Nurses’ Concerns with COVID19: Update April 1, 2020


Ongoing Issues: By now, most of us know the obvious: nurses and other healthcare professionals do not have the PPE that they need to practice safely. Nurses are testing positive for COVID19. The Defense Production Act has not been activated to produce more PPE and ventilators, and nurses and other providers are even fired for speaking out about it or organizing ways to access more PPE (Doctors and Nurses Fired for Speaking Out ).

Nurses’ Skill Level: Nurses are worried about being asked to do work they aren’t prepared to do. A former student of mine, who has been in more of an administrative role, is extremely concerned with being asked to go back into a hands-on medical surgical or even ICU in a supportive role. Practicing beyond one’s skill level or expertise is just one area of concern that is likely to grow as more nurses become ill, or refuse to work, or are otherwise unable to work. 

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Volunteer calls: From California to NYC to Maine, nurses are being asked to submit their names to volunteer to work. Most of these nurses will be paid, and it is an effort to organize our resources.

Nurses on the Front Line: The stories I am hearing from nurses are war-time hell-like, maybe even worse then you have heard of if you don’t have direct contact with nurses on the front line.

An example is a story a friend of mine posted from his friend in NYC: in the ER, there may be 7-10 COVID+ vented patients waiting for ICU placement. Some patients are lying on the floor in the ER because there are no beds. People are being taken to rooms on the floors and passing away before they even get seen by a nurse on that floor. Medications like propofol, ketamine, versed, and fentanyl are being run without pumps because there are no more pumps. Supplies are running out. Med Surg nurses are being forced to run drips and vents that they have not been trained on.

Pay Issues: In Utah, nurses and doctors are being asked to take pay cuts, and there is concern that this will create a great deficit of providers in this state when professionals go elsewhere to work (Utah’s largest medical provider announces pay cuts). Meanwhile, note this lovely NYC serene skyline shot, with pay that must recognize the obvious inherent hazard pay for these positions.

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(nurses recruitment add, contact information removed)

Populations and Outcomes:

Much preventative and maintenance care for those with chronic and even acute illnesses is now taking a back seat. A positive note is that telemedicine and telehealth are being used much more widely, and this may have a favorable effect on how we care for populations in the future.

Dr. Chinn forwarded a first-hand account to me of a nurse who is working in Brooklyn. She is concerned about how this illness is impacting Latinx populations, as they are often members of “essential worker” populations, and they also live in large households. This nurse states that these patients are at higher risk for death, and often experience death with less dignity. She also sees all staff getting sick, from direct care providers to janitors, and patient care technicians.

Anecdotally, in one social media group, I heard the nurses estimating that survival rate once a patient is ventilated is only around 14-20%. This is devastating to be surrounded around so much futile care and facilitating so much end of life care without perhaps the time and space it requires to do this well. (Edited: national statistics show a recovery rate of about 50% post ventilator initiation).

Heartbreak:  I am hearing heartbreaking stories of nurses sending off their children to grandparents or ex-spouses, so they won’t be exposed in the household should the nurse become sick themselves or accidentally contaminate the household. Nurses who can’t hug or hold their loved ones are aching inside every day. Nurses dying. Nurses looking around at their colleagues and they might wonder, who will be the next to not be at work, which one of us might end up in the ICU? Nurses may know that much of the care they are providing is futile or palliative, which creates moral distress. I am very concerned when I hear of nurses working multiple shifts, with one nurse posting that she had worked 13 shifts in a row, another posting about minimal sleep, and losing 10 pounds already. They don’t have time to eat and when they go shopping, the stores are lacking in supplies. There is no question in my mind that nurses are being put at greater risk not only due to exposure, but also due to physical, mental, emotional, and spiritual stressors.

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Post-Traumatic Stress: We could say nurses are stressed, or maybe we should just be truthful and say that nurses are being traumatized. I have great fears of nurses leaving the profession after this, and I also have great fears about the health of the population in general. I am fearful for those on the front lines without access to proper PPE. This sort of chaos we are experiencing may lead to positive change eventually, but for now, it’s extremely uncomfortable, painful, confusing, infuriating, and even disorienting.

We need to take good care of ourselves and take good care of one another.

I am reaching out with loving-kindness to all nurses:

May all nurses be safe

May all nurses be at ease

May all nurses be loved

May all nurses know personal healing

Namaste

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Nurses’ Concerns COVID 19: Update March 26, 2020


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.

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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


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.

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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.


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


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.

 

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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.