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Will Nurses Work During a Pandemic?

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  • #61
    Re: Will Nurses Work During a Pandemic?

    Welcome CBloom.

    I admire all health care professionals. When my family has needed medical attention, I have always been impressed with the dedication I have seen in the faces of those helping us.


    S.

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    • #62
      Re: Will Nurses Work During a Pandemic?

      If and when my employer showed an inkling of concern for safety of the workers, yes I would work there. From what I have observed to date, that is not likely to happen. If a pandemic occurred, I have obtained my own safety gear and will volunteer in my community.

      Flight attendants put oxygen on their faces FIRST so that they will be able to help others. We need to learn from them. We're no good to our patients if we cannot function due to illness or death. Safety technology exists. Cost of the technology is irrelevant and in the end, cost-effective.

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      • #63
        Re: Will Nurses Work During a Pandemic?

        what is a safer injectable?

        Comment


        • #64
          Re: Will Nurses Work During a Pandemic?

          Originally posted by Sunshine123 View Post
          what is a safer injectable?
          Hi Sunshine! Thanks for asking! Currently, laws are in place that ensure that facilities provide safe devices.
          One problem is, they (safety devices) haven't been adequately defined. One nurse I know said, "You could package dog poop but as long as you put the word "safety" on the packaging, it's supposedly safe and the facility is in compliance!" Well, that statement may go a bit far, but studies have shown that some of the so-called safe devices are really resulting in more, not less needle stick injuries. What's taking so long to define them properly? Look up the 60 Minutes expose on the corruption involved.

          Do you like the safety devices at your facility? Do you know what else has been put on the market but you have never seen?

          Another loophole is that facilities are buying a small amount of safety devices, but are claiming that it is the nurses who are choosing not to use them. But the nurses are not even aware that the devices exist, much less are available at their facility. When was the last time you went down to purchasing to explore the list of available items? How would you know if the devices were available unless you saw them in your clean utility room?

          I would like to discuss this further with any interested nurse. Thanks again for asking Sunshine!

          Comment


          • #65
            Re: Will Nurses Work During a Pandemic?

            Dear Laidback:
            I noticed you posted about ebola. Thank you!
            Researching the disease at cdc.gov, the reader is told that ebola is spread by contact (not airborne) route.

            The CDC also lists Biosafety level 3 and 4 as use for airborne or inhalation route transmission only. HIV, a bloodborne disease, is a Biosafety level 2 disease.

            Why do you think then that every single place that researches ebola, including the CDC does it in a Biosafety-Level 4 area only? That level is used only for airborne diseases.

            Comment


            • #66
              Re: Will Nurses Work During a Pandemic?

              Originally posted by CBloom View Post
              Dear Laidback:
              I noticed you posted about ebola. Thank you!
              Researching the disease at cdc.gov, the reader is told that ebola is spread by contact (not airborne) route.

              The CDC also lists Biosafety level 3 and 4 as use for airborne or inhalation route transmission only. HIV, a bloodborne disease, is a Biosafety level 2 disease.

              Why do you think then that every single place that researches ebola, including the CDC does it in a Biosafety-Level 4 area only? That level is used only for airborne diseases.
              Welcome to FluTrackers, CBloom. You pose an interesting question.

              I posted the note about HCWs workers in Uganda to show that nurses everywhere are aware of the dangers of their job and respond accordingly. I think it is naive for hospitals and administrators to think that all HCWs will blindly and obediently continue to work once a pandemic starts.

              I dont know what the CDC biosafety protocols are for Ebola or other infectious diseases, so I can't respond to your question. You may want to post your question in the thread, Ask general questions here II , where someone with the right knowledge and expertise can respond.
              http://novel-infectious-diseases.blogspot.com/

              Comment


              • #67
                Re: Will Nurses Work During a Pandemic?

                J Urban Health. 2005 Sep;82(3):378-88. Epub 2005 Jul 6.

                Health care workers' ability and willingness to report to duty during catastrophic disasters.

