A Nurse’s Experience
Recently I received an email from a nurse about an unsettling phenomenon- nurses refusing to care for patients. Here is some of that email, with specific details omitted to preserve confidentiality.
When I was a nurse intern, I worked with a group of RN/LPNs that seemed to have a lot of prejudice about caring for certain types of patients. 1) Prisoners who had been accused of sexual assault or pedophiles and 2) LGBT patients. I remember one of the latter who was admitted to our hospital in my local town and the nurses were all making fun of him/her, because he wanted to be called by a female name (he identified as female).
When I heard the nurses discussing the patient, I asked what he wanted to be called. They told me the name, the diagnosis, that the patient was acting very effeminate. Sirens were going off in my head, as they were describing someone that I had known and worked with before. I really considered him to be a sweet man and a very gentle soul.
I walked down the hallway and sure enough, it was my friend.
I felt terrible for him because I knew that he had REALLY struggled with gender identity when I had hung out with him in the past. I was furious with my co-workers but went back to the nurses’ station, and calmly educated them that I knew him and was a good friend of his at one time and to please respect his wishes as they had no idea of what he went through to be comfortable enough to request that people respect his gender identity.
Can a Nurse Refuse a Patient?
While I am no expert on transgender health or working with the prison population (for that, I am going to have to refer you to this blog post which features nurse experts in both of these categories)- I do have experience in psychiatric nursing. I have worked in the emergency department, a short stay detoxification unit, and on a general adult floor. I have experienced patients from all walks of life. And I have never, ever witnessed this type of behavior described by the nurse who emailed me above.
However, when I think of a nurse, I think of someone who takes care of people. We come to work and collect a paycheck to take care of human beings. How can we decide which human person we will care for and which we will not? This is absolute insanity to me!
Surprisingly, They Can
In doing a bit of additional research into this topic, I learned that nurses actually can refuse to treat a patient. According to the American Nurses Association (ANA) position statement from 2009, nurses “have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm”. Additionally, in 2014, The American Nurse published an article that discussed ‘conscientious objection’ when caring for a patient contradicts a nurse’s morals.
However, let us be careful in our reasons for refusing care. Just because a patient is in the prison system, does not mean that a nurse can automatically refuse to care for them. If a patient who is also a prisoner shows up on the unit, many times they are there with guards or police or whoever’s custody they are in. They are with the nurse at all times and a nurse cannot refuse to care for this patient.
Why Did Nurses Go Into Nursing?
Whether the ability to refuse is ‘right’ or not really is not the issue for me. In order to get to the heart of the matter, I think that we need to ask ourselves… “Why did I go into nursing in the first place?” Was it not to help another person? To make a difference? To care for the population and promote health/healing?
I also caution you to know the legal ramifications in your area, as they vary state to state, for refusing to care for a patient. If you have already accepted the patient and then decide you cannot work with them- you may be charged with abandonment. I will tell you right now I am not a lawyer and do not know the ins and outs of all the legalese related to this topic. This post on Nurse Together may be a starting point for information related to the legality of this issue.
A Touchy Subject for Sure
I want to thank the nurse who emailed me, sharing her experience. I think that dialogue needs to occur around these sensitive issues. And I would love to hear what you have to say in the comments below.
So go ahead… share your experiences with patient refusal. What have you witnessed and how was it handled? What are your thoughts related to patient care and do you think that nurses need to take care of each and every human being? Thanks for reading!
About the Author: Keynote speaker and virtual conference host, Elizabeth Scala MSN/MBA, RN, partners with hospitals, nursing schools, and nurse associations to transform the field of nursing from the inside out. As the bestselling author of ‘Nursing from Within’, Elizabeth guides nurses and nursing students to a change in perspective, helping them make the inner shift needed to better maneuver the sometimes challenging realities of being a caregiver. Elizabeth received her dual master’s degree from Johns Hopkins University. She is also a certified coach and Reiki Master Teacher. Elizabeth lives in Maryland with her supportive husband and playful pit bull.
