Can Nurses Refuse to Treat Ebola Patients?
How Prepared Are U.S. Nurses to Care for an Ebola Patient?
Among the findings of a National Nurses United survey of 400 nurses conducted in early October
- 60 percent of nurses indicated their hospitals were "not prepared to handle patients with Ebola"
- 80 percent responded that their administration had "not communicated with them any policy regarding the disease"
- 30 percent said they had insufficient PPE gear (e.g., eye goggles and fluid-resistant gowns) on hand to protect themselves from bodily fluids, the main method of Ebola transmission
Although the CDC revised PPE guidelines and there is now tremendous awareness of the Ebola virus, it is improbable that every hospital, ambulatory care clinic, and physician practice in the Unites States has been trained to a level of automatic competency, obtained the correct PPE resources, and established the proper protocols for nursing staff, ancillary staff, custodial staff, supervisors, and healthcare managers.
In short, only a few highly specialized hospitals such as Emory, the University of Nebraska, and the National Institutes of Health are well-prepared to care for an Ebola-infected patient.
Ebola: An Ethical Dilemma for Nurses
If their healthcare organization has not prepared in accordance with the CDC Checklist for Ebola Preparedness, nurses and other healthcare workers, including triage personnel, are putting their lives and the lives of other patients and their families at risk. No other occupation, including the military and law enforcement, expects you to place your family in harm’s way. In my opinion, if a nurse or other healthcare worker is put into this ethical dilemma, she has an obligation to refuse to care for a patient with Ebola.
Only health care facilities and health care workers, clinical and non-clinical, who have achieved a high level of expertise in caring for Ebola-infected patients, should be caring for these patients at this time.
What Training Should Nurses Have Going Forward?
Every hospital mandates pre-employment bloodborne disease training. Ebola-virus training should be included in this educational program. Even healthcare organizations that plan to send Ebola-infected patients to specialized hospitals for care must prepare their staff and facilities for the potentially Ebola-infected walk-in patient in the following ways:
- Triage workers, literally the first people to see the patient, need to be physically protected from this highly infectious disease, much as bank tellers are protected from robbers.
- The patient must be isolated immediately in a separate room with a private bathroom.
- The hospital must have a well trained Ebola rapid-response team that can provide supportive care for the patient until he or she can be transferred to an appropriate unit or facility.
Given the limited number of cases at the moment, the CDC should be prepared to send in highly trained teams to care for Ebola-infected patients while training local staff until they have reached a high level of comfort and competency for providing care.
Pending the appearance of a safe and effective vaccine that will curtail, if not eradicate the spread of Ebola, we must take proactive, forceful steps to protect all healthcare workers.
Sharon Buchbinder, RN, PhD, is a professor and program coordinator for the MS in Healthcare Management program at Stevenson University in Owings Mills, Md., and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.
Video: Morals, Ethics, and Nursing: Can a Nurse Refuse to Treat a Patient
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