COVID-Positive Nurses Working: Irresponsible or Smart?

On Monday, November 9th, the governor of North Dakota announced COVID positive healthcare providers (HCP), without symptoms, will be allowed to continue working in COVID-19 units in hospitals and nursing homes. Is the decision a step in the right direction or simply irresponsible?  Read on to learn more.

COVID-Positive Nurses Working: Irresponsible or Smart?

On November 12th, the CDC reported 94% of U.S. jurisdictions are experiencing an increase in COVID-19 cases.  Hospitals are having to consider creative ways to stretch resources as admissions rates continue to climb.  In North Dakota, hospitals are at 100% capacity, lacking needed beds and facing dire staffing shortages.. Hospital administrators asked state leaders to allow asymptomatic COVID-positive healthcare providers (HCP) to continue working in COVID-19 units in hospitals and nursing homes to help with staffing.

CDC Crisis Guidelines

The CDC published a set of guidelines to provide relief during the pandemic when staffing shortages reach crisis level. This includes developing criteria to identify staff suspected of having the virus (or have tested positive) who are well enough to return to work before meeting the CDC’s Return to Work Criteria.  The employee must be willing to continue working or suspected having COVID-19 or actually testing positive.  Other considerations include:

  • The type of HCP shortage that needs to be addressed.
  • Where the HCP is in the course of their illness.
  • The type of symptoms they are experiencing
  • What interaction they have with patients and other facility HCPs (do they work in direct patient care, telemedicine, etc).
  • The type of patients they care for (patients who are not COVID-19 positive).

The governor reported other states are already using this strategy already.  However, the governor’s spokesman lacked available information on any other states that have this policy in place.

Nurses Pushback

If you are a nurse (or any HCP), your internal “this is just wrong” alarm may be going haywire at the thoughts of working while COVID- positive.  The North Dakota Nurses Association (NDNA) released a statement recommending additional public health measures be mandated before implementing the policy.  For example, North Dakota doesn’t have a statewide mask mandate at this time.

The president of the NDNA, Tessa Johnson, argues “The governor has put this policy out and still, no masks are required.  It feels like a slap in the face to nurses right now”.  Johnson also made these arguments against nurses working while testing positive for the virus.

  • The policy has protections built in for patients and co-workers, but these don’t work in real life.  For example, if a COVID-positive nurse is only caring for other COVID-19 patients, they will still use common areas, such as bathrooms, elevators, break rooms and hallways.
  • Rural hospitals are often connected to a long-term care facility, with the same nurse caring for all the COVID-19 patients.  How would virus spread be prevented in these situations?
  • As the most trusted profession, would nurses lose credibility with the public by working COVID-positive?  Especially after nurses have been pushing the importance of social distancing and staying home to prevent virus spread.
  • Will employers retaliate if a virus-positive nurse is unwilling to work, or will their decision be respected by the facility.

Could More Be Done?

The CDC provides other strategies to alleviate staffing shortages during the pandemic.  But, are hospitals and nursing homes doing what the CDC considers “baseline” to ease the problem?  Take a minute to consider your employer and ask yourself “Does my facility….?.”

  • Understand the minimum number of staff to provide a safe work and patient environment?
  • Communicate with local, federal, state, and health partners to identify additional HCPs to help when needed, such as:
  • Hiring additional HCPs, such as retired nurses and nursing students
  • Adjusting staff schedules
  • Rotating HCP to patient support positions.
  • Providing adequate orientation and training

The Guilt We Carry

The pandemic is placing a healthy dose of guilt on nurses all across the country (and world).  We know nurses have a high work ethic and are dedicated to both patients and their co-workers.  Saying “no” to care for ourselves often results in feelings of guilt.  I can only imagine the unbearable guilt nurses may experience thinking they passed the virus to a vulnerable patient.

What Do You Think?

Would you be willing to work if you tested positive for COVID-19?  

References

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J.Adderton

About J.Adderton, BSN, MSN

(Columnist)

Hello There! I am a nurse with over 25 years nursing experience. I specialize in staff development, education and project management.

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Specializes in ICU + Infection Prevention.

You would think this was a satire, but it's real.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

The Guilt We Carry?  They (Hospital Administrators, Governors, etc) should be the ones feeling guilty!  This just increases the chance of spreading the virus...

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Seems that nurses are once again expected to be superhuman and show up for work no matter what they are sick with-and how dare they call out for catching something at work! Just drag them in until they crash and need a bed themselves to make the numbers look good on paper. 
 

