Tell me I'm being too literal

[imintrouble, BSN, RN]

Haven't been here in a while, but I need some advice.  Covid has come to my little rural corner of the world.  We're taking care of covid positive patients.  I'm not afraid to take care of them.  I've  always figured I'd contract it eventually.  However, my place of employment has issued a memo full of instructions and requirements to enter  the Covid rooms.  They've directed us what kind of masks to wear, and where to wear them. Eye protection the same.  Detailed instructions on what to do and how to do it.  The problem is they haven't supplied the PPE as directed in  the memo.  The way I interpret it is, they've covered their butts  with the proper procedure, then I get to decide how I protect myself and those I care for.   The last day I worked I didn't have an N95 mask, and threw a fit until I got "one" even though I'm supposed to have a different one for each covid room I enter.  

I've been burned several times in my long nursing career, improvising when I found I simply couldn't do what I was told to do.  Management can and does leave you hanging when you try to do your best with what you have. 

I've read the horror stories about nurses in NY, and other hot spots, who weren't properly protected and what they had to do.  I feel small complaining about my little problem,  that's why I'm asking for advice.  

When they tell me I have to have a new N95 mask for each Covid room, and  only supply me with one, what do I do?

[NRSKarenRN, BSN, RN]

Many nurses across the US receive ONE N95 mask per day to use for entire shift + multiple patients, not just per 1 patient as still a shortage.  Document to the powers that be, PPE supply does not confirm to their new policy --and keep being proactive throwing fits as needed to protect yourself and your patients.

[Jedrnurse, BSN, RN]

Keep personal notes documenting the dates, what the deficiencies were, and what management told you. It won't protect you from COVID-19, but it'll help your legal standing if the poop hits the fan.

[imintrouble, BSN, RN]

6 minutes ago, Jedrnurse said:

Keep personal notes documenting the dates, what the deficiencies were, and what management told you. It won't protect you from COVID-19, but it'll help your legal standing if the poop hits the fan.

They're hanging us out to dry aren't they.    What I don't get is why the nurses I work with aren't as anxious about  this as I am.  

[Jedrnurse, BSN, RN]

18 minutes ago, imintrouble said:

They're hanging us out to dry aren't they.    What I don't get is why the nurses I work with aren't as anxious about  this as I am.  

Denial/minimization are both important coping mechanisms. Not always healthy, but they can get you through a lot. I wonder if COVID fatigue has blunted people's reactions to situations like these...

[Corey Narry, MSN, RN, NP]

4 hours ago, imintrouble said:

When they tell me I have to have a new N95 mask for each Covid room, and  only supply me with one, what do I do?

This is where your institution has a disconnect between policy and practice.  Many places have implemented some form of N95 re-use or extended use policy.  It could just be that the administration in your hospital "cut and paste" a policy from years back prior to the pandemic when nurses did use one N95 mask per encounter.  In many places, it's not uncommon to hear nurses wear the same mask all day in various ways. 

There are places that allow nurses to place masks in a personal receptacle (a brown bag is an example) to be stored while not in use and then re-worn when needed for the day.  There are others who plainly wear the N95 mask all day without removing it (hence, the pictures of face marks caused by the masks were trending on social media for a while). The important part here is that you don't touch the inside surface of the mask and that you wear a face shield over the mask to prevent it from getting splashed.

I think the biggest fault I would say for your institution is their lack of transparency.  Where I work, we have a COVID-19 dashboard that is accessible by all staff while on-site (can't look it up from home). It gives us our COVID 19 alert level, COVID  19 patient census and their acuities as well as projections for how long the PPE's we have on hand will last if not replenished. 

This system, gives staff an understanding of the situation the hospital is in and how we as employees can work together to keep things safe for everyone.

[Missingyou, CNA]

We have the same thing happening at our facility. 

We wear the same 1 KN95 mask for 5 straight shifts. In & out of both positive & non positive patient rooms. we have all made a fuss but are told it is in compliance. 

My opinion is that it all comes down to money. You cannot convince me that there is STILL a shortage of N95 masks.  

Masks cost money (more than what they did pre covid) &yes we are using lots of them. The facility would go broke if all staff were given a new mask every day. 

I would prefer to be given a new mask every shift & be assigned to positive patients only, then be given a $2. An hour "hazard pay" & work with the any ole willynilly shift I do now.  

[Guest219794]

I am a big fan of E-mail.  It is a paper trail, but better.
"As you know, the policy states XYZ, but the hospital has not provided adequate resources to comply with the policy.  As this is likely to cause staff to contract Covid 19, what is the facility's plan for covering that staff member when sick?

If they do screw you, trust me, the local paper will love a copy of this e-mail.

[gettingbsn2msn, MSN, RN]

My RN son is leaving nursing after spending $$$ on a BSN. 

He worked in NYC metro at the beginning of the pandemic.  He said he realized quickly that the hospitals could give a damn about him.  They wore garbage bags over their scrubs and got one N95 mask for the shift.

They had to do their own respiratory therapy, phlebotomy, IV's and accompany their patients to other locales in the hospital. 

I always worked in hospitals that had RT's (and I am in the southeast).

He is looking in to counseling as he is having flashbacks and nightmares over this.  He said not worth the money.

He is going back to school for IT.

[TriciaJ, RN]

It's going to be time-consuming, but I'd submit an incident report for EACH day you do not have the equipment specified in the policy.

The written policy is to cover their *** when someone gets sick.  They plan to throw you under the bus if anything untoward happens.  That's where a daily incident report comes in - the all-too-necessary paper trail.  If your incident report system is strictly online with no provision to generate a copy for yourself, then do keep track in a notebook of each report you submit.  Keep this notebook AT HOME.  It is not safe even in a locked locker at work.

I'm sure you don't have a union.  If you do, please speak to them about possible courses of action, or at least additional ways to maintain a paper trail.

[imintrouble, BSN, RN]

Thanks for all the replies.  I figured documentation of deficiencies was how I was going to handle the difference between policy and reality.  

The stupid thing is, hospitals and nursing homes all over the country are having to improvise with N95 masks.  It's no secret there just plain aren't enough.  Attorneys and families know it.   Putting out a memo that no hospital or nursing home in the country can comply with, won't protect you from lawsuits if somebody wants to litigate.  It always makes me mad, when management anywhere, expects a result they know nobody can deliver.  Just to cover themselves. 

When I talked to the nurses I work with about my concerns, they looked at me like I was overreacting.  They'd already started improvising  with masks, goggles, and face shields, without complaint or direction.   Doing what they thought was best,  disregarding the mandates of the Covid memo.  

 

[imintrouble, BSN, RN]

On 10/15/2020 at 2:55 PM, juan de la cruz said:

 

I think the biggest fault I would say for your institution is their lack of transparency.  Where I work, we have a COVID-19 dashboard that is accessible by all staff while on-site (can't look it up from home). It gives us our COVID 19 alert level, COVID  19 patient census and their acuities as well as projections for how long the PPE's we have on hand will last if not replenished. 

This system, gives staff an understanding of the situation the hospital is in and how we as employees can work together to keep things safe for everyone.

Funny you should post the above.   We were threatened with our jobs for HIPAA violation if we told anybody how many or who the Covid patients were.    It's obvious where the rooms are, when you look at the isolation signs.    But it seemed pretty over the top to threaten staff on the unit, when they told each other.  

I guess we're all just feeling our way through a situation we couldn't even imagine a year ago.