With the recent Ebola scare, many nurses can’t help but imagine “what if” scenarios. What if a patient with Ebola or an equally virulent virus came to their state, their town, their Emergency Department? What if they were assigned to care for an Ebola patient? What if, despite wearing recommended personal protective equipment (PPE), they contracted Ebola? What if they took the virus home to their families?
Nurses have always been exposed to contagious diseases, but the sudden emergence of the Ebola virus left many feeling unprepared, unsafe and vulnerable.
For the first time, many nurses wondered if they would refuse a patient assignment that could very well put themselves and their families at serious risk for harm.
There are several things to consider when deciding whether or not to refuse a patient assignment.
No nurse wants to abandon a patient. Patient abandonment occurs when a nurse caring for a patient needing professional care ceases to provide care before transferring the patient to another nurse.
To constitute abandonment, a nurse-patient relationship must have been established. A nurse-patient relationship generally begins when responsibility for the nursing care of a patient is accepted by the nurse. Receiving report is generally considered to be accepting a patient assignment.
Deciding to charge a nurse with patient abandonment requires an investigation of the surrounding circumstances. Questions will include:
- Was the assignment accepted, and a nurse-patient relationship established?
- Was reasonable notice provided when severing the nurse-patient relationship?
- Following notification, could the employer have reasonably made arrangements for continuation of nursing care by others?
Depending on the findings, a nurse may be subject to discipline of his or her license by their state Board of Nursing. However, patient abandonment cannot be charged if a patient assignment has not been accepted. Refusal to accept an assignment is not considered patient abandonment.
ANA Position Statement
The American Nurses Association (ANA) has a position statement on the rights of Registered Nurses (RNs) to accept or reject a patient assignment. State law definitions may differ in some respects from the profession’s definition.
Statement of ANA Position:
The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm.
This was written before Ebola, and was more in response more to unsafe staffing levels, unsafe patient assignment, and mandated overtime. An example would be a Med-Surg RN floated to ICU to care for a ventilated patient on a balloon pump, who has not yet received training on care of these patients.
At the same time, it must be noted that state Boards of Registered Nursing have no jurisdiction over employment and contract issues.
This is where it gets tricky.
Hospital employers and nurses have an “employer-employee” relationship. This means that hospitals determine the work assignment, and that nurses have an obligation to fulfill those duties. This is opposed to the arrangement a contracted employee, for example, a nurse consultant, has with an employer.
In addition, hospital-nurse work arrangements without a defined duration are presumed to be employment “at-will.” In theory, at least, this means that the employer or employee may terminate the employment relationship at any time, with or without cause. There are exceptions to the at-will rule , such as discrimination, or an employee refusing to violate the law. More often, most employers follow a progressive discipline and coaching model, but the at-will clause can be used at the discretion of the employer.
Therefore, employers can choose to terminate the employment of a nurse who refuses an assignment. It is possible for a nurse to be supported by the ANA, and/or their Board of Registered Nurses, and still be fired.
This is not saying that the Board or the ANA would support refusal to care for an Ebola patient, it’s that neither body has jurisdiction over an employer.
By terminating your employment, your ability to land another job may be affected.
In summary, you most likely do not have grounds to refuse to care for a patient with Ebola, or other contagious disease.
The best thing is to educate yourself, and be aware of the importance of protecting yourself through following infection prevention protocols.
Good luck and stay safe! Until next time friend,