And as it’s already been said, impossible to isolate the employee from the common areas-they have to get to and from the covid unit first in order to work there. 

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Translation: We don't care about the health or welfare of our nurses.

 

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Specializes in Clinical Research, Outpt Women's Health.

Those other strategies do not seem to me to be very realistic.

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Specializes in clinic nurse.

Months back, I feel like I read something on allnurses by a nurse who'd tested positive who was working, and the provisions made for her and others. I raised my eyebrow then. I'd have to spend some precious time going back to look for that.

Otherwise, creativity is called for. There are nurses on the sideline who are being ignored. They want to get in the game but may lack the acute care experience, so they are just trodded over. Creativity would come into play by putting them to work in a limited but skills build-able capacity in an acute care setting. This can be done, but it takes energy, smarts, and commitment. There are nurses who are willing to work on an ad-hoc basis in return for the chance to build skills and provide care. No one's asking, are they?

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On 11/16/2020 at 11:11 AM, J.Adderton said:
In North Dakota, hospitals are at 100% capacity, lacking needed beds and facing dire staffing shortages.. Hospital administrators asked state leaders to allow asymptomatic COVID-positive healthcare providers (HCP) to continue working in COVID-19 units in hospitals and nursing homes to help with staffing.

Irresponsible or smart? I don’t think that is the right question to ask.

The irresponsible part was getting to the point in the first place where hospitals no longer can care for all patients who need care, without resorting to this disastrous solution to meet staffing requirements. It’s the highly foreseeable result of a failed strategy. It’s in my opinion the collective failure of every single person who hasn’t to the best of their individual ability, done their part in trying to mitigate the spread of the infection. This is what happens when we aren’t able to flatten the curve. When healthcare needs of the population exceeds the available healthcare resources.

I place a lot of responsibility on individuals. What we can do varies due to the circumstances of our lives. Some people have been forced to take more risks than others. Both for themselves and as possible vectors of disease spread. The grocery store employee who lives paycheck-to-paycheck doesn’t have the same ability to avoid meeting others as someone who can easily work from home. But we can all make the sacrifice of not going to that party or invite ten of our best friends over for dinner. 

You also ask if it’s smart? No, it isn’t. But it might be the least lousy available option when the alternative may be that patients simply don’t get their healthcare needs met because there simply isn’t anyone left to care for them.

North Dakota isn’t the only place where this solution has been proposed, or indeed implemented. In some parts of Europe the same thing has happened. And I would suspect in other places around the globe as well. I don’t think anyone thinks it’s a good idea. It’s more in the line of: desperate times calls for desperate measures. I personally think it’s a bad idea. It goes against everything we know about infection control. 

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On 11/16/2020 at 11:11 AM, J.Adderton said:

The Guilt We Carry

The pandemic is placing a healthy dose of guilt on nurses all across the country (and world).  We know nurses have a high work ethic and are dedicated to both patients and their co-workers.  Saying “no” to care for ourselves often results in feelings of guilt.  I can only imagine the unbearable guilt nurses may experience thinking they passed the virus to a vulnerable patient.

I think that this pandemic has taken a heavy emotional toll on many frontline nurses and other healthcare professionals. But guilt? No. If anything we should be kind to ourselves and acknowledge and be proud that we’ve performed a vital function. 

If an employer mandates a nurse to work despite the employer knowing that the nurse is Covid-19+, and the nurse does so because the alternative is that the patient doesn’t receive any care at all, it would be destructive AND unwarranted mental self-flagellation to heap feelings of guilt on oneself. Doing so is really poor self-care. Feel guilty when you consciously do something bad or cruel. Not when you find yourself in a real crappy situation and your only motivation is trying to help others. 

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17 hours ago, PMFB-RN said:

Translation: We don't care about the health or welfare of our nurses.

Nor it would seem the general public that the nurse might meet on the way to and from work. The whole idea of having infectious individuals ”out and about” is just contrary to infection mitigation/control. 

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Specializes in Peds ED.

An asymptomatic positive nursing home employee is credited with spreading COVID to 30+ residents at a home here, and they get tested regularly so this person was at work only a few shifts between their last negative covid test and catching COVID and then infecting residents. 
 

I think it’s a bad move. And yes, less nursing staff means worse patient care and that means death rates will increase as cases rise, but risking spreading it further and worsening the problem is robbing Peter to pay Paul.

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Specializes in BSN, RN, CVRN-BC.

That is desperation! 

Is it to save money on agency and travelers or will patients have to go with less care without these nurses at the bedside?  

 

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