Years ago, a wealthy citizen requested his nurse assignment be changed because he did not want an African-American nurse to care for him. My mentor and friend was the nursing supervisor. She happens to be an African-American woman. She refused to change the assignment, informing the patient that we do not make assignments based on race. So how do you deal with a race-related request in a nursing care?
The “Register Guard” reported a hospital recently settled a suit claiming the hospital allowed an infant’s father to refuse nursing care based on the race of the nurse. Jeff Karoub of the Associated Press reports the father, a white man bearing a swastika tattoo insisted African-American nurses not be allowed to touch his newborn. The suit claims a note was placed on the assignment clipboard instructing, “No African-American nurse to take care of baby.” African-American nurses in the neonatal intensive care unit were left confused and “didn’t know what to do if the baby was choking or dying.” The nurses wondered if they would be fired if they rendered aid in this situation. Could they morally NOT render aid? Could these nurses be sued if they failed to render aid? At least one nurse filed suit against the hospital, citing violation of her civil rights.
Both the American Medical and The American Nurses Associations’ Code of Ethics address discrimination of the patient by the health care provider. Provision 1.1 of the American Nurses Association “Code of Ethics for Nurses” addresses human dignity and states: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” Neither code addresses the patient’s refusal of care based on the race of the health care provider.
While the Patient Care Partnership’s “Understanding Expectations, Rights, and Responsibilities” does address the patient’s rights, it also does not address the patient’s refusal of care based on the race of the health care provider.
Refer to your state’s Nurse Practice Act to see if such requests are addressed.
Each facility must develop specific policies for handling race-based requests from patients. Most facilities have adopted a “zero tolerance” policy for incivility. Such incivility increases staff turnover and impairs nursing care. When the hospital named in the suit prohibited African American nurses to care for this child, it created a hostile environment in which professional relationships lacked compassion and respect for the inherent dignity, worth, and uniqueness of the staff members. The staff members were placed in an unnecessarily uncomfortable position. The facility must enforce their policy and educate their staff. If the hospital named in this suit had such a policy, the father should have been informed of the hospital policy against discrimination which prohibited the hospital from accommodating this request. The supervisor should then have made the staff aware of the father’s feelings, requesting the staff to be supportive and sensitive where they could. If this was not acceptable to the father, the hospital could offer to transfer his child to another facility.
What would you do if you are faced with a similar situation?
While we want to respect the inherent dignity, worth and uniqueness of every individual including the nurse, we cannot legislate away bigotry. Accommodating the patient request may be preferable for a post traumatic stress patient such as a patient who has been raped or served in combat. Denying such a request may further increase the liability for the nurse and the facility. Patients are less likely to sue if they like the nurse. As a rule, nurses should maintain professionalism and avoid arguing with patients and without becoming defensive.
What should you do if you are faced with a similar situation?
Nurses should begin documenting any discriminatory acts, noting what happened, who did it, day and time of the event, and any witnesses. Some laws require the reporting within a specific time period. Report discrimination to your supervisor as soon as possible. Follow your company’s grievance policy and contact Human Resources or the compliance hotline if needed.
Contact an employment attorney if you do not get resolution to your complaint. For reporting to the federal government, contact the U.S. Equal Employment Opportunity Commission. For reporting to the state government, contact the state’s Department of Labor. An advocacy group may also be helpful regarding federal and state laws regarding reporting acts of discrimination.