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.

[Kooky Korky, BSN, RN]

On 3/24/2020 at 9:59 AM, Walti said:

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.

Are you working as a nurse without a license? Are you working at all?

What do you mean you have aged out? Is there an age limit on who can be licensed as a nurse? Which state does this?

Nurses are always thrown under the bus. Nothing new about that. Maybe now, though, nurses will begin to realize that they must protect themselves. Government and nursing "leaders" will never do that for them.

[cazreye]

WOW!. Oregon nurses you have just entered the category of indentured servitude. You don’t have any say or voice on how you are protected at work - according to the letter they don’t even have to follow the WHO or CDC unless they decide to.

[Cozy LifeRN]

On 3/20/2020 at 5:04 PM, MunoRN said:

Healthcare workers are physiologically comparable to non-healthcare workers when it comes to how our bodies are affected by a virus. It's not as though our mortality risk is not comparable because of our third lung.

Non-healthcare workers aren't going in and out of high-risk Covid 19 pt populations for 12-13 hours a day either. I am on a Covid-19 unit for a large hospital. I am 3 to 1 with telemetry and step-down Covid high-risk pt's, it is a huge undertaking. I am told soon we will have to take 4 pts, some stepdown and some telemetry, Our doors are not glass-enclosed, you cannot see the pt. 's.

The donning and doffing are encumbered by disorganization, lack of various supplies at any given time and how to attain them when you do run out. There's confusing Covid updating, some of us have been educated via a training class, others have not. Our techs are disappearing, so I am doing everything from toileting, bathing, linen changes, getting glucose checks and VS's to my regular duties of care. I am exhausted. I will give notice if they go 4 to 1, with high acuity and high-risk conditions for the same patients.

I signed on to care for others with the right skills, training, and equipment. I have been an American Red Cross volunteer as well for years.

I think we should have a voice and some rights when it comes to being on the frontlines of a Pandemic. I know MunoRN will have an issue with this, frankly, I don't care. You sound like admin, not like a current

Covid 19 bedside nurse. Just sayin..

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

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.

[Jory, MSN, APRN, CNM]

On 3/23/2020 at 2:40 PM, FLOATnureCO said:

what good are you as a nurse if you knowingly contract covid19 and possibly die?

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.

[Stellar88]

12 minutes ago, 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.

WOW! way to add to the already terrible nursing shortage. When this is all said and done there will be even less nurses and even less willing to become one after the horrible way we have been treated. Glad to see you’re doing your part to add to the shortage.

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

So I guess the only option is surrender the license or die? No vents, no PPE, do you just bag the patient until you die or can you go home if you get a fever? If you have to come back by ambulance do you go to the front of the line for a vent?

Glad to be retired and hunkering down. I know at 70 years old when the vents are triaged to the younger folks I will be up the proverbial creek. Best of luck to all of you.

[Closed Account 12345]

21 minutes ago, 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.

You're willing to risk your life to save a patient's. Great. I care deeply for patients, but I care more for the tiny people at home who love their mama.

No one is declining these patients because they have a scary diagnosis. That would not be appropriate. I would agree with you that nurses who refuse to care for patients based on their diagnosis are in the wrong field.

People are declining to accept assignments that jeopardize their health/lives and the health/lives of their loved ones.

Good for you, if you're willing to purposefully clean poop with bare hands, have someone vomit blood on you, or go stand in a coughing TB patient's room mask-free since nurses should never bank on equipment being guaranteed, apparently. I'm not willing to do those things on purpose.

Accidental exposures are always a possibility in nursing, and that's a risk I'm willing to take each time I provide care. I'm not, however, willing to knowingly and purposefully breathe in aerosolized droplets that could land me in an ICU for 3 weeks or worse. I'm educated enough to know that intentionally exposing myself to communicable diseases would be dumb, for lack of better wording.

I can't even fathom that you're fighting a battle against nurses who stand up for evidence-based practices and their personal safety. Use that anger and fight the system that even asks us to endanger our lives instead.

I love nursing. Love it. I would walk away from any job, or even the profession, and never look back if I was told that I wouldn't have access to appropriate PPE anymore.

Employer: "Oh hey, we're not going to let you wear gloves anymore."

Me: "Oh hey, I don't work here anymore. Bye."

I think it's interesting that you said "IF" a shortage should occur. Of course a shortage is about to occur. All of our ER and ICU nurses are about to be patients for working in the unsafe conditions you'd like to keep them in

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

All of you still working need your pay doubled at the very least. Except the ones not involved in patient care. You should take pay cuts to help with the raises.

[subee, MSN, CRNA]

On 3/24/2020 at 4:20 PM, Walti said:

So I guess the only option is surrender the license or die? No vents, no PPE, do you just bag the patient until you die or can you go home if you get a fever? If you have to come back by ambulance do you go to the front of the line for a vent?

Glad to be retired and hunkering down. I know at 70 years old when the vents are triaged to the younger folks I will be up the proverbial creek. Best of luck to all of you.

As long as they give us MSO4 or Propofol drip, this 72 year old is down with that! I don't want anyone jeopardizing their young life for me.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

23 hours ago, cazreye said:

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.

I love this ? and agree 100%!

My current attitude is this: police officers get guns and bullet proof vests to protect themselves against the inherent risk in their jobs. We need PPE. Thus, it should ALWAYS be an institutional/government priority to manage and provide the supply!

I demand evidenced-based personal protective equipment to work through this pandemic... and if I'm ever denied, I'll be happy to risk my licence by refusing the assignment and then promptly talk to any news outlet or hungry journalist to put that institution on public blast. I've tried this already once and they found me anbox of N95s so effing fast it was alarming!

What is a Nurses' life worth? We have to set that standard! If we don't, they (ex. gov't, agencies, etc) will continue to treat us like toilet paper as one-by-one we all get sick and some of us die. None of these politicians telling us that the dwindling PPE is "adequate" are on the frontlines scrubbing up to fight the pandemic... So, they sure as hell won't be telling me what to do. If the government ever gets any silly ideas about conscripting Nurses to work with inappropriate safety measures... then they can come take my licence! At the end of the day WE are the ones keeping people alive. We have to set standards by pushing back.

[ReflectiveRN]

OSBN the evidence-based practice tells us to don the proper PPE, and with what was learned from other viruses such as EBOLA, not wearing the proper PPE is unacceptable. Take away a license? You will be held liable for your unsavory, unethical management of the State Board of Nursing. Especially if you cannot prove that you as a medical provider did not risk your own life - even then you didn't follow evidence-based practice and not sure you should hold the role you do. What do you think?

Threatening sole supporters of families with the risk of losing their license and jobs is criminal given the current state of this Pandemic and lack of proper PPE! Unacceptable.