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.