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.

[amoLucia]

Protocol would be funny if it were NOT so serious (with a bit of truth in it).

[Leader25, ASN, BSN, RN]

On 3/25/2020 at 12:44 PM, FacultyRN said:

Failure to work a scheduled shift is not abandonment, nor criminal.

No but it is job abandonment.

[Closed Account 12345]

8 hours ago, Leader25 said:

No but it is job abandonment.

Yes, and I thought my post was pretty clear that I was referring to patient abandonment, not job abandonment, since it also said the following information right before the quote you included.

"There would likely be employment repercussions, to include termination. In some states, there may even be Board repercussions.

Ultimately, we each get to make our own decisions and weigh the risks in our free society though. Nobody can force nurses to physically present to their assigned units when scheduled and provide 12 hours of competent nursing care without appropriate PPE."

So, to clarify, even though I didn't think clarification was needed, I was referring to *patient* abandonment in the sentence you quoted.

[Niennah]

The ANA states:

"the registered nurse is responsible for being knowledgeable about state law under which they practice during a pandemic.

Questions nurses should seek answers to include:

Does the law mandate that nurses must provide care in all situations, regardless of the danger nurses face providing that care?

How is the nurse’s license protected during crisis standards of care during pandemics?

What protections exist against lawsuits for negligence or malpractice, especially in circumstances of scarce resources or where practicing outside of the normal specialty area?"

https://www.nursingworld.org/~495c6c/globalassets/practiceandpolicy/work-environment/health--safety/coronavirus/nurses-ethics-and-the-response-to-the-covid-19-pandemic.pdf

[ladycody, BSN, RN]

On 4/2/2020 at 10:24 PM, Jory said:

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.

I call BS. Even the armed forces...where one actually DOES have a very clear expectation that one's life may be lost ... even THEY have dependency, hardship, and medical discharges that relieve their soldiers from duty, without shame, to prevent unreasonable risk to health and to protect the needs of family. There are a hundred ways to fulfill a role in nursing and meet the expectations of the nightengale pledge and a good many of them do not require direct patient care and even those that do can be VERY different with regards to skill set and emotional stamina required. That pledge does not require nurses to forsake theit own health or to forsake the needs/ lives of their families. The way YOU choose to practice does not have to be EVERY nurse's choice.

You are also likely one of those who thinks a nurse educator or one in informatics or mental health is not a REAL nurse. We did NOT all sign on for trench nursing. We signed on to maintain and advance the profession and to devote our service to human welfare....but it does NOT specify the manner in which we fulfill those expectations. Stop shaming those who can't be YOUR type of nurse.

[ladycody, BSN, RN]

On 4/7/2020 at 6:35 PM, anonymous-phn-RN said:

....if it was just a Job, you wouldn't have to have a license, and you wouldn't have to continue you education

Thanks for the giggle. There are... literally... HUNDREDS of jobs that require licensure and continuing education outside of nursing. Licensure is a 'protecting the public from incompetence' thing....not a 'giving my life for my job' thing.

Also...just to be clear:

"The ANA states nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."

LOTS of different aspects to nursing besides "providing care for the sick and infirm".

[Sunspun]

There should be a voluntary, administrative union of allied health care workers and laborers to prevent the overall mass reduction of needed maintenance and procedural supplies for everyday work in Western health care agencies, home care organizations and hospitals. OSHA is a related organization that assumes some of the common sense duties I am posing this would ensure, however, easier access to and quicker refilling of safety equipment to direct care workers is of the essence, and a different union could be a future remedy.
There is no shortage of accountability only resolve.

[amoLucia]

13 hours ago, ladycody said:

Thanks for the giggle. There are... literally... HUNDREDS of jobs that require licensure and continuing education outside of nursing. Licensure is a 'protecting the public from incompetence' thing....not a 'giving my life for my job' thing. ...

T H A N K Y O U !

Realtors get a license - selling a house is NOT hazardous.

Cosmetologists get a license - cutting hair is NOT hazardous.

Accountants get a license - completing a tax form is NOT hazardous.

But HCWs, the front-line workers, are facing HAZARDOUS, LIFE-THREATENING situations.

There was only one Mother Theresa, but she was a religious and SAINTED.

[hppygr8ful, ASN, RN, EMT-I]

5 hours ago, amoLucia said:

Accountants get a license - completing a tax form is NOT hazardous.

I don't know I think our accountant takes risks his life every time he prepares our taxes

[toomuchbaloney]

On 3/24/2020 at 8:09 PM, Walti said:

50 years ago I was a young medic in Vietnam. We had to do so scary stuff but we were never ordered into battle without ammunition. For some of us, sometimes the ammunition ran out. When that happened they died. They were soldiers and they didn't have any other choice. No nurse gets paid enough to die for her patients.

Good reply about eating any young.

Did I work with you years ago in a NICU in the Midwest as you were starting your nursing journey? I know that attitude from somewhere.

[Kooky Korky, BSN, RN]

On 3/24/2020 at 1:20 PM, Walti said:

Kooky Korky,

Sadly as I've aged I'm starting to show signs of cognitive decline. Senior moments so to speak. For all of us there comes a time to hang up the scrubs and stethoscope.

I once made an "age" mistake when I was a much younger man. I was caring for a 96 year old retired public health nurse. I said to her, "I understand you used to be a new nurse." She put me in my place when she responded, "I still am."

It is a title we carry to the grave unless a board of nursing takes it from us. Yes, I've aged out but I'm still a nurse and proud of the 45 years I put into the profession.

Ops, not new nurse, strike the new part, senior moment there.

How about giving flu shots this coming flu season? There are agencies that hire for this and for doing biometric screening (cholesterol, BP, ht, wt, EKG - very easy, pretty sedentary).

You could work as much or as little, probably, as you like. No benefits, low pay but you would be doing something valuable and get some work. Keep your hand in Nursing.

Thank you for clarifying.

Right now we need Contact tracing of COVID pts. Check with your local County or City Health Department.

God bless you, Nurse.

[herring_RN, ASN, BSN]

On 4/6/2020 at 1:40 PM, subee said:

How does someone simply sitting quarentine at home know that they have lost 80% of lung function?

A pulse oximeter can be purchased at Rite Aid, CVS, Walgreens, Amazon, and other businesses for less than $40.00.

Quote

The Infection That’s Silently Killing Coronavirus Patients

... We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature...
... Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath...

... There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter...

https://www.nytimes.com/2020/04/20/opinion/Sunday/coronavirus-testing-pneumonia.html