11 months into pandemic and entering the cold and flu season, nurses say there are no excuses for the continued lack of PPE, testing, and workplace protections

National Nurses United’s new nationwide survey of more than 15,000 registered nurses reveals that 11 months into the pandemic, hospitals are failing to prepare for a surge of Covid-19 cases during flu season and that basic infection control and prevention measures are still lacking. Nurses cite the health care industry’s inappropriate pursuit of profit during this public health crisis as the main reason for its failure to follow the proper infection control measures that nurses have been demanding since the beginning of the pandemic.

This survey is the fourth national survey of nurses during the pandemic by NNU, the nation’s largest and fastest-growing union of registered nurses. NNU’s latest survey also reveals that nurses face ongoing issues of not getting tested, not being notified in a timely manner when they are exposed, inadequate personal protective equipment (PPE), unsafe staffing, mental health impacts, and increasing workplace violence.
 
The country is heading into flu season, yet only 18 percent of RNs in hospitals report any preparation for surge capacity and planning. Meanwhile, just 16.5 percent of RNs in hospitals report they have universal personal protective equipment (PPE) in the emergency department, where patients may not be screened for Covid-19 before receiving care. Only one in five nurses report that all patients are screened for respiratory symptoms to identify and distinguish between Covid-19 and other illnesses before admission to a health care facility -- an important step to stop infectious disease transmission within health care facilities. (See below for more data on the lack of preparation.)
 
Fewer than half of RNs who work in hospitals (43.6 percent) report that all patients are screened for Covid-19. All patients should be screened for Covid-19. Hospitals are failing to implement proven measures to prevent the spread of Covid-19 within the facility: Only 60 percent of RNs who work in hospitals report that their facility has a dedicated Covid unit or area. Strikingly, 8 percent of RNs who work in hospitals report that their facilities shut down their Covid unit or area.  
 
“Hospitals are continuing to fail when it comes to preparation for Covid-19, even as flu season begins,” said NNU Executive Director Bonnie Castillo, RN. “They have had nearly a year to get their act together. We should not still be operating under crisis standards of care. Their lack of preparation means they are knowingly sacrificing the lives of nurses and other health care workers. More than 240 registered nurses have died from Covid-19. Enough is enough. Nurses need PPE now to do their jobs safely. We know that President-Elect Joe Biden is committed to using the Defense Production Act to get PPE mass produced in this country and to pass an OSHA Emergency Temporary Standard to protect nurses and other workers.”
 
Nurses are not getting tested and they are not being informed in a timely manner when they are exposed to Covid-19 at work. Only one-third of RNs overall and fewer than half (42 percent) of RNs in hospitals report that they have ever been tested for Covid-19. This is an increase from the last survey in July, when just 23 percent of RNs overall reported being tested, but does not go far enough. RNs must have access to testing and employers must take seriously the task of identifying and responding to exposures, including conducting contact tracing and informing staff of exposure. Over 70 percent of nurses say their employers do not inform them of exposures in a timely manner.
 
Employers are not providing RNs with the necessary PPE to do their jobs safely. More than 80 percent of nurses report they are reusing at least one type of single-use PPE. About 20 percent of nurses in hospitals report that their employer has recently limited the use of N95 respirator masks. In addition, fewer than half of nurses in hospitals report not using respiratory protection when caring for patients who might have Covid-19 but who have not been tested or whose test results are pending. In comparison, more than 70 percent of hospital RNs report using N95s for Covid-19 patients. In order to protect nurses and other patients, hospitals must ensure that patients who are suspected of having Covid-19 have the same precautions in place as confirmed Covid-19 patients.

Short staffing is increasingly an even bigger problem in hospitals, with 30 percent of nurses reporting that it is their number one safety concern. Nearly half of hospital nurses (42 percent) report that staffing has gotten slightly or much worse recently. In addition, 20 percent of nurses report being reassigned to units where new skills or competencies are required, without adequate training.

Employers are forcing nurses to go to work sick, rather than stay home. Paid sick leave is an important and proven measure to protect the health of nurses, other health care workers, and their patients. But only 36 percent of hospital RNs reported always being able to stay home when they have influenza or Covid-like symptoms.

Covid-19 is having a deep impact on the mental health of nurses, with more than 70 percent of nurses in hospitals reporting that they are afraid of getting Covid-19 and 80 percent fearing that they will infect a family member.

• Half of hospital nurses report they have more difficulty sleeping than before the pandemic.
• Nearly 80 percent of hospital RNs report feeling more stressed than before the pandemic.
• Nearly three-quarters of nurses report feeling more anxious.
• 62 percent report feeling more sad or depressed.

About 20 percent of nurses report facing increased workplace violence on the job, which they attribute to decreasing staffing levels, changes in the patient population, and visitor restrictions.

Lack of preparation for influenza season
Health care facilities are not prepared for a Covid-19 surge during flu season:

• Just 18 percent of RNs in hospitals report any preparation for surge capacity and planning.
• Only 17 percent of hospital RNs report universal PPE use in emergency departments.
• 8.6 percent of hospital nurses report plans for outdoor triage for patients with respiratory symptoms.
• Only 20 percent of nurses report screening of all patients for respiratory symptoms before admission; 27 percent of hospital RNs report this.
• Only 12 percent of RNs report their employer has increased PPE stock and supply in preparation for flu season/Covid-19 surge.
• 11 percent of RNs report receiving staff education on recognizing respiratory infections.

NNU’s first survey in March focused on hospitals’ lack of preparedness for Covid-19; the second survey in May highlighted government and employers’ disregard for nurse and patient safety; and the third survey in July revealed the devastating impact of reopening too soon. This fourth survey demonstrates clearly the continuing disregard that hospitals and health care employers show for the safety of nurses and health care workers.
 
The survey results were gathered from both NNU unionized nurse members as well as nonunion nurses in all 50 states plus Washington, D.C. and two U.S. territories. The preliminary results cover the period Oct. 16 to Nov. 9.