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Some Las Vegas nurses fear that COVID-19 could easily spread in hospitals due to what they describe as rationing of personal protective equipment (PPE), inadequate testing of patients and staff, and poor communication from managers.
Because of a shortage of N95 masks, which shield nurses from infectious respiratory droplets from confirmed or presumptive COVID-19 patients, staff at MountainView Hospital are being asked to reuse masks for the duration of a shift, nurses Nicole Koester and Dina Armstrong said.
The masks are supposed to be discarded after one patient interaction, said Koester, a representative with National Nurses United.
“A mask that’s good for 15 or 20 minutes is now expected to be good and adequate for 12 hours. That’s not appropriate,” she said.
The problem stems in part from what nurses consider to be weakened guidelines set by the Centers for Disease Control and Prevention. The agency has been changing its guidelines for hospitals in light of a nationwide PPE shortage, Las Vegas nurse Zachary Pritchett said.
In a statement, MountainView Hospital said it is following CDC protocols for PPE and that nurses speaking out were “adding to the confusion, misinformation and fear spreading across the industry.” Nurses counter that the CDC has lost credibility on PPE and that its new guidelines conflict with those of other federal agencies, including the Occupational Safety and Health Administration (OSHA).
“When there are national guidelines like the CDC that are watered down, our hospitals can then defend themselves on what they ask us to do,” said Geoconda Hughes, a nurse at a hospital in the valley.
Another issue at MountainView, according to Koester and Armstrong, is that potential COVID-19 patients are not being isolated when they arrive at the hospital. Unless patients are placed in isolation, nurses cannot use N95 masks and other PPE, Koester said.
Until this week, nurses at the hospital were not allowed to wear even simple surgical masks when in non-isolation areas. Now, the hospital is allowing nurses one surgical mask per 12-hour shift, said Armstrong, also a representative with National Nurses United.
“Everything changes every day,” she said.
In a statement, MountainView said it has enacted “universal masking for all of our employees” and appointed a PPE “steward” who deploys PPE as efficiently and safely as possible. HCA Healthcare, the hospital’s parent company which also runs Sunrise Hospital and Medical Center and Southern Hills Hospital and Medical Center, has created PPE distribution centers at all campuses to quickly deliver protective gear.
“Currently our hospitals’ PPE and additional clinical supplies remain intact,” spokesperson Sunnye Owens-Garrett wrote in an email. “Through our proactive supply management process that aligns with CDC guidelines, we have been able to sustain our supply and keep our patients and healthcare workers safe.”
PPE is in high demand at hospitals across the country, noted Dr. Shadaba Asad, medical director of infectious disease at University Medical Center. Like other hospitals in Las Vegas and nationwide, UMC is closely monitoring its supply and extending usage of available PPE when possible, Asad said.
“We’re not out of PPE,” she said. “We’re also doing everything we possibly can to make sure we don’t run into any kind of shortage.”
While PPE supply is one of Las Vegas nurses’ biggest concerns, several said communication issues from hospitals could also potentially put them, their families and patients at risk of contracting COVID-19.
Nurses at MountainView say they are not being told when a patient they interacted with goes tests positive for COVID-19, creating unnecessary uncertainty and fear. In some instances, nurses could interact unprotected with patients who are awaiting test results, which as of late, takes nearly two weeks at MountainView, Armstrong said.
“Now I might have been exposed, and have not been sent home to self-quarantine,” Koester said.
Because of lack of communication from his hospital, Pritchett said he isn’t sure whether there are contingency plans in place for when the hospital reaches capacity or runs out of PPE, ventilators or other supplies.
“I think there has to be better communication, from the administration to the frontline nurses,” he said. “I don’t know what all the plans are right now.”
Testing for nurses who develop symptoms is another challenge, Koester and Hughes said.
Hughes said she knows of an area nurse who developed COVID-19 symptoms and is now being denied benefits nurses normally receive from work-related illnesses. Hospitals can deflect blame and workers’ compensation pay by pointing to the fact that they followed CDC guidelines, Hughes explained.
Nurses therefore have to use vacation time — or even stay home unpaid — if they contract the virus, she said.
“If I’m exposed, am showing symptoms and have to quarantine myself, hospitals are saying, ‘Well, we provided appropriate PPE, so this is not a work exposure,’” Hughes said.
Because tests are in short supply, HCA Healthcare hospitals are primarily administering tests to acute inpatients or emergency patients, Owens-Garrett said. At Sunrise Hospital, protocols for provider and employee testing follow CDC guidelines, said Sunrise strategic communications director Dan McFadden.
UMC is administering tests to health care workers with symptoms, considering staff to be the second-highest priority for testing after acute inpatients, Asad said.
“Having a healthy workforce is a priority,” she said.
In addition to asking hospitals to better protect employees, nurses say state and federal lawmakers could do more for them. In particular, President Donald Trump should invoke the Defense Production Act to compel companies to make N95 masks and other PPE, Las Vegas nurses say. Trump has only used the wartime act once since the pandemic began, to force General Motors to make ventilators.
The CDC must also strengthen its policies to protect nurses, while OSHA should better monitor the working conditions of those on the frontlines of the pandemic, Armstrong said.
“Nurses want to be there, nurses want to do their job, nurses want to take care of patients,” Pritchett said. “We signed up to take care of patients. We didn’t sign up to be martyrs.”