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Advocating for Nurses: Allow Nurses Their Own PPE

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AmericanNurseAdvocates AmericanNurseAdvocates (Trusted Brand)

Specializes in ER, Advocacy. Has 6 years experience.

Why are employers firing nurses for protecting themselves?

In the face of a global PPE shortage, ever-changing research, and supply-driven guidelines, nurses attempt to protect themselves by wearing individually-acquired PPE at work. Many of these nurses are fired. A national standard needs to be set, allowing for healthcare professionals to wear their own PPE at work in emergency situations, and prohibiting employers from preventing healthcare professionals from doing so.

Advocating for Nurses: Allow Nurses Their Own PPE

A Global PPE Shortage

The lack of Personal Protective Equipment, or PPE, has been a persistent problem in the United States throughout the course of the COVID-19 pandemic. Even now, nearly two months after shortages began, protective equipment that has traditionally been one-time-use only is being re-used to the point of failure. The continued anecdotes and reports from nurses throughout the country are concerning, and there has been little discussion about a consistent return of PPE for frontline healthcare workers. We see the same stories repeated over and over:

One nurse reports, “Last night we had to use the same isolation gowns, repeatedly pulling them over our heads. These are the thin, plastic disposable (gowns). They gave me a Sharpie and told me to write my name so I can use it again tomorrow.”

Chelsie, a nurse in Utah, states, “I was given 2 gowns, 2 booties, 2 face masks and told to reuse as much as possible. We have been denied getting any more supplies.”

Another nurse notes, “We were instructed to use ONE (surgical) mask per shift…we are to fold it ‘clean’ side together and store in a paper bag.”

A number of hospitals have requested that nurses stop wearing makeup to prevent soiling of N95 respirators, which would force the hospitals to discard them. Several facilities have taken to sterilizing masks with UV light, so that they can be re-used. However, these short term solutions are akin to driving a cross-country road trip on a doughnut spare tire: it might work for a while, but it will end tragically.

There are several factors about the COVID-19 pandemic that rightfully worry nurses; though chief among them is the lack of PPE. According to a story in the Spanish newspaper ‘El Pais’, a lack of PPE contributed to more than 31,000 infections of healthcare professionals, resulting in dozens of deaths. (De Benito & Jan, 2020) Healthcare professionals make up 15% of all COVID-19 infections in Spain. These abnormally high rates of infection are attributed to insufficient protection and the global shortage of PPE. (De Benito & Jan, 2020)

Differing research and recommendations regarding the necessity of specific PPE also adds to nurses’ already considerable anxiety, stress, and concern. The CDC’s original supply conservation recommendations, fueled by existing and anticipated PPE supply deficiencies, have been utilized to justify healthcare facilities’ decisions to deny PPE to healthcare professionals. But nurses are natural problem-solvers, frequently relying on their resourcefulness to better serve their patients. Many recognized the PPE crisis in its early stages, and acquired PPE commercially. Generous friends, family members, and businesses have also donated PPE to nurses when they realized the gravity of need. Nurses acknowledged both the importance of protecting themselves from this virus, and the limitations of healthcare facilities’ ability to provide optimal PPE to their staff. With these factors in mind, several nurses have chosen to bring their own personal PPE to work. Unfortunately, this kind of self-reliance has been met with considerable opposition, including punitive action and termination.

Ever-Changing Research and the Practice Gap

Research concerning the spread of the virus is still early, and the conclusions and recommendations are varied. The CDC maintains that N95 respirators and PAPRs are to be reserved for healthcare professionals caring for patients undergoing specific aerosol-generating procedures, implying that the virus is not typically aerosolized under ordinary circumstances. (Center for Disease Control and Prevention, 2020) However, Dr. Fineberg of the National Academy of Sciences notes that there is some research to suggest that people infected with COVID-19 can aerosolize the virus simply by breathing. (Cohen, 2020) Another study notes that the virus is spread by “respiratory droplets, contact with bodily fluids, or from contaminated surfaces.” (Chang, et al., 2020) The article also states that “…conventional measures, such as face masks, provide insufficient protection.” (Chang, et al., 2020) Meanwhile, an Italian hospital boasts zero infections amongst their healthcare workers. They attribute this to donning hermetically-sealed, waterproof suits and “high-tech masks”, while adhering to strict isolation protocols. (Steinbuch, 2020)

