update

Nurses’ Concerns with COVID19: Update April 17, 2020

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

The COVID19 pandemic continues to be quite an issue in New York, with over 14,000 deaths reported. I found this link to the New York Times to be helpful in assessing where we are with official numbers of reported testing and deaths (NYTimes CVOID19), though in many states we know that testing remains very limited and accuracy of tests is still only at about 67-70%.

PPE: Nurses are still without proper PPE. While the federal government claims to have distributed millions of masks and gowns, frontline workers are still faced with shortages and putting themselves at risk. Now we are seeing surges in the cost of PPE, with costs going up over 1000%, according to a report published last week by the Society for Healthcare Organization Procurement Professionals. Competitive bidding for these supplies both internationally and within our own county has compounded the issue, and if we had federal government oversight and processes in place, it is likely these issues could be addressed in ways that would help to prevent price inflation ( CNN review of the inflation of PPE cost).

This video that appeared on CBS’s 60 minutes made it clear that nuses like New York nurse Kelley Cabrera are beginning to speak out. Nurse Cabrera works at Jacobi medical center in the Bronx. She makes the point that when nurses are required to reuse N95masks for up to 5 days, they are literally being provided with medical waste to be used as PPE. Nurse Kelley Cabrera 60 minute’s interview

Nurses Stories: Meanwhile, I have heard the stories of nurses continuing to work without proper PPE and we reultantly have high numbers of nurses testing positive in areas like Ohio.

Nurses have started to reject the idea that they be considered to be angels or heroes. They didn’t become nurses to die, and they don’t want to be martyrs. While the 7 pm clapping and cheering ritual in New York City seems to have built a community spirit, some nurses experience this differently. One New York City nurse wrote: ” I ask that you do not pity me, that you do not call me a hero. I do not wish to be made into a martyr….Clap for me and other healthcare workers at seven o’clock if it makes this pandemic feel more bearable. I concede, your cheers help us trudge on. Just know that cheers and hollering don’t change the outcome. This is my fervent plea – that we change what we can after all this is over”.

Fallen Nurses: The loss of nurses becomes hard to track as the numbers increase. NYSNA has set up a memoriam page: Fallen Nurses Memoriam

A 28-year-old pregnant nurse in the UK passed away on 4/12, RIP nurse Mary Agyeiwaa Agyapong. Her father passed away two weeks before she died. Mary’s baby daughter was delivered via cesarean section before Mary died.

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Many other nurses and hospital staff in the UK have also died (daily mail review of nurse and staff COVID19 deaths).

Two nurses in Palmetto, Florida have also died from work related exposure to COVID19. Nurse Danielle Dicensio leaves behind a 4 year old son and hubsand. Nurse Earl Bailey also worked at the same hospital, Plametto General Hospital, and he passed away from CVOID19 a few weeks ago. Both nurses complained about not having access to proper PPE, which the hospital denies (two nurses die of COVID19 ). 

A colleague of Nurse Cabrera’s (mentioned above), Freda Orcan,  who worked at Jacobihospital in the Bronx passed away March 28.

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ANA’s response to COVID19:

The Ameican Nurses Association has issued a statement that nurses should be reporting when then experience retaliation around their raising concerns regarding their personal safety in the workplace, as these are OSHA violations (OSHA and retaliation issues). While hundreds of complaints have been filed, it’s difficult to determine specifically how OSHA is responding to reports made. There is a plethora of information on their website regarding COVID19 issues (https://www.osha.gov/SLTC/covid-19/),

The ANA has created a page of resouces for nurses (ANA COVID19 page). There have developed a corona virus response fund for nurses. There is also a section about ethical guidelines for nurses that may help some in their decision making process and calls forward the bigger ethical issues that nurses are facing, and  links that show all of the steps that ANA is taking in advocating for nurses.

The latest ANA/ AHA/AMA letter witten calls for the government to address the issue of minorities and the disparities they experience with receiving adequate care for their COVID19 issues. (ANA letter to the Secretary, US Department of Health and Human Services). The letter in part reads:

“As organizations that are deeply committed to equity in health status and health care, we have long recognized differences in the incidence and prevalence of certain chronic conditions, such as diabetes, asthma, and hypertension — conditions that are now known to exacerbate symptoms of COVID-19. We also recognize that other factors, including but not limited to socioeconomic status, bias and mistrust of America’s health care system, may be resulting in higher rates of infection in communities of color. Lack of access to timely testing and treatment will inevitably lead to worse outcomes for these patients.