                <!--AuthorList-->Qureshi K, Gershon RR, Sherman MF, Straub T, Gebbie E, McCollum M, Erwin MJ, Morse SS.
                Mailman School of Public Health, Columbia University, New York, New York, USA. qureshi@adelphi.edu
                Catastrophic disasters create surge capacity needs for health care systems. This is especially true in the urban setting because the high population density and reliance on complex urban infrastructures (e.g., mass transit systems and high rise buildings) could adversely affect the ability to meet surge capacity needs. To better understand responsiveness in this setting, we conducted a survey of health care workers (HCWs) (N =6,428) from 47 health care facilities in New York City and the surrounding metropolitan region to determine their ability and willingness to report to work during various catastrophic events. A range of facility types and sizes were represented in the sample. Results indicate that HCWs were most able to report to work for a mass casualty incident (MCI) (83%), environmental disaster (81%), and chemical event (71%) and least able to report during a smallpox epidemic (69%), radiological event (64%), sudden acute respiratory distress syndrome (SARS) outbreak (64%), or severe snow storm (49%). In terms of willingness, HCWs were most willing to report during a snow storm (80%), MCI (86%), and environmental disaster (84%) and least willing during a SARS outbreak (48%), radiological event (57%), smallpox epidemic (61%), and chemical event (68%). Barriers to ability included transportation problems, child care, eldercare, and pet care obligations. Barriers to willingness included fear and concern for family and self and personal health problems. The findings were consistent for all types of facilities. Importantly, many of the barriers identified are amenable to interventions.

                Catastrophic disasters create surge capacity needs for health care systems. This is especially true in the urban setting because the high population density and reliance on complex urban infrastructures (e.g., mass transit systems and high rise buildings) could adversely affect the ability to meet s …

                Comment


                • #68
                  Re: Will Nurses Work During a Pandemic?

                  Originally posted by CBloom View Post
                  Dear Laidback:
                  I noticed you posted about ebola. Thank you!
                  Researching the disease at cdc.gov, the reader is told that ebola is spread by contact (not airborne) route.

                  The CDC also lists Biosafety level 3 and 4 as use for airborne or inhalation route transmission only. HIV, a bloodborne disease, is a Biosafety level 2 disease.

                  Why do you think then that every single place that researches ebola, including the CDC does it in a Biosafety-Level 4 area only? That level is used only for airborne diseases.
                  Thinking without official confirmations can drive us to:
                  1 - it's better to treat ebola in an BSL-4 if you have one
                  2 - looking at the new various simptoms of new Ebola strains in Africa, seems reasonable to do it in a BSL-4 if we have one, in a case of spontaneous strain changing in a lab
                  3 - we talking of infectious disease laboratories - what do you think they do there - they EXPERIMENTING ...

                  Comment


                  • #69
                    Re: Will Nurses Work During a Pandemic?

                    Originally posted by gullwing View Post
                    Sunshine what I envision as the only hope for success is for those health care providers who are of the belief that there is futility in attempting to "treat the masses" to fall back away from any "hot zone". You will need a facility that is clandestined and you will treat only those persons with a chance for survival. How do you determine the later? It would be essentially only those who have food water and PPE. The way I figure it only the ones that build the ark will know where it is and will be invited on board. It sounds pretty harsh but all have been invited on board. If you choose not to "sign up" until its too late then you are free to persue your previous plan (or lack there of). I think there are enough medical personell in my clique that will fall back quickly and with equiptment to make this work. Most are unwilling to commit openly for fear of reprisals. Thes are interesting times we live in.
                    Hi gullwing,

                    you depicted well the mentality we all would face on when we will try to get some help from the medical estab.
                    That's real, but obviously it is not humanitarian, nor compassional.

                    We can see by this text how a good part of the medical sector will doing it. Are this kind of behaviour correct?
                    It would be correct if the same people who adopted it, previously tried to push the rapresentatives, the med.estab., and so on, to change their policy, and invest more in the health system, and after that was not sucessfully.

                    About the "all have been invited on board", I presumed that figure for the "block around", but seems that we can put it much wider, at the world level:
                    "The way I figure it only the ones that build the ark will know where it is and will be invited on board."

                    Comment


                    • #70
                      Re: Will Nurses Work During a Pandemic?

