Dangerous patients and healthcare workers rights (or no rights?)

  1. Hypothetically speaking:

    Suppose you have a know drug user patient with infectuous conditions, and you get stuck by a needle found in his possessions?
    Is there any way to push the suits to discharge the patient and if so where?
    Do you as a healthcare worker have the right to refuse to care for this person?
    Who is responsible for the fact that the patient had a dirty needle and someone got stuck with it?
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  2. 14 Comments

  3. by   frankie
    Nursegoodguy, Frankie here. I suspect that the patient would not be discharged, unless he was ready for discharge, like an ER visit. If you were stuck with any sharps while at work, you would follow your institutions directions for reporting, follow-up, patient testing, prophylaxis. Doesn't make any difference who had the needle, it would be the institutions responsibility. Probably you would have to work with workmans comp. Sort of the same thing like car accident while driving during working hours in home care - you are on the job. And then of course, you would be remiss if you did not plan for MSW consult and referral, and teaching r/e improper needle disposal by patient - frankie
  4. by   nursegoodguy
    Frankie,
    you are more than likely right...
    When you hear about someone getting stuck for such a reason... Wouldn't you think it would be considered like assault?
  5. by   frankie
    Goodguy, frankie here. Probably not assult. The patient probabley did not have the intent to harm anyone with the needle. He or she could probably find the right attorney and file suit against you for making him/her get labs drawn and for being in his/her posessions. This world is a strange place. I am not a legal person, but intent to harm would be an issue. frankie
  6. by   cactus wren
    Assault? Could be hard to prove, patient would have to know he had a transferable condition, like hepc or hiv, and planned to infect you, wouldn`t he? Truthfully don`t know for sure. But wasn`t some folks convicted for biting or spitting when aids was just starting?And as screwy as our courts are getting..........
  7. by   Stargazer
    Giuseppe, agree w/frankie--it would be unethical, IMO, and almost certainly illegal to prematurely discharge this patient for that reason. I don't know that it would be anybody's particular responsibility that the needle was there, except the patient's, and you can't really "punish" him/her for that.

    And no, legally I don't believe this is assault, esp. given that the needle was found passively in the pt's belongings. My brother, a cop, was stuck with a needle during the capture of a drug suspect, and I know the perp was not charged with assault, even though my brother had to go through follow-up testing and take the drug cocktail.

    I don't believe, actually, that you can even test the patient against his will to determine HIV status--but I'm not 100% sure on that.
  8. by   frankie
    Stargazer, frankie here. You usually can test a patient for HIV, HBV, etc...Your institution probably has a policy for this. I work in infusion, so we get consent for HIV testing, even if the patient is requesting the test. I know there is a protocol for needle sticks, but I leave that up to the NP in employee health. she does all that stuff for you, and offers prophylasis - she also counsils staff r/e do you really need an HIV cocktail X 1 year. Last time I got stuck, I refused the cocktail (but I called our medical director the ID doctor for his opinion). - frankie
  9. by   nursegoodguy
    To me it's just so frustrating... I got into nursing to help people but I shouldn't have to feel like my life is on the line, and I chose the area specifically so I could work with the geriatric population. I don't want to work with drub abusers but it seems they are everywhere? And the places once designed for the geriatric patient are now becoming populated with a different sort of client.
    Any thoughts...
  10. by   adrienurse
    OOpsi, did a double post. My bad!
    Last edit by adrienurse on Oct 14, '02
  11. by   adrienurse
    Speaking pure ethics here. No, you cannot have the person discharged. It would be unethical to do so, because he has the right to treatment and self-determination. You also have the right not to be stuck by a dirty needle, but his rights superceed yours. Not a perfect world by any means.
  12. by   nursegoodguy
    I gotta get back in school and get me a computer science degree...
  13. by   BadBird
    guiseppe,

    I know what you mean about fearing for your safety. I was working on a floor where 2 gangs had a shoot out, the shooter and the shootee were admitted to the same unit. DUH, what moron did that! The families were at each others throats, it was ugly. Thankfully, I only worked 1 shift there. What about our safety? In another unit, there is 24/7 police bedside coverage due to another shooting. The police are there why? to protect the nurses or the patient or both? Who knows. I didn't get into nursing to take care of jerks like that, I wish they would all blow themselves away. Sorry, just venting here while I watch my paycheck get taxed so we can keep those upstanding members of society alive. GRRRRRRRRRR
  14. by   Nurse Ratched
    Psych viewpoint here: we go through all patient's belongings as part of their admission process. We also search their clothing (offer a gown, allow them to get undressed in a reserved bathroom in private, and search their clothing. It's like customs ("Do you have anything to declare?") Bags are gently dumped, not reached into because of situations like you noted. We are gloved at all times. Recently, two guns were found in a patient's belongings (loaded, naturally.) Security had to be involved, and there was question of whether the guns would or would not be returned to the patient since apparently they were not entirely legally owned. (Long story - honestly don't know how that turned out - the lawyers got involved there.)

    If a staff member got stuck with a contaminated needle, they would be subject to the same protection as any other job-acquired injury.

    The law is such that we cannot draw for an HIV test without the permission of either the patient or their legal representative regardless of why the results are needed.

    Theoretically, the patient's care would be unaffected by all of the above.

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