Nurses at health systems around the country are endangered by a shortage of appropriate personal protective equipment and other supplies amid new surges of COVID-19 patients, the nation's largest nurses union said Monday.
During a virtual press conference, National Nurses United (NNU) called for more federal financial and regulatory support, as well as increased support from health systems, to protect the nursing workforce.
"We're here today to demand change. Since the earliest days of the pandemic, National Nurses United has called on our employers and our government to follow science and use the precautionary principle. That means that until we know for sure what's safe, we use the highest levels of protections and precautions, not the lowest," said Bonnie Castillo, NNU's president. "Nearly a year later with science now clearly showing that airborne, aerosol transmission of SARS-CoV-2 virus is a major form of transmission, nurses and other healthcare workers are still fighting for the protections we need."
Specifically, Castillo called for the federal government to fully utilize the Defense Production Act to mass produce and distribute PPE in the volumes required. She also called for the passage of the Heroes Act to require temporary, emergency Occupational Safety and Health Administration rules mandating infection control protections from employers during the pandemic.
She also called on public support for safety measures that would help curb the spread of the virus in light of the approach of Thanksgiving later this week.
"We urge the public to stay home this holiday season to make sure this time next year no one is missing from the dining table," Castillo said. "We know that we can get this virus under control. We need a vaccine that is safe, effective, and widely available, free of charge, but during and after any rollout we will still need to continue with all the protections I mentioned. We call on the public and our leaders to do their part."
Nurses say PPE availability lacking
During the press conference, a group of several nurses working at hospitals in Florida, Texas, Illinois, Michigan and Minnesota described in stark terms what they're experiencing as COVID-19 patients pour in. They said they are worried about their safety and the safety of their families, as well as for the safety of patients. At least 2,100 healthcare workers have died of COVID-19 since the pandemic began, officials said during the call.
"Florida is a hot mess. My hospital is a hot mess," said Marissa Lee, a labor and delivery nurse at Osceola Regional Medical Center in Kissimmee, Florida, and a vice president for NNU. Osceola Regional is part of Nashville, Tennessee-based HCA Healthcare. "The proper infection control measures ... my hospital is not doing. We don't have optimal PPE that provides airborne droplets precaution. Most of the nurses in my hospital only get surgical masks unless they are caring for patients that are confirmed COVID positive. They get a single-use N95 respirator that they wear for the entire 12-hour shift."
Her concerns were echoed by the other nurses who spoke, including Juan Anchondo, a registered nurse at Las Palmas Medical Center in El Paso, Texas, also a part of HCA. El Paso has been a hot zone of COVID-19 cases.
While he works on a general medical-surgical floor at the hospital instead of a COVID-19-designated floor, he said patients sometimes make it to the unit that turn out to be COVID-19-positive. The hospital has expanded its use of oncology, telemetry and pediatric units to create COVID-19-designated floors, and Anchondo said he gets floated to a COVID-19 floor “practically every other week.” That makes it important for he and his co-workers to have proper protection, he said.
“At the beginning of the pandemic, we only got surgical masks," Anchondo said. "Now we get one N95 per shift, unless it gets soiled."
He also said nurses do not get hair or shoe coverings, and many are buying their own to protect themselves. “We are told: We don’t need them anymore," he said.
Hospital officials defend surge planning
A spokeswoman from Las Palmas said the union has been using the pandemic in an attempt to discredit the work the health system has done to respond to the pandemic. She said the health system is proud of the work it has done.
"From day one of this pandemic, our focus has been on protecting the wellbeing and livelihood of our caregivers and their families," she said in a statement. "As part of HCA Healthcare, we have access to extended resources for PPE, equipment, and staffing support. Our frontline caregivers have shown unwavering commitment, and our efforts to protect them have included the screening and testing of our colleagues, universal masking, contact tracing and notification, the assignment of a PPE steward to ensure the proper use and fitting of protective equipment and other safeguards, in line with guidance from the CDC. We maintain an open dialogue with our caregivers and round on them regularly to ensure they have adequate supplies and equipment."
Hospitals nationwide reported PPE shortages early in the pandemic and even into the summer months amid surges. Many reported changing their supply chain practices. Amid the challenges to obtain enough masks, Charlotte, North Carolina-based healthcare improvement company Premier and 15 healthcare systems partnered to buy a minority stake in Prestige Ameritech, the largest domestic maker of PPE such as face masks and N95 respirators.
This fall, federal officials have said hospitals across the U.S. are no longer reporting problems with obtaining enough PPE. Large publicly-traded health systems like HCA reported strong stockpiles of supplies, saying they were using their scale to their advantage to move additional supplies to hospitals from other areas of the country as needed.
But nurses say efforts by their employers, as well as support from the federal government, are falling short.
"At my facility, I have been asking for an inventory of PPE since mid-October and I have not gotten it," said Consuelo Vargas, a registered nurse in the emergency department at the John H. Stroger Hospital Jr. of Cook County in Chicago. "When I do go to get my PPE, I am told the N95 I used before is no longer available and therefore I’ve gone and purchased my own N95 to protect myself and my family."
Vargas also raised concerns about enough staffing as well as worries that confirmed and suspected COVID-19 cases were not being properly isolated in the emergency department.
North Memorial ICU nurse and Maryland Nurses Association President Mary Turner said she's growing alarmed as Minnesota hospitals run out of beds. She said nurses in Minnesota hospitals have protested multiple times to the governor and the state legislature to get proper PPE and protections. The federal government needs to make it easier for hospitals to obtain more supplies, and hospitals need to be more transparent about their crisis staffing plans, she said.
"We are trying to care for patients despite limited supplies, limited staff and a rapid decline in hospital beds," Turner said. "Meanwhile, we know that at any time, we could get sick or worse yet, get our families infected. Every night I work, I see the devastating physical effects of this virus. Patients who are intubated are face down as they struggle to breathe, laying in a bed alone with no family support around them. It’s up to me and my fellow nurses to bring them comfort. As a labor leader and a fellow nurse, I’ve had to care for co-workers, nurses, and other front-line workers as they struggled for their lives on a ventilator. This is because our hospitals and our government haven’t protected us."
I've reached out to officials at Stroger Hospital, as well as at North Memorial, for comment and will update this story when I hear back.
During the call, nurses grew emotional as they extended their calls for help to the public, imploring their communities to take the threat seriously and to follow basic safety measures to prevent the spread of the virus, particularly in light of the holiday season.
"You need to protect the nurses and all hospital workers so that we can care for you," Turner said. "We are your front line of defense and more importantly, and please listen, we are your only line of defense."