Nurses’ Concerns COVID19: Update March 29, 2020

March 29, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN

There is so much going on that it’s really hard to summarize all of the issues. I welcome dialog and discussion of your concerns and what you are seeing and hearing about.

Nurses’ Shifting Thinking About Duty To Provide Services

I am seeing a shift in thinking with more nurses being willing to leave their jobs as they are not adequately protected: working without adequate PPE creates harm to self, others, and community. An emergency room doctor was fired for speaking out about his hospital’s response (US NEWS report). So these actions are not without their cost.

We are also seeing more and more healthcare workers testing positive for COVID19. What stands out to me is the over 160 healthcare workers in Boston have tested positive for COVID19 in these early days. (Boston Hospital Workers test positive) and 12 nurses in Chicago have tested positive for COVID19 Chicago nurses test positive for COVID19.

Nurses who are staying in the direct care workforce are often very frightened: they are staying because if they quit, they won’t’ get unemployment, they are fearful that they won’t find another job because they left their current job abruptly, they are the sole or majority breadwinners in their families, and they are afraid of losing their healthcare benefits. Some nurses may still feel the deep roots of historically being linked to self-sacrificing, or with links to nursing’s history of religious or military duty (I do anecdotally feel like I am seeing less of this as the pandemic crisis grows).

New Grad Nurses as a Resource: Dr. Chinn pointed out to me that one area that is not getting enough attention is the idea of new grad nurses being allowed to or recruited into practice early, perhaps even before sitting for NCLEX or even finishing their final exams. An example: A CNO in a large New Jersey medical facility is begging a Nursing Program Director to send her senior nursing students to the clinical site, the NLN is okay with this, but how can she, in good conscience, allow her students to be there without proper PPE? Her students who work as techs at this facility also convey the dire conditions in the facility. Also, her faculty, like most nursing faculty, is older (in this case, age 59 on average) with underlying health conditions, which creates a greater risk for them as well.

My ethical perspective answer to this is that unless adequate supervision and proper PPE can be assured, the students should not be allowed into theses settings, as they will ensure harm to self and others, and we must abide by our ethical responsibility to practice beneficence and nonmaleficence. In my own setting as a director of an RN-BSN nursing program, we decided to remove all of our students from all clinical settings, even though we had students who wanted to stay in these community settings, the risks do not outweigh the benefits.

I also think of the challenges of being a new grad nurse: there is so much to learn and process and in a crisis situation will this even be possible? Will we ultimately end up losing a large number of these new grad nurses to post-traumatic stress and illness? This seems to me to really be lacking an ethic of care toward a very vulnerable population, our new grad nurses.

Is Nursing Political?

I was reminded this week that nursing is of course political. I found an interesting posting about how very political Florence Nightingale was. Cynthia Sim Walter (March 22, 2020, facebook) stated that during the Crimean War, Florence was first known as the Lady with a Hammer; she fought for her nurses to have what they needed to provide proper care, and she beat down military storerooms with a hammer. I loved this quote: “Military leaders loathed her and feared her. She drank brandy with the soldiers, did statistics for fun, and had no respect for the politics of men,” (I did not fact check this).

Florence took physical action when nobody else would and her actions were a political act of rebellion to save lives in dire times.

Let’s Reuse Our Masks? Here’s some data

This is heartbreaking when our leading facilities are looking for ways to somehow sterilize single-use masks. Here is something floating around on social media, put out by Stanford.

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The full report can be read here. It sums up two important things, that autoclave may be effective (the mask will not have the same integrity, particularly over time; please see stats above). Also with the plastic face shields over other masks, we have no efficacy data around their effectiveness (Stanford Report).

We still need PPE to be well stocked so we can be more assured that we are well protected. We still need to be demanding that.

New Resources and Webinars:

To share more current information, the American Journal of Nursing has joined with Johns Hopkins and others to share ideas around keeping nurses safe. Here’s the link with all the info. https://nurses.wikiwisdomforum.com/

The Schwartz Center for Compassionate Healthcare is offering a webinar on Tuesday, April 7, 1-2 pm EDT, entitled: Leading with Compassion: Supporting Healthcare Workers in Crisis. Register Schwartz Compassion Center Webinar

Be well.

Nurses’ Concerns COVID 19: Update March 26, 2020

March 26, 2020March 26, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

Yesterday, I received an email from Governor Cuomo asking about my availability to be part of the surge, where they are training and employing nurses to be on the front line of care during this pandemic. I am assuming I received it as I am newly licensed in NY state for my job.