                      Dear Laidback, Due to my work, I have seen first hand the Ebola in the BioLevel 4 lab. I was told Ebola is always in BioLevel 4. Yet the CDC states that this disease is spread by contact, not airborne route. (And yes, I do have proof of these statements) It is just one of the examples of my reluctance to use the CDC as a credible source and to seek out other facts.

                      Comment


                      • #71
                        Re: Will Nurses Work During a Pandemic?

                        Tropical, my previous post responds to Laidback, yet I think it is pertinent to your thoughts also.

                        Comment


                        • #72
                          Re: Will Nurses Work During a Pandemic?

                          Originally posted by CBloom View Post
                          Tropical, my previous post responds to Laidback, yet I think it is pertinent to your thoughts also.
                          Hi CBloom,

                          I supposed the answer is for the:
                          "3 - we talking of infectious disease laboratories - what do you think they do there - they EXPERIMENTING ..."
                          The above means that after the "new tecnic" (in some FT threads noticed by posts) which allowing to doing BSL-4 level experiments (classed A) with avian flu virus in an BSL-2 level lab (Kawaoka, ...) - maybe for Ebola is now the same?

                          "Yet the CDC states that this disease is spread by contact, not airborne route."
                          I must said that I had always thought that to be on-face submerged by droplets of an patient can infected an person but that Ebola isn't airborne in an respiratory way of thinking (?).

                          Maybe the BSL-4 question is for security redundance reasons only, or because of airborne Ebola experiments?
                          I hope the experts will state something about.
                          Thank you.

                          Comment


                          • #73
                            Re: Will Nurses Work During a Pandemic?

                            Potential Penalties for Health Care Professionals Who Refuse to Work During a Pandemic

                            Carl H. Coleman, JD; Andreas Reis, MD

                            JAMA. 2008;299(12):1471-1473.

                            The severe acute respiratory syndrome (SARS) epidemic and the spread of avian influenza have generated renewed interest in health care professionals' (HCPs?) obligations to work during a pandemic. However, most discussions of this issue have occurred on a relatively abstract level of ethical analysis, with less attention to what should actually happen to HCPs who are unwilling to work. Should HCPs who refuse to work be fired from their jobs? Should they lose their licenses? Should they go to jail?

                            It is a real possibility that some HCPs may refuse to work during a pandemic. Working during pandemics could place HCPs?and, by extension, their families?at significant risk of infection. Protective measures like masks may reduce the risk, but some HCPs were infected during the SARS crisis even after such measures were implemented. Even though most HCPs continued to work during the SARS epidemic despite the risks, survey results indicate that a substantial number of HCPs would be unwilling to work under comparable conditions.

                            This commentary argues that the penalties for refusing to work during a pandemic should be limited to those an HCP would face for refusing to treat patients with contagious infections in nonpandemic situations. This argument is important because some states, such as Maryland and South Carolina, have enacted laws that authorize license revocations, fines, or even imprisonment for HCPs who disobey public health officials' orders to work during public health emergencies. These penalties would apply even to HCPs whose occupations do not ordinarily encompass clinical responsibilities, or to HCPs who are not currently part of the workforce?for example, physicians or nurses who are taking time off from work to care for their children. These laws seem unjustified.

                            General Penalties Applicable to HCPs Who Refuse to Work

                            Health care professionals may be subject to a variety of work obligations during a pandemic. First, many HCPs are employees, such as nurses in a hospital. If they do not report to work, they could be fired or subject to other penalties, such as a reduction in pay. It is possible that some employees would be able to demonstrate that their workplaces are "abnormally dangerous," in which case labor laws might grant them the right to refuse to work without jeopardizing their employment. However, the "abnormally dangerous" standard is difficult to meet, particularly in workplaces that involve inherent risks, such as hospitals.

                            Second, some HCPs are subject to contractual work obligations. For example, physicians' contracts with hospitals may require them to be on call for emergency consultations, or contracts with managed care organizations may require physicians to treat members of the organization's health plans. If physicians fail to fulfill their on-call duties, they could lose their clinical privileges; if physicians fail to treat members of their health plans, they could be dropped from the managed care network. Health care professionals who breach contractual obligations also may be required to pay for replacement coverage and, in some cases, to compensate patients who sustain injuries as a result of delays in obtaining necessary treatment.

