Withdrawing from Care - Unreasonable Burden in a Pandemic

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 I refuse or withdraw from care? 
A. Nurses are accountable for their actions and inactions at all times. They make decisions based on an analysis of all the data at hand, the needs of the client, employer policy, their duty to provide care and their obligation to protect themselves and their families.

An unreasonable burden may exist in rare situations, such as public health emergencies, where the nurse is unable to provide safe care and meet professional standards of practice because of unreasonable expectations, lack of resources or ongoing threats to personal safety.

Refusing to provide care or withdrawing from care may be appropriate in very specific circumstances. Before withdrawing from care, you must fully consider the risk and impact to clients. Additionally, you must first attempt several other strategies to improve the safety of the situation, such as working with your employer to obtain the appropriate PPE and isolation spaces. 

Consider the following when contemplating withdrawing from care: 

  • What is the risk to the client(s) if I withdraw from care?
  • Is the care I am providing directly preventing harm to the client(s)?
  • Does the benefit of the care I am providing outweigh my risk of harm?  
  • What can I do to minimize my risk?
  • What can I do to minimize the risk to the client(s) if I withdraw from care? 

If you do decide to withdraw from care you must:

  • Negotiate a mutually acceptable withdrawal from care plan with your employer (or the client if you are self-employed). 
  • Provide care until a replacement is found.
  • Provide your employer a reasonable amount of time to find a suitable replacement or make alternative arrangements. What is reasonable will vary from situation to situation; however, you are obligated to work with your employer. 
  • Ensure care is transferred to a care provider willing and professionally able to provide safe care. 

You are accountable for your actions and inactions at all times. While you have the right to refuse to work in situations where you cannot manage or reasonably mitigate the risk, it is equally important to note that you are accountable to take every reasonable action to prevent withdrawal from care and abandoning clients.

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