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.

[GoodNP]

On 3/29/2020 at 9:17 AM, DallasRN said:

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! ?

Amen to this. I'm sick of the uber-wealthy preaching at us in general, but especially right now. A few have made donations - but at such a tiny percentage of their net worth. There are billionaires out there. Why aren't they paying for masks and vents to be made? I've heard people mention nurses and our "social contract". What about the social contract for those who became wealthy off of ordinary people buying your iphones, or watching your talk shows/subscribing to your magazines, buying your lady parts-scented candles, etc.? Take one for the team!

[kindredspirit2021]

39 minutes ago, GoodNP said:

Amen to this. I'm sick of the uber-wealthy preaching at us in general, but especially right now. A few have made donations - but at such a tiny percentage of their net worth. There are billionaires out there. Why aren't they paying for masks and vents to be made? I've heard people mention nurses and our "social contract". What about the social contract for those who became wealthy off of ordinary people buying your iphones, or watching your talk shows/subscribing to your magazines, buying your lady parts-scented candles, etc.? Take one for the team!

lady parts-scented candles??? HolyMoly!! LMBOOOOO...You're killing me here!

[eerrmm]

On 3/24/2020 at 4:05 PM, Jory said:

Equipment is never, ever guaranteed. I have written a letter to my BON that full action should be taken against any nurse that refuses to care for a patient....IF A SHORTAGE SHOULD OCCUR.

Yeah, it is.

https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134

OSHA:

1910.134(a)(2)

A respirator shall be provided to each employee when such equipment is necessary to protect the health of such employee. The employer shall provide the respirators which are applicable and suitable for the purpose intended. The employer shall be responsible for the establishment and maintenance of a respiratory protection program, which shall include the requirements outlined in paragraph (c) of this section. The program shall cover each employee required by this section to use a respirator.

[eerrmm]

On 3/28/2020 at 12:41 PM, 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

Did you actually listen to him? He said it can be aerosolized but that is not probably the primary way it's being transmitted.

If it was truly an airborne virus, there'd be a whole lot more people infected and no cases of persons living with an infected person and not getting infected themselves (of which there are many).

Ihttps://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

"In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures that generate aerosols are performed (I.e. endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation). In analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported."

[hppygr8ful, ASN, RN, EMT-I]

On 3/29/2020 at 9:17 AM, DallasRN said:

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! ?

I don't find your rant inappropriate at all. It was well written and didn't use a single #$%^^ word.

Hppy

[Katillac, RN]

44 minutes ago, kindredspirit2021 said:

I've heard people mention nurses and our "social contract". 

Included in the people talking about nurses' social contract and their duty to care is the Oregon State Board of Nursing. If the BON suggests a social contract is binding on nurses so should the facilities' part be in that same social contract - to keep nurses safe while in their employ.

When one part of a contract is broken, the whole thing is null and void.

ETA: It was GoodNP I was quoting. Not sure how that happened. Sorry, GoodNP and kindredspirit2021

[hppygr8ful, ASN, RN, EMT-I]

I've largely stayed out of this thread because it is such a hot topic. Let me first say that I am not a person who worries excessively. I used to be but maybe 20 years of continuous sobriety has done that for me. In the beginning I was treating all the hype coming out of China as "Chicken Little" Nonsense. Still when the thing moved into Europe I started to take it more seriously - Then it hit the US.

I work in a setting where risk of exposure is minimal as I work with "At risk teens" in an acute inpatient setting, but we have 8 adult units where patients come in off the street. Adult Psych patients are not known for being reliable historians with regard to their health and when the weather gets bad we often have an influx of patients who use the acute setting as a shelter. The beds and the food are better and one just has to say the magic words and they get 3 hots and cot for 3 to 7 days.

I have always been careful about what comes home on my cloths. I wear antimicrobial scrubs, Take my shoes off by the back door, strip down, throw my scrubs in the laundry and take a shower. All of which can be accomplished without entering the main living area of the house.

While the management maintains with daily announcements that our facility remains "CORONA VIRUS FREE" It's only a matter of time before we accept a patient with this virus. Our management initially stated that we were not to wear masks because it was alarming for the patients. They even wrote up a few who came with their own masks. A patient "Bless her soul" complained to a higher authority in California and now we can wear masks but we have to provide our own. We are checked for fever and respiratory symptoms as we walk into the facility. I don't think we are doing enough but what can I do. My husband is working from home at his "TOP SECRET" government job and my 18 year old son is finishing high school via the internet as his school has gone to dynamic web-based instruction. Still while I know he's relatively safe at home I feel bad as he will not have a PROM, Grad Night, Senior Sunrise and possibly the actual graduation ceremony. He plans to enter the military and we had planned to go to Europe as a last mother/son adventure and now that trip is canceled.

Still my family and extended family have remained healthy so far and that is enough for now. Be safe everyone!

I'm off to find out if lady parts scented candles are an actual thing!

Hppy

[hppygr8ful, ASN, RN, EMT-I]

OMG I found it first try

https://www.harpersbazaar.com/uk/beauty/fragrance/a30510012/gwyneth-paltrow-lady parts-candle/

[Wuzzie]

The FDA pretty much just shut down a company that has produced a machine that can sterilize 160,000 masks per day. They have placed a limit to allow only 10,000/day. They have additional machines ready to ship to areas in the US that are in crisis mode (and ironically DC as well) but the FDA quashed that too. This is not a fly-by-night company folks. It’s Batelle. If you know anything about military defense you are familiar with them. WTH is going on with the federal government?!!

[Katie82, RN]

First of all, everyone is a suspected positive these days. Many of those who test positive have mild symptoms resembling cold or flu, yet are still contagious. I think what the CDC is saying is N-95 is ideal, but if you don't have them, use a surgical mask. In most states, you are free to refuse if you want to lose your license. Certainly your choice. Many are saying they would abandon then hope that their BON will excuse them retroactively. I wouldn't count on it. By next year at this time, most of the powers-that-be will have forgotten how hard we worked, or didn't as the case may be.

[DeaneB246]

On 3/28/2020 at 12:48 PM, ReySkywalker said:

No matter what, you cannot abandon the patient.

npr-I-15.pdf

We’re not talking about abandonment. That is a different definition.

[HiddenAngels]

10 hours ago, DallasRN said:

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! ?

?? you said it!