There is little doubt these days that one of the most important questions on the minds of nurses is “if I am assigned a patient infected with the Ebola virus, can I refuse to take care of that patient?”
The answer is “no!” I know how scary it can be to take care of a patient with a highly contagious disease with no cure. Unfortunately, nurses cannot pick and choose which patients we want to care for. As an employee, it is considered a master-servant relationship and we are required to tend to those patients for whom our employer asks us to tend.
Should you refuse to take care of certain patients it is not only discrimination, it is patient abandonment. I know that in the early stage of this disease in the United States, where there is not much known about how to protect ourselves while treating patients with Ebola, it can be very terrifying. But even in considering that, it is still our responsibility to take care of the patients we are assigned.
However, if you are asked to provide care outside your competency, you must express your concern. If your employer insists that you take the assignment, you should write a letter to your supervisor explaining your concerns and keep a copy for yourself but do not refuse to accept the assignment.
Now, let’s say this fear is so great that you resign and walk off the job, that also is considered patient abandonment.
I understand that some States have a statute that should you refuse to accept a patient assignment and quit, that is permissible. The ANA has a position statement “a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others. Refusal to accept an assignment (or a nurse-patient relationship) does not constitute patient abandonment” (ANA, 2001c). However, there is a footnote which notes that state laws may differ in some respects from the professions definition. So check the laws in your State to determine whether that is a valid act or not.
When I first entered the nursing profession, it was in the early 1980s during the height of the AIDS outbreak before there was a known treatment. Back then, we did not even have universal precautions. Even though we were required to gown, mask and glove for certain patients, it was difficult to perform the required tasks in such garb. The gloves at that time were not well fitting and there was not a plethora of sizes (at least not on the floor) available as is the case today.
I recall in particular one AIDS patient on our floor who I was terrified to treat. Fortunately, I was not assigned to his care; however, I was called in to help on numerous occasions.
At one time the patient was vomiting and the treating nurse could not reinsert the NG tube with her gloves on. She had removed her gloves to reinsert the NG. She felt it was so important that this patient got the treatment needed that she chose to risk her own health and safety by taking off the gloves to insert the tube. I think of her often and I hope she is doing well.
Our current crisis with Ebola is just as scary now as AIDS was then since not much is known about the disease. One point to note: while AIDS was a 100% fatal, Ebola has a 60% fatality rate. What separates the two is that with Ebola patients supportive treatment is provided to counter the bleeding, hypertension and volume depletion.
Another factor that helps people to survive an Ebola epidemic is a healthy immune system. Therefore, it is important for nurses to take care of themselves and strengthen their immune system with proper diet, exercise and vitamins.
I do urge that nurses come together to improve our profession so that we can have more freedom and autonomy to get more pay for treating patients who require more care, especially those with deadly illnesses for whom we are required to treat.
We can even call this “combat pay!”
I wish I had better news for health care providers about this outbreak but, unfortunately, I do not.