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.

[Christina MacCorkindale]

11 minutes ago, lukegail said:

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.

To be honest I'm not sure exactly where the line is.

I have been re-wearing my n95 mask for a solid week with a surgical mask over to protect it from droplets because we are no longer offered n95 due to supply and as of last night my hospital is wearing 1 gown per room to share between staff members. I have brought a change of clothes to work and shower immediately after getting home.

Even though all this makes me very angry and scared I am not prepared to abandon my job in a time of need. I just wish people would hear our concerns and advocate for us nurses on the front-lines.

[herring_RN, ASN, BSN]

Nurses Send Petition to Congress Demanding Immediate Protections During COVID-19 Outbreak

... “When nurses and doctors get sick from this virus who is going to be left to take care of the public?” Bonnie Castillo RN continued. “If they don’t want the entire health care system to collapse, Congress must act immediately to protect the frontline health care providers.”...

https://www.nationalnursesunited.org/press/nurses-send-petition-congress-demanding-immediate-protections-during-covid-19-outbreak

[brittnie89]

1 hour ago, Stellar88 said:

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.

Thank you! I’m so tired of hearing that! How can you shame other nurses for wanting to stay alive for their families? One thing I notice about police, firefighters and military is their bosses care and they support them right or wrong. Our bosses are telling us oh well even though they know healthcare workers have died. I know they would NOT take patients with no PPE. I’m def not gonna do it and if it comes to it, that’ll be my shift. If people are dumb enough to risk their lives, they can have it. I hope they get the handclaps they so desperately need at their bedsides cause if no ones noticed, this profession does not care at all about its workers.

[herring_RN, ASN, BSN]

Congressional Stimulus bill fails to protect frontline workers from COVID-19 exposure, say nurses

“Nurses across the country are risking their lives on the frontlines of this public health crisis because they don’t have the protections they need. Senators from every state have heard from their local nurses about the dire circumstances they are facing, and yet these senators failed to protect the workers who are the foundation of this country’s COVID-19 response,” said Bonnie Castillo, RN, executive director of National Nurses United...

... NNU advocated for Congress to mandate that the Occupational Safety and Health Administration promulgate an emergency temporary standard to protect health care and other frontline workers from COVID-19 exposure. The provision was originally in the Families First Act proposed by Speaker Nancy Pelosi, but was taken out of that bill because the hospital industry opposed it. It was once again proposed in the House stimulus bill on Monday evening, but Senate republicans refused to include it in the Senate package....

https://www.nationalnursesunited.org/press/nations-nurses-united-condemns-congressional-inaction-protecting-nurses-other-health-care

[justpoorfect]

I wondered if anyone here has had experience with the plastic bubbles that I see on the video of Italian patients being cared for due to Covid-19? Are those simply O2 personalized tents? Could a caregiver benefit from using an oxygenated bubble like that, wearing a portable concentrator under the isolation gown?

I am currently licensed but retired early due to fibromyalgia, arthritic knees and spine. I wonder if the BON will try to threaten anyone with an active license to come back to work or give up the license?

For those who are working without proper PPE, I would hope a loving family member might accidentally break one of your arms, thus preserving your life and families' (potentially) and your license (certainly).

Alas, I don't think the BON will have time to provide hearings to all the accusations to be filed against nurses during this pandemic. The reason all the N95s are locked up is so they can be doled out to Doctors, as they are scarcer than nurses. They don't want you bringing in your own gear because they don't want to provide everyone with gear that complains.

When you do become overwhelmed, do not feel any shame. Some of us will die in our homes regardless. You are still doing your best if you insist on PPE or nothing.

[DeaneB246]

These judgmental and sarcastic comments have me furious, please excuse my vent.

I say of course you have a choice.
It is YOUR life, your LIFE, and YOUR license.

You didn’t join the military where an expectation of dying in the line of duty is the norm. Don’t let anyone guilt you into it. That is totally out of line.

We are all extremely dedicated nurses and we are needed, but there are boundaries. It should be a personal choice.

* We are bound by strict legal rules we follow, as the hospital is:should be. If they are unable to measure up to their obligations to provide you with all safety equipment necessary then imo you or I are certainly not bound to the agreed upon ’contract’. These are uncharted waters.

To suggest you would have to surrender your license or lose your job is preposterous, and I’d suggest seeking legal advice if someone were actually callous enough to be serious about that.

Everyone’s personal situation is different. I would never judge someone else for this choice, nor intimate how dare they leave the front lines, or in any way attempt to make them feel bad for such a difficult, individual, adult choice based on their own needs. How dare anyone.

Whether elders at home, sick children, or concerns for themselves, it is not a sin so to speak to put your priorities in order. Some obligations come before job, regardless.

I appreciate all you supportive nurses here who are there for each other with kind, uplifting words and heart, constructive suggestions, and offers of help.

[LovingLife123]

First of all, I’m not being sanctimonious, at all. But somebody has to care for these people. Everyone can’t just walk away.

It absolutely sucks that we don’t have PPE. I’m wondering the action that any of you have taken on this, or are you just preparing to refuse at the last minute?

I’ve contacted my senators, my governor, my state representatives concerning this issue of PPE. I’ve been working with my hospital on obtaining more. But I still am going to care for these patients. I refuse to let anyone die alone and die without my best effort.

If you deem that sanctimonious and crazy, so be it. But at least I’m actively working on a resolution to the problem.

[Megarline, CNA]

That's a tough situation for the healthcare workers where you literally put your life on the line for the others. I hope that you have a place to rest your head so you won't infect your family and friends.

[ComeTogether, LPN]

I was surprised to see that folks were looking to use the N95 masks, to be honest. This isn't an airborne virus, so unless you're working in an area which has equipment, etc. that could cause it to become airborne I don't see the issue, but it seems I'm in the minority.

[MunoRN, RN]

26 minutes ago, Glycerine82 said:

I was surprised to see that folks were looking to use the N95 masks, to be honest. This isn't an airborne virus, so unless you're working in an area which has equipment, etc. that could cause it to become airborne I don't see the issue, but it seems I'm in the minority.

"Airborne" transmission refers to a pathogen than remains suspended in the air for extended periods of time, which you correct that Covid doesn't do.

It does commonly transmit from one person to another through the air, often expelled by one person and then inhaled by another, spreading the virus. You only have to receive a few of these viruses to become infected, and even N95's only block 95% of the pathogen. So when a cough can produce anywhere from a few hundred to a few hundred thousand of individual droplets of these pathogens, and it only takes a few to get infected, that's why N95s are considered better than procedure masks, which typically block anywhere from 10 to 50% of these pathogens.

[Blujai]

I don’t think anyone should be caring for a patient with out an N 95. At this point two of my RN friends at home for quarantine because they were exposed to COVID 19. They are not old and one of them has lost more than 80 % of her lung function. She will never be the same again. So refuse to treat the patient..... It is a suicide mission and it is legal....

The CDC should treat the patient without an N 95 and sees what happens to them.

[Older Male LPN, LPN]

In a break from nursing, I taught school autistic kids. the first year I was sick most of the time. Moms wouldn't let the Kids stay home unless they barfed up a lung. My trust my immunity - even though I am 59 and diabetic. As an old guy - I am old school and military. In my judgment nursing is a vocation not a career. I accept risk for myself in order to provide Compassionate Care to others. On the other hand, at home, I have my 80-year-old, high-risk Mother for which I provide not just a home but care as well. My husband has a chronic disease that affects respiratory perfusion ( autoimmune that attacks pulmonary capillaries.) I am not willing to put my family at risk. I quit