Should you be able to refuse an isolation assignment when pregnant?

[SteveNNP, MSN, NP]

Hi,

This issue has come up a few times over my career, and I was wondering what you all think. In this day and age of MRSA, VRE, and ESBL, do you believe that a pregnant RN can refuse to care for an isolation assignment of this type? I understand that there are many infections in whose case the RN must NOT be pregnant (varicella, rubella, HSV, etc) However, a few pregnant coworkers over the years have repeatedly refused to care for routine isolation pts. Usually the effort had been made to reassign those pts, but in some cases, it's impossible. I often got the feeling that they did so because they just didn't want to care for isolation kids to begin with. Any thoughts?

edit: apparently I forgot to add the modifier: pregnant to the poll.... please vote as if I had...

[brissie]

Interestingly enough our NM brought this up yesterday at our biannual staff meeting. She said that for the obvious infections that are dangerous to a pregnant woman, those pregnant will be excused from caring for those babies, but for other infections they will not be excused, primarily because there is no risk to the fetus and also because we as nurses should be practicing universal precautions and treating every baby as if they were infected anyway. As a male nurse I am pretty much always a sure fire bet to care for a lot of our what I like to call, "tocolytic" babies, which of course I don't mind in the least. Our isolation room is a closed off room from the rest of the unit so I park myself in there with my 1 or 2 babies and a good book and am set for the next 12 hours!

[fergus51]

I do not believe they should unless like you say they are contraindicated for pregnancy. I am personally sick of people going to work and being unwilling to work.

[elizabells, BSN, RN]

I agree, Fergus. Two different situations to ponder:

a) Transport came in the other night, and the RN assigned is pregnant, although very few people know that, including the charge nurse. Kid's initial WBC? 115,000, and we don't know why yet.

b) A baby who a week ago was on a medication that was category X and had a 1/2 life of 4 hours. The neo fellow refuses to touch or come near the baby, who is a terrible IV stick and has an unstable intubation. (For clarity: the baby has been OFF the med for a week by the time the fellow made her refusal)

What do you guys think?

[fergus51]

I think B was wrong. If you know the kid hasn't been on the med for over a week, you shouldn't have a problem.

A, I would leave up to the individual though I don't see any real reason to refuse. Standard precautions still apply. JMHO.

[BittyBabyGrower, MSN, RN]

If it is something contraindicated in pregnancy, yes, they should be able to refuse. If is something like MRSA, then no, they shouldn't be refusing. Luckily, we don't have this problem on our unit.

[wjf00]

I am male myself and I get a lot of assigments that are refused by pregnant co-workers. I have no problem with that. I don't think anyone other than the manager has the right to know why a nurse needs to change assignments, in fact it seems like it might be a HIPPA violation if I were to ask. As long as the patients are covered and staffing levels are safe, it is fine with me.

[llg, PhD, RN]

Patients can be carrying all kinds of bugs before we know about them. So, ANY patient could be carrying something that could you (or a fetus). If you can't tolerate the risk, you shouldn't be working at while pregnant.

While I would recommend a policy that did not require pregnant nurses to care for babies with known special risks -- I would not recommend a policy in which a pregnant woman could excuse herself from all patients with infections of any kind.

[nicutoo]

unless you are the ony person that has the special skill set to take that patient you should be able to switch.

[CRDBear]

Given that we as NICU nurses know what CAN go wrong during a pregnancy even with all the best prenatal care and the fact that nurses do have a higher rate of miscarriage and preterm labor (don't know where I read that statistic but it's somewhere!) I feel like we should be a little more tolerant. I'm not saying that pregnancy should be an excuse for not working and being a member of the team. I just think that if you know that a nurse is pregnant, try to make it as easy for her as possible to get through her pregnancy without any other added stressors. It's only nine months!

[jalarms]

I agree with most of the comments posted. Certain diseases- definitely not while pregnant. I believe that one of the most important things to consider is human behavior. We should always practice standard precautions at all times, but I know that we do not always do our best.

I know personally that when a patient is in isolation, I am much more careful. I should be just as careful with all patients. One of our infectious disease specialists once mentioned this as well and said that often pregnant nurses are safer taking care of known illnesses because of the use of proper precautions as opposed to our tendency to be more lax with other patients. While pregnant, I think I would prefer to care for a baby in isolation (not contrindicated for pregnancy) than to care for a baby and later discover they have CMV or another illness.

I would hope that fellow nurses would be supportive and work through assignments for any reason.

[hikernurse]

I'm done having babies and I'm more happy to take an isolation assignment for someone who is pregnant. Even if the risk is negligible, I can surely understand a pregnant mom not wanting to take chances. We have a big enough unit that switching would rarely cause a problem.