Tech Refuses Patient

[UM Review RN, ASN, RN]

So the tech states she cannot care for Mr. Smith in Rm 555 because Mr. Smith has MRSA in the nares.

The tech's doctor gave her strict orders to stay out of isolation rooms.

But....sad to say....this directive came without a work excuse.

The nurse who had the patient then told the Charge nurse, who basically said there was nothing that could be done about it, and so the nurse did all the patient care.

I told the nurse if she didn't write that tech up pronto, she was completely out of her mind.

How would you have handled it?

[bethin]

I'm with you Angie. If it was so important that she not go into a room with MRSA, wouldn't you keep that note in your purse or come in as soon as the dr wrote it and hand it to the DON or supervisor?

[november17, ASN, RN]

That's a really odd thing for a physician to order.

I'd educate, educate, educate - about MRSA and precautions.

Failing that, I'd personally consider a write-up.

[psalm, RN]

I wouldn't go to work without a doctor's excuse for something I couldn't do and expect my co-workers and team-mates to just take it on my word. To protect myself, you better believe I would have it in writing.

Could she have at least called her doctor's office and had an excuse faxed to your facility since she was negligent in bringing one? At least that would have covered her...still inconvenienced her co-workers but she would have to make it up somehow!!

[Valerie Salva, BSN, RN]

Write up needed. I don't think the tech was being truthful.

[ZippyGBR, BSN, RN]

depends whether there was a valid reason or not AND that valid reason should have been provided to Occupational Health who can then inofrm the Nurse managers in question...

if there's not a valid reason Occupational health need to open a can of whoop with he doc involved and the CNA involved needs to be told to consider their place in that team...

[Dolce, RN]

Wow, that would never fly where I work. We always have about 4-5 patients on MRSA precautions for testing positive in their nares. That's why you gown and glove up!! I think she should prove what her doctor told her by producing an excuse note.

[al7139, ASN, RN]

OK,

Come on! This sounds like a you-know-what excuse for getting out of having to care for a pt with isolation precautions.

MRSA is everywhere! Our patients may have it with out our knowledge, because we did not test them for it, since they didn't have a big nasty decub, or weren't febrile, or coughing up stuff.

PLUS, if you tested anyone in the population randomly (including us nurses), chances are most would test positive for MRSA at some point. Healthy immune systems can fight it off before it becomes a problem. It's those who are immunocompromised, or have other risk factors that have to worry. Then MRSA can colonize, and take advantage of an already compromised body. This is why standard precautions are in place. To prevent the spread of MRSA to other people who cannot fight it off. Unless this person is sick with a condition that enables them to catch secondary infections, or they are pregnant, there is no reason why they cannot care for a pt. I would be asking for a doctor's note explaining why this person can't be exposed.

You are right, they should be written up unless they can prove a valid reason. This doesn't mean telling the whole staff, just the supervisors, who will then inform the staff that this person is on restricted duty.

We don't allow our pregnant staff to care for isolation patients for the safety of the child and mom.

Amy

[locolorenzo22, BSN, RN]

please.....what a crock....Unless the tech is pregnant or somehow otherwise immunocompromised...there is NO excuse for not taking that patient. You gown/glove/mask appropriately and no prob....Was the patient on iso confused, incontinent, tough/total care patient? If you answer yes there, I think you may have solved your own riddle.

Personally, I don't mind isolations....at least I know they have the room to themselves.....

[RN007]

MRSA is everywhere! Our patients may have it with out our knowledge, because we did not test them for it, since they didn't have a big nasty decub, or weren't febrile, or coughing up stuff.

PLUS, if you tested anyone in the population randomly (including us nurses), chances are most would test positive for MRSA at some point.

:yeahthat:

[DutchgirlRN, ASN, RN]

We can't pick and choose on the basis of a diagnosis. Will she refuse a HIV+ patient? A TB patient? etc? A write up and a little education is definately in order.

[snowfreeze, BSN, RN]

This may be simply fear of the unknown. teach this tech/aid about the infection and how to protect him/herself and the problem might just go away. Why do we need to become defensive? I become interested and questioning with my patients, why not with co-workers?