Ebola: Will Nurses Have a Choice?

In August, Jo Smith, another Associate Editor of EBN, wrote a blog about Ebola. The question was whether it was a global health problem. At that time, the disease had been largely a scourge in West Africa. Since then, we’ve seen the first cases of Ebola in the US and, it feels like only a matter of time before the disease is found in a wide range of countries.

Just over 10 years ago, the world was dealing with SARS, and not long before than, HIV/AIDS. Caring for these patients hasn’t been without dangerous consequences. In Toronto, two nurses and three other health care workers lost their lives from SARS. http://www.archives.gov.on.ca/en/e_records/sars/report/v3-pdf/Vol3Chp5i.pdf

Despite the risk, nurses have cared for patients with these scary infections, even in the earliest stages when knowledge about how to prevent the spread of infection wasn’t entirely understood. Some people understand the incredibly important role that nurses play in these circumstances, such as television personality Rick Mercer: http://www.cbc.ca/mercerreport/videos/clips/ricks-rant-nurses

In the past, these nurses and health care providers have been seen as heroes. Not so in the recent cases where nurses in Dallas contracted Ebola after caring for a patient with the disease. They were criticized on a number of fronts including failing to take proper infectious control precautions and travelling in the days after working with the Ebola patient. The outcome of this was information arising from the nurses themselves, through a national nurses association, outlining the lack of proper protective equipment, failure to place the Ebola patient in isolation early, and even the fact that the nurses caring for the patient with Ebola had other patients in their workload. http://www.nationalnursesunited.org/blog/entry/statement-by-registered-nurses-at-texas-health-presbyterian-hospital-in-dal/National Nurses United has since posted a letter to President Barak Obama, outlining the minimal requirements for caring for patients with Ebola. http://www.nationalnursesunited.org/page/-/files/graphics/1014_Ebola_Letter_Obama.pdf

One wonders, though, is it enough? Refusal to work is a topic on the minds of nurses and nursing organizations across the globe. In his blog, Dr. Brian Goldman, discusses the response of Canadian nursing associations. He rightly identifies the risk that nurses, in particular face because they spend the most time and the closest contact with high-risk patients. There is a lack of specialized knowledge about the specific infectious control procedures required to safely care for people with Ebola. http://www.cbc.ca/whitecoat/blog/2014/10/20/can-health-workers-refuse-to-treat-ebola-patients-maybe/  I also wonder if there is a will on the part of hospitals to appropriately train and staff the units where Ebola is present. There is a law in my province of Ontario that gives a limited right of refusal of a healthcare worker if there are circumstances where the worker feels there is danger.

As countries prepare for the potential of Ebola within their borders, one wonders what the nursing response will be if/when it arrives. If nurses are not given the tools and knowledge for safe care and are criticized as they were in Dallas, maybe, just maybe, will they say no?

Roberta Heale, Associate Editor EBN, @robertaheale

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