Nursing involves direct patient care, which introduces occupational hazards during pregnancy that can affect both the nurse and the developing fetus. Reviewing patient assignments and daily duties is necessary risk management to protect against potential exposure to infectious agents, hazardous chemicals, and undue physical stress. The goal is to ensure a healthy pregnancy outcome while maintaining the nurse’s professional role, often by seeking modifications to the work environment and specific assignments.
Patient Assignments Involving Infectious Risks
Pregnant nurses who are not immune to certain common pathogens should seek reassignment from patients known or suspected to be infected. Exposure to Cytomegalovirus (CMV), a herpesvirus often shed by young children, poses a risk for congenital infection, which can lead to long-term neurosensory disabilities in the fetus. Strict hand hygiene and minimizing contact with body fluids, particularly in pediatric settings, is a primary protective measure against this virus.
Parvovirus B19, or Fifth Disease, is another hazard often encountered in pediatric and school settings, and infection during the first half of pregnancy can trigger severe fetal anemia and non-immune hydrops fetalis. Similarly, exposure to Varicella-Zoster Virus (VZV), or chickenpox, in a non-immune pregnant nurse can lead to severe maternal illness and the development of Fetal Varicella Syndrome. Immunity status for these agents, as well as for Rubella and Toxoplasmosis, is a primary factor in determining safe patient assignments.
Toxoplasmosis is a parasitic infection that can cause serious congenital complications, including chorioretinitis and neurological damage, especially if the mother contracts the infection early in pregnancy. While typically transmitted through contaminated food or cat feces, nurses should avoid assignments that involve handling potentially infectious materials where exposure might occur. Checking pre-pregnancy antibody titers for these teratogenic infections allows non-immune nurses to advocate for temporary duty modifications that limit exposure risk.
Exposure to Hazardous Medications and Chemicals
Contact with cytotoxic and antineoplastic agents involves a significant risk, as these drugs are designed to kill rapidly dividing cells and can be mutagenic or teratogenic. Studies suggest an association between handling these hazardous drugs and an increased rate of spontaneous abortion, even when standard personal protective equipment (PPE) is used. The safest protocol for a pregnant nurse is to request a temporary reassignment that eliminates the preparation or administration of these chemotherapy drugs entirely.
Other chemical exposures include certain antiviral medications, high-level disinfectants, and waste anesthetic gases. Exposure to anesthetic gases, found in operating rooms and post-anesthesia care units, has been historically associated with reproductive risks, though modern scavenging systems have reduced the hazard. Nurses should minimize time spent in areas with high ambient levels of these agents, as they can be absorbed through inhalation or skin contact.
When handling any hazardous substance, the pregnant nurse must adhere to institutional guidelines, including the use of chemotherapy-tested gloves, impermeable gowns, and engineering controls like biological safety cabinets. However, because low-level contamination can still occur on work surfaces, avoidance of the highest-risk medications remains the most prudent course of action during pregnancy.
Physical Demands and Environmental Hazards
Physical requirements of nursing, such as heavy patient handling and prolonged standing, pose ergonomic risks exacerbated by physiological changes of pregnancy. Ligament laxity and a shifting center of gravity increase the risk of musculoskeletal injury, while frequent or heavy lifting may be associated with adverse pregnancy outcomes like pre-term labor. Provisional guidelines often recommend that a pregnant worker limit manual lifting to no more than 20 to 25 pounds.
Nurses should avoid tasks that require repetitive lifting, especially those involving bending down low or reaching overhead, and must utilize patient lift equipment and assistive devices for all transfers. Prolonged static standing, common during long procedures or medication passes, can also contribute to fatigue and venous issues and should be mitigated by using stools or requesting more frequent breaks.
Environmental hazards include exposure to ionizing radiation in areas like the Cardiac Catheterization Lab, Interventional Radiology, or the Operating Room during portable X-ray use. For a declared pregnant worker, the Nuclear Regulatory Commission (NRC) limits the total dose to the fetus to 500 millirem (5 mSv) for the entire gestation period. The nurse must formally declare the pregnancy to the Radiation Safety Officer and wear a second dosimeter at the waist to monitor fetal exposure, though complete reassignment from high-exposure areas is often preferred.
Another environmental hazard is the heightened risk of workplace violence (WPV) in certain units, such as the Emergency Department. Verbal and physical assaults are more common in these areas than in other hospital settings.
Workplace Accommodations and Nurse Rights
Federal law provides frameworks to support pregnant nurses seeking modifications to mitigate occupational risks. The Pregnancy Discrimination Act (PDA), the Americans with Disabilities Act (ADA), and the Pregnant Workers Fairness Act (PWFA) mandate that employers provide reasonable accommodations for known limitations related to pregnancy or childbirth.
A request for accommodation should be initiated with a medical note from the nurse’s healthcare provider detailing necessary restrictions, such as lifting limits or avoidance of specific hazardous assignments. The employer is then required to engage in an “interactive process” to determine a reasonable accommodation that allows the nurse to perform the essential functions of the job.
Reasonable accommodations may include:
- Temporary light duty.
- Reassignment to lower-risk units.
- Modification of the work schedule to eliminate night shifts.
- Modification of the work schedule to eliminate long periods of standing.
An employer cannot force a pregnant nurse to take leave if a reasonable accommodation can be provided without causing undue hardship to the business operations. The institutional Occupational Health department is typically the contact point for formally requesting and implementing these modifications.