Can nurses who are pregnant, breastfeeding, or trying to conceive administer hazardous drugs?

Developing fetuses and newborn infants may be more susceptible to harm from certain hazardous drugs (HDs). Therefore, an additional level of protection is suggested for those most vulnerable to the reproductive and developmental effects of HDs (Connor, Lawson, Polovich, & McDiarmid, 2014). The degree of risk faced by an employee working with HDs may vary due to the availability and use of PPE and other equipment, and practices followed. Despite following the most stringent safety precautions, the risk of accidental exposure when handling HDs persists. For this reason, OSHA states employees who are actively trying to conceive, who are pregnant, or are breastfeeding need a mechanism by which they can arrange alternative work activities with the employer to protect them and their infant from reproductive health hazards such as chemical, physical, or biologic agents (Occupational Safety and Health Administration, 2016). 

Institutional policies should be in place that describe the process for educating those at risk for exposure to HDs, options available for alternative duty (responsibilities that do not include HD handling), and the process to request alternative duty. ONS supports the provision of alternative duty for healthcare workers who are pregnant, breastfeeding, or trying to conceive, but acknowledges that an employer’s ability to provide this may vary depending on staffing, census, and other factors (Olsen et al., 2023). ONS supports high-level institutional strategies to operationalize fulfilling alternative assignment requests for these individuals whenever possible. The employee has the responsibility of notifying the employer of the specific situation (e.g., pregnancy, preconception, breastfeeding).

The American College of Occupational and Environmental Medicine provides guidelines for reproductive hazard management.

Consider reviewing the following additional resources:

Ensuring Healthcare Worker Safety When Handling Hazardous Drugs

Safe Handling of Hazardous Drugs (Third Edition)

The Risk of Handling Hazardous Drugs While Pregnant Video

References

Connor, T.H., Lawson, C.C., Polovich, M., & McDiarmid, M.A. (2014). Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: A review of the evidence. Journal of Occupational and Environmental Medicine, 56, 901–910. https://doi.org/10.1097/JOM.0000000000000249

Occupational Safety and Health Administration. (2016). Controlling occupational exposure to hazardous drugs. Retrieved from https://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html

Olsen, M., LeFebvre, K.B., Walker, S., & Prechtel Dunphy, E. (2023). Chemotherapy and immunotherapy guidelines and recommendations for practice (2nd ed.). Oncology Nursing Society.   

Polovich, M., & Olsen, M.M. (Eds.). (2018). Safe handling of hazardous drugs (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.