This article was published in May 2020 and reflects information current at the time of publication.
Footcare nurses may be considering whether or not to continue providing care to clients during the COVID-19 pandemic. This may raise a number of questions, for instance: What considerations should I be keeping in mind when making this determination? Should I be asking clients to sign a waiver form stating that I cannot be held responsible if they contract COVID-19 following a visit?
Footcare nurses who are considering providing care during the COVID-19 pandemic should first consider whether there have been any emergency declarations or orders which may impact their ability to continue practicing. All provinces and territories in Canada have declared a state of emergency pursuant to emergency measures and/or public health legislation. These declarations may also include orders made pursuant to provincial or territorial legislation which place restrictions on services that are permitted to continue during the state of emergency, and may also authorize certain essential services to continue, sometimes under particular conditions or requirements. Footcare nurses should therefore consider what declarations, orders and/or directives have been made in their jurisdiction to understand what restrictions might apply to their continued practice.
Once they have determined to what extent they are authorized to provide care, footcare nurses should consider to what extent it would be appropriate to continue providing care given the risk of COVID-19 transmission. There may be patients who do not require urgent or essential footcare and for whom it may not be advisable to continue providing care given the risk of potential infection. Conversely, there may also be patients who require ongoing care and who may face significant risks or complications if that care is not provided. Footcare nurses may therefore wish to assess to what extent it is appropriate to continue providing care for each patient, taking into account all relevant factors including clinical presentation and status, as well as the risk to the patient if care is delayed.
There are a number of considerations that could reduce risk in the event a footcare nurse has determined it is appropriate to provide care during the pandemic. One important consideration is obtaining informed consent to proceed with care given the increased risks associated with the pandemic. Footcare nurses should consider whether the patient has provided informed consent to proceed prior to attending for a visit. This will generally include having a fulsome discussion with the patient about the risks, benefits and consequences of accepting or refusing care in the circumstances, taking into account their clinical status and the risk of potential COVID-19 transmission. It may also be helpful to review with the patient the infection control measures that nurses intend to implement to minimize the risk of transmitting COVID-19 during the visit. Such discussions may then be documented thoroughly in the patient health record including confirmation that the patient has consented to proceed. Footcare nurses may also wish to consider the use of a consent form which formalizes this discussion and confirms the patient is aware of the potential risks, benefits and consequences that have been reviewed with them beforehand, including any risks related to COVID-19 transmission.
Footcare nurses should exercise caution when relying upon waiver forms releasing them from liability in the event that a patient contracts COVID-19 following a visit. It is important to remember that such waiver forms do not relieve nurses of their professional obligations to provide care within the applicable professional standards and to follow appropriate infection control practices. As regulated health professionals, nurses have a duty of care towards their patients which will continue to apply notwithstanding any waiver or agreement signed by the patient. Footcare nurses should bear in mind that they may still be found liable if they fail to meet these standards and obligations, and should not assume that a waiver form will prevent a patient from bringing a claim forward or that it will constitute a full defence to allegations of professional negligence made against them. It would be prudent for footcare nurses who are continuing to provide care to familiarize themselves with the applicable infection control practices and consider whether they have the necessary protective measures in place to minimize the risk of infection to the extent possible.
Footcare nurses may also wish to consider taking additional steps to manage their risk when providing care during the pandemic, including the following:
- Update knowledge of best practices and standards for infection control measures to be used when providing care during the pandemic;
- Assess whether there is appropriate personal protective equipment in place;
- Consider whether the appropriate sterilization practices have been implemented with respect to equipment and tools;
- Thoroughly document care and any discussions with patients, including clear documentation outlining the infection control and other protective measures that have been implemented;
- Assess whether there are any particular risks or restrictions that might apply when providing care to clients in long term care or other facilities where there is an increased or known risk of infection, and considering what additional protective measures might be required;
- Clearly communicate with clients about what footcare services are currently provided and whether it is appropriate to continue with their care in the circumstances, including instructions on what to do in the event that their symptoms may change or become urgent;
- Check emergency orders and updates on a daily basis to confirm whether any restrictions or conditions have been placed on the ability to practice;
- Consult with the provincial nursing regulatory body to confirm whether they have provided any applicable directions or guidelines regarding care provided during the pandemic.
The above considerations may also be applicable for other nurses who are considering providing care during the pandemic, for instance, nurses in independent practice or those providing non-urgent or elective services. The CNPS recently published COVID-19: Six considerations for independent practice during a pandemic that may be of additional interest.
Footcare and other nurses who are beneficiaries of the CNPS and have any further questions may contact CNPS at 1-800-267-3390 to speak with CNPS legal counsel directly.
Published May 2020
THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.