Although the CDC encourages preserving N95 respirators for aerosol-generating procedures, the guidelines do not suggest that N95 respirators are inappropriate for the general care of a COVID-19 patient. Given the high rate of asymptomatic COVID-19 patients, it is easy to see how a nurse would want the comfort and security of wearing an N95 around patients, regardless of their symptoms. The recommendations from the CDC are obviously heavily influenced by the well-known nationwide shortage of PPE. There is clearly a gap between research results and guidelines; perhaps most notably being the CDC’s former recommendation of utilizing bandanas while caring for patients. Make no mistake; this gap is created by supply shortages, not necessarily by research—and healthcare professionals have noticed. Nurses and other professionals should not be forced into martyrdom due to the perpetuation of these supply-driven standards. If healthcare professionals have acquired higher levels of PPE, and feel inclined to use them, they should be allowed to do so without question.

Resourcefulness is Punished

The lack of PPE is not something that can be fixed overnight. N95 respirators and PAPRs cannot be pulled from thin air. It is understandable that hospitals, uncertain of when another shipment of PPE will arrive, write policies that protect the limited supply. However, nurses are encouraged to think critically and analyze data from the very beginning of nursing school. When nurses conclude that they need a higher level of protection than hospital policy dictates, they should be allowed to wear their own personal PPE.

This is a common-sense idea. Why should a nurse be punished for going above and beyond hospital policy, particularly when her actions have no effect on the hospital’s ability to provide resources for other staff members? Yet there are stories from around the country of nurses being fired for wearing N95 respirators that they brought from home.

One nurse on social media posts, “Just got fired for wearing a mask in the hallway…I even brought my own N95. It’s not like I was wasting supplies for them.”

Another nurse states, “I was fired because I wanted to use my own N95 under the simple mask that we demanded to wear.”

A simple Google search of the term “Nurses fired for wearing masks” brings up several similar instances on the very first page.

The American Society of Nurse Advocates Position

We believe that the people who can best determine the needs of healthcare professionals, are healthcare professionals themselves. With the support of our members, we strive to achieve a national standard, and our solution is simple. We propose to reasonably permit healthcare professionals to utilize their own PPE in cases of emergency, and to prohibit employers from preventing them from doing so. This does not require a vast change to existing laws; only a simple extension of existing OSHA guidelines. If hospitals are unable to provide adequate protective equipment to their staff, healthcare workers should not be punished for finding other means to protect themselves. Nurses should not be forced to choose between their own personal safety and their calling.

References

De Benito, E., & Jan, C. (2020, April 21). Faulty batch of face masks prompts the isolation of more than a thousand Spanish healthcare staff. In El Pais. Retrieved April 23, 2020, from https://english.elpais.com/society/2020-04-21/faulty-batch-of-face-masks-prompts-the-isolation-of-more-than-a-thousand-spanish-healthcare-staff.html

Center for Disease Control and Prevention. (2020, April 13). Interim infection prevention and control recommendations for patients with suspected or confirmed Coronavirus 2019 (COVID-19) in healthcare settings. In Coronavirus Disease 2019 (COVID-19). Retrieved April 18, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Chang, D., Xu, H., Rebaza, A., Sharma, L., & Dela Cruz, C. S. (2020, February 13). Protecting health-care workers from subclinical coronavirus infection. The Lancet, 8(3). doi:https://doi.org/10.1016/S2213-2600(20)30066-7

Cohen, E. (2020, April 4). Experts tell White House coronavirus can spread through talking or even just breathing. In CNN Health. Retrieved April 18, 2020, from https://www.cnn.com/2020/04/02/health/aerosol-coronavirus-spread-white-house-letter/index.html

Steinbuch, Y. (2020, April 1). This Italian hospital takes extreme precautions to battle coronavirus. In New York Post. Retrieved April 18, 2020, from https://nypost.com/2020/04/01/how-an-italian-hospital-protects-its-medical-workers-from-coronavirus/

Mary C. Kelly has been an emergency department RN for 5.5 years, including two years as a travel nurse to emergency departments throughout the United States. She is also the founder of the new nursing organization "The American Society of Nurse Advocates."

