVID. The idea that age will protect you, is your prerogative, but consider the 37 Dr.s in Italy, who died, or the 40 year old nurse in New York. You will carry the virus for days to weeks, without knowing, and I doubt that everyone you come in contact with will have age on their side. But as I said, PPE is not just about YOU. "There is no emergency in a pandemic. You are a force multiplier" . Please everyone read:

There is No Emergency in a Pandemic

[Christina MacCorkindale]

On 3/19/2020 at 6:41 PM, 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 firmly do not agree with this. There are multiple issues here. First I'm glad you think you will be okay but what about the other patients you are caring for? What about your coworkers who are not as healthy as you? What about your family? When you are not protecting yourself you are not protecting your other patients who are not as healthy as you. Healthcare workers who think they are fine are spreading the virus during incubation to our sicker patients. We are becoming part of the problem by not using proper PPE.

Also you can be completely healthy and still get critically ill. You are not immune.

My second issue is I signed up to care for people and help them heal. I understood the risks but never have I been without the equipment to protect myself, my coworkers, and my family. I did not sign up sacrifice my life. I am not a soldier and if I was I would not go to war without armor. Our admins and the gov are taking advantage if us because we are selfless and it is being used against us. We should not be looked down on for wanting safe patient care. Safe for us and patients.

[Ikea Monkey]

On 3/19/2020 at 3:41 PM, 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.

That's great that you're healthy, however, this isn't about YOU, you need to consider the people around you.
While you may be healthy, what about your patients/patient's loved ones/staff members/your loved ones that you're exposing covid-19 to including:
-The ages of 60
-Have respiratory diseases such as Asthma
-Pregnant women
-Immunocompromised/low immune systems
-People with HIV

PPE is to protect the wearer from infection to prevent spread any highly contagious disease.
Obviously, these people deserve care and they didn't ask for this, but neither did the people listed above. If you're going to provide care, please be safe and smart about it.

[subee, MSN, CRNA]

Question for someone more knowledgable than I: Does the amount of viral load one is exposed to corrolate in a linear relationship to the severity of the disease you will get? Are nurses caring for Covid patients having a higher rate of infection than patients that come from outside of the hospital? I don't think this is the case in Italy but I have not followed staff infection rates in the past few days.

[lukegail, RN]

Question for everyone who says "I am prepared to refuse work / quit on the spot / lose my license if not given appropriate PPE"

Where exactly is that line for you?

• being denied a fresh N95 for each patient encounter for PUI (rule-out) and confirmed positive covid patients?

• being denied an N95 for PUI?

• being denied an N95 for positive covid patients unless an aerosol-generating procedure is underway?

• being denied an N95 for any positive covid patient?

...and how firm is your resolve? I'm struggling with this and interested in others' thoughts.

[MunoRN, RN]

5 minutes ago, subee said:

Question for someone more knowledgable than I: Does the amount of viral load one is exposed to corrolate in a linear relationship to the severity of the disease you will get? Are nurses caring for Covid patients having a higher rate of infection than patients that come from outside of the hospital? I don't think this is the case in Italy but I have not followed staff infection rates in the past few days.

I don't know that this has been closely studied with this particular strain of coronavirus, but a common characteristic of viral infections is that unlike bacteria where there is a dose-dependent relationship between the amount of bacteria you're exposed to and the severity of illness or infection, the severity of a viral illness isn't dependent on the actual number of viruses that enter your body. Although the amount of exposure might affect the length of the incubation period.

It's just as likely that inhaling 100 viral droplet nuclei will cause a severe illness as it is that inhaling 100,000 viral droplet nuclei will result in a mild illness. This is likely because of differences in how viruses and bacteria cause illness. The effects of a bacterial illness are a direct result of the bacteria and their byproducts; the more bacteria the worse the illness. Whereas a virus effectively tricks your body into harming itself, and it only takes a small number to do that.

This is why complete respiratory protection is so important, unlike a bacterial infectious risk where reducing the amount of inhaled bacteria by 80% serves some purpose, this has little benefit with viral pathogens, where that 20% you're still inhaling will do just as much damage as all of them would.