NSNU Position Statement
Emergency Room Closures and Staff Responsibilities
Planned and unplanned Emergency Room closures are becoming frequent events within our healthcare system due to staff (physician and/or nurse) shortages. Some Emergency Departments do not have physician contact/coverage for the closure periods and nurses are faced with the ethical dilemma of dealing with the public who arrive at the doors of a closed/locked ER seeking treatment. It has come to our attention that some employers do not have clear policies which give direction regarding the protocol for dealing with the public who try to access treatment through closure periods. We are also aware that nurses may register, triage and initiate treatment to patients without physician support or contact.
Nurses have a professional obligation to provide clients with safe, competent and ethical care which is a requirement as defined by their Colleges through Standards for Nursing Practice, Code of Ethics, and related legislation. These professional obligations can have limits as the duty to provide care may be constrained by several factors such as lack of physician services.
‘Duty of care’ is a legal term used to describe the obligation imposed on nurses requiring that they exercise a reasonable standard of care while providing nursing services. The moment a nurse engages in the provision of care with a client, a nurse-client relationship is established and that nurse is held to that standard of care. Breach of the duty of care, if resulting in an injury, may subject a nurse to legal liability.
While there is an expectation that nurses will provide care to the sick, there should be no expectation that nurses will place themselves at unnecessary risk. Such risk may occur when a nurse’s ability to provide safe care and meet professional standards of practice is compromised by unreasonable expectations or lack of resources such as physician support.
Employers are responsible to ensure mechanisms are in place to support safe and ethical practice and are accountable for providing:
- policies, procedures, and/or guidelines to assist employees in making decisions regarding duty to provide care
- sufficient and appropriate staffing for safe, competent and ethical care
In Canada, there is no legal duty that forces nurses to help someone in an emergency outside of the workplace setting. While a nurse may feel a moral or ethical duty to do so, s/he cannot be held liable for failing to assist where there is no legal duty to do so.
During Emergency Room closure periods:
- Employers shall ensure that contingency policies and protocols are developed and circulated to all Emergency Room and other appropriate staff.
- Nurses will not triage, treat or register the public when physician coverage/contact is not available.
- When the public try to access a closed ER, nurses will contact 911 for paramedics/ambulance to transport public to nearest open emergency department.
- Nurses shall be informed prior to closure whether there will be physician coverage and shall be given clear direction re protocol for dealing with the public.
- The employer shall issue timely Public Service Announcements and public notices re closure and instructions for accessing treatment.
- The employer shall ensure there is signage at Emergency entrance directing the public to alternate site/services.
- If a nurse is instructed by the employer to triage, treat or register public without physician coverage, the nurse shall contact NSNU and/or CRNNS/CLPNNS.
- If the event occurs after NSNU/College office hours, the nurse shall follow the direction of the employer but shall complete a work situation report and contact the NSNU/College during office hours. The nurse may also contact the Local Union representative.