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:

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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 Cardiology, Research, Family Practice.

I wish I had adequate PPE.

The death rate in my age group is 0.25%.

If I had no mask at all, I would willingly strap on a bandana and take care of a patient who would likely otherwise die.

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The older nurses who complain all the time are actually keeping quiet now cause the charge nurses arent giving them Covid patients...LOL

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3 hours ago, ReySkywalker said:

No matter what, you cannot abandon the patient.

npr-I-15.pdf

this is true.. but if you haven't taken report and don't feel comfortable, speak up about it. It might not help, but at least you tried.

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20 hours ago, Ana m said:

What happened to OSHA?

ha! ?

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On 3/27/2020 at 2:00 PM, lukegail said:

if you walk way, your hospital will just hire a traveler and give them crisis/hazard pay to bear the same risks that you currently are. there will always be people willing to do any work for the right $$$. the hospitals just want to save money.

Travelers are nurses with loved ones too. We love nursing just like staff nurses but we want to travel, see the world, and meet new people as well. We don't just do it for the money.

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Specializes in Critical care, tele, Medical-Surgical.
7 hours ago, ReySkywalker said:

No matter what, you cannot abandon the patient.

npr-I-15.pdf

The link is from the California BRN. The BRN is clear that refusal to accept an assignment is NOT considered patient abandonment, but that nurse can be disciplined or terminated by his or her employer.

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CALIFORNIA BOARD OF REGISTERED NURSING

Generally for patient abandonment to occur, the nurse must:

a) Have first accepted the patient assignment, thus establishing a nurse-patient relationship, and then

b) Severed that nurse-patient relationship without giving reasonable notice to the appropriate person (e.g., supervisor, patient) so that arrangements can be made for continuation of nursing care by others.

A nurse-patient relationship generally begins when responsibility for nursing care of a patient is accepted by the nurse. Failure to notify the employing agency that the nurse will not appear to work an assigned shift is not considered patient abandonment by the BRN, nor is refusal to accept an assignment considered patient abandonment. Once the nurse has accepted responsibility for nursing care of a patient, severing of the nurse patient relationship without reasonable notice may lead to discipline of a nurse's license.

https://www.RN.ca.gov/pdfs/regulations/npr-b-01.pdf

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Specializes in Non judgmental advisor.
15 minutes ago, HiddenAngels said:

Travelers are nurses with loved ones too. We love nursing just like staff nurses but we want to travel, see the world, and meet new people as well. We don't just do it for the money.

When I was a travel nurse, I was only in it for the flexibility and travel 3 months on and 3-6 months off, I would have no issues with a low paying contract in a nice fun area I.e hawaii,

I avoided highpaying contracts because I always assumed there was a catch

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Specializes in Critical Care.
6 hours ago, lukegail said:

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

He said it can be transmitted by aerosolized droplets, not airborne transmission which refers to a particle that remains in the air for an extended period of time. Aerosolized droplets can remain in the air for some period of time, but still less than airborne particles, which tend to be particles with a large surface area relative to its weight, the dry skin particles that facilitates varicella shedding for instance.

Your general point is correct though, coughing produces aerosolized droplets that can transmit to someone else through the air.

The reason why airborne precautions are recommended is that those precautions are the best way to keep staff protected from infection by those droplets. 'Normal' droplet precautions aren't actually intended to protect caregivers from infection, they're only intended to prevent staff from being a vector of the pathogen from one patient to another.

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Specializes in neuro & cardiac stepdowns, vascular access.
3 hours ago, HiddenAngels said:

Travelers are nurses with loved ones too. We love nursing just like staff nurses but we want to travel, see the world, and meet new people as well. We don't just do it for the money.

agree 100%. I have no problem with travelers whatsoever. I meant that when there's a staffing hole in a pandemic, it will be likely be a traveler who is more risk tolerant when the reward is greater.

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Specializes in SICU, trauma, neuro.
On 3/26/2020 at 3:14 PM, Ikea Monkey said:

That's like telling a fireman wearing nothing but casual clothes to battle a forest fire, or a policeman without equipment to face a gang with firearms; you expect them to jump out? No, they need to be smart and equipped. The same principle when it comes to healthcare.

Personally, if I was a patient with covid-19 and nurse refused to enter my room due to a shortage of ppe, guess what.........I wouldn't get mad at the nurse, instead, I'd get mad at the hospital. Why? Because it is NOT the nurses fault that there's a shortage of supplies, it is the hospital's fault for not being prepared for a pandemic such as this one. In my last moments, I wouldn't want blood in my hands....

It's not like the nurses are say "Nah, I don't feel like taking that patient" and lounge in their station, the nurses are being smart and protective- because if they don't wear their ppe, guess what, now the next 2 patients they have that didn't have covid-19........BOOM! Now there is 3 patients with covid, all thanks to the nurse who didn't wear the proper ppe, bravo!! SMH

Exactly... what is the very first thing you do when approaching any lifesaving situation? Survey the scene for safety.

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Specializes in Dialysis.
On 3/26/2020 at 4:24 PM, 2BS Nurse said:

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.

This! And folks stealing them from those settings, and clinics once it set in

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Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
On 3/20/2020 at 4:14 PM, Pulsar said:

This. So much this. My hospital network has been trumpeting the horn of "for the motherland" type emails, going on about how "we're going to get through this together!", but has been suspiciously quiet about childcare options, what will happen if we become infected while treating infected, etc. Their silence on their support of us is absolutely deafening and extremely scary.

My comment has little to do with title of this thread but I want to say one thing.

I am sick to my core of hearing/seeing these mega-rich stars, politicians, and others on TV - those living in their 15,000 SF homes (or more) with their personal swimming pools, tennis courts, 9-hole golf courses, etc, etc, etc - parroting this "we're all in this together" thing. I sometimes feel like screaming at the TV - No! Until you are living in your 1000 SF apartment or wondering how you're going to protect yourself and your own family members - your own children and elders - because you are having to go off to work without appropriate PPE (talking about all doctors, nurses, first providers)...knowing every patient you encounter could be the one that ultimately leads to your demise...No. Sorry. We're not "all in this together." You, Mr and Ms mega-rich, living in the safety of your compounds with nannies and manicured grounds on which to entertain your children, have no idea what the average person - and especially the healthcare providers - are living through.

Thanks for listening to my probably inappropriate rant! PS: Maybe someone needs to start an "inappropriate rant" thread! ?

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