1. James, Dottie C. PhD, RNC

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I believe it is not professionally acceptable for nurses to abandon their workplaces and roles during a pandemic. Today, as antibiotic-resistant bacteria and dangerous viruses emerge and as reports of intentional release of pathogens surface, it is no longer if, but when a pandemic will occur. I understand how fear would make refusal to come to hospitals and clinics seem like the only safe option for the nurse and his or her family, but professional nurses and healthcare organizations have special responsibilities and obligations and must fulfill them. It is also the responsibility of healthcare institutions to make advance, adequate preparations to protect workers and their families, thus reducing their risks and increasing the likelihood that nurses will be able to provide care for the patients who depend on them. Participating in these planning activities can be a vehicle to reducing fears through education and action.


Regulatory agencies such as the Joint Commission require healthcare organizations to develop plans to manage large numbers of infectious individuals seeking care to be able to meet a surge of need (Joint Commission, 2008). Multiple resources are available to guide and focus this planning (Joint Commission, 2005). Part of the planning involves protecting workers against disease so that nurses are available to care for patients whose needs may threaten to exhaust the resources of healthcare centers. These plans include vaccinations and prophylaxis and education about self- and community protection.


Vaccinations against certain diseases, such as smallpox, are not routinely recommended for all nurses because the vaccinations may present a level of risk not warranted for a theoretical danger. Once a case has been diagnosed, however, then the risk of vaccination becomes less than the danger posed by the disease, and mass vaccinations of healthcare workers would occur. These plans must be in place before the need arises so the administration processes of vaccine procurement and workers to administer the treatment can be organized. If the risk is from a bacterial organism such as anthrax, then antibiotic prophylaxis with medications such as ciprofloxacin or doxycycline becomes necessary. In addition to providing prophylaxis to nurses, most large healthcare systems plan for prophylaxis of nurses' families, which makes it possible for nurses to come to work without fear of either transmitting the disease to their families or needing to care for sick family members. This is both required and responsible planning and, in my opinion, makes refusal to come to work unethical and unnecessary.


Nurses have chosen a profession that has inherent risks. The specific disease entity may have changed throughout the centuries, but the mission of caring for the sick has not. The advantage today is that immunizations can offer protection to nurses for some diseases. How can nurses refuse to fulfill their vocation because the disease itself is unpleasant or risky? Just as men and women enter the military with insight into the risks of the profession they have chosen, so must nurses fulfill their duties and help patients who need them.


Nurses are traditionally identified as the most trusted and admired professionals. We have earned this respect through our efforts to provide reliable and competent care during times when people are most vulnerable. Pandemics are not a new risk, but in today's world they are more publicized in the press. The risks of caring for sick people have always been borne by nurses. Nurses in the past responded to the need and cared for patients although they had no protection from the disease. Can we do less?




Joint Commission for the Accreditation of Healthcare Organizations (JC). Emergency management standards. Retrieved February 26, 2008, from[Context Link]


Joint Commission for the Accreditation of Healthcare Organizations (JC), Illinois Department of Public Health (IDPH), Maryland Institute of Emergency Medical Services Systems (MIEMSS), and National Center for Disaster Preparedness at Columbia University (CPHP). Standing together: An emergency planning guide for America's communities. Retrieved February 26, 2008, from