The Royal College of Nursing (RCN) has updated guidance on when and how nurses and nursing associates could decide to refuse to treat a patient in their care.
The update comes amid ongoing racist and Islamophobic threats against minority ethnic communities, including healthcare workers.
Earlier this week, health secretary Wes Streeting reportedly said that abusive patients can and should be refused care.
While reminding nurses of their duty of care, the RCN lists discriminatory behaviour including racism, health and safety hazards, and fear or existence of physical violence, amongst situations that may justify the refusal to treat.
Outlining key steps to take before refusing care, the union recommends nurses, nursing associates and midwives to consider the NMC code and their duty of care, advising that staff get support from their manager and keep an accurate record of their refusal to provide care.
An RCN spokesperson commented: ‘Employers have a duty of care to keep you safe at work, whether that’s a hospital or delivering care alone in community settings. Your organisation needs to act urgently to reassure nursing staff, review risk assessments and implement any measures necessary to keep you safe.’
RCN recommendations for precautions to take before refusing care:
- consult with your manager and make your concerns known verbally and in writing as soon as possible
- follow the agreed protocols and policy for your place of work and familiarise yourself with your local safeguarding policies where necessary
- if you are a nurse, nursing associate or midwife, consider the NMC Code, the NMC’s ‘Standards for competence for midwives’ (where applicable) and your duty of care
- if you are not a registered practitioner you must nevertheless consider your individual accountability for your actions. For further information please see accountability and delegation
- consider the need for a risk assessment when taking these decisions. As always, the need to ensure safe systems of working is critical to patient safety
- keep a copy of all documentation and keep a record of dates of any meetings/discussions
- consult with the patient/client and (if appropriate) their family
- make an accurate record of the decision to refuse to treat, to include the reasons for the decision so that you are able to justify your actions later if care is withdrawn.
