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.

[BlueJsMomma]

A 31 year old woman with no known medical history died today, she lived in my neighborhood. Young, healthy, mother. 86% mortality rate in covid patients intubated last I heard. I'm pregnant with a 2 year old at home. I told my manager when there are no supplies I will quit. I am good at my job, but my family costs me more than a license ever will. 3 of our nurses are positive. Our peak is not due until mid May. In the ED we wear surgical mask and goggles all day. N95s, surgical hairnets and gowns for treatments and intubations, for positives. Max 3 people in the room for intubations, for positives. No one wears uniforms home. The hospital has a done a great job clearing out unnecessary occupants in anticipation. I always thought I was the type to run into fire, but now I can set my family on fire. Nurses are being shamed for not wanting to do "what they signed up for". Nurses are being shamed for dropping their kids off for a month so they can continue to work. Nurses are being shamed for being nurses and others for deciding this isn't for them. It's been an eye opening experience for all.

[BradleyRN]

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

Suspected COVID patients at our hospital and confirmed cases are not taking care of anyone else. The alternative is to let the patient die if we don't take care of them.

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.

That is ridiculous. "Equipment is never guaranteed"? Ludicrous!

You would willingly spread the virus to your grocery store clerk, your family, other patients and your fellow workers, trying to be a martyr. You do what you want, but leave me out of what is only your choice. (Of course, you sound like you're hiding in an office, pointing fingers at everyone else, terrified that if they won't do it, you will have to.) You don't tell me what to think like you know something. If a shortage should occur? Oh, a shortage is going to occur, so break out your scrubs. Then, we will see whether you want your PPE or not. "Full action should be taken against my coworkers! "Pfft.

[AuntieNurse]

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.

Which states are mandating permanent surrender of license for refusing to care for patients under-protected? I've tried to find info on this for my state unsuccessfully.

[brittnie89]

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

Suspected COVID patients at our hospital and confirmed cases are not taking care of anyone else. The alternative is to let the patient die if we don't take care of them.

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.

It’s nurses like you I really can’t stand. This is our opportunity to stand together and you do the work for them. Shame on you! This is a profession based on care but does not care for those who make up the profession. Nurses have died from this and a lot more will because they are afraid of companies reporting them and of snakes like you. You deserve your license taken, you’re really the nurse I would not want on my team. No compassion! Equipment has been granted up until now. Infection control was pushed down our throats since nursing school and when we took boards now we should surrender our lives? I guess when we. Econ’s the patient that the only thing that could get you to care?

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

Jesus ******* christ. Who is this little snitch tattle tailing on nurses who are simply advocating for safety? I didn't see a username for the person who said this:

Quote

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.

That is simply nasty behaviour, not to mention simple-minded. The OP embodied everything that has gone wrong with our profession with their thinly veiled threat. Whomever this user OP is, do you realize nurses continue to get sick and many have died of COVID-19 due to a lack of PPE? If we use logic...1+1=2... and, if more nurses continue to get sick and die there will be less of us to take care of the public. Ensuring the safety of nurses ensures public safety....

[waufah, BSN, RN]

9 hours ago, brittnie89 said:

It’s nurses like you I really can’t stand. This is our opportunity to stand together and you do the work for them. Shame on you! This is a profession based on care but does not care for those who make up the profession. Nurses have died from this and a lot more will because they are afraid of companies reporting them and of snakes like you. You deserve your license taken, you’re really the nurse I would not want on my team. No compassion! Equipment has been granted up until now. Infection control was pushed down our throats since nursing school and when we took boards now we should surrender our lives? I guess when we. Econ’s the patient that the only thing that could get you to care?

I have worked with nurses like these,I call them miracles workers too. Management might tell them to take care 4 patients in an ICU, and they will never complain, and make the rest of us look bad. You are right nurses, need to unite and take a stand.

[skylark, BSN, RN]

On 3/19/2020 at 5:30 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.