                            Health care professionals also may have contractual obligations to individual patients. A treatment relationship between an HCP and a patient creates an implied contractual obligation of "continuing attention." This obligation prevents the HCP from unilaterally terminating the relationship without adequate notice for the patient to seek treatment elsewhere.

                            Individuals can be excused from performing contractual obligations because of health dangers that were not foreseeable at the time the contract was entered. However, this defense would have little application to most HCPs because it would be difficult to demonstrate that the risks of treating patients with contagious infections were not reasonably foreseeable.

                            Moreover, some HCPs who refuse to work may be subject to penalties pursuant to statutes or regulations. Under state licensing laws, for example, abandonment of an existing patient is grounds for disciplinary action. In addition, the federal Emergency Medical Treatment and Active Labor Act (EMTALA) authorizes fines and exclusion from the Medicare program of physicians who fail to provide appropriate screening or stabilizing treatment at a hospital at which they have emergency care responsibilities. The secretary of Health and Human Services has the authority to waive certain EMTALA sanctions during public health emergencies, but these waivers would probably not apply to physicians who simply fail to report to work at a hospital.

                            Special Penalties for HCPs Who Refuse to Work During Public Health Emergencies

                            Some states, such as Maryland and South Carolina, have enacted laws that subject HCPs who refuse to work during a pandemic to penalties in a far broader range of circumstances than those described above. Many of these laws are based on the Model State Emergency Health Powers Act (MSEHPA), which authorizes public health officials to order HCPs "to assist in the performance of vaccination, treatment, examination or testing of any individual as a condition of licensure, authorization, or the ability to continue to function as a health care provider in this State." Some states, including Maryland, have gone further than the MSEHPA by authorizing fines or imprisonment of HCPs who disobey orders to work.

                            There is a significant difference between these laws and penalties for failing to fulfill voluntarily assumed employment or contractual obligations. An HCP who affirmatively agrees to treat patients leads hospitals and patients to rely on his or her presence and, as a result, to refrain from making alternative arrangements. If the HCP fails to follow through on the commitment to treat, those individuals and institutions that have relied on it will be worse off than if the promise had never been made. By contrast, laws that penalize HCPs for disobeying public health officials' orders to work, regardless of the HCP's employment or contractual responsibilities, cannot be justified as mechanisms for enforcing prior commitments. The fact that an individual is qualified to treat patients does not necessarily mean that he or she has promised to do so.

                            One way to justify the application of these laws to HCPs who are not subject to preexisting employment or contractual treatment obligations would be to demonstrate that HCPs implicitly consent to treat patients in emergencies as part of the process of becoming a professional. One argument, for example, is that the oaths taken at graduation from medical school, or professional associations' statements affirming a duty to work during disasters, indicate that professionals are aware that they could be required to work during infectious disease outbreaks. However, although it might be possible to modify medical school oaths to incorporate a commitment to work during public health emergencies, current oaths contain only general pronouncements like "I solemnly pledge myself to consecrate my life to the service of humanity." Individuals who make such a statement would have little reason to believe that they have agreed to treat patients with contagious infections regardless of employment responsibilities. As for professional associations, it is important to remember that, unlike professional associations in many other countries, professional associations in the United States are voluntary organizations with no authority to regulate medical practice. Even though courts sometimes cite professional associations' statements as evidence of professional standards, they have not treated those statements as a sufficient basis, in and of themselves, for establishing enforceable duties.

                            Some scholars maintain that HCPs, or at least physicians, implicitly have accepted an obligation to treat patients during a pandemic as part of a "social contract" between society and the medical profession. The claim is that "society grants the medical professions special social status and certain privileges" in exchange for the profession's implicit agreement "to promote society's health." Generally, physicians do incur obligations in exchange for benefits such as subsidized medical education and monopoly protection of the profession (ie, legal protection from competition by nonlicensed practitioners). However, the fact that physicians have social obligations does not mean that they must fulfill those obligations by risking their lives. Many physicians provide other valuable forms of community service, such as by working in medically undeserved areas or providing free care to indigent patients.

