I'm a senior nursing student and this debate arose with a couple of my classmates and me. I work as an ER tech and they work as patient care techs on the floor. As of right now, CDC guidelines state for PPE:
Quote
Updated PPE recommendations for the care of patients with known or suspected COVID-19:
Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP.
Facemasks protect the wearer from splashes and sprays.
Respirators, which filter inspired air, offer respiratory protection.
When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.
Eye protection, gown, and gloves continue to be recommended
So basically CDC is saying wear an N95 if you have it, but if you don't, wear a surgical mask until you can get an N95.
So if you have a suspected or confirmed COVID-19 patient, and all you have is a surgical mask and no N95, can you refuse to take care of that patient? Do you face any legal repercussions or potential fallout from your employer if you do refuse? Asking not only about tech positions, but RN positions as well.
I’m just saying that at my hospital we have different levels of risk, therefore different levels of PPE. With there being a shortage, they have evaluated the greatest threat to healthcare workers and those are the ones that will wear the N95 masks. A PUI is treated differently than a confirmed, intubated case.
We've had multiple HCWs turn positive, all were caring for non-intubated and not-yet-positive patients.
There's no basis for identifying an intubated, confirmed case as being a higher level of exposure risk than a non-intubated patient awaiting the test result.
Something we learned early on is to avoid placing too much confidence in what hospital administrators say is safe and what isn't, this is something we as frontline caregivers have to take ownership of.
We've had multiple HCWs turn positive, all were caring for non-intubated and not-yet-positive patients.
There's no basis for identifying an intubated, confirmed case as being a higher level of exposure risk than a non-intubated patient awaiting the test result.
Something we learned early on is to avoid placing too much confidence in what hospital administrators say is safe and what isn't, this is something we as frontline caregivers have to take ownership of.
This. So much this. My hospital network has been trumpeting the horn of "for the motherland" type emails, going on about how "we're going to get through this together!", but has been suspiciously quiet about childcare options, what will happen if we become infected while treating infected, etc. Their silence on their support of us is absolutely deafening and extremely scary.
Yeah I absolutely believe U.S. nurses are being thrown under the bus. I do not believe that paper surgical masks are protective against airborne virus, which this is. I plan to bring my own N95 to work. If I’m asked to take care of a c-19 I’m gonna wear it under the surgical mask. If my manager doesn’t like that I’m gonna ask for my union rep and they can send me home. They’re offering $90 an hour hazard pay with good ppe for crisis positions. In other hospitals. I’m not planning on letting some admins decision infect me and my fam.
Nurses are dedicated and selfless and that is being used against us. The work from home administrators aren’t going in those rooms with paper masks.
I agree. As nurses we have to protect ourselves in order to be able to care for others. We have to DEMAND that because hospitals, facilitues will expect a nurse to use " whatever " is available. I cant afford to do that.
We've had multiple HCWs turn positive, all were caring for non-intubated and not-yet-positive patients.
There's no basis for identifying an intubated, confirmed case as being a higher level of exposure risk than a non-intubated patient awaiting the test result.
Something we learned early on is to avoid placing too much confidence in what hospital administrators say is safe and what isn't, this is something we as frontline caregivers have to take ownership of.
I don’t disagree with you, it’s just what my hospital system has implemented due to the shortage of PPE which directly relates to the OPs question. We are also being told to reuse our PPE.
But, it won’t keep me from caring for the sick. I’m needed and there aren’t enough us. Somebody with knowledge has to do it.
I’m worried our regular patient population is going to have bad outcomes as we are stretched thin abs trying to train non ICU nurses to be ICU nurses. I’m prepared to do long hours in the upcoming weeks to keep everyone safe.
Specializes in Psych, Addictions, SOL (Student of Life).
15 hours ago, NormaSaline said:
I said among healthcare workers.
There has been no data released by the CDC, Nurses Unions or Hospital Associations with regard to the morbidity of Covid 19 in healthcare workers. What we do know is that while health care workers on the front line may have higher risk - it's no higher risk that that for any other contagious disease. I saw somewhere (Still looking for it) that among the 19,000 cases in US only about 60 have been diagnosed in health care workers and half of those were travel related as opposed to work related. So actually a very small number.
Lets also not forget that most cases of Covid 19 in non immunocompromised adults are mild or completely asymptomatic and approximately 89% recover completely.
I can't tell you how many times I've been exposed to God knows what and never caught anything and I am immunocompromised. I have a choice to wear a mask at work but choose at this time not to as I am working with a patient population that mostly consists of young physically healthy people( Mentally they are a train wreck) Thanking our hospital for not allowing the teens to watch the news.
A hospital that has PPE and is hoarding it is a totally different situation from one that has none. If there is nothing available— well, somebody has to care for the patient. We can’t let them die in the hallway because we don’t have masks.
But if you know the N95s are locked in a storage cabinet somewhere, then yes, I can see refusing care (I mean unless he’s actively coding right now, obviously). That would be your only leverage.
