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.

[AuntieNurse]

1 minute ago, balletomane said:

Out of curiosity, how many Magnet hospitals are union?

Our hospital recently lost magnet designation... But has never had a union that I am aware of. I honestly don't know of one in the state that does.

[balletomane, ADN, RN]

On 3/28/2020 at 3:20 PM, irvine123 said:

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

I am 61 and the second oldest on my unit. Was sent to float onto COVID last weekend. Pneu past 2 years, A+ blood, with a 64 y.o. husb at home. I don't complain...not then and haven't now. Being sent there the next 4 weekends and don't hear younger nurses stepping forward to cover for me.

[dinah77, ADN]

11 minutes ago, balletomane said:

I work for a non-union hospital. Compared to the other hospitals in the area, I am not seeing any difference. What are you seeing in your area?

Great questions! Amazing benefits, but most importantly if I ever get called to my manager for an investigation I have a union rep that goes with me and asks all the questions, demands assurances on my behalf etc

happened to me once for a fairly minor incident and the union rep with all the contract power did all the talking, had my manager agree I could not be called on again re: it and got her to sign a contract that it would not reflect poorly on me in the future.

that one was easy and it wa more about asking about and incident that mainly involved another nurse

that is invaluable

also, right now with lack of PPE our unions reps are basically working on that issue constantly for us- much more power and resources to do so then non union

[balletomane, ADN, RN]

On 3/29/2020 at 8:17 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! ?

[balletomane, ADN, RN]

On 3/29/2020 at 10:10 AM, eerrmm 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."

If it can be and I'm working COVID, I want to err on the side of caution.

[dinah77, ADN]

1 hour ago, balletomane said:

If it can be and I'm working COVID, I want to err on the side of caution.

As you should! I know my union leaders are citing the precautionary principle as far as PPE

[Orion81RN]

On 3/31/2020 at 7:39 PM, brandy1017 said:

Now over 700 nurses and doctors are infected in Boston and NYC because of the unsafe PPE put thru by the CDC! How many need to be infected or die before they take this seriously and supply TB masks and even better PAPRs! And who is going to replace all these health care workers at the front lines!

Very inexperienced "I'm going to save the world" types. It's scary the conditions that are expected to be at McCormick place with grueling work/hours.

[hppygr8ful, ASN, RN, EMT-I]

On 3/31/2020 at 5:39 PM, brandy1017 said:

Now over 700 nurses and doctors are infected in Boston and NYC because of the unsafe PPE put thru by the CDC! How many need to be infected or die before they take this seriously and supply TB masks and even better PAPRs! And who is going to replace all these health care workers at the front lines!

Can you please cite the source for this statistic I have googled all over and can't find it. I not saying it's not real but have not seen any reliable news source cite this number?

Hppy

[Jory, MSN, APRN, CNM]

On 3/30/2020 at 9:39 AM, 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?

Classic Millennial thinking and I not only don't care about what you think of me, I can't stand nurses like you either. Selfish! Selfish! Selfish!

Don't you freaking get it????? What do you think happens during a national emergency that overwhelms a hospital system? That you can demand your 15 minute breaks twice a shift plus a full 30 minute lunch and by gosh, your PPE before you touch anybody even though it's on backorder and no amount of money can produce it? Even though the corporations can't crank it out fast enough? Even if there isn't enough in the entire United States????

Let's stop calling nurses heroes...today...right now, if that is going to be your attitude. We are not heroes if we run when the fight gets tough, even if it risks our own life. We have chosen a profession that not everyone can do.

I have done CPR on someone to save their life before without any protection at all and had their blood ALL OVER my hands and face. That is what I am willing to do when called upon. Clearly you are not that kind of nurse.

On 3/31/2020 at 8:39 PM, brandy1017 said:

Now over 700 nurses and doctors are infected in Boston and NYC because of the unsafe PPE put thru by the CDC! How many need to be infected or die before they take this seriously and supply TB masks and even better PAPRs! And who is going to replace all these health care workers at the front lines!

CDC doesn't produce PPE and if you were paying attention to the regulations, other alternatives were listed in case we ran out.

There isn't always going to be a PPE fairy.

[Jory, MSN, APRN, CNM]

On 3/30/2020 at 2:20 AM, BradleyRN said:

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.

So you actually believe there is an endless supply of everything medical in our country? Seriously? Do you really believe that?

Break out my scrubs? Honey, I wear scrubs every day. Get out of the profession if you are that self centered.

On 3/28/2020 at 1:55 PM, Gingerpup said:

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.

Then we are cowards. Thanks for that clarification and yes, supplies frequently ran out on soldiers when they were at war in very hard hit areas. They are also taught to do what it takes to help when called regardless if the situation is ideal or not.

[Jory, MSN, APRN, CNM]

On 3/24/2020 at 11:42 PM, Leader25 said:

WOW!! that is cruel and crude,shows your compassionate side,you are not really a bedside nurse are you? Eating any young lately? ......

I didn't exempt APRNs from that letter either. If there is a national emergency declared, the state can order you to the hospital and revoke your license if you don't go. Keep that in mind before you puff your chest.

[BradleyRN]

1 hour ago, Jory said:

So you actually believe there is an endless supply of everything medical in our country? Seriously? Do you really believe that?

Break out my scrubs? Honey, I wear scrubs every day. Get out of the profession if you are that self centered.

Then we are cowards. Thanks for that clarification and yes, supplies frequently ran out on soldiers when they were at war in very hard hit areas. They are also taught to do what it takes to help when called regardless if the situation is ideal or not.

Companies just sent 280 million masks overseas. Those shipments should have been stopped and redirected to our facilities. Trump still hasn't released the supplies promised by the Pentagon. 1000s of ventilators apparently don't work because Trump let the maintenance contract expire last year. He didn't accept the tests from the WHO months ago, and is still delaying testing around every corner.

It appears that it is not just an accident that we dont have equipment. It looks like a result of precisely calculated moves by the White House to make things worse than they need to be.

Face it. We can work at a big hospital for years with loyalty, dedication and sacrifice, but they have rarely been on our side. If they have to bid more to get the same supplies that used to cost a lot less, well that is what they should do. We are the ones thrown under the bus through all this. Thus, I wouldn't mind if a nurse doesn't want to risk hurting themselves or their families or patients by exposing themselves intentionally to the virus. Kudos to those who risk it, but kudos to the ones who don't. Who am I to tell them what to do? Who am I to tell on them if they don't agree with me?