Yes it’s touchy to not want to care for someone for what’re in for. As a male in nursing I have more than once been assigned a pt that my females co-workers didn’t want care for. Tho that did go both ways. If there was a sexually occupied female a female nurse would be assigned. My experience was not do a lot. We used careful judgement when done
Thanks, Fred. I often wondered what it was like for the nurses of the other sex… being that most nurses these days are still women. I appreciate you sharing your insights and experiences with us. Thanks for taking the time to comment!
What a complicated issue Elizabeth!
Thanks for sharing the ANA’s position statement. Questions still remain as to who makes the decision to grant a nurse’s request?
In writing? Ok, what is the procedure? Write a letter to the nursing supervisor? Administrator? What if the person isn’t available on the shift you are working?
Wouldn’t it mean that the nurse would, at the very least, have to complete his or her shift until a request was reviewed?
Good points, Donna. In reading the documents, it is my understanding that you cannot leave a patient without any care. So you are right, if there is no one available to take the assignment, it sounded to me like the nurse has to work with the patient. Otherwise it would be viewed as abandonment. And yes, I do not think that there are clear procedures for refusal- I imagine it is specific to each organization and the policies at that institution.
I think tat the ANA’s position is more in regards to safety – too many patients, a patient requiring a skill that a nurse is not trained in, etc. And there are generally work arounds for the skills issue. Perhaps another nurse is more appropriate and you can learn the skill so you’ll be better prepared for the next patient. Staffing issues is an ongoing problem, but I do see nurses speaking up more about this rather than just struggling through. Though I have never heard a nurse refuse a patient assignment because of staffing, our unit is pretty vocal about the need to send us another nurse or a clinical leader or director will take patients in a pinch. To refuse a patient based on criminal status, gender identity, or race is completely ridiculous to me. I had an instructor in nursing school who put it based when she said to “check your prejudices at the door because your work as a nurse is not about you but that patient”.
Great points, April. Thank you for sharing. So, I do agree- safety and staffing should be the considerations when refusing to take a patient or not. I do agree that it should have nothing to do with the particular patient’s race, gender, demographic, etc. Thanks for the comment!
What about a patient who accuses the nurse of abuse. I have a male patient on the unit I work, a paraplegic. That patient takes pleasure in making nurses miserable; his requests never stop. He call us all the names in the book and he lies a lot, and manages to touch the young nurses in all wrong places, or making sexual comments. All young the nurses quit because of him, and no one would pick up shifts on our unit because of him. I decided not to tolerate his behavior. He told his family he was abused by me. He told his mother I refused to give him pain medicine. The mother called the charge nurse to report me. Luckily for me, the time he gave his mother was close to end of my shift. and I was on an emergency call for a pt suspected with DVT. The on coming nurse, gave him the medicine, he wanted me to coming so he could torture me before the end of the shift. The charge nurse defended me. This is very recent. I do not see myself caring for that man again. I fear for my Licence; I have worked too hard for it, to lose it because of a wicked human being, that he is. I am planning to refuse to care for that man. Do I have good reason? I do not know how to go about it.
Fascinating and provocative post, comments, and questions. I agree with the concept of safety for patients AND nurses. I want to preserve the option, for instance if I felt threatened, however agree that a process/policy must be in place to address how, when as Donna M. suggests. And think your statement, “However, let us be careful in our reasons for refusing care”, sums it up very nicely, Elizabeth.
Thanks, Beth! Appreciate your insights on this. Thanks for the comment.
Wow- this recently came up for me when a younger new nurse told me that she thought ‘unconditional love’ and caring for all patients with equal care and kindness was ridiculous. She said that it wasn’t possible and we (older nurses) needed to get real with that. Let me say that I do not believe that her comments are in direct relation to her age or time in nursing as much as her own mindset. I asked her the very question you bring up- why did you go into nursing? I think it’s a calling/vocation and not a job. Nondiscriminatory nursing care is essential and a core assumption. I believe it is important to be aware of one’s own limitations or prejudices in order to address it BEFORE we care for patients. People, including our patients, come into our lives for reasons and to teach us something about life and about ourselves. What a great classroom the clinical site can be! AND guess what? I had to be careful of my own prejudices about nurses who feel this way, and pray they find a way to leave their prejudices at the door in order to deliver the care the patient needs like April Koenig’s nursing instructor guided.
