Nurses’ Lives Aren’t Negotiable

by Lori Nerbonne and Kathy Day

This post is dedicated to all medical workers on the front lines, and those who have given their lives in service to COVID-19. We will never be able to repay you, but please know we see you, hear you, and will continue to stand up for you and your patients.

N95 Filtration Mask

We are two nurses, who have bonded over the great personal loss of family members who died as a result of serious medical errors and healthcare acquired infections. Before we became a member of this unfortunate club, we were nurses on the front lines.

We are also the proud members of an accomplished and tight knit online community of advocates who have moved mountains in health care policy and patient safety. Our members include co-founders of patient safety and advocacy organizations, retired doctors, nurses, PhD’s, patient activists, policy wonks, and passionate volunteers. We are bonded by losses of loved ones, and the desire to prevent it from happening to others.

I think it’s fair to say, we’ve been around the block in healthcare.

What compels us to write, is the current reality unfolding in this pandemic: that the many healthcare system issues we have experienced and been working so hard to improve for patient safety’s sake, are now tragically playing out and happening to front line nurses and healthcare workers:

• Over 320 healthcare workers have died in the US in the first 90 days
• In several states, nearly half of all deaths from COVID-19 are a result of large outbreaks in nursing homes, affecting both patients and staff. These facilities are often short-staffed, have high administrator and staff turnover, and many don’t have infection control professionals (ICPs) to guide them.
• Nurses and doctors are being fired for speaking out about lack of Personal Protective Equipment (PPE), vital equipment that serves to protect them and their patients.
• Nurses are being fired for refusing to care for patients without proper PPE.
• Hospitals are receiving 100 billion dollars in relief package money, with reports of bonuses going to C-suite administrators in one city, while thousands of healthcare employees are being furloughed or laid off.
• Our dependence on China for manufacturing the majority of medical supplies and medications has turned out to be disastrous. Direct shipments of PPE from China have been blocked at ports of entry or intercepted by our own FBI agents, slowing down and complicating their arrival to hospitals. State Governors are being forced to fend for themselves, resulting in bidding against each other or FEMA to get PPE to their hospitals while driving up costs. The President has chosen not to engage the Department of Defense in the rapid manufacturing of much-needed PPE, instead leaving it to states or hospitals to organize private-sector outsourcing.
• In 2003, the US had a practice-run when another coronavirus named SARS (Severe Acute Respiratory Syndrome) was a global threat, with known spread in healthcare facilities. This resulted in the CDC updating their infection control guidelines for hospitals in 2007. Knowing this, it’s difficult to understand why basic PPE, or at the very least, US manufacturing capability and supply chains were not at the ready for COVID-19. Here is an excerpt from one of multiple studies about what public health and medical leaders had learned from SARS: (note ‘IC’ means Infection Control)

“It is also about surveillance, surge capacity, information provision, consistent application of IC measures and an appropriate and adequate public health infrastructure. Many of the IC measures implemented during SARS are yet to be formally evaluated. Nevertheless, the literature clearly demonstrates that failure to implement appropriate IC procedures and apply them consistently was an important factor in the hospital transmission of SARS. It is now upto IC practitioners to harness momentum generated by SARS into actions that will improve local, national and global infection control infrastructure.”

• The CDC, likely under pressure from hospitals and the federal government, relaxed their PPE guidelines in the second week of March. Nursing Unions opposed this change, with concern over their safety.
• More alarming, was Emily Kopp’s Roll Call article about The American Hospital Association’s (AHA) March 12th action alert sent to Congress around the same time the CDC relaxed their guidelines. The alert was to lobby Democratic leaders to withdraw a requirement in the Coronavirus Federal Relief Package that would require hospitals (and other front line employers) to come up with a comprehensive infectious disease exposure control plan to protect their employees. At a minimum, it called for the levels of protection outlined in 2007 CDC guidelines published after SARS, and those provided by state Occupational Safety and Health Administration (OSHA) plans.

To put this in context, in the days before COVID-19 hit American soil, hospitals required their staff to wear N95 filtered masks, eye shields, gowns and gloves for an airborne virus, according to CDC guidelines. It also required negative pressure rooms for air filtation. Failing to abide by this standard of care prior to the Pandemic, could result in reprimands or even being terminated.

In the Relief Package, Congress was giving OSHA 30 days to implement a standard for hospitals to comply with . It would be understandable in the face of PPE supply shortages if the AHA had requested an extension, while their hospitals worked to ramp up supply volume. But to ask for the new OSHA & CDC requirements to be completely removed is puzzling.

Nurses put on & remove PPE several times every day even for routine infection control. They need it to participate in ventilator intubations, specimen collections, and all hospital care for these very infectious patients. Without proper protective equipment, they know they are putting themselves, their patients, coworkers, and family members at risk.

In this pandemic, nurses are also standing in for families and caregivers who are not allowed to stay at the hospital with their loved ones. They bear witness to the devastating loss of human lives, holding the hands of the dying, as their only source of comfort.

