APPENDIX 1-1

The Ethical Duty of Nurses to Provide Care During a Pandemic*

Janet L. Storch, Rosalie Starzomski, and Patricia Rodney

1. What is the nurse’s duty to provide care?

The duty to provide care is foundational to nursing practice.

The duty to provide care is the obligation of nurses to provide safe, competent, compassionate, and ethical care.

This duty arises from the ethical principle of beneficence, which means to benefit others.

Nurses play an essential role in responding to a pandemic and in sustaining a functional and compassionate health care system.

2. How does a pandemic affect or alter the duty to provide care?

The risk of harm to a nurse can be serious or potentially life-threatening.

Nurses must consider their risks and take all measures to avoid serious harms.

Nurses must also consider their personal relational obligations, such as parenting duties and other caregiving commitments.

Nurses should expect their leaders to engage in regular consultations with them to prevent and address harms in practice areas and to consider risks to persons in their care.

Proactive and regular debriefing and support services ought to be provided for nurses and health care leaders to sustain their ability to provide care.

3. When is it acceptable for a nurse to withdraw from providing care, or refuse to provide care?

Each nurse must first weigh the evidence about the risks involved in providing care, or continuing to provide care.

Each nurse must justify whether the expectations placed on them is unreasonable, taking into account the tasks they are being asked to do, mitigation strategies (such as appropriate personal protective equipment) that is provided, and their personal circumstances.

Nurses can withdraw from providing care, or refuse to provide care, if they believe that providing care would place them and/or others at an unacceptable level of risk, such as when there is a lack of personal protective equipment (gowns, masks, gloves).

Please refer to Endnote #4 in this chapter for more information about reasons for a nurse withdrawing from providing care.

4. How should a nurse withdraw from providing care or refuse to provide care?

The nurse should speak to their leader about their need to refuse to provide care or withdraw from care.

The nurse’s decision should be made known, as soon as possible, in time for alternate arrangements to be made. Risks to the person(s) in care must be considered.

Reasons should be given for the planned withdrawal of care, with a willingness to discuss and consider improved personal protective equipment and/or a different assignment, if possible.

The nurse must then weigh and consider any new information received from the leader to determine if their decision to refuse to provide care, or withdraw from providing care, would change.