Union Nurses and healthcare professionals are in a unique position to provide valuable insight and precise guidance. For decades, we have been at the forefront, pushing hard for every major safety advancement in our professions. We led the way (often fighting hospital administrators) on:
- AIDS treatment
- Needle safety
- Workplace violence prevention
- Safe nurse-to-patient ratios
- Aerosol transmissible disease standards
- Workplace violence protections
- Safe patient handling
- and more
The COVID-19 pandemic is no different. Those of us on the front line continue to see clearly what is needed. We propose our Pandemic Safety step-by-step plan for our hospitals, which includes:
- New, optimal PPE
- Immediate notification of exposure
- Regular testing
- Quarantine that’s safe and affordable
- Safe staffing levels
- Dedicated Labor/Management Pandemic Safety Committee
Pandemic Safety Platform
The coronavirus global pandemic has uncovered severe deficiencies in our hospitals, including—but not limited to—dangerous lack of staffing and supplies, inadequate patient care, reckless COVID-19 transmission, and needless staff burnout.
For some of what we outline below, it’s as simple as better adherence to the things we’ve already established. The Cal/OSHA Aerosol Transmissible Disease Standard, for example, was specifically created for a time like this. And yet in hospital after hospital, it wasn’t effectively followed, leading to illness and unnecessary transmission. Our Title 22 safe staffing regulations should have guided our hospitals as they shifted resources to treat COVID-19 patients. In other cases, this once-in-a-century crisis has made us aware of weaknesses in our systems that we haven’t yet addressed.
Here’s what our hospitals need in order to improve safety during a pandemic:
New, optimal PPE
Early in the pandemic, the public learned a new acronym: PPE—personal protective equipment. They learned that our hospitals, our local public health departments, California and our nation were caught woefully under-supplied.
Our Union urged California legislators to ensure that this lack of PPE won’t happen again. SB 275—The Healthcare and Essential Workers Protection Act—was introduced by State Senators Leyva and Pan to create a reliable supply of PPE to ensure healthcare workers, essential workers, and the public at large are protected during the next health emergency. SEIU members from all over the state pushed for its passage. Governor Newsom signed it into law in September.
SEIU Local 121RN members point out that having a stockpile of PPE is a first critical step in the right direction. It must go hand-in-hand with other necessary remedies. Nurses need more than a supply closet full of N95s. We need access to them. We need to be able to wear them the way we were trained to wear them—for a single use when visiting an infected patient, to prevent the spread of disease to other patients and to staff.
All hospital staff must have access to adequate PPE. There are no “clean” areas, as several deaths in our hospitals have proven. We don’t know who’s infected. Both patients and staff go untested when they don’t show symptoms, potentially spreading the disease to both. Test results are often delayed or even inaccurate.
NIOSH approved and tested N95s or PAPRs must be available for all staff facing possible exposure—especially, but not limited to, those caring for COVID-19 patients or those suspected of having COVID-19. PPE must not be reused from patient to patient. All staff must be properly fitted and thoroughly trained in safe donning and doffing. Staff members must have the right to replace any PPE they consider unsafe (for any reason). Any recycling, reuse or sterilization programs must be used only as the very last resort in a true emergency situation when all supplies have actually been depleted, including the supplies of all vendors and sources of PPE. Hospitals must not allow shortages simply because supplies became more expensive.
Bottom line: we know that our colleagues have died as a direct result of inadequate PPE. We know that we have likely infected patients who came into our hospitals without COVID-19. L.A. County now reports more than 6,300 Nurses have fallen ill in the county and 46 have died as of November 2020.
Immediate notification of exposure
Hospitals must notify staff of all possible exposure as soon they are aware, including exposure to suspected COVID-19. This notification must happen immediately, but no longer than 24 hours after the exposure incident. Hospitals must provide immediate testing of all exposed staff.
Hospitals must establish a regular schedule for testing of all frontline workers to ensure patients are safe and not unnecessarily exposed to COVID-19 from those providing care. Staff members must also have access to free, on-demand testing whenever they consider it necessary.
Quarantine that’s safe and affordable
Hospital staff must have access to paid quarantine as needed for the full recommended duration or until they test negative. Contraction must be assumed to be job related. Hospitals must provide additional PTO for the care and quarantine of family members.
Safe staffing levels
Hospitals also must have enough staff on their floors every shift to safely care for patients. California’s nurse-to-patient ratio regulations should have guided our hospitals as they shifted resources to treat COVID-19 patients. Instead, many hospitals use the pandemic as an excuse to slash their staffing levels. Having enough Nurses and other healthcare personnel on duty is critical. A New York Times investigative journalist discovered that the death rate in hospitals without sufficient staff and equipment was as much as three times higher than properly staffed/equipped hospitals. Our hospitals have the available staff, but they’ve chosen to reduce hours or remove them from the schedule. Nurses leave their shifts near tears because they aren’t able to spend time with their frightened, isolated COVID-19 patients.
There must also be minimum staffing levels for support and specialty staff, including Respiratory Therapists, Phlebotomists, Nurse Assistants, Environmental Services and Unit Secretaries.
COVID-19 patients, due to the risk of rapid and unpredictable decline, are akin to ICU patients. The maximum number of COVID-19 patients per RN should be two. There must be a dedicated Charge Nurse who is not put into this ratio. There must also be minimums established for support and specialty staff, including Respiratory Therapists, Phlebotomists, Nurse Assistants, Environmental Services and Unit Secretaries.
Dedicated Labor/Management Pandemic Safety Committee
Those of us on the front lines of patient care must have a voice in safety policies and procedures. We knew from the outset that there were airborne risks with COVID-19. That’s why we desperately scrambled for PPE that our hospitals weren’t supplying. That’s why we risked being disciplined when we insisted on wearing our own. We know from decades of safety fights that official guidelines are sometimes off the mark. We moved Cal/OSHA to establish the Aerosol Transmissible Disease standard, not the other way around. We demanded needle safety, not the other way around. We must be at the table on pandemic safety issues.
Union Nurses and healthcare professionals will continue to risk our health and safety to care for our communities during this pandemic. At the same time, we will continue our long tradition of fighting for the establishment of improved professional standards. In addition to urging our hospitals to join us in these efforts as outlined here, we will also continue to push for better enforcement of the standards we have and will establish.