Am I a coward for going on FMLA due to COVID?

[ML1376]

Hello everyone. I am extremely conflicted in this decision. I work in an ICU which is now basically a COVID unit, on top of the PCU (the designated COVID unit) which we get pulled to regularly. It's no surprise there is an incomprehensible shortage of PPE, and shockingly bad backpedaling and safety recommendations from the CDC that had they made even 4 months ago would have cause a national uproar.

I have asthma and chronic bronchitis. Any little chest cold turns into full blown bronchitis for me. My girlfriend (we don't live together) has respiratory issues that require monthly injections of an immunosuppressant to manage. We haven't seen each other for almost a month now. Last week at this time, we had 1-2 two COVID patients.. at this point, all critical care units are overflowing and the safety precautions are terrible as they are everywhere else. The testing is awful with 4-6 day turnaround time. We get one N95 per shift no matter how many patients. They've increased nurse to patient ratio, which makes the one N95 even more unsafe. We can only wear it if the patient is undergoing aerosol producing procedures/treatments, otherwise, a standard surgical mask. I failed the fit test anyway. RN's are told to come in if exposed but asymptomatic, and if we are exposed to a positive patient, we only get tested if symptomatic. We have PAPRs but can only be used with positive patients due to lack of filter supply, but we won't know if they are positive until almost a week. To this day, I don't think they've been used yet. So by the time we CAN use them, it's pointless.. we've already been exposed. We are seeing younger patients with only a history of asthma or no real history crashing and burning.. going into ARDS and being intubated and placed in rotoprone beds. That's what scares me the most. Otherwise young healthy patients on the brink of death.

I really like my unit. I respect my manager, and my team, but I just don't feel safe and the anxiety is crushing. The healthcare system in general failed us. I feel it's not a matter of if but WHEN I will get this, and given my respiratory issues, will it take me out, or just hit me hard enough to cause permanent lung damage. That said, I was going to put my two weeks in but girlfriend suggested FMLA to buy some time to think about it.

I feel like I'm deserting my team when needed most. But I also didn't sign up to risk my life due to a comedy of errors, oversight, indifference, and/or just the never ending need for more profit by the powers that be. I feel what I'm doing is the logical, right, and safe move but can't get over this feeling of cowardliness and letting everyone down for doing it. However other times I feel I am being strong for giving up a well paying job with benefits for my physical/mental health and not allowing them to do me this way. Just looking for opinions one way or the other. Thank you and stay safe out there.

[BlessYourHeartt]

On 4/4/2020 at 5:16 PM, Gingerpup said:

Also, we might be seeing in the media nurses across the nation saying "this is what I signed up for". Keep in mind, this is a great media story.

You're absolutely right. After 12 years of bedside nursing with many adventures, good reviews, CCRN earned, as much as I enjoy taking care of patients, I can say with 100% confidence that this is not what I signed up for, nor what many others had ever envisioned.

[Ms S. 78]

NO IT MEANS YOU WANT TO LIVE, AND GOD IS NOT MAD AT YOU.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

On 3/30/2020 at 1:09 PM, JohnyPapr said:

No you are not a coward. Your health comes first. And remember. There is NO loyalty in nursing. You are just another body to your manager. Your “friends” at work will throw you under the bus when you need them the most to save their skin and political ambitions.

100% to this! AMEN! ???

[eggyweggy, MSN, RN]

Choosing to put your health and the health of your loved ones ahead of your career is something that nobody should be judged for. It is a very personal decision and the amount of acceptable risk is highly variable for every single person working in healthcare. Fact of the matter is, we are all replaceable in our employer's eyes. The ICU will continue to operate with or without you. If you leave the bedside, someone else will fill your shoes. It is ultimately the responsibility of management to ensure that units are adequately staffed - if the unit suffers because someone leaves, that's on management. Not on the person who left the unit.

Truth is, most employers are not providing a truly safe work environment for anyone working with COVID patients. There will be many who choose to accept these less than ideal working conditions and accept the increased personal risk under the guise "This is what we signed up for." There will be others who are only willing to accept the increased personal risk if their pay is also increased. And there will be still others who determine that the risk is not worth any amount of hazard pay. Choosing to leave a high risk area is not being cowardly at all. It's about respecting your boundaries and knowing what level of risk is too much for you and your loved ones.

[Jtm74, BSN]

Passing the mask fit test was a requirement for my employment as an RN. I assumed this was a routine and nationwide requirement.

[Rose_Queen, BSN, MSN, RN]

35 minutes ago, Jtm74 said:

Passing the mask fit test was a requirement for my employment as an RN. I assumed this was a routine and nationwide requirement.

Nope. Certain units in my facility do not do fit testing. That will likely change moving forward.