They are putting their families at risk, steering clear of other family members by living in a garage or basement separate from their family members. They have stations in their garages where they remove their shoes and clothing, and then showering before reentering their homes. Some are not returning home at all, instead staying in hotels, motels or other housing to stay away from vulnerable family members.

Yet, most are not receiving hazard pay, many are furloughed, some have been denied workers’ compensation for COVID-19 contracted at work. Their faces are bruised or broken out from masks, they suffer from exhaustion, and the mental stress from the sheer volume of very sick patients, many who die. Now, they are even facing off with demonstrators who want their “freedoms”.

Add to this, AHA lobbying efforts, asking that their hospital employers be relieved of their duty to protect front line staff in a pandemic and beyond. This is yet one more way nurses feel unsupported or even abandoned, at a time when they deserve stong underpinnings and accountablity to ensure their safety.

We know from experience and evidence backs it up, that employee and workplace safety has a direct impact on patient safety and good patient outcomes. Nurses and all healthcare employees deserve trustworthy and accountable leaders, adequate staffing, training, equipment, and supplies. Workplace wellness and ‘a culture of safety’ aren’t just buzzwords. And no one should ever have to go to work with the fear of dying.

Notes:

1. Names of US healthcare workers who have died: https://twitter.com/ClaireZebra/status/1245126583536562177
2. The 2003 SARS outbreak and its impact on infection control practices Karen Shaw, Public Health. 2006 Jan; 120(1): 8–14. Published online 2005 Nov 16. doi: 10.1016/j.puhe.2005.10.002 PMCID: PMC7118748 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118748/
3. March 9: Hospitals Slammed for Not Doing Enough to Protect Nurses, Infection Control Today, https://www.infectioncontroltoday.com/covid-19/hospitals-slammed-not-doing-enough-protect-nurses-covid-19https://
4. March 12: AHA Lobbying Alert to Congress: https://www.aha.org/action-alert/2020-03-12-action-alert-urge-house-leadership-withdraw-provision-coronavirus-funding
5. March 13: Hospitals Want to Kill a Policy Shielding Nurses from COVID-19, Roll Call, Emily Kopp: https://www.rollcall.com/2020/03/13/hospitals-want-to-kill-a-policy-shielding-nurses-from-covid-19-because-there-arent-enough-masks/
6. March 16: OSHA and CDC issue changes to PPE, Environment Safety Update, Seyfarth Shaw LLP: www.environmentalsafetyupdate.com/public-outbreaks/cdc-and-osha-issue-changes-to-ppe-and-respirator-recommendations-for-the-care-of-patients-with-known-or-suspected-covid-19/
7. March 17: JD Supra’s reporting on CDC & OSHA changes to PPE guidelines: https://www.jdsupra.com/legalnews/cdc-and-osha-issue-changes-to-ppe-and-69331/
8. March 23, Nurses demand immediate protection during COVID-19 outpreak:https://www.nationalnursesunited.org/press/nurses-send-petition-congress-demanding-immediate-protections-during-covid-19-outbreak
9. April 1: Private Equity-Backed Company Slashes Doctor Benefits Amid COVID-19, Stat News https://www.statnews.com/2020/04/01/slashes-benefits-for-doctors-coronavirus/
10. April 7: 201 Hospitals Furloughing Workers In Response to COVID-19,Alia Paavola: https://www.beckershospitalreview.com/finance/49-hospitals-furloughing-workers-in-response-to-covid-19.html
11. April 9: Doctors and Nurses Speaking Out on Safety Now Risk Their Jobs NY Times, Noam Scheiber, Brian M.Rosenthal: https://www.nytimes.com/2020/04/09/business/coronavirus-health-workers-speak-out.html
12. April 16: Nurses Must Prove They Got COVID-19 On the Job, Press Democrat, Julie Johnson https://www.pressdemocrat.com/news/10874578-181/sick-nurses-must-prove-they
13. April 19: A Doctor Describes the Clandestine Deal He Made to Get Masks and Respirators During the Coronavirus Pandemic, Stephanie K. Baer https://www.buzzfeednews.com/article/skbaer/coronavirus-ppe-masks-shipment-doctor-fbi
14. Gibson, R., Singh, J.P. (2018), China Rx: Exposing the Risks of America’s Dependence on China for Medicine, Prometheus.
15. April 24: Denver Health Executives Get Bonuses One Week After Workers Asked to Take Cuts, Health Leaders Media, CBS Denver https://www.healthleadersmedia.com/finance/denver-health-executives-get-bonuses-1-week-after-workers-asked-take-cuts
16. April 24: Want a Mask or Some Ventilators? A White House Connection Helps, Jonathan Allen, Phil McCausland and Cyrus Farivar, NBC News, https://www.nbcnews.com/politics/white-house/political-influence-skews-trump-s-coronavirus-response-n1191236
17. Organizational Safety Culture — Linking patient and worker Safety Occupational Safety and Health Administration (OSHA): https://www.osha.gov/SLTC/healthcarefacilities/safetyculture.html
18. State Reporting of COVID-19 Cases & Deaths in Long Term Care Facilities: Priya Chidambaram, Kaiser Family Foundaiton https://www.kff.org/medicaid/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/