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

Nurses COVID

Updated:   Published

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

Specializes in neuro & cardiac stepdowns, vascular access.
1 hour ago, 2BS Nurse said:

Patient care requires you to basically be right in their coughing faces. Coughing produces aerosols.

Dr. Fauci said this coronavirus is airborne on 3/26.

Unless anyone can present a body of evidence that is concrete enough to contradict the top CV expert in the country, please stop spreading the misinformation that it's not airborne, or that it's only airborne during aerosol-generating procedures. Coughing produces aerosols.

Go to 2:20 to listen to what he said

3 Votes

Protection of the nurse is paramount. If we all drop like flies, we can't save anyone.

3 Votes
Specializes in MS, Quality, Employee Health.

No matter what, you cannot abandon the patient.

npr-i-15.pdf

7 minutes ago, ReySkywalker said:

No matter what, you cannot abandon the patient.

npr-I-15.pdf

A nurse without proper protection may at some point become useless to the cause.

2 Votes
Specializes in Critical Care.
22 hours ago, lukegail said:

could you link to conclusive evidence supporting the claim that cv can't be airborne? to the contrary, if aerosol-generating procedures require airborne precautions, so should a coughing patient.

http://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science

We could start with the article you linked to that accurately describes the mode of transmission as being droplet, and yes I agree that a coughing patient or really any COVID patient can aerosolize droplet nuclei and the proper form of respiratory protection for all staff caring for these patients is at least an N95 level of filtration, although I'd argue even that is insufficient, N100 (HEPA, ULPA) are the appropriate level of respiratory protection.

A thread on the topic:

The aerosolized droplet nuclei that are the mode of transmission are airborne, but it's different than airborne transmission which leads to confusion, it might be better if we called airborne transmission 'sustained airborne'. Airborne transmission refers to pathogenic particles that can remain suspended in air for extended periods of time. Droplet nuclei can remain suspended in air for some amount of time, but not in the range of true airborne particles.

2 Votes
Specializes in neuro & cardiac stepdowns, vascular access.
1 minute ago, ReySkywalker said:

No matter what, you cannot abandon the patient.

npr-I-15.pdf

if you get diarrhea and have to skip a shift, are you abandoning your patients? no, because the hospital will replace you with someone else. likewise, if nurses choose not to work in outright hazardous conditions, they will be replaced with travelers who get crisis pay for bearing that risk. this argument about not abandoning patients doesn't actually hold water. the patients will get taken care of, even if not by you.

2 Votes
On 3/19/2020 at 6:30 PM, 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.

"Surrender your license "? Why wouldn't someone just quit instead? Can't take license then!

3 Votes
Specializes in ICU,Tele,Interventional Radiology,PACU,Research.
6 minutes ago, lukegail said:

if you get diarrhea and have to skip a shift, are you abandoning your patients? no, because the hospital will replace you with someone else. likewise, if nurses choose not to work in outright hazardous conditions, they will be replaced with travelers who get crisis pay for bearing that risk. this argument about not abandoning patients doesn't actually hold water. the patients will get taken care of, even if not by you.

There is a difference between

12 minutes ago, ReySkywalker said:

No matter what, you cannot abandon the patient.

npr-I-15.pdf

There is a difference between patient abandonment and job abandonment. One has legal ramifications while the other doesn't. I have never heard of someone being sued because they didn't show up for a shift or quit their job.

2 Votes
Specializes in neuro & cardiac stepdowns, vascular access.
8 minutes ago, MunoRN said:

We could start with the article you linked to that accurately describes the mode of transmission as being droplet, and yes I agree that a coughing patient or really any COVID patient can aerosolize droplet nuclei and the proper form of respiratory protection for all staff caring for these patients is at least an N95 level of filtration, although I'd argue even that is insufficient, N100 (HEPA, ULPA) are the appropriate level of respiratory protection.

A thread on the topic:

The aerosolized droplet nuclei that are the mode of transmission are airborne, but it's different than airborne transmission which leads to confusion, it might be better if we called airborne transmission 'sustained airborne'. Airborne transmission refers to pathogenic particles that can remain suspended in air for extended periods of time. Droplet nuclei can remain suspended in air for some amount of time, but not in the range of true airborne particles.

Dr fauci just stated that cv is airborne.

the article meanders all over the place, and does initially state droplet precautions, but eventually gets around to the point of the article, which is that the definition of droplet precautions has been stretched specifically for this CV situation, and that CV is indeed airborne.

According the study below, coughing produces a range of droplet sizes, but 97% of them are small enough to remain airborne, with the majority of them (the mode) being smaller, 0.34 microns –– aerosols able to float freely for ages, diffusing uniformly throughout a room.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3331822/

1 Votes
Specializes in Hospital Employee Health.
On 3/23/2020 at 9:15 AM, Jory said:

My suggestion is if you cannot do this, then make your own cloth mask for an emergency, or leave healthcare. It's better than nothing.

This is when the true call of duty arises. When I took this job, I made a pledge to take care of everyone that I was called to take care of...that means, regardless of what they have. I am not going to refuse care to someone because of it and I do support the sanctioning of licenses to those that do.

I have a plan in place to send my children to a relatives home if things get bad at my hospital. So far, no cases. But I have a plan.

There is a difference...between a hospital not providing equipment and THERE NOT BEING ENOUGH PPE TO SUPPLY THE HOSPITALS.

If you can't take care of the patient in front of you...then you went into healthcare for the wrong reasons. This is truly, what nursing is all about.

There are no legal risks. They are still RNs with a valid license. They can run a code or give medication just like anybody else.

Disagree. Nurses are not martyrs. You would not send solders to war without guns, ammo or fire-fighters without water. I have spend 40 years in nursing and helped thousands. I have been underpaid and over-worked and exploited by almost every employer. I do not need to give up my own life to save another.

7 Votes
Specializes in Cardiology, Research, Family Practice.
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.

If you are referring to yourself, please do not come back from retirement unless you're going to work phone triage or something like that. You have done your part and we thank you eternally.

1 Votes
On 3/23/2020 at 11:15 AM, Jory said:

My suggestion is if you cannot do this, then make your own cloth mask for an emergency, or leave healthcare. It's better than nothing.

This is when the true call of duty arises. When I took this job, I made a pledge to take care of everyone that I was called to take care of...that means, regardless of what they have. I am not going to refuse care to someone because of it and I do support the sanctioning of licenses to those that do.

I have a plan in place to send my children to a relatives home if things get bad at my hospital. So far, no cases. But I have a plan.

There is a difference...between a hospital not providing equipment and THERE NOT BEING ENOUGH PPE TO SUPPLY THE HOSPITALS.

If you can't take care of the patient in front of you...then you went into healthcare for the wrong reasons. This is truly, what nursing is all about.

First of all, you are a clown for thinking being afraid of contracting a deadly virus makes you any less of a nurse.

Second of all.......you say you have a plan to send your kids away if the hospital gets bad.......... a huge chunk of Covid-19 patients are asymptomatic; not to mention the incubation period has reports of 14+ days. You, as well as any nurse, could potentially get Covid-19 and not even know it, then go home to your family and spread it. What are you going to tell nurses who have kids, immunocompromised husbands/wifes and/or have an old parent living with them & they die?

Your literally saying " if you aren't ready to die while floor nursing as well as pass on the disease to your family, you are not meant to be a nurse"...give me a break

7 Votes
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