EBOLA- Is this a game changer?

[HouTx, BSN, MSN, EdD]

I am heavily involved in development of my organization's strategy for dealing with EBOLA & any other "highly infectious disease". As part of this process, it has become apparent that some new workplace issues are surfacing.

The issue of Quarantine- our state health dept issued public transport/travel bans on anyone who was involved involved in the care of 'patient zero' ... for 21 days after their last contact. They are forbidden to use any public transport or leave the state during this time. Remember, these people are not symptomatic, they just happened to enter the room - and everyone was wearing PPE. Violators could be subject to criminal penalty. This supports the CDC position.

So - in practice, facilities could essentially "quarantine" staff who are involved in the care of these patients... there is no exception granted for those who were wearing PPE. What would you do if you were caught in this situation and had to be isolated not only while you were caring for the patient but 3 weeks afterward? Who would take care of our family? Will our employer continue to pay your salary during this time?

Contracting the illness: You'll probably be covered by Workers Compensation, but this only covers treatment, not income replacement. If your employer claims you became ill because you "violated protocols"... they may not cover the cost of your care. How can we support ourselves with a dramatically reduced (or lack of) income? What if we're stuck with treatment costs?

This is serious stuff. Nurses need to be aware of the very real consequences of simply caring for patients with this category of disease. Those of us who work in ED, ICU and even L&D would be the most affected.

Thoughts?

[APRN., DNP, RN, APRN, NP]

This is why I carry additional insurance. I do not look towards my employer to be my safety net in the instance where I am disabled (even temporarily). I think it is the prudent thing to do.

[lifelearningrn, BSN, RN]

I don't know that they could force you to stay in the facility if you have access to your own transportation, unless you're exhibited symptoms? I think if they do, they should be responsible for all expenses, including (and not limited to) child care expenditures.

Honestly, I think the 'panic' with Ebola is mostly unwarranted. The nurses were not given proper PPE. So far, neither of them have infected anyone else. Duncan, who was in close contact with friends and family before being hospitalized didn't even pass it to those people. The healthcare workers that took care of the other people brought into the country for Ebola treatment have gone about their lives, and nobody has been infected. It's absolutely ridiculous that someone who "might" have handled a glass vile (wearing gloves) from the Ebola pt's blood, be forbidden to exit a cruise ship, or get on an airplane.

If this were a true pandemic disease (it is NOT, and never has been in it's nearly 40 years since discovery), I might change my opinion on how it's being handled, but for now, I think it's insane.

Having said that, I think hospital workers are only going to benefit from this exercise, and perhaps all this craziness will serve to better prepare us for a REAL catastrophic pandemic.

[llg, PhD, RN]

I hope it is a game-changer in at least one way. ... I hope that it will be a "kick in the butt" for hospitals that have decreased their investment in staff education ... counting a very basic online module as sufficient yearly training for infection control and other safety procedures. This year, it's Ebola. Next year, it could be TB ... or a hospital fire where staff doesn't react properly ... etc. Staff need regular updates that include face-to-face time to discuss issues, ask questions, and actually practice with equipment in order to be able to handle critical situations effectively. The little computer modules do not do a good enough job to ensure good performance in an unexpected, real-life situation. I hope this unfortunate situation causes hospitals to re-instate better, more thorough training on these things -- as well as an investing more effort into developing appropriate policies, having equipment on hand, etc.

[LadyFree28, BSN, LPN, RN]

I hope it is a game-changer in at least one way. ... I hope that it will be a "kick in the butt" for hospitals that have decreased their investment in staff education ... counting a very basic online module as sufficient yearly training for infection control and other safety procedures. This year, it's Ebola. Next year, it could be TB ... or a hospital fire where staff doesn't react properly ... etc. Staff need regular updates that include face-to-face time to discuss issues, ask questions, and actually practice with equipment in order to be able to handle critical situations effectively. The little computer modules do not do a good enough job to ensure good performance in an unexpected, real-life situation. I hope this unfortunate situation causes hospitals to re-instate better, more thorough training on these things -- as well as an investing more effort into developing appropriate policies, having equipment on hand, etc.

THIS.

Preparedness is key, as well as thorough, frequent reviews before annual reviews assist in making sure that everyone is prepared, knowledgeable and comfortable when a situation occurs. It is up to facilities to be prepared and I hope those who have cut these programs are putting the funding back ASAP.