The difficulty *I* have with the current "recommendations" is that they changed as the equipment supply changed. These were not the original recommendations.
COVID-19 is not airborne by nature, the particles are sized larger than tuberculosis and smaller than influenza. The only time it is airborne is when you are providing a treatment that aerosolizes respiratory droplets, suck as a nebulizer, a bronch, intubation, or using BiPAP. Then, use of an N95 mask is the level of protection required, otherwise the pathogen is considered to be transmitted as droplet requiring droplet precautions. (Gloves, gown, surgical mask, and eye protection)
Healthcare workers are physiologically comparable to non-healthcare workers when it comes to how our bodies are affected by a virus. It's not as though our mortality risk is not comparable because of our third lung.
I hope you're right, but fear our level of exposure is much higher than a "comparable non-healthcare worker." (Depending of course on what any one HCW is assigned to do that day/shift.)
I guess people were trying to tell me that using lesser PPE (masks) simply because the appropriate PPE (N95) isn't available doesn't justify putting your health and safety as risk, especially if the hospital does have N95's available but is not giving them out. Again - not my opinion, that's why I was seeking other opinions.
I agree with them. I'd personally still work, but I'd be quite angry and shouting from the rooftops how wrong it is. Our country KNEW we would eventually have another pandemic. Yet they didn't prepare for the MOST BASIC equipment. To me this is unacceptable for America. This country wants to spout how great it is, but bc we value money over lives...well, this happens.
I'm trying to recall the moment I decided to become a nurse, knowing I would someday be mandated to work during a pandemic without proper PPE or be threatened with my job or license. Oh wait, that never happened. We NEVER thought the CDC would be telling us to use bandanas, reuse masks, go without...
So no. I did NOT sign up for this. Despite what many people want to say about us..."Well they knew the career they were getting themselves into." ? Like I said, I'd still do it. But only bc my morals wouldn't allow me to make someone else do it. I wouldn't judge anyone else for walking away, though. They did not sign up for this. This is NOT the military, as I was so very politely told once. I was in a political debate and MISPOKE defending myself on an issue and said as a nurse I serve my country. What I meant was I do my part to do good in this world by serving mankind. I got REAMED. How DARE I compare nurses to those who put their lives on the line! My brother was career military, and my dad was in the military too. I have the utmost respect for our military members and would never try to make people believe I am something I am not.
BUT....Months later...want to tell me again how nurses shouldn't say they are serving their country? But, oh no. This isn't the military remember? In my opinion nurses should have the right to refuse if they wish, go to another assignment, if not given the most basic protection. Specifically because we should have had it all along.
We are told to adhere to the CDC recommendation of N95 for aerosolizing procedures covered by a procedure mask and just a procedure mask for all other pt interactions with r/o COVID pts. I hear repeatedly from my manager that is all you need and since CNAs do not do these procedures they shouldn't even get N95s. Coughing does not qualify as aerosolizing since the CDC doesn't include it in their list. I fail to comprehend how coughing is not aerosolizing and I disagree with hospital policy. I understand that we're rationing the remaining stock of N95s for when we get hit with pts but we're already taking care of r/o pts who may or may not be positive. I ask myself would I go into a r/o COVID pt room w/o an N95 and my answer is no way so how can I insist that other staff do so? Perhaps it's time to resign from my position.
We are told to adhere to the CDC recommendation of N95 for aerosolizing procedures covered by a procedure mask and just a procedure mask for all other pt interactions with r/o COVID pts. I hear repeatedly from my manager that is all you need and since CNAs do not do these procedures they shouldn't even get N95s. Coughing does not qualify as aerosolizing since the CDC doesn't include it in their list. I fail to comprehend how coughing is not aerosolizing and I disagree with hospital policy. I understand that we're rationing the remaining stock of N95s for when we get hit with pts but we're already taking care of r/o pts who may or may not be positive. I ask myself would I go into a r/o COVID pt room w/o an N95 and my answer is no way so how can I insist that other staff do so? Perhaps it's time to resign from my position.
The CDC could have better explained their recommendations, but the basis for taking additional precautions during this procedures is that they may produce aerosols, more than just regular breathing would, but they don't typically aerosolize to the same degree as a cough, which is a well established source of aerosolized droplets. Whatever additional precautions are considered necessary during these procedures certainly should be taken when caring for a coughing patient with COVID or suspected.
We use an N95 for a full day and sometimes multiple days, that's still way better than a fresh procedure mask.
MunoRN, RN
8,058 Posts
We've had multiple HCWs turn positive, all were caring for non-intubated and not-yet-positive patients.
There's no basis for identifying an intubated, confirmed case as being a higher level of exposure risk than a non-intubated patient awaiting the test result.
Something we learned early on is to avoid placing too much confidence in what hospital administrators say is safe and what isn't, this is something we as frontline caregivers have to take ownership of.