Thank you Carmen. I appreciate you bringing this very example to the discussion. Additionally, appreciate you reminding us that we can learn from every person, experience, and even our own reactions. Great points!
I have had the experience where a patient or family member was very angry for any reason and I was the target because I was simply present. When a patient or family member becomes upset or argumentative or hostile towards me , I feel that it is better to have someone else step in to care for them in our emergency room setting. Sometimes simply the change in personnel puts the aggressor or patient “in check” and allows them to re-evaluate the emotional situation they are in, de-escalating the situation which promotes the safety and welfare of the patient.
This is a great example of shifting proactively in the situation to respond to a patient’s needs, Roxanna. Thank you for pointing this out. I do think that if the rapport is not there maybe another nurse can do better with a particular patient. Hey- in business we always say “There’s no competition, what one client may need from me another may find in someone else.” Great points, thank you!
Interesting post on a difficult topic. I remember working in the ED. One night I had to care for a drunk driver who had hit a family. We also have the family as patients in the ED. All were badly injured and in critical condition. The man had minor injuries, but he needed to be medically cleared as he was going to jail. He did not know what he did because he was so drunk. It was the hardest day in my nursing career caring for that man, but I did it because I felt it was my duty as a nurse.
Not sure what the rules are today, but back in the mid 80s we did what we had to do.
Wow, thanks for this example. I am sure that must have been very hard. Appreciate you sharing this with me and the readers!
I worked with a transgender Neurologist and the patient refused to be seen by her because he felt uncomfortable. The patient had been seen by him before the change. We then by request of the patient had to reschedule the appt with another Neurologist.
I can’t imagine how Alice must have felt! The other issue is that is was wasted appt slot. Alice was very capable of evaluating the patient.
Wow, thanks for sharing this example with us. It puts the spin of this article to the provider experience. Appreciate it!
I was working in the ED when a young teenager was brought in by her parents, because she had had sex with a boy some days before. The parents wanted her to take a “morning after pill” to prevent any pregnancy. The teenager felt it was too late and was unethical. Initially I admired her decision. Unfortunately, she also had a big attitude. She actually looked to me for confirmation of her decision. I was so shocked and disappointed by her disrespectful attitude that I wasn’t able to give her the support she asked for in the moment. I found myself looking down and waiting for the family to decide on their own. I saw in her body language and change of voice, that she took my body language to mean that I support such a pill intervention. Which I don’t. She agreed to the pill, and I went and got it. Against my conscience.
That incident has made a permanent mark on my life. I don’t have an easy answer, only that I am not perfect. Neither is anyone else. I am convinced that we judge way too much, and life is just bigger than the picture frame we try to put around it. I’ve decided that I’m willing to admit that I am wrong sometimes, and I invite my colleagues to live there with me.
We need to make room for each other, even when we are ALL wrong.
Theresa, thank you. This is beautiful. I appreciate you sharing this story with us and how it has touched your life forever. Thank you very much for the comment.
I’m a licensed nurse in a home care setting
I have a pt. that wishes to go outside for ambulation when it is 41 degrees outside, he has cancer, he also bathes outside in the cold
When I contact my employer and inform them that I don’t believe it is in good judgement to do these things, I am told that I cannot tell the pt. no, that I can advise him that this is not a good idea for him or myself, my employer tells me that I am here to do as the pt. wants, that if my judgement is not to do it, and pt. does anyway and something happens to the pt. I can be in violation of my contract and can receive repercussions
Do I have the right to refuse to such activity and cold weather conditions
I’m a CNA at a in home care Mental Health Facility. They say I can only refuse one client, but my client is a male who recently learned how to ejaculate on women staff. If I use him for my refusal they will jump on the opportunity to give me the worse clients because I can’t say no. I’m trying to find out if that’s legal. Because we have more than enough male staff to cover.