Today, I learned from a nurse colleague of this story of an assistant nurse manager dying of COVID19. He had been treating COVID19 patients, was hospitalized March 17, and passed away Tuesday. Kious Jordan Kelly, RN, may he rest in peace, was only 48 years old. It was reported that he had asthma.

Unfortunately, he worked at one of the hospitals, Mount Sinai West Hospital, where nurses were reportedly short on PPE and using trash bags for PPE.

The nurses were also posting that they were out of masks and they were reusing disposable ones, along with reusing face guards that are simply wiped and reused. Some nurses are stating that the hospital should be held responsible for Nurse Kelly’s death, as they failed to provide him with proper PPE. Despite the pictorial evidence, Mt Sinai denies that the staff doesn’t have proper PPE.

I am seeing a bit of a shift in social media, where nurses are starting to resign or refuse to work due to lack of PPE. Nurses, in general, appear to be more accepting of the idea that some nurses have decided that it’s not worth the personal risk. I think we have to consider that the amount of stress and anxiety this pandemic has caused can also decrease immunity and stress resilience. We need to take care of each other.

Meanwhile, many states are calling for new grad RNs who may not even be licensed yet to be trained and allowed to work in these settings. We all know that ER and ICU type nursing skills that COVID19 patients require are not created overnight: it takes many nurses years of learning and growing toward expertise to be truly effective in these settings. This brings to mind questionable standards of care; as the population in need grows, we will lack the ability to provide skilled care that is needed. Some hospitals are trying to do rapid ICU classes, in literally 2-3 days, attempting to train nurses with some experience to become ICU prepared. I don’t know if that is really effective or possible, and I also don’t have other solutions to offer. I’d love to hear your thoughts on this.

Lastly, I leave you with this great link to the New England Journal where Dr’s Ranney, Griffith, and Jha discuss much of what I have also written about around the Defense Production Act. We need the President to actually enact so ventilators and PPE can be manufactured and distributed here. https://www.nejm.org/doi/full/10.1056/NEJMp2006141

Please, take action: contact your congressional members and the white house and demand that action be taken. https://www.usa.gov/elected-officials

Nurses’ Concerns COVID19: Update March 24, 2020

March 24, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I heard from a friend of mine who is a nurse; her sister is a nurse who is now off from work because she became very ill with COVID19 after just a few days of working.

I’ve seen nurses in social media posts fashioning PPE from garbage bags and using plain cloth gowns.

I’ve been told nurses are now putting cloth masks over N95 masks (no evidence that this helps and it may actually harm). There is talk on social media of nurses washing or autoclaving or UV sterilizing N95s, although all of these actions likely degrade the masks or render them useless.

The World Health Organization’s guidelines clearly state to not use cloth masks and to not reuse single-use masks. You can download the guidelines here. https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak?fbclid=IwAR2NRGtIs9AIIeI2HWiA5ZnOu4DoQL3GBOr40AvEJxul3Gms8RnQPb_ORCg

Through the social media grapevine, I heard that a health system in California has notified unionized nurses that they can be fired for choosing to wear their own N95s masks in the workplace. The systems standards of care and use of PPE around COVID19 positive and presumptive positive appears to have degraded due to lack of PPE and CDC claims. I could not verify this, but below is the circulation of the information.

Lastly, I received notice today that the American Academy of Nursing joined the ANA, AHA, and AMA calling upon the president to enact the Defense Production Act’s authorities in order to ensure that all healthcare providers have PPE and the needed medical equipment to care for people.

You can take similar action; all of the links to contact your legislative representatives and the President are in yesterday’s update posting.

Wishing you wellness and peace.

Nurses’ Concerns COVID19: Update March 23,2020. Take Action.

March 23, 2020March 23, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

Today in social media land, nurses state that they are being told to not use PPE for MRSA and VRE and other contact precaution patient care situations. I think we all know the dire implications around this.

Some are claiming that in other countries they have contacted nurses and doctors who do have access to adequate PPE.

Additionally, many are discussing at what point do you refuse to work because you don’t have proper PPE, or any PPE at all. Some nurses are grateful to be working and still have an income, others are worried and exhausted, some haven’t seen their kids or family in a week out of fear of exposing them to COVID19.

