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.

[Closed Account 12345]

I don't think anybody should be pressured to care for patients without appropriate protective equipment, especially by other nurses.

Nursing, unlike law enforcement, military, firefighting, is not a profession where we signed up to risk our lives to save others.

According to WHO, the death rate among COVID patients with pre-existing respiratory conditions is 8%. Should I, as an asthmatic with crappy lungs and mother of young children, be pressured to take on a 1 in 12 chance of death to care for these patients without proper PPE? If your answer is yes, you're fooling yourselves. In that case, am I obligated to donate a kidney to a patient on the transplant list because there'd be a very low mortality rate, and as a nurse, it's my duty to save lives? Would you encourage your fellow nurses to perform a bare-handed blood draw on a patient with HIV because most likely they wouldn't get it at all, and if they did, they'd still have a long lifespan with modern meds? That's ludicrous. The COVID mortality rate for older adults and people with pre-existing conditions is significantly higher. Some nurses are the primary care givers for immunocompromised family members. What should they do during this time- move their parents to a nursing home that lacks adequate PPE and staffing? We saw what happened in Washington.

*Being a good nurse doesn't mean you must be willing to risk your life, or the lives of those you love.*

We did not sign up to risk/give our lives because of poor planning on admin's part. We signed up to provide care with appropriate PPE. In fact, failure to use the appropriate protective equipment every single time makes us vectors who could very easily cost other patients their lives because we exposed them to this virus. Elderly patients, chemo patients, children with aplastic anemia, diabetics, COPD patients, heart failure patients- they all still need care, too. And their mortality rates with COVID aren't a nice low number. Additionally, a nurse who is taking up an ICU bed and vent for 3 weeks can't help anyone.

Thank the Lord, there are MANY nurses who are willing to work 80 hour weeks and care for these patients, protective equipment or not. They are choosing to respond to the call. These nurses are heroes for their willingness to risk their own health, lives, and families... But for those who don't want to take on those risks, that's OK, too. It doesn't mean you're not a good nurse, or caring, or ethical. It means you have boundaries and that you'll be ready to jump right back in the game as soon as your employer provides you the equipment to do so safely.

No one should feel shamed by fellow nurses for having legitimate concerns about their own health. We should be supporting each other as best we can during this time.

[Serhilda, ADN, RN]

Personally, I don't recall becoming a martyr as part of my job description. As such, I expect adequate, evidenced-based protection. There are risks involved in direct patient care that we all accepted, absolutely, but asking bedside nurses to either fight a pandemic without adequate protection or leave healthcare is the equivalent of asking police officers to accept BB guns in place of firearms in the event of a shortage. It would never happen, so don’t expect me to walk into a patient’s room with a bandana.

I have yet to see physicians touting the same emotionally charged demands to become a martyr like I have among nurses. It’s a complete embarrassment to the profession. Instead of accepting unbearable conditions as always and presenting your support as some badge of honor, why not unite and take legal action? Speak with your representatives, take to the streets to raise awareness, or do literally anything aside from the approach we’ve always taken.

[choughlesRN]

On 3/19/2020 at 5:30 PM, MunoRN said:

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.

My hospital has issued some guidelines and recommendations for high-risk staff who may work with COVID/PUIs, basically saying that supervisors/managers have been given some leeway or guidance in terms of possibly reassigning those staff. The staff just need to be very clear with the supervisors as far as why they're high risk.

[RN4kids18]

I hate this for all of us! I agree with all of this-we didn't sign up to risk our lives or the lives of our families. We signed up to help people. Just like in an airplane-you put your mask on first before putting your child's on. Homemade masks will not protect us. Bandannas will not filter out this virus. What scares me is that there have been documented cases of younger docs dying from COVID-19. 8.3 percent of cases in Italy are from Health Care workers (according to Ministry of health 4 days ago). Who knows the statistics of HAIs. First reports showed younger people were not at risk-but who knows the accuracy of that-there's so much info out there and that has changed to now we are less likely to die. There are so many unknowns and for us to be protected less than our soldiers, our firefighters, our policeman is ridiculous. I cannot believe I read a comment that if we refuse patient care, then our license is taken away. I was thinking of helping during this pandemic since I am not currently working the front lines-but I am scared to help under these conditions. I believe in prayer-this is the year of the nurse....we will get through this!