Totally agree, but management has different ideas.

Here the only exceptions are nurses who are either pregnant or are cancer survivors. So we have breastfeeding moms going into covid rooms, and then going to another room to pump.

How on earth is that acceptable?

[Walti, LPN, LVN, RN, EMT-I]

Just wondering how many of you would prefer to use an expired N95 instead of a surgical/procedure mask?

Wondering what your thoughts are on the Customs and Border Patrol transferring 1.5 million expired N95s to TSA. Especially since TSA is doing so little passenger screening as of late. Seems to me that the masks could have been more appropriately distributed.

Last thought for the day, POTUS appears to be pulling facts out of his imagination again. Anyone know of any major hospitals with only 2 ventilators?

[subee, MSN, CRNA]

11 hours ago, BlueJsMomma said:

A 31 year old woman with no known medical history died today, she lived in my neighborhood. Young, healthy, mother. 86% mortality rate in covid patients intubated last I heard. I'm pregnant with a 2 year old at home. I told my manager when there are no supplies I will quit. I am good at my job, but my family costs me more than a license ever will. 3 of our nurses are positive. Our peak is not due until mid May. In the ED we wear surgical mask and goggles all day. N95s, surgical hairnets and gowns for treatments and intubations, for positives. Max 3 people in the room for intubations, for positives. No one wears uniforms home. The hospital has a done a great job clearing out unnecessary occupants in anticipation. I always thought I was the type to run into fire, but now I can set my family on fire. Nurses are being shamed for not wanting to do "what they signed up for". Nurses are being shamed for dropping their kids off for a month so they can continue to work. Nurses are being shamed for being nurses and others for deciding this isn't for them. It's been an eye opening experience for all.

I would believe an 86% death rate in intubated nursing home patients, but do not believe this is a true figure for all intubated Covid patients. Please cite sources because I can't find anything online. Thanks.

[MunoRN, RN]

2 hours ago, skylark said:

Totally agree, but management has different ideas.

Here the only exceptions are nurses who are either pregnant or are cancer survivors. So we have breastfeeding moms going into covid rooms, and then going to another room to pump.

How on earth is that acceptable?

That's non-sensical criteria for exceptions, I agree, but I'm not sure what's clearly unacceptable about a breastfeeding mom caring for Covid patients, or pumping in a separate, designated area.

[Rose_Queen, BSN, MSN, RN]

Several off topic posts have been removed. Please stick to the topic of refusing care due to lack of PPE.

[brandy1017, ASN, RN]

On 3/25/2020 at 8:21 AM, Tegridy said:

long story short if the hospital is following current cdc guidelines then I doubt anyone will get away with refusal. Whether or not the CDC is sure on his and how much data there is backing it doesn’t matter unfortunately.

But I will say there are very few airborne diseases most being droplet. Of course minus certain procedures.

Can nurses say thru the National Nurses United file a lawsuit against the CDC, even expand to a class action lawsuit for all the HCW who are knowingly being exposed to unsafe and potentially deadly working conditions by the CDC's lowering safety measures?

I hope the CDC is sued for purposely caving to the hospital interest's over the safety of the HCW's!

I haven't heard of a PAPR shortage, so why can't the hospitals provide PAPRS for everyone working with COVID pt's? Don't want to spend the money I would guess.

We are pawns, totally expendable, warm bodies till they find someone to replace us! We are being pressured and guilt tripped to work overtime due to a shortage created by management before the pandemic ever happened and not renewing the travelers we did have till at the very last moment and most had taken other jobs in the interim.

Travelers are now being offered hazard pay throughout the country, while we are supposed to pick up extra for overtime. At the same time mgmt is supposed to stay away from us and keep themselves safe! The masks are locked up out of our reach and thanks to the new CDC rules the staff on the COVID wing are being given one simple surgical mask for the whole shift, no N95, no PAPRs. And we have PAPRS in the building that are not being used. It is a total disgrace!