[kbrn2002, ADN, RN]

The funding is the issue, isn't it always? I just read the thread on new CDC recommendations and sure,it looks good on paper. I see nothing in those guidelines that requires facilities to implement them and I bet that unless a hospital [or any other facility] has already been identified as a hot zone that those guidelines won't be put in place.

[emtb2rn, BSN, RN, EMT-B]

Duncan, who was in close contact with friends and family before being hospitalized didn't even pass it to those people. The healthcare workers that took care of the other people brought into the country for Ebola treatment have gone about their lives, and nobody has been infected.

.

This is what has been puzzling me.

[imintrouble, BSN, RN]

I'm a pretty practical person. The loss of wages when you're quarantined would be a main concern of mine. I honestly don't know if the hospital would pay me, or if I'd have to use up all my sick time. I don't have three weeks at this point.

If I were quarantined I couldn't babysit my granddaughter. My daughter would have to pay a babysitter, which she can't afford.

The financial aspects of a quarantine seem minor, when compared to worrying about your life, but they're valid.

What about those of us who work two jobs? What about the second facility?

Would they be quarantined? Would they hire somebody to take my place?

What about the restaurant where I eat lunch everyday? Would they lose business when other patrons stopped eating there?

What about my granddaughter's school? My daughter's employer?

The list is endless.

Most of the above would be considered hysterical, but the general public has already demonstrated a willingness to embrace hysterical.

Read the comment from a texas nurse who works at Presbyterian hospital.

[smspicer]

I think the reason given for that is that the nurses who ended up infected were taking care of him when he was the sickest, not long before he died. The other ebola patients were known, and handled more effectively in terms of PPE also, but also did not get as sick.

[herring_RN, ASN, BSN]

Governor meets with nurses over Ebola concerns

Flanked by key state health and safety department heads, Gov. Jerry Brown on Tuesday said California will address the concerns and worries of nurses who say the hospitals where they work are ill-prepared for a potential case of the deadly Ebola virus.

"We are moving-this is a top priority on my list," said Brown, according to a spokesman for the California Nurses Association who was at the meeting with about 50 nurses representing major hospital chains and some independent hospitals around the state, including Kaiser Permanente, Sutter Health and Dignity Health.

"We are engaged. We are listening to the nurses and we're in action mode," Brown told them after a 90 minute meeting in his office.

The governor pressed both the Department of Industrial Relations and California's Occupational Safety and Health Administration for immediate action, said Michael Lighty, director of public policy for the California Nurses Association. "We emerged cautiously optimistic."

CNA spokesman Chuck Idelson said the nurses are pushing for the highest standards to protect medical workers treating Ebola cases, including Hazmat suits like those used by Nebraska Medical Center, which is treating an Ebola patient.

The nurses also asked for continuous hands-on training for themselves and other front-line health workers, including practice, in teams, putting on and taking off the proper protective gear...

... The U.S. Centers for Disease Control and Prevention announced new guidelines Monday that in part called for health care workers caring for Ebola patients to wear face shields, hoods, boot covers and other clothing, leaving no part of the body exposed.

The association representing hospitals says its members are working with California's workplace regulatory agency to implement the new guidelines.

The governor's office has not said what actions Brown might take from the meetings.

"California's workplace safety and health standards go further than national standards in protecting workers from hazards such as Ebola," Juliann Sum, acting chief of the state's Division of Occupational Safety and Health, known as Cal/OSHA, said in announcing workplace guidelines last week. ..

http://www.contracostatimes.com/bay-area-news/ci_26772636/governor-meets-nurses-over-ebola-concerns

[RNSue]

What about STAFFING?

None of the new recommendations say anything about ebola patients being one on one or two on one.

Who can do all this donning and doffing and taking a shower AND have other patients?

You KNOW the hospitals will push us to the limit like they always do.

What do you think?

RNSue

[APRN., DNP, RN, APRN, NP]

Ebola patients are Not going to be on a general medical floor. They're going to be in an ICU. They also Have to be 1:1 - 2:1 by the very nature of their disease progression.

However, just to entertain the idea a of team or total care care delivery system that would group an Ebola pt with non-Ebola: can you imagine being the 'other' patient(s) that do not have Ebola in the RNs assignment? What would be the hospital's liability if the non-Ebola patient contracted Ebola?