COVID-Positive Nurses Working: Irresponsible or Smart?

[J.Adderton]

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?  

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References

• Nurses Reject ND Policy on Working While COVID-19 Positive
• With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurse can stay at work

[Hoosier_RN, MSN]

On 11/17/2020 at 5:33 AM, PMFB-RN said:

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

 

Or the patient base who may receive care from said nurses

[NurseNelly24, BSN]

On 11/18/2020 at 2:44 PM, macawake said:

I don’t think that is what they’re suggesting. The plan seems to be for Covid-19+ nurses to care for patients who are also Covid-19+, not that sick nurses care for immunocompromised patients who do not have Covid. 
 

 

I see what you mean but even if a nurse is COVID++ and is able to take care of patients in the same cohort, it doesn’t mean it reduces her risk of spreading it to her colleagues. The nurses station, locker room, bathroom lounge area, cafeteria are all places where the potential to spread. Unless we expect that nurse to stay in those rooms their entire shift. 
 

Also, these hospitals are absolutely NOT considering the personal self-care measures needed for those nurses to overcome the virus. How can we take care of other people if we’re not taking care of ourselves first. 

[NurseNelly24, BSN]

I don’t see how it’s possible that hospitals will implement visitor restrictions, institute social distance practices, tell people to stay home, yet the very factor that could potentiate increased exposure to the virus, is being implemented by hospital systems; and nurses are once again the sacrificial, disposable lambs. 

Some hospitals are even making it optional for doctors to enter COVID+ rooms so they aren’t exposed—leaving the nurses to be the jack of all trades, doing the meds, assessments, feedings, family meetings, etc.
 

I don’t care how long I’ve been working there, any hospital that doesn’t take my health or my safety seriously will get the boot. Not in these times. 

[Here.I.Stand, BSN, RN]

Wth no.... COVID+ nurses should be at home resting their bodies.  ?

[OUxPhys, BSN, RN]

This isn't just happening in North Dakota. Here in Ohio there are several hospitals that allow covid positive nurses to still work if they are asymptomatic. 

[bestallaround, ADN, CNA, LPN, RN]

Real talk......I work at a small rural hospital in NC. We have had probably over half the staff test positive at some point. The very first nurse to get sick and test positive was out of work for about 3-4 weeks. She could not return until she had 2 consecutive negative tests. That was in the beginning. Months into COVID, when many more staff got it, people were coming back to work as early as within the week. In one weekend, we had 9 nurses test positive on my unit alone! And were experiencing symptoms! And back to work in less than two weeks! The whole frigging county had it! Small town, (Trumpers), not following simple guidelines like wearing masks in public and staying home. These people are still going to church, having gatherings, going out of town...yes, even the nurses who are supposed to know better. In fact, our nurse manager's father was admitted on our floor with COVID. There are 3 of us who haven't gotten sick (yet) and have been super vigilant about our practices. We are scared, but it is easy to see how others are letting their guard down and endangering themselves and others...starting with hospital leadership. Really, I hate to get political, but if the leader of our great nation didn't take it seriously....

[NurseNelly24, BSN]

4 hours ago, bestallaround said:

Real talk......I work at a small rural hospital in NC. We have had probably over half the staff test positive at some point. The very first nurse to get sick and test positive was out of work for about 3-4 weeks. She could not return until she had 2 consecutive negative tests. That was in the beginning. Months into COVID, when many more staff got it, people were coming back to work as early as within the week. In one weekend, we had 9 nurses test positive on my unit alone! And were experiencing symptoms! And back to work in less than two weeks! The whole frigging county had it! Small town, (Trumpers), not following simple guidelines like wearing masks in public and staying home. These people are still going to church, having gatherings, going out of town...yes, even the nurses who are supposed to know better. In fact, our nurse manager's father was admitted on our floor with COVID. There are 3 of us who haven't gotten sick (yet) and have been super vigilant about our practices. We are scared, but it is easy to see how others are letting their guard down and endangering themselves and others...starting with hospital leadership. Really, I hate to get political, but if the leader of our great nation didn't take it seriously....

1000% agree. Public health goes hand in hand with politics. So if our country's leaders didn't take the virus seriously, how do we expect the citizens to do the same. There's people who to this day don't believe the virus exists. It's sad. Also, I hope you continue to stay safe, because to have so many COVID+ staff on the unit is wild. 

[Frannyjoy]

Irresponsible or smart? 
That is a strange question to pose when looking at this situation. There are other options, they are simply not convenient for administrators, nor are they focused on the bottom line. How about wards? Open areas with beds where patients of similar acuity in a region can be placed and cared for by a nurse who can much more easily have eyes on and assess 12 patients in a row than she can 6 or 8 in individual rooms. That would address staffing needs by reducing the need for as many nurses. I wouldn’t accept these working conditions, making Covid positive nurses work, until this was done first. This would be possible, it would simply require a cooperative effort and funding from corporate healthcare. They need either an incentive to do this or they need to be forced to do this. They have made money hand over fist via the commodification of healthcare in this country for years. It’s time to pay it back. Supply shortages at this stage of the game are unacceptable, and forcing nurses to work short and infected 9 months in without a better plan is also unacceptable. Nurses should not feel ANY guilt. They should not let administrators push them toward feeling guilty, when it is the administrators, ceos, politicians, and the public that has failed THEM. Nurses work hard and they will show up in the storm for their patients. It’s time for nurses to hold everyone else to the same standard. 

[T-Bird78]

I’m an LPN in ambulatory care but my office is part of a large healthcare system that includes several hospitals across 7 counties in my state. When this was starting up, they made all LPNs and RNs who don’t work in acute care take an online learning course to learn the hospital portion of our EMR and we were on stand-by to be called up to an acute care setting, in theory to let us work the med-surg floors so those nurses could work with COVID pts. I was “tier 5” and they got to tier 3 before they stopped reassigning people. One of the CMAs I work with was called up and worked in ICU with COVID+ pts as a CNA though. 

[bestallaround, ADN, CNA, LPN, RN]

When all this started, the ER was not testing patients for COVID. They would send the patient up to our tele/step down unit and the next day, the attending would order the test. So we'd come in the next day and our patient that we had not worn full PPE on would be on the COVID unit. Now our COVID unit is full, usually always is, and we have all their over flow positive patients. Our floor was the first to have the staff outbreak, then med surg, now it's slowly making its way through ICU. So far, none of the nurses on the COVID unit have been sick. They have air purifiers in every room, at the nurses station, and break room. All their patient rooms have big windows so they can look in, and they have bedside monitors that can be watched at the nurses station. The ICU has had multiple COVID patients code on them recently. In such a small hospital, their hands are tied on where to assign patients. 

[Newgurl17, CNA, LPN]

I think the obvious answer to the title of this post would personally be no... That's how outbreaks start! 

[NurseBlaq]

I know nurses who won't get tested because they're afraid of missing time from work and they're the sole breadwinner in their homes due to layoffs. Even worse, the employers don't push them to get tested because they see it as not having to replace that nurse while they're off. The only time it seems to be an issue is when the nurse is symptomatic and sick themselves. IMO it's setting a bad precedent because we're not superhuman and we have our own health and families to protect as well. If we're all sick, who's going to take care of the patients?