                            Physicians may enjoy high societal status in part because the public expects physicians to act altruistically. Thus, if physicians refuse to work during a pandemic, the medical profession may be perceived negatively. However, physicians who have never undertaken patient care responsibilities should not be penalized solely because of public expectations about the profession in general. Expectations alone do not normally create enforceable obligations.

                            Some scholars suggest that whether HCPs have agreed to treat patients during infectious disease outbreaks is not the relevant question. Instead, the obligation to work during a pandemic derives from HCPs' specialized skills that "enable [them] to help more effectively, and in greater safety, than the average citizen."

                            The argument that special skills give rise to special ethical duties has some merit. In contrast to many other countries, US jurisprudence does not recognize a legal "duty to rescue," yet most people would probably agree that a person who is uniquely qualified to save someone's life has a prima facie ethical obligation to do so. For example, few members of the public would deny that a passerby who sees someone lying injured on a deserted road should try to help, regardless of whether doing so is legally required. The moral obligation stems from the fact that a person's life is in danger, a simple intervention like calling for an ambulance would involve minimal burdens, and no one else may be around to help.

                            However, even the most ardent proponents of the duty to rescue generally agree that individuals should not be required to undertake rescues at significant personal peril. Requiring HCPs to treat patients with contagious infections, in the absence of any preexisting treatment obligations, would violate this principle. Such requirements also could conflict with HCPs' obligations to their other patients or their own families. Moreover, even if the moral obligation to assume risk is considered to be greater than usual during public health emergencies, HCPs are not the only ones whose services will be required during infectious disease outbreaks. Numerous categories of individuals will be essential during a pandemic, ranging from funeral directors to border control agents. The law should not single out HCPs for drastic penalties like license revocations or imprisonment when other individuals whose contributions are equally important are free to refuse to work without similar repercussions.

                            Penalties for HCPs who refuse to work during an epidemic have not yet been imposed. Rather than relying on punitive measures, policy makers should develop incentives to encourage all essential professionals to volunteer to work during infectious disease outbreaks. For example, governments could create funds to provide hazard pay for individuals who volunteer to work during a pandemic. They also could make it easier to credential individuals to work during emergencies and adopt measures to protect volunteers from criminal or civil liability. Professional organizations can play a role by promoting a spirit of volunteerism, which can be a powerful way of encouraging service without resorting to compulsion. Threatening HCPs with license revocations and imprisonment, even if they have not violated any preexisting treatment obligations, is not the solution.

                            AUTHOR INFORMATION

                            Corresponding Author: Carl H. Coleman, JD, Health Law & Policy Program, Seton Hall Law School, One Newark Center, Newark, NJ 07102 (colemaca@shu.edu).

                            Financial Disclosures: None reported.

                            Disclaimer: Dr Reis is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily reflect the decisions, policy, or views of the World Health Organization.

                            <!--stopindex-->Author Affiliations: Health Law & Policy Program, Seton Hall Law School, Newark, New Jersey (Mr Coleman); and Department of Ethics, Equity, Trade & Human Rights, World Health Organization, Geneva, Switzerland (Dr Reis).



                            hat-tip to pseudorandom
                            http://novel-infectious-diseases.blogspot.com/

                            Comment


                            • #74
                              Re: Will Nurses Work During a Pandemic?

                              LAIDBACK AL,

                              THESE ARTICLES ARE OFTEN POSTED TO GIVE THE PEOPLE A FALSE SENSE OF SECURITY. THE PURPOSE IS TO SCARE THE INNOCENT CIVILIAN WORKER INTO THINKING THEY HAVE TO WORK AT ALL COSTS. THE SYSTEM CANNOT FORCE A HEALTH CARE PRACTITIONER TO WORK ANY MORE THAN A PAINTER CAN BE FORCED TO PAINT A BEAUTIFUL PAINTING OR A PLUMBER TO FIX A LEAKY FAUCET.

                              PEOPLE WANT TO BELIEVE THAT THE HOSPITAL IS OPEN 24/7 FOR THEM BECAUSE THAT IS THE WAY IT IS IN THE MOVIES. BUT HOSPITALS AND THE STAFF HAVE TO PROTECT THEMSELVES FROM STUPID PEOPLE DOING STUPID THINGS.

