The nurses right to refuse to provide care

grannynurse FNP student · Mar 9, 2006

Howdy dudes and dudettes!
I'm writing a paper on the the nurses right to refuse care to a patient. Any sources, info, or insight you want to provide, would be most super-d-dooper helpful!
It can be on anything, from the legailty, to the implications, to the circumstances that you would refuse care... etc..
Thanks!
Luke-e-doo
(Future Pediatric Nurse)

Go to your college library and look into books concerning the legal aspects of nursing, as well as journals. Use their computor to do an on line search of the laws and nurse practice acts of various states.

Grannynurse:balloons:

CHATSDALE · Mar 9, 2006

could you be more specific about the circumstances under which said nurse would decide

i have been asked by other nurses to take care of someone they knew and didn't like or with whom they had a problem on a previous admit

is this what you had in mind??

prmenrs, RN · Mar 9, 2006

The only circumstance I can think of off the top of my head would be refusing to scrub in on any sort of pregnancy termination if that is against your personal beliefs. Most hospitals would allow you to avoid that scenario.

**canoehead, BSN, RN** · Mar 9, 2006

I think in most cases you have to differentiate between passing the care on to someone else and actually refusing (where the patient gets no care at all). I think that in most cases passing the care along to someone who qualified and willing would be no problem, but refusing...well, I don't think we can absolutely deny care even in an abortion situation. BUT...in that case one would assume you'd let someone know about your limitations before you were actually put on the spot.

gwenith, BSN, RN · Mar 9, 2006

One of the circumstances, at least here, to refuse to engage in care of someone (it is different if you are actually looking after someone and decide half-way through to terminate that care relationship without passing it on to another carer) would be if there is a significant danger to yourself or your unborn child.

I am thinking here, of the "hot" chemotherapy patient or the overdose who has taken organophosphates. The latter is the more exteme example - these people give off the organophosphate and we have to nurse them in special isolation and wear protective clothing as well as only limit ourselves to 4 hours exposure at a time.

http://www.emedicine.com/med/topic1677.htm

Strip and gently cleanse patients with suspected OP exposure with soap and water because OPs are hydrolyzed readily in aqueous solutions with a high pH. Consider clothing hazardous waste and discard accordingly. Ethyl alcohol has been used to wash intact skin to prevent further absorption of the OP compound through the skin.

Healthcare providers must avoid contaminating themselves while handling patients. Use personal protective equipment, such as neoprene or nitrile gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory protection when decontaminating patients.

I would never allocate a pregnant team member to care for a patient like this and I would have NO difficulties with someone refusing under these circumstances.

Daytonite, BSN, RN · Mar 10, 2006

When I was doing hospital supervision we would get nurses who would refuse to give care to patients with active TB even when they were in isolation. Nurses would also refuse to give care to patients who were in radiation isolation even though safety standards and time exposure for the nurses were clearly posted and marked. The problem with the radiation was most often among the young women who worried about the effect on their future pregnancies. We had one LPN who would refuse to give care to patients who had roses in their rooms because she got violent allergic reactions to roses. It was easier to just work around these people just to get through the shift and have their managers deal with the employee. I personally didn't have a problem with any of these things though and when I was a staff nurse would either take care of a patient like this myself or have another staff member do it. I think that peer pressure worked on them worse than anything a manager could do to them because they were looked at like little babies by the rest of their staff. I saw the LPN have one of the allergic reactions (roses were on the floor and they didn't know they were in the room) and she got pretty bad, so she was never given a hard time about switching patients, or with the patient's permission the flowers would be removed from the patient's room so the LPN could go in there to give care during her shift.

When AIDS first came to attention in the 80's there were problems with a lot of staff who would refuse to answer the lights of the AIDS patients or to take them as an assignment. At that time everyone was afraid of it, so it was only the brave who stepped forward to carry on with the care. It seemed like everyone was very understanding of those who were refusing to give care. But, remember that at that time, we didn't know what is known about the disease today. There was a lot of fear about it, the foremost being that there was no cure and that everyone who got it died from it. The news was filled with stories of AIDS patients who were being run out of their towns and in some cases their houses burned down and discriminated against in every way you can imagine--it was a terrible time. These patients were sick too. Some of them had severe diarrhea and needed cleaning up. Others had respiratory problems and some needed suctioning and respiratory care. You know how some people don't like being around sputum.

I think that all throughout history there are examples of disease that put the caregivers at personal risk. Leprosy, plague, typhoid. Are those who come forward to care for others angels of mercy or just irresponsible to the consequences to themselves? Good question.

Dingo8Who · Mar 10, 2006

I don't see my previous post, so here goes (sorry if it shows twice)...

Great responses, thank you!

When a nurse does refuse to provide care, what are the implications on nursing?

I know by word of mouth, nurses would start to be looked down upon, especially if it became to common. Someone wouldn't go to get care because, they know they nurse won't help anyway.

But besides that, I really don't see what the implications on nursing as a whole would be...

Any ideas?

Daytonite, BSN, RN · Mar 10, 2006

i think it would indicate a breakdown in nursing theory and practice. a kind of chaos in the profession would ensue i would think. some of the standards would have to be re-written. if care was refused to certain diseased peoples i would think that the treatment of those diseases would stagnate. as an example, look at what happens to people who have one of lesser known diseases which the drug companies do not research treatment for because of the expense. they suffer. sometimes their stories get out to the public, but mostly they suffer and withdraw from society. i think that if you look to history and how things like leprosy and tb were treated it would be very much the same. while the caregivers refused care to specific groups with specific diseases, those groups would end up ostracized from society and become the objects of discrimination. i think that alienation and discrimination are two of the undesireable human characteristics that are just within all societies. it takes a lot of energy and education to override the impulse to isolate those who are different and welcome them and treat them. it's always been a hallmark of the healing professions to kind of courageously go where others fear to tread. look at what people say when they hear someone is a nurse. i've heard, "well, god bless you. i couldn't do what you do." "i don't know how you can put up with all the blood and guts." i think that a movement of refusing to provide care would break down that public image of nursing very badly. when the sick have no one to turn to then it seems like their only recourse would be to isolate themselves while they continue looking for help. people will socialize to their living conditions as is necessary in order to be able to thrive as best they can.

some time ago i had been watching a tv program on an archeological dig in england which was thought to be one of the very first rudimentary hospitals. they found a mass grave and the examination of the bodies revealed that they were all diseased or deformed in some way. it was clear that these people had been confined to an area away from the rest of the healthier public. records indicated that the caregivers were others who were also sick or disabled in some way themselves.

what i'm saying is i think that you need to look back at history to find the answers to what you are asking. look to how people who lived in small tribes handled illness and how the treatment of illness changed as society evolved and people became more educated and technilogically advanced. in other words, kind of back into the ideas for your paper.

Shaneomac · Mar 14, 2006

I don't think nursing should be about the nurses, it should be about the patients, regardless of your own personal beliefs.