[herring_RN, ASN, BSN]

CDC suggests nurses use bandanas, scarves during face mask shortage

CDC acknowledges recommendations are out of step with U.S. standards of care

https://www.rollcall.com/2020/03/18/cdc-suggests-nurses-use-bandanas-scarves-during-face-mask-shortage/

[cazreye]

I saw a great quote from a physician. He said that the cdc didn’t lower ppe standards because droplet masks were actually safe for healthcare workers. They lowered them in order to allow us to keep taking care of the public in the face of a shortage. Increased risk to healthcare workers was a risk they were willing to accept.

Quite a few of the nurses in local hospitals have been reporting their employers to OSHA and the state. This has resulted in some of these places changing policies. One hospital has purchased all nurses p100 respirators for covid patients. Only one hospital so far- but I hope more will follow.

[Katillac, RN]

16 minutes ago, cazreye said:

One hospital has purchased all nurses p100 respirators for covid patients. Only one hospital so far- but I hope more will follow. 

Good heavens. Here I was thinking the inadequate PPE was because these places couldn't get masks etc. because of shortages, not because they were too stingy.

I'm so naive.

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

The P100 will do all that a N95 will and more. Many folks find them difficult to breath through. Not cheap either, sounds like your hospital cares enough to spend the money to protect you. I'll put in a plug here for Home Depot, I bought one a while back for spraying paint. Home Depot sells them for $10.98 apiece. They do have them in stock online with a limit of 10 per buyer. Mention this to purchasing, see if they are willing to pay the price for them.

[MunoRN, RN]

14 hours ago, RosesrReder said:

Fun times.........

That's messed up.

What the Oregon BON seems to be saying is that because the OHA Public Health Division PPE recommendations are "scientific and evidence based", this is what nurses are going to be held to in terms of limiting their ability to advocate for their own safety.

What the OHA says is that procedure masks are fine when caring for COVID patients and that the appropriate level of protection (PAPR, N95 or better) is only needed during Aerosol Generating Procedures because that's the only time aerosolized droplet nuclei occur.

The claim that close range aerosolized droplet virus transmission doesn't occur with a cough or sneeze is not only not scientific or evidence based, it's the most ignorant statement I've ever heard by a health related entity or individual. And I'm not being hyperbolic, I really can't think of any statement more asinine than that.

[bitter_betsy, BSN]

I am aware of a situation where RNs and providers are provided 1 N95 mask and CNAs on the floors are as well. The techs, registration, housekeepers, secretaries and even security and maintenance workers who are in and out of the ED where all the sick people show up - aren't given N95s. These people "aren't allowed" into the rooms of suspected patients, but at this point everyone who walks in the door is probably a carrier and no one is protected. N95 should be standard issue for every worker - even if they only get one - they should all have 1 or not be at work. If they don't have one they won't be at work soon anyway --- and then what cha gonna do?

[rzyzzy]

19 hours ago, RosesrReder said:

Fun times.........

Yeah- wrapping themselves in a flag of deniability, with the weasel-words of “evidence based”, when the government keeps moving the goalposts to prevent panic..

I’m not in this particular area, but I’d love to see them try to enforce sanctions against anyone who’s ordered to save the world using an “evidence based” paper mask , or pretty soon- a bandanna..

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

I live on the California/Oregon border. I have held licenses in both states. I've also aged out and let my licenses lapse. Since I don't have to worry about the state pulling my license for inappropriate behavior I really don't have to worry about losing a license. I guess that means I can tell them just about anything without fear of retribution. Oregon is going to get an earful. Sounds like they've thrown the nurses under the bus and, or are in the pockets of the AHA.