                              PERSONAL PREPARATIONS FOR TROUBLE HAVE BEEN ENCOURAGED BY THE MEDIA SINCE Y2K.

                              THOSE PEOPLE WHO DEMAND HEALTH CARE PROFESSIONALS GIVE THEM CARE ARE THE FIRST TO MAKE ANYONE ACCOUNTABLE FOR THEIR OWN LACK OF PREPARATIONS. PEOPLE HAVE TO TAKE SOME RESPONSIBILITY FOR THEIR OWN STUPIDITY OR LACK OF PREPARATIONS. IF THEY ARE STUPID ENOUGH TO GO OUT INTO THE WORLD AND CONTRACT THE DISEASE, WHY SHOULD I RISK MY HEALTH, LIVELIHOOD AND MY FAMILY'S HEALTH FOR THEM? IT IS THE SAME ARGUMENT AS THOSE FOOLS WHO REQUIRE EMERGENCY TRANSPORT BECAUSE THEY ARE LOST IN PERALOUS CONDITIONS AND THE RESCUE HELICOPTER CRASHES KILLING ALL ABOARD BECAUSE THE THRILL SEEKERS WANTED TO HAVE BRAGGING RIGHTS.

                              WE HAVE NOT EVEN BEGUN TO DISCUSS THE COST.....

                              Comment


                              • #75
                                Re: Will Nurses Work During a Pandemic?

                                Originally posted by Sunshine123 View Post
                                LAIDBACK AL,
                                Originally posted by Sunshine123 View Post
                                THESE ARTICLES ARE OFTEN POSTED TO GIVE THE PEOPLE A FALSE SENSE OF SECURITY. THE PURPOSE IS TO SCARE THE INNOCENT CIVILIAN WORKER INTO THINKING THEY HAVE TO WORK AT ALL COSTS. THE SYSTEM CANNOT FORCE A HEALTH CARE PRACTITIONER TO WORK ANY MORE THAN A PAINTER CAN BE FORCED TO PAINT A BEAUTIFUL PAINTING OR A PLUMBER TO FIX A LEAKY FAUCET.

                                PEOPLE WANT TO BELIEVE THAT THE HOSPITAL IS OPEN 24/7 FOR THEM BECAUSE THAT IS THE WAY IT IS IN THE MOVIES. BUT HOSPITALS AND THE STAFF HAVE TO PROTECT THEMSELVES FROM STUPID PEOPLE DOING STUPID THINGS.

                                PERSONAL PREPARATIONS FOR TROUBLE HAVE BEEN ENCOURAGED BY THE MEDIA SINCE Y2K.

                                THOSE PEOPLE WHO DEMAND HEALTH CARE PROFESSIONALS GIVE THEM CARE ARE THE FIRST TO MAKE ANYONE ACCOUNTABLE FOR THEIR OWN LACK OF PREPARATIONS. PEOPLE HAVE TO TAKE SOME RESPONSIBILITY FOR THEIR OWN STUPIDITY OR LACK OF PREPARATIONS. IF THEY ARE STUPID ENOUGH TO GO OUT INTO THE WORLD AND CONTRACT THE DISEASE, WHY SHOULD I RISK MY HEALTH, LIVELIHOOD AND MY FAMILY'S HEALTH FOR THEM? IT IS THE SAME ARGUMENT AS THOSE FOOLS WHO REQUIRE EMERGENCY TRANSPORT BECAUSE THEY ARE LOST IN PERALOUS CONDITIONS AND THE RESCUE HELICOPTER CRASHES KILLING ALL ABOARD BECAUSE THE THRILL SEEKERS WANTED TO HAVE BRAGGING RIGHTS.

                                WE HAVE NOT EVEN BEGUN TO DISCUSS THE COST.....
                                Hi Sunshine123,
                                Why you will risk?
                                Because you are payed for.

                                What do you think why so many people do such risky jobs: bonificate mined land, deep mining, ..., contractors ..., only for a vocation?
                                Obviously, some people would be willing to react to a pandemic.
                                The problem would be: how much of them.
                                But the "painter" text can solve that:
                                If an state of emergency would be declared, the "painter" will be forced to paint if it would be necessary, and if included in the "emergency workers" list.

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