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9 Comment(s)

sirI, MSN, APRN, NP

Specializes in Education, FP, LNC, Forensics, ED, OB. Has 30 years experience.

On 4/24/2020 at 8:31 AM, AmericanNurseAdvocates said:
We believe that the people who can best determine the needs of healthcare professionals, are healthcare professionals themselves. With the support of our members, we strive to achieve a national standard, and our solution is simple. We propose to reasonably permit healthcare professionals to utilize their own PPE in cases of emergency, and to prohibit employers from preventing them from doing so. This does not require a vast change to existing laws; only a simple extension of existing OSHA guidelines. If hospitals are unable to provide adequate protective equipment to their staff, healthcare workers should not be punished for finding other means to protect themselves. Nurses should not be forced to choose between their own personal safety and their calling. 

Thank you, @AmericanNurseAdvocates

HiddenAngels

Has 7 years experience.

WOW!!

It is such a disgrace that nurses were fired during this pandemic for such unjustifiable reasons as those stated above. This just shows the enormous abuse of power and ever extending glass ceiling that pervades and perpetuates the work that we perform, the work that some of us dedicate our blood sweat and tears towards for the greater good of humanity .

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

Sounds like some hospitals don’t want it getting out that their nurses need to buy their own PPE and they have also probably refused to reimburse them for it (such as submitting receipts and having it reimbursed during payroll). Trying to save face at the cost of losing their nurses. Yet they will gladly put the ones who don’t stand up for themselves at risk.

I will also add that it is not a cost issue for them to reimburse for PPE if they can advertise for a travel nurse at over 5K a week in desperate areas-including Florida. I left acute care 2 years ago and my phone is blowing up with travel offers-um-sorry-not with that kind of work culture. I honestly feel horrible for those who are being abused by administration. Fired for protecting yourself-seriously? That’s just beyond screwed up.

SummitRN, BSN, RN

Specializes in ICU + Infection Prevention. Has 8 years experience.

If the hospital provides appropriate PPE, then they get to say what you use.

If they don't... well that is a different story!

But it is also remarkable the amount of ignorance about PPE.

I've seen people using exhalation port respirators - BAD.

I've seen OR staff try to use PAPRs in OR that they sourced from who-knows-where - BAD.

I told people that they can use their own masks while not performing patient care as long as it is not a exhalation port respirator (no source control).

Edited by SummitRN

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 43 years experience.

Joint Commission Statement on Use of Face Masks Brought From Home

Quote

The Joint Commission supports allowing staff to bring their own standard face masks or respirators to wear at work when their healthcare organizations cannot routinely provide access to protective equipment that is commensurate with the risk to which they are exposed....

...The Joint Commission also emphasizes that none of our standards prohibit staff from bringing in their own PPE or wearing PPE throughout the day. Nor do we know of any other organization that recommends against this. The CDC state sthat when organizations have reached “crisis capacity,” they may need to rely on “strategies that are not commensurate with U.S. standards of care:

In settings where face masks are not available, healthcare personnel (HCP) might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. ...

https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/infection-prevention-and-hai/covid19/public_statement_on_masks_from_home.pdf

CDC: https://www.CDC.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

OSHA: File a Complaint | Occupational Safety and Health

View website to see how to file online, fax or phone to report concern facility unable to provide PPE nor permitting personal PPE to be worn in violation of CDC and JC standards. Karen

Quote

How to File a Safety and Health Complaint.

You (or your representative) have the right to file a confidential safety and health complaint and request an OSHA inspection of your workplace if you believe there is a serious hazard or if you think your employer is not following OSHA standards.

How to File a Whistleblower Complaint

You have the right to file a whistleblower complaint with OSHA if you believe your employer retaliated against you for exercising your rights as an employee under the whistleblower protection laws enforced by OSHA. In states with OSHA-approved State Plans, employees may file complaints with Federal OSHA and with the State Plan. See the Whistleblower Protection Program website to learn more.

https://www.osha.gov/workers/file_complaint.html

Links at OSHA Covd-19 https://www.osha.gov/SLTC/covid-19/ for following topics -located right bottom corner website:

  • Required annual fit-testing in healthcare and all other industries
Quote

Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak

Appropriate respiratory protection is required for all healthcare personnel providing direct care of these patients. For additional guidance, see COVID-19 Hospital Preparedness Assessment Tool, https://www.CDC.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.html.

