An RN’s Right to Refuse to Treat an Ebola Patient – And the Consequences

Over the past few weeks I have received emails and private messages from registered nurses throughout the U.S. asking me about their rights to refuse to treat an Ebola patient at their RN job. I have also been on national television with Stuart Varney of Varney & Co. to bring attention to this very issue.

For the record, RNs are the front-line providers and they knowingly put themselves at risk every day. They are constantly exposed to virulent bacteria and viruses. This is what they live for – to care for sick people. They do so selflessly and without fear.

That’s why I think it’s pathetic that an RN feels so unprepared and unprotected that she has to ask the question “Do I have the right to refuse to treat an Ebola patient?” Certainly many more hospitals are better prepared today, but there are still unprepared hospitals pushing nurses to ask this very question.

RNs should not be afraid to do their job when there are basic procedures that can keep them safe. I am aware of at least two nurses who have been required to treat a R/O Ebola patient without the appropriate PPE and at risk of termination if they refused. The choice shouldn’t have to be “Do I refuse an assignment because of unsafe conditions and risk getting fired OR do I risk my own life?

Whether the issue is an Ebola patient or any other patient, the American Nurses’ Association Position Statement states “…registered nurses have the professional right to… reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.” They further say: “Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm.” Examples the ANA cite as unsafe practice situations include: “improper policies and procedures, or a lack of supplies or equipment.” It’s arguable that both the serious risks of harm and the lack of equipment applied in the Thomas Eric Duncan case.

While the ANA’s position is “Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution,” RNs continue to report fear of retaliation when speaking out on behalf of themselves and patients. I’ve personally talked to more than a fair share of RNs who have been retaliated against.

Here’s the reality: The ANA doesn’t hire nurses and they don’t fire nurses – hospitals do. Unfortunately, nurses live in fear of retaliation when they report unsafe conditions and that’s why Briana Aguirre, the nurse from the Dallas hospital who spoke up about the inadequate training and PPE in the Duncan matter, expressed fears of retaliation against her for speaking out. There have even been some nurses who have publically said that Briana should not have criticized the facility and should have tried to solve the problem internally. Really? Did those nurses not notice that’s exactly what Briana tried to do to no avail?

The issue of the “right to refuse” may also be addressed by your Nurse Practice Act, which requires an RN to accept only assignments that are within a nurse’s education, training or experience. Once an RN accepts an assignment, however, the RN is responsible for his/her actions.

There is Safe Harbor and Whistleblower protection an RN may seek, but these are complicated protections and equally complicated procedures. I highly recommend you study your state’s guidelines carefully. You should know the proper process and understand your actual rights and risks in advance of invoking those protections.

Even if an RN does everything correctly in refusing an unsafe assignment, a hospital has hundreds, if not thousands, of opportunities to put every move that RN makes under a microscope. It’s easy to nitpick every action ad nauseum until they find a ridiculous reason to terminate the nurse.

While there are many progressive hospitals in the U.S., this draconian behavior of punishing nurses for speaking up for the truth has to stop. If nurses are not allowed to be a patient’s advocate without fear of retaliation, the patient is screwed. Who’s going to speak up for the patient when the patient is most vulnerable?

As Gandhi said, “Many people, especially ignorant people, want to punish you for speaking the truth… If you’re right and you know it, speak your mind. Even if you are a minority of one, the truth is still the truth.”

Beyond the right to refuse is the right to retire. And that is exactly what 55% of RNs (the baby boomers) will do if they believe their life is at risk, or that they might expose and infect their families. What’s their incentive to stay? Certainly not the white cake and punch they’ll get at their hospital retirement party.

If the baby boomers say “I’ve had enough” (And exactly how much more do hospitals expect them to take anyway?) we could have more than one million nursing vacancies overnight. And how will we attract the next generation of RNs if hospitals are viewed as draconian and nursing is seen as an unnecessary dangerous and onerous profession?

Hospitals are in the business to make money – as a business owner myself I have no quarrel with that. Living amidst the largest medical center in the world, I have huge respect for many hospitals. However, I do believe it’s time that more hospitals start respecting, appreciating and properly compensating their RNs. If RNs don’t already have enough stress, do they really have to ask the question “Do I have the right to refuse? ” My answer is a resounding NO! How about you – what’s your opinion on this?

God bless registered nurses. Be safe!

P.S. Comment and share your feelings about an RN’s right to refuse treatment in dangerous situations.


3 thoughts on “An RN’s Right to Refuse to Treat an Ebola Patient – And the Consequences

  1. Proper PPE is required with training, otherwise I refuse and my attorney gets a call immediately.

  2. Doing my part to stay safe by being part of the exodus from the bedside. Trust of the establishment is not in my makeup. My value according to hospital systems in which I’ve worked has been made crystal clear. I may be too old to be hired in another job field, but I’m too young not to move on as quickly as possible working as a contractor, consultant or subject matter expert.

  3. Vickie, nurses should have a consultation with a nurse attorney or attorneys who represent RNs in these type of situations. Every nurse who feels at risk should know who to contact ahead of time. Daily, nurses are at risk at work. It is common and is not just due to Ebola exposure. I agree that nurses should also review their state’s nurse practice act and carry their own liability insurance.

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*The opinions and statements made by Vickie Milazzo, the founder of Medical-Legal Consulting Institute, Inc. are based on her experiences and expertise, should not be applied beyond the specific context provided, and do not guaranty or project actual results. Vickie Milazzo is no longer involved in the operations or management of the business, but is involved as an independent education consultant.

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