As America’s hospitals and health systems, physicians and nurses continue to battle COVID-19, we need the federal government to identify areas where disparities exist and help us immediately address these gaps.”

While ANA has been interacting at the national level, my perception from the nurses directly working with patients on the frontlines is that they feel under-represented and that ANA is not providing them with the voice they need. One time letters to federal authorities seem to make little measurable immediate impact. around what matters for nurses being able to practice safely. They also feel that many of the practicing nurses don’t belong to ANA exactly for this reason: that there is somehow a gap between the reality of nursing practice and the work and publications of the ANA. The crisis is far from over.

May all nurses and all beings know some peace and ease.

Nurses’ Concerns with COVID19: Update April 1, 2020

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 4 Comments

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 COVID19: Update 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.

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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.

COVID19 and Nurses’ Concerns

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 1 Comment

Nurses are the backbone of all of the health care professions: we care for people and communities in difficult situations. We are compassionate and ethical. We put ourselves at risk daily for everything from violence from patients and families to contacting contagious diseases to post-traumatic stress from what we witness.

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Here is some of what I have read about on the social media COVID19 for nurses and healthcare providers pages that are popping up faster than dandelions.

  1. There is poor planning by, and a lack of communication from, most hospital systems, likely in part impacted by the lack of leadership at the state level. A national survey of nurses by National Nurses United found “high percentages of hospitals do not have plans, isolation procedures, and policies in place for COVID-19; that communication to staff by employers is poor or nonexistent; that hospitals are lacking sufficient stocks of personal protective equipment (PPE) or are not making current stocks available to staff; and have not provided training and practice to staff on how to use PPE properly”. https://www.nationalnursesunited.org/press/survey-nations-frontline-registered-nurses-shows-hospitals-unprepared-covid-19
  2. Personal Protective Equipment is now rationed. In inpatient settings, some nurses are asked to use just one mask/ day. An article in the New YorkTimes details how nurses are begging for PPE: https://www.nytimes.com/2020/03/05/us/coronavirus-nurses.html 
  • In the home care settings, nurses are asked or told to use one mask and one gown/ day. Obviously, this means they can’t maintain or implement proper precautions when traveling from house to house, the gown itself potentially becomes a contaminant.
  • In the home care setting, patients are canceling appointments because they view the nurses as vectors. In the long run, this could have huge implications for greater levels of care needed by these patients if they decline without proper care and guidance.

2. Most facilities do not have plans in place for the forthcoming surge in COVID19 patients.

3. The Centers for Disease Control rolled back the N-95 mask requirement and has stated that a simple surgical mask is sufficient in caring for COVID19 suspected or confirmed patients, and that may be used for extended periods while caring for multiple patients. They also have decided that reusable gowns are fine to use. https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

4.  Fears of getting sick themselves are rampant amongst nurses and other providers. Pregnant nurses have no idea if a COVID19 infection might affect their pregnancy. Those nurses with existing health conditions who are at risk are not sure if they should come into work, or reveal their health conditions to the workplace, or risk losing their jobs. Additionally, nurses who come home to care for elderly relatives, children, etc. are petrified of making them sick.

5. Nurses are not offered COVID19 testing, and if they have symptoms, they are often being told to use vacation, paid time off, or leave without pay, and to self-quarantine and contact the workplace in 14 days.  Those who are at risk are not identified quickly. https://www.theverge.com/2020/3/5/21166088/coronavirus-covid-19-protection-doctors-nurses-health-workers-risk

6.  Nurses may be mandated to work overtime, which can wreak havoc on stress levels and immune responses. https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

The CDC and NIOSH recognized years ago that working 12-hour shifts alone may be dangerous, with deteriorating performance on psychophysiological tests and an increase in risk for injuries. Poor outcomes and personal capabilities worsen with 12-hour shifts worked particularly in combination with working more than 40 hours. Working overtime obviously leads to physical fatigue, and it also increases risks for alcohol use and cigarette smoking. And there is still a lot we don’t know, such as how does working longer impact women or older workers? What about those with pre-existing or chronic conditions? What is the influence of occupational exposure?

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What can we do, and what are nurses doing?

Now is the time: we are going to have to advocate for ourselves. We also need to demand proper access to PPE, PPE training, proper testing approaches, and call for OSHA standards related to the risks we face.

We can all act as advocates locally to call for safe working conditions, and we can join forces with our national nursing organizations to continue to call for support, funding, and access to proper PPE.

Feel free to share your ideas here.