OSHA recommends HCP employers follow existing CDC guidelines, including taking measures to conserve supplies of these respirators while safeguarding HCP. One such measure is that healthcare employers may provide HCP with another respirator of equal or higher protection, such as N99 or N100 filtering facepieces, reusable elastomeric respirators with appropriate filters or cartridges, or powered air purifying respirators (PAPR). Another measure is that healthcare employers may change the method of fit testing from a destructive method (I.e., quantitative) to a non-destructive method (I.e., qualitative). For filtering facepiece respirators, qualitative and quantitative fit-testing methods are both effective at determining whether the respirator fits properly. See 29 CFR § 1910.134, Appendix A, Fit Testing Procedures.2 The fitted respirator can then be safely used for work tasks that require respiratory protection. For additional guidance, see Strategies for Optimizing the Supply of N95 Respirators, https://www.CDC.gov/coronavirus/2019-ncov/hcp/respirator-supply-strategies.html.3

  • Supply shortages of disposable N95 filtering facepiece respirators (FFRs)
  • Use of respiratory protection equipment certified under standards of other countries
  • Decontamination of FFRs in healthcare
  • Considering employers’ good faith efforts to comply with OSHA-mandated training, audits, assessments, inspections, and testing

Joint Commission Statement on Use of Face Masks Brought From Home

Quote

The Joint Commission supports allowing staff to bring their own standard face masks or respirators to wear at work when their healthcare organizations cannot routinely provide access to protective equipment that is commensurate with the risk to which they are exposed....

...The Joint Commission also emphasizes that none of our standards prohibit staff from bringing in their own PPE or wearing PPE throughout the day. Nor do we know of any other organization that recommends against this. The CDC state sthat when organizations have reached “crisis capacity,” they may need to rely on “strategies that are not commensurate with U.S. standards of care:

In settings where face masks are not available, healthcare personnel (HCP) might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. ...

https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/infection-prevention-and-hai/covid19/public_statement_on_masks_from_home.pdf

CDC: https://www.CDC.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

SummitRN, BSN, RN

Specializes in ICU + Infection Prevention. Has 8 years experience.

Anyone ordering you to take a contaminated iso gown off over your head should be slapped in the face with a covid contaminated glove. That's the height of idiocy. There are better ways.

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

20 hours ago, SummitRN said:

Anyone ordering you to take a contaminated iso gown off over your head should be slapped in the face with a covid contaminated glove. That's the height of idiocy. There are better ways.

The problem is the people coming up with these regulations are probably far away from the actual patients that their employees are being exposed to. It would be a lot different if it were them being exposed.

We had a hospital-wide order that all staff wear surgical masks while on hospital property. About half the staff comply. Even in my ICU where about a third of the patients are COVID +, only about half the nurses wear a surgical mask at the nurse's station. Our manager doesn't wear a mask, charge nurses don't, security at the front door doesn't.

No one seems to believe that they could be asymptomatic carriers. I'd love to wear one of the N95's I've saved from my fit tests through the years but that's not allowed. I guess I could just be paranoid but it scares me to get report from a nurse who is not wearing a mask.

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

I buy my own. My money. My health. If my employer doesn’t like it-let me go. I’m not risking my life over a power struggle pissing contest. If they won’t provide me with it then I will. Luckily, mine had been okay with it.

My husband is a manufacturer’s representative for healthcare equipment. He showed up in an N95. Hospital wanted him to remove it and put on a procedure mask. Excuse me? He offered to take out another individual wrapped never used mask and put it on-the insisted on surgical. He quickly got out of their line of sight and put on his N95 and tossed the procedure mask. His company had directed him if a site ever imposed unsafe standards that he had the right to refuse service, turn around, and leave. He just switched it out afterwards and no one said anything when he got to the correct department. Some of the rules are nuts but as long as it’s a clean unused mask applied when you get to the work what’s the issue? We should have the right to work safely and should not be forced into harms way if we have the necessary equipment to protect ourselves.

Edited by NurseSpeedy

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