Q. A high percentage of our clients have tested positive for COVID-19. We are running low on isolation spaces and personal protective equipment (PPE). Nurses on the unit are concerned and are considering refusing to work on the unit. Can they refuse or withdraw from care?
A. Nurses are not expected to unnecessarily expose themselves to risks resulting from a lack of appropriate resources, equipment or clearly defined policies and procedures. They may refuse to provide or withdraw from care in very specific circumstances. They should fully consider the impact to clients and attempt several other strategies to improve the safety of the situation, such as working with their employer to obtain the appropriate PPE and isolation spaces.
To withdraw from care a nurse must:
- Negotiate a mutually acceptable withdrawal from care plan with their employer (or the client if you are self-employed).
- Provide care until a suitable replacement is found.
- Provide their employers with a reasonable amount of time to find a suitable replacement or make alternative arrangements. What is reasonable will vary from situation to situation.
- Ensure care is transferred to a care provider willing and professionally able to provide safe care.
Employers are obligated to protect and support employees by ensuring staff have access to the appropriate protective equipment and supplies. These recommendations may assist you in situations where a nurse is considering withdrawing from care:
- Be open about the realities of the care situations at hand.
- Engage the nurse in an open and honest conversation about their concerns.
- Work together to create solutions.
- Keep the dialogue focused on the needs of the client.
- Recognize that in unusual circumstances, such as a public health crisis, nurses are expected to prioritize care to the most critical activities, i.e., assessments, treatments, medications, and that some non-critical routine care may be deferred until the situation improves.
Nurses are accountable for their actions and inactions at all times. While they have the right to refuse to work in situations where risk cannot be managed or reasonably mitigated, it is important to note that you both are accountable to take every reasonable action to prevent withdrawal from care and abandoning clients.
