RNs forced to reuse PPE and work in unsafe conditions

As many states have moved to reopen, a new groundbreaking survey of more than 21,200 nurses reveals that health care workplace conditions remain dangerous and nurses are afraid of infecting their families with COVID-19, announced National Nurses United (NNU) today. The safety of nurses is essential to a safe reopening.

Only 24 percent of nurses surveyed think their employer is providing a safe workplace. Nurses are at risk of exposure to the virus for many reasons, including reuse of personal protective equipment (PPE), patients and nurses not being tested, and lack of dedicated COVID-19 units. One result of these unsafe practices is that 43 percent of nurses reported that they are afraid of infecting their families.

Some 87 percent of hospital nurses reported reusing at least one type of single-use PPE, such as an N95 respirator or a face shield. Reusing single-use PPE is a dangerous practice that can increase exposures to nurses, other staff, and to patients.

“Nurses warned about reopening too early, and now this survey shows that nurses are bearing the brunt of premature relaxing of shelter-in-place orders,” said NNU Executive Director Bonnie Castillo, RN. “We are facing a record-breaking number of infections everyday across the country, and more than 165 nurses have died of COVID-19.”

Months into the pandemic, only 23 percent of nurses reported being tested. Yet 85  percent of nurses who work in hospitals reported that their facility has restarted elective procedures. The lack of testing jeopardizes nurses’ health and safety and their ability to protect their patients and families.

“One of the only agreed-upon criteria for reopening has been robust, reliable testing,” Castillo said. “Nurses and other health care workers must be prioritized for testing. It is a travesty that only a fraction of health care workers have been tested. Nurses do not have the access to testing that they need. We have seen how essential nurses' contributions are, so it is essential that they are both protected and their voices heard as they insist on science-based interventions to mitigate the spread of COVID-19. “

“At a time when the skills of registered nurses and other health care workers are most needed, it is unconscionable that they are being treated as if their lives are worth less than others with this utter disregard for their safety. Nurses are willing to be at the bedside caring for COVID-19 patients; their employers should be willing to protect them. Sadly, that’s not the case.

“This is why we need the Occupational Safety and Health Administration (OSHA) to pass an emergency temporary standard for infectious diseases to mandate that healthcare employers provide protections needed for COVID-19. We also need President Trump to use the Defense Production Act (DPA) to order the mass production of PPE now. And, finally, we need the Senate to pass the HEROES Act, which contains language on the DPA and mandates an OSHA standard on infectious diseases.”

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 three U.S. territories. The preliminary results cover the period July 7 to July 27.

Workplace Safety

Only 24 percent of nurses think their employer is providing a safe workplace. Health care facilities should have designated, separate zones for COVID-19 patients, persons under investigation, and patients for whom COVID-19 has been ruled out. Facilities should be isolating COVID-19 and suspected COVID-19 patients in a negative pressure room. But only 15 percent of nurses reported that COVID-19 patients were always placed in a negative pressure room and just 18 percent reported that they were sometimes placed in a negative pressure room.

●   32 percent of nurses reported that their facility does not have a dedicated COVID-19 area or unit; 68 percent of respondents have a dedicated area. Commingling patients increases the risk of cross infection.
●   Only 31 percent of nurses report that every patient is screened for COVID-19. Screening is a critical part of infection control and reducing exposure to the virus.
●   16 percent reported that their facility did not have a negative pressure room.
●   36 percent of nurses who work in hospitals reported that they are afraid of catching COVID-19 and 43 percent are afraid of infecting a family member.

Personal Protective Equipment

Overall, 87 percent of nurses who work in hospitals report reusing at least one piece of PPE. Here’s the breakdown by type of PPE for nurses who work in hospitals:

●   53 percent reported they had to reuse single-use N95 respirators
●   36 percent said they had to reuse single-use face shields
●   37 percent reported they had to reuse single-use surgical masks
●   Only 9 percent said they did not have to reuse single-use PPE

So-called decontamination of single-use PPE has increased. About 54 percent of nurses who work in hospitals say their employer has implemented a program to “clean” single-use PPE, such as N95 respirators, between uses. This is nearly double from NNU’s May survey of nurses, when 28 percent of nurses reported using these so-called decontaminated N95s. “Decontamination” of single-use PPE has not been proven to be safe or effective. If a facility reprocesses PPE, the FDA requires notification as part of the authorization for these systems to be used in healthcare settings. Yet only 12 percent of hospital nurses were notified by their employer of the risks associated with using so-called decontaminated PPE. Health care employers’ use of unproven “decontamination” systems means they are experimenting on their employees without consent.

COVID-19 Testing

Only 23 percent of nurses reported being tested.

Staffing

Staffing at some hospitals is at a crisis level due to the pandemic, with short staffing and nurses being reassigned to areas where they do not have clinical competencies, which puts patient safety at risk.

●   27 percent of nurses who work in hospitals reported that staffing has gotten much worse recently. Short staffing is unsafe for patients and nurses. The likelihood of patient death increases by 7 percent for every additional patient in the average nurse’s workload in the hospital.
●   30 percent of nurses who work in hospitals reported that they had been reassigned to a clinical care area where they were expected to care for patients that require new skills or competencies; of those nurses,42 percent said this reassignment limited their ability to practice safe nursing care.

Mental Health

The pandemic has had a negative impact on the mental health of nurses who work in hospitals. Registered nursing is a stressful occupation; the COVID-19 pandemic has amplified that stress. The lack of care for nurses only magnifies that stress further as the results of the survey illustrate.

●   42 percent report feeling stressed more often than before the pandemic.
●   38 percent feel more anxious than they did before the pandemic.
●   29 percent feel sad or depressed more often.

The survey results underline the impact of reopening too soon. NNU issued a statement on April 28 that reopening was “premature when the threat of the virus causing COVID-19 is not yet behind us.” Then on June 2, NNU issued a joint statement with other nurses unions warning against early reopening without meeting certain criteria, including nurses having optimal PPE.