Survey Of Nation’s Frontline Registered Nurses Shows Hospitals Unprepared For COVID-19

Results confirm little planning, poor communication, and shortage of equipment, National Nurses United petitions U.S. OSHA to act

A nationwide survey National Nurses United (NNU) conducted of registered nurses, the country’s frontline health care staff, reveals that the vast majority of United States hospitals and health care facilities are unprepared to handle and contain cases of COVID-19. The results were shared at a press conference held Thursday by NNU, the country’s largest union and professional association of registered nurses.

Photos of the press conference are downloadable here. Please give photo credit to National Nurses United.

Video of the press conference and other media resources are available here.

On Wednesday, NNU petitioned the U.S. Occupational Safety and Health Administration to adopt an emergency temporary standard to protect health care workers, patients, and the public. Currently, no enforceable OSHA infectious diseases standard exists nationally.

And in recent days, NNU has heard discussion about the Centers for Disease Control (CDC) weakening its current guidance even further, including recommending surgical masks instead of respirators for nurses providing care to patients with COVID-19. NNU is opposed to these changes.

“Nurses are confident we can care for COVID-19 patients, and even help stop the spread of this virus, IF we are given the protections and resources we need to do our jobs,” said Bonnie Castillo, RN and executive director of National Nurses United and the California Nurses Association. “This is not the time to relax our approach or weaken existing state or federal regulations. This is the time to step up all of our efforts.” 

While the survey is ongoing, results as of March 3, tallying responses from more than 6,500 nurses in 48 states, including the District of Columbia and the Virgin Islands, show that 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 properly use PPE.

Nurses at the press conference shared on-the-ground experiences that confirmed the lack of readiness indicated by the survey results. “The lines of communication between our employers and frontline staff on protocols for coronavirus and suspected coronavirus patients are not open for all shifts and all units,” said Cathy Kennedy, a neonatal intensive care unit RN and NNU vice president who works at Kaiser Permanente in Roseville, Calif., where the first California COVID-19 patient just died. “What happens when there is a lack of clear communication both ways between staff and management? Rumor and falsehoods fill the void, stoking unnecessary fear and anxiety. And the information nurses do get is contradictory.”

Deborah Burger, RN and an NNU president, read a statement by a quarantined Northern California Kaiser Permanente nurse who cared for a confirmed COVID-19 patient and has become symptomatic, but has run into numerous delays in getting tested for COVID-19. When her physician and the county health department agreed she should be tested, the CDC at first refused, saying that since she was wearing PPE, she couldn’t have the virus.

“What kind of science-based answer is that?” questioned the RN in her statement. Then, the CDC found other excuses. “[The CDC] claim[s] they prioritize running samples by illness severity and that there are only so many to give out each day. So I have to wait in line to find out the results. This is not the ticket dispenser at the deli counter; it’s a public health emergency! I am a registered nurse, and I need to know if I am positive before going back to caring for patients. I am appalled at the level of bureaucracy that’s preventing nurses from getting tested. That is a health care decision my doctor and my county health department agree with. Delaying this test puts the whole community at risk.” 

Some highlights from the survey include:

• Only 44% report that their employer has provided them information about novel coronavirus and how to recognize and respond to possible cases.
• Only 29% report that there is a plan in place to isolate a patient with a possible novel coronavirus infection. 23% report they don’t know if there is a plan.
• Only 63% of nurses report having access to N95 respirators on their units. 27% have access to PAPRs. 
• Only 30% report that their employer has sufficient PPE stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections. 38% don’t know.
• Only 65% report having been trained on safely donning and doffing PPE in the previous year.
• 66% have been fit tested in the previous year; 33% have not been fit tested in the previous year.
• Only 14% report that their employer has an overflow plan to place additional, trained staff to enable safe care provision to patients on isolation for possible novel coronavirus. 43% report they don’t know.
• Only 19% report that their employer has a policy to address employees with suspected or known exposure to novel coronavirus. 43% don’t know.

NNU nurses have been demanding that health care facility employers, the presidential administration, and federal and state and health officials and regulatory bodies follow the precautionary principle in their response to COVID-19, meaning that they act to protect workers, patients, and the public even before they know for certain that something is harmful.

Of employers, NNU is asking the following:

1. Employers shall implement plans and protocols in response to COVID-19 based on the precautionary principle, which holds that lacking scientific consensus that a proposed action, policy, or act is not harmful – particularly if that harm has the potential to be catastrophic – such action, policy, or act should not be implemented and the maximum safeguards should be pursued.
2. Employers shall clearly communicate with all RNs/health care workers, including notifying nurses when there is a possible or confirmed COVID-19 case.
3. Employers shall provide education and training for all RNs/health care workers, including on protective gear, donning and doffing, and all other protocols relating to COVID-19.
4. Employers shall provide the highest level of protection, including functioning negative pressure rooms and personal protective equipment for nurses providing care to possible and confirmed COVID-19 cases. Employers must ensure negative pressure rooms remain functional at all times during use. Highest level of PPE must include PAPR (powered air-purifying respirator), coveralls meeting ASTM (American Standard for Testing and Materials) standard, gloves, temporary scrubs, and other protections.
5. Employers shall plan for surge of patients with possible or confirmed COVID-19, including plans to isolate, cohort, and to provide safe staffing.
6. Employers shall conduct a thorough investigation after a COVID patient is identified to ensure all staff and individuals who were exposed are identified and notified. Any nurse/health care worker who is exposed to COVID-19 will be placed on precautionary leave for at least 14 days and will maintain pay and other benefits during the full length of that leave.

Of government, NNU is asking the following:

1. All registered nurses and other health care workers must receive the highest level of protection in their workplaces, as determined by the precautionary principle.
2. The CDC must improve screening criteria and testing capacity to ensure prompt recognition of and response to COVID-19 cases.
3. The Occupational Safety and Health Administration must promulgate an Emergency Temporary Standard to protect healthcare workers from emerging infectious diseases like COVID-19 as soon as possible.
4. Congress and the administration must ensure that any vaccine or treatment for COVID-19 that is developed with U.S. taxpayer dollars is provided to the American public when needed for free.
5. Congress must act immediately to pass an emergency spending package to fund the emergency response to the COVID-19 outbreak.