We do have an alternative for those who either are not fit tested or cannot pass- they wear PAPRs

[ML1376]

I haven't been there since the end of March, but at that point, it was surgical masks only for covid rule outs, with test results taking 4-6 days to come back. Only if pt was having aersolizing procedures was an N95 required. That was protocol then and I'm told by my coworkers is still the case. So I guess you're kind of screwed if the patient turns out positive and you were only wearing a surgical mask and they went into a coughing fit, or otherwise got it into the air. Also most covid patients aren't in negative pressure rooms due to lack of availability. I got push-back from my manager and managers manager on PAPR use and told they could only be used on positive only patients.. not patients being ruled out. The issue here is the long test result time.. we could have been with a rule out that was really positive for that time frame only wearing a surgical mask, which I didn't and don't feel comfortable with, especially being high risk for complications myself.

As anywhere else, sometimes what happens in the unit, stays in the unit.. routines and requirements aside. We do the best we can with what we have, whether it's true protocol or not. Rules can be and are bent if need be, but if you suffer as a result, in the name of doing it for the greater good, don't think they'll have your backs. They'll say you should've known better and been looking out for your safety first and foremost. It's talking out of both sides of their mouths, or they'll say there's no way to prove if we got it at the hospital or outside somewhere to avoid accountability.

I was in the ER on covid detail with several rules outs, but two very likely positives, with a beard at the time (shaved the day after and failed the fit test then too), wearing N95's that didn't fit correctly obviously. One of the negative pressure rooms was broken, one worked, and the other two were regular rooms. They wouldn't give me a PAPR because the patients weren't officially positive yet. It was explained to me that they can't overuse the PAPRs due to a shortage of filters needed. I asked how about just the hood and I'll wear the N95 under it.. no filters needed. They still said no. So the PAPR was sitting there, not being used, while I'm caring for these patients who were coughing out of control wearing only an ill fitted N95 and only one negative pressure room out of 4 patients. They were completely fine with this scenario. No one jumped into to help out or look after my safety, and my attempts to address it were shot down. So yeah.. what "should be" and "what is" are often vastly different as we're all seeing.

[ML1376]

Well, as an update, they didn't allow FMLA, but I took an unpaid LOA until the end of May. My manager emailed about the upcoming schedule and what my availability is. I've been in regular communication with my co-workers and consistently told how bad it is, how low they still are on PPE and reusing it, and having a discussion on reusing plastic gowns was a possibility if it continues. One nurse offered to buy a medical UV light to help with disinfecting equipment. He was told to come up with a presentation for that, even though nationally respected hospitals in our area are already using it. No sense of urgency.. PAPRs are finally in use but in short supply. Nurses from other floors have been infected. They say it's been war. The good news is that the numbers have been gradually going down, so that's comforting to hear.

In response to my managers email, I asked if there was still a PPE shortage, and being that I failed the N95 fit test, will I now be able to use a PAPR (they denied it prior) for both positive and rule out covid patients being as test results still take 4-5 days to return.

The response had a cool tone and not what I hoped for. Without directly citing, the response was:

They have had appropriate PPE from the beginning and are using PPE conservation measures that all other healthcare systems around the world are using. They are dedicated to ensuring the protection of their colleagues and have been since day one. As far as answering my PAPR question, the response was indirectly.. "we have PAPRs available to colleagues as needed."

Well.. these PPE conservation measures used all over the world are leading to healthcare workers untimely death all over the world, or the potential for permanent multi-organ damage. And to say there is an adequate supply of PPE is just factually not true. They may have just enough to not crash and burn, but I wouldn't call that having an appropriate level of PPE.

I understand this is the stance a manager must take; she has to back up the hospital, especially in writing, but the tone spoke volumes. We both know what's going on with the situation and regarding my concerns, is really no different from when I left, but I feel her response makes it seem my decision was pure overreaction.

So it looks like I'll be working elsewhere. I don't feel I can go back now as my concerns are still valid, and I'm sure my return won't be well received. I'm disappointed and feel a sense of betrayal, but this is the situation. I don't envy her position as a manager during this. I understand she may harbor a negative opinion as I am the only one on day shift to have gone on leave (others from night did though). That said, being higher risk with asthma and chronic bronchitis, a girlfriend on immuno-suppresants for respiratory issues, and seeing what I saw the last week I was there was eye opening in that I took care of several rule outs with 2 very likely positives at the time with one ill fitted N95 and management to allow a PAPR or even just the hood for extra protection, even though they were sitting unused in storage, etc.. Justifiably, I did not feel safe and lost confidence in their ability to protect us. I know I am explaining myself here as if to get approval. Being as the logic and emotion sides are still very much in conflict, I'm probably looking to get it from others, but in the end it won't change the situation. So that's all from over here. Thanks for reading/listening and everyone please stay safe out there.

[Marianna5]

ML1376,

I understand how you feel. Initially I took unofficial unpaid leave because it was too hard for me to just leave. Shortly after I send my resignation notice without working two weeks. I know the situation with PPE was only getting worse at my work place. My hubby works at ED in a different state. Every nurse on COVID unit wears N95 and every nurse! dons a PARP before entering a patient room on top of N 95.

I feel much better now and know I made a right decision. There will be consequences for my decision, no rehire, no references, etc. I am trying to figure out my next job. I will not work without having N95 and goggles and being allowed to wear them for the whole shift without multiple donning and doffing. I understand the dire situation with PPE and ordered my own reusable envo N95.

I hope you feel better and figure out your next step. Stay safe!