Yes, it is acceptable for nurses to dismiss their duty to their workplace during a pandemic. One might assume that the moral and professional obligation of nurses to provide care to ill individuals under any circumstance is implicit and that the code of ethics governing nursing practice specifies this. Actually, on the contrary, the American Nurses Association (2001) code of ethics emphasizes the moral autonomy of nurses and states that "nurses are accountable for judgments made and actions taken in the course of nursing practice, irrespective of health care organizations policies or provider's directives" (p. 16), which may not be in the best interests of patients or organizations. Furthermore, the code (ANA, 2001) specifies that "the nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety" (p. 17).

The unfortunate reality is that many nurses, physicians, and other healthcare workers will not be at their posts during a pandemic. This will happen for a number of predictable reasons, including illness of the nurse or his or her family or because the nurse is fearful of becoming ill. Fear of illness may not happen frequently, but it is possible that a pandemic will decimate large portions of the healthcare workforce, thus creating extreme stress for individuals still available to care for ill patients.

If a pandemic occurs, most nurses will probably have been immunized with the available vaccine (if the pandemic is due to human influenza) and will report to work unless compelling circumstances intervene. It is possible, however, that a pandemic may occur for which there is no vaccine, in which case nurses and other healthcare providers will be faced with an ethical conflict: do they provide care for sick patients, or do their obligations to protect themselves, their family, and friends (whom they might infect) come first? This is particularly problematic if the nurse is at high risk due to his or her own pre-existing conditions (e.g., pregnancy, being immunocompromised, having a chronic disease). We learned from the SARS outbreak in 2003 that it is difficult to predict what individuals will do during a crisis. Many healthcare providers refused to care for persons infected with the SARS virus, and the morbidity and mortality of individuals who did provide this care was high (Wynia, 2007).

It is doubtful that the United States has enough respirators, supplies, personnel, or medications (especially antibiotics) to care for everyone who might be afflicted in a pandemic. We also have no national or state policies regarding triage or allocation of resources. These facts alone will lead to myriad ethical conflicts for nurses in the event of a pandemic. Who should receive care first? Is triage even ethical? Should we use respirators, for instance, on a first-come, first-served basis? Do we have another solution to this dilemma? Unless we deal with the triage and resource allocation issues before a major epidemic, we may be destined for a period of chaos resulting in unproductive responses to a pandemic.

The workplace would be a difficult environment during a pandemic, with limited supplies and workers. Many services other than nursing will be in short supply, including dietary services. Dietary and other workers will have the same concerns as nurses: do they care for their families and homes, or do they stay at the hospital to meet the needs of the patients and available staff? Other essential services (e.g., garbage pickup and other city services) also may be interrupted. The reality is that many nurses and others will not be in the workplace during such a crisis. It will happen, so let's accept it and get prepared.

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