There are private companies that are helping hospitals and healthcare systems access more PPE for their needs. A former state legislator from Maine, Diane Russell, has been working as a broker to help state legislators from Massachusetts to procure PPE. So, instead of the federal government helping to ensure that the people on the front lines are protected, states and healthcare systems are having to turn to private organizations for assistance in just finding PPE: https://www.bostonglobe.com/2020/03/21/metro/message-maine-massachusetts-yields-much-needed-medical-supplies/? I do not know much about the company, I don’t know if the pricing is fair, but I do know they are able to provide many with PPE. https://noblemedicalsupply.com/products

It’s still early on the east coast, but I am not expecting the president to take action on the Defense Production Act today. I implore you to do the grassroots things and contact our representatives.

Be direct and clear; state your name, where you live, your contact information, your profession, and that you are asking them to ensure that the federal government takes action on the Defense Production Act so that healthcare workers have access to Personal Protective Equipment and patients have access to ventilators.

I suggest both phone and email messaging. I suggest leaving messages with the president’s office, and each of your representative federal lawmakers. It took me about 30 minutes to organize myself, write out my message, and both call and email the president, my governor, my federal legislators.

The full list of how to contact all of your federal and state lawmakers is found here on this main landing page: https://www.usa.gov/elected-officials

This link takes you to your house of representatives legislator and provides phone and email contacts: https://www.house.gov/representatives/find-your-representative

This link takes you to the senator’s contact information: https://www.senate.gov/general/contact_information/senators_cfm.cfm

It’s also important to contact your state government and aks them to request that the federal government take action. You can find your state government links here: https://www.congress.gov/state-legislature-websites and also from the main landing page, including your governor’s information.

*Thanks to those of you who dialogued and posted yesterday, though I haven’t had the energy to respond. I am trying to take good care of myself, as I still have a sore throat, headache, runny nose, body aches, no fever. All of the symptom checkers say it’s not COVID19. I wish you all wellness and peace.

Nurses’ Concerns with COVID19 Update: March 22, 2020

March 22, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I know for many people at this point a day might feel like a decade. We are worried and stressed. I myself have some concerning symptoms (headache, fatigue, weakness, sore throat, nasal congestion; no fever), but I will ride it out at home for now as we all know it could be a cold, the flu, or even adenovirus.

Cloth Facemasks, Update from the CDC: “In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.” https://www.cdc.gov/…/hcp/ppe-strategy/face-masks.html

In other words, the CDC is recognizing that an adequate barrier is still needed. I have heard from nurses that face shields are also in low supply; they are being shared, cleaned, and reused. I would assume this may be a safe practice for some face shields, and not for others.

From the nurses: One of my nurse colleague friends stated the hardest part of working in an ER is the changing circumstances; she told me that the recommendations for how they can safely care for patients literally shifts every 12 hours. In order to keep herself and her colleagues safe, she was able to purchase PPE, spending her own money, and they were allowed to bring it into the facility.

Some facilities are not allowing nurses and other providers to bring in their own PPE.

Some nurses on social media platforms state that they are buying, and some facilities are investigating the use of, what one might call industrial-grade respirators that have filters, which can be changed. Nurses have posted pictures of themselves in these types of respirators on social media pages. I have no data on whether these we will work and if this is the right move to make to be protected. I don’t know if a face shield works with them.

Lastly, nurses on social media platforms are concerned that they are being told that they cannot wear PPE unless absolutely called for, and hospitals are establishing those guidelines of when PPE is appropriate. They are being told that it’s an optics issue and that the administrators are concerned if everybody is wearing PPE in a setting like the ER, it gives patients and families the wrong image. And in this time of PPE shortage, there is the need to conserve PPE. This means that many nurses feel like they are taking unknown risks every time they work. Many have stated that they generally don’t feel safe, and they have anxiety about being in these settings.

I reached out to my federal representatives and received canned responses. I do suggest everybody do the same and consider manning the phone on Monday and calling their elected congressional representatives and senators to express concerns and ask for clarity around how the federal government plans to address the lack of PPE.

Ask them how the Defense Production Act is being used to ensure that those on the frontlines are being protected: it’s enacted, but it needs to be implemented. According to CNN, there is little evidence that it is being used to actively enhance the production of PPE and medical equipment like ventilators.

https://www.cnn.com/2020/03/20/politics/defense-production-act-trump/

Ask them for a clear plan for your state in procuring PPE.