By Sheri Williams
Patients are swarming into emergency rooms in Sacramento and across the county, as nurses continue to fight for basic protective gear to safely do their jobs during the pandemic.
“All that nurses are asking for is to make sure they are protected,” a Roseville nurse told media during an action in front of her Kaiser hospital recently. “They need to have gowns, they need to have gloves… so that we don’t infect ourselves.”
Coronavirus cases have surged to more than 100,000 across the country in recent weeks, and hospitals in California are increasingly seeing their beds filled with patients battling COVID-19, the illness caused by the virus. The highly-contagious virus can infect up to three people for every person that has it – likely more in health care settings where patients may need high-risk procedures such as being placed on ventilators.
But hospitals still lack basic protective gear including masks. In New York, where the epidemic is worst, some medical workers have been forced to resort to trash bags as gowns run out.
The U.S. Centers for Disease Control and Prevention issued guidelines recently explaining how to use a store-bought bandana instead of a sterile surgical mask. That, say nurses and union leaders, is an unacceptable failure. Faced with the potential of months of shortages, nurses unions are fighting back.
The California Nurses Association/National Nurses United have called on California Gov. Gavin Newsom and other state officials to sharply escalate steps to immediately get personal protective equipment to nurses and other health care workers, along with federal efforts.
“It is outrageous for the CDC to tell hospitals that nurses and other health care workers don’t need the maximum protective gear to prevent them from getting sick during this pandemic, said Bonnie Castillo, RN and CNA Executive Director. “Protecting nurses is absolutely essential as we are head into a crisis, the scale of which many of us have not seen in our lifetimes.”
Yet, PPE supplies are still drastically short of what is needed to stem the danger of nurses becoming infected and exposing patients, family members, and other healthcare staff.
“While the Governor has taken some important steps, including the statewide stay-at-home order, and reopening two closed hospitals, we need to do far more, especially in producing proper personal protective equipment,” said Castillo.
“We hear from scores of nurses every day, across the U.S., and many of them in California. They still do not have access to proper protective masks, such as N95 respirators, and full head-to-toe protective clothing,” said Castillo.
She continued, “They fear for their safety, for their patients’ safety, for their family’s safety, and for their co-workers’ safety. If they are not protected and safe, more people will die, and the virus will continue to spread in greater numbers.”
To make matters worse, the California Department of Public Health, which has been underfunding public health budgets for a decade, recently informed California hospitals that it is waiving the state’s current strong requirements on hospital safety.
This waiver will allow hospitals to sharply lower practices on a wide variety of standards, including personal protective equipment (PPEs) and even safe nurse staffing for patients (nursing ratios).
On PPEs, CDPH cites the much lower, non-mandatory, guidelines suggested by the Centers for Disease Control and Prevention that is allowing hospitals to use vastly inferior materials, such as bandanas, that provide almost no effective protection when patients are highly contagious.
“At a time when nurses are already being told to use makeshift, inferior coverings, see N95 respirators locked up, and even being disciplined when they bring in their own N95s, this is the worst message we can send to hospital employers,” Castillo noted.
“When nurses see that neither public officials, nor their hospitals, are putting much value on their safety, that is a prescription for even further disaster,” warns Castillo, “that will have tragic consequences and do nothing to stop an escalating disaster.”
California should be moving in exactly the opposite direction, said Castillo.
While President Trump has refused to use his authority under the just re-enacted 1950 Defense Production Act to order domestic manufacturers to mass produce personal protective equipment, as well as ventilators and other critical hospital supplies, states should take the steps they can, said Castillo.
New York Gov. Andrew Cuomo has said he will use state funding to pay businesses to mass produce protective equipment for health care workers.
“Gov. Newsom should do that as well,” Castillo said.
NNU has surveyed more than 8,200 nurses from all U.S. states and territories. As of March 16, just 55 percent report having access to N95 respirators, and only 27 percent have access to the highest standard, powered air-purifying respirators (PAPRs). Only 24 percent say their employer has sufficient PPEs in stock to protect staff when the inevitable surge of COVID-19 patients occurs.
National Nurses United is stepping up pressure on hospital employers across the U.S. to provide safer facilities for health care workers and patients as confirmed coronavirus cases, and COVID-19 deaths, continue to skyrocket.
In recent days NNU has filed over 125 complaints with Occupational Safety and Health Administration (OSHA) offices in 16 states charging individual hospitals with failing to provide safe workplaces, as required by law.
Most of the filings concern insufficient personal protective equipment (PPE) for nurses and their co-workers which exposes health care workers and patients to severe risk of infection and further spreading of the dangerous virus. Complaints also cite other unsafe conditions, such as improper isolation rooms for infected, or suspected infected, patients.
“This is a national emergency and far too many hospitals are still failing to ensure that our caregivers who are placing their own safety at grave risk have the protections they need to stay at the bedside for their patients,” said Castillo.
Across the U.S., hundreds of health care workers have been infected, even with incomplete reports, with deaths of health care workers already reported in New York and Georgia.
“We have learned from tragedies in Italy and Spain that hospitals have become a major vector for the spread of COVID-19. That is happening in the U.S. now too. It is long past time for our hospitals to do more, far more, to guarantee they will protect the frontline nurses and other staff who are putting their own lives in grave danger every day,” Castillo said.
In about a dozen cases, so far, state OSHA branches have required the hospitals to respond within five days confirming that they are investigating and addressing the violation or face on-site investigation which could be followed by citations and fines for continuing to operate unsafe facilities.
At Marin General Hospital near San Francisco, for example, state regulators warned the hospital it “failed to provide necessary PPE to employees who may provide care to suspected COVID-19 cases.” Additionally, that the hospital was not meeting California’s standard, among the strongest in the nation, of an exposure plan and workplace precaution controls for airborne transmission as well as the more lax just droplet contagion.
Near Chicago, the state OSHA office notified Ingalls Memorial Hospital that it has received notice of alleged workplace hazards of “nurses assigned work in negative pressure units with COVID-19 patients not provided appropriate PPE and N95 respirators,” and “required to re-use PPE and N95 respirators or overextend their recommend use.” Additionally, the hospital reportedly has “some negative pressure rooms (that) do not function properly.”
Additionally, NNU members have submitted over 1,400 electronic complaints directly to employers citing similar concerns. NNU members have also engaged in multiple facility protests as well, including candlelight vigils and standing outside facilities, with signs and proper social distancing, to alert the public to unsafe safety protections inside.
California accounts for over 60 percent of the filings, at a time the state health department has been underfunding public health budgeting for a decade.
“With these filings, we are making it clear to both the hospitals and our state regulatory agencies that they have an essential job to do to protect public health and safety,” said Stephanie Roberson, legislative director for the California Nurses Association/NNU.
“If they don’t act now, our hospitals will quickly become overwhelmed with patients, and we will face a dire shortage of nurses who will themselves be sickened and no longer available to care for patients,” Roberson said.