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.

Can a Nurse Refuse to Care for a Patient?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!

Can a Nurse Refuse to Care for a Patient?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!

Elizabeth Scala, MSN/MBA, RNAbout 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.

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