The head of the country’s largest union of registered nurses walked away disappointed from a Congressional hearing Friday morning, worried that a lack of mandated protections for nurses could endanger not only health care workers but, eventually, the public.
Deborah Burger, RN, co-president of National Nurses United, or NNU, said in her testimony to the House Committee on Oversight and Government Reform, “The risk of exposure to the population at large merely starts with front-line caregivers like registered nurses, physicians and other healthcare workers – it does not end there. If we cannot protect our nurses and other healthcare workers, we cannot protect anyone.”
She wants Congress to mandate that all hospitals in the U.S. follow protocols to protect not only nurses but other health care workers and patients. Without federal action, she’s concerned that hospitals will choose the cheapest guidelines from the Centers of Disease Control when it comes to protective gear for nurses.
“We know these hospitals,” said RoseAnn DeMoro, executive director of NNU which represents 185,000 registered nurses, in a press release. “Their priority is not optimal Ebola preparedness, it is protecting their budgetary goals and profit margins.”
Both women believe it will take an act of Congress or executive order from the White House.
While neither the President nor Congress seems interested in forcing hospitals to follow stricter protocols to protect nurses, there was talk Friday of quarantining doctors and other health care workers returning from West Africa where the Ebola virus is rampant.
It was a patient from Liberia who infected Nina Pham, the first person to contract Ebola in the U.S. She was declared “virus-free” by doctors at the National Institutes of Health and was released Friday.
Pham, 26, is one of two nurses who were infected with Ebola after treating Thomas Eric Duncan, from Liberia, who died Oct. 8 in a Dallas hospital. The other nurse, Amber Joy Vinson, 29, is also virus-free, according to a statement from her family, and has undergone treatment at Atlanta’s Emory University Hospital.
It’s no surprise that nurses were the first to come down with Ebola in this country. They’re the front-line caregivers, making them the most vulnerable because the virus is spread through bodily fluids. That makes Thursday’s news of another Ebola patient in the U.S. — this time a physician in New York who returned earlier in October from Guinea where he worked with Doctors Without Borders — even more frightening for the nursing community as the number of patients increases.
“This month has been a nightmare, frankly, for the nurses across the nation,” said DeMoro during a national conference call on Ebola preparedness Oct. 15. Another nurse, who called in, put it even more forcefully: describing Ebola as the “nurse-killer disease.”
National Nurses United has also sent a letter to Obama requesting he issue an executive order mandating standard protocols as well. “We would not send soldiers to the battlefield without armor and weapons,” wrote DeMoro, and the group is asking for signatures on a petition as well.
We’ve all seen photos of health care workers lumbering about in hazmat suits, but not all hospitals have such equipment available for their staff. Although the Centers for Disease Control has issued guidelines regarding protective wear, they’re only guidelines without the weight of law behind them, Burger said in a phone interview Thursday. “Even with the new CDC guidelines, they’re still not mandated and 5,000 hospitals in the U.S. get to pick and choose” what to do.
NNU wants hazmat suits meeting certain specifications, at least two registered nurses to care for each Ebola patient (with no other patient assignments) and on-going training.
“It’s frustrating because most hospital administrators have no clue just how stressful it is to take care of a patient with all this bodily fluid coming from every orifice,” Burger said.
Patients with Ebola suffer from projectile vomiting, explosive diarrhea and urinary incontinence, along with bleeding. “Nurses are in close, intimate contact with patients,” Burger said. “They’re changing bed sheets and wiping and cleaning bodies.”
And that makes them “extremely vulnerable,” she said. Protecting against all those fluids can be tough.
Training exercises using Tabasco — yes, the hot peppery sauce — are helping health care workers at the University of Texas Southwestern Medical Center learn how to avoid contamination when removing their protective gear. As a stand-in for blood and other fluids, the Tabasco stings so nurses and doctors realize it’s on their skin.
Nurses at Texas Health Presbyterian Hospital in Dallas have reported anonymously to NNU about their fellow nurses who contracted Ebola, saying the hospital did not provide proper protective gear and that the nurses’ necks were exposed while their gowns were not impermeable to fluids. CDC Director Tom Frieden at first tried to blame the infections on “a breach of protocol” that sounded like the nurses were at fault.
Nurse Briana Aguirre told the “Today” show: “We never talked about Ebola and we probably should have.”
Hospitals aren’t ready for what may happen, Burger said. She cited the results of a study by NNU of more than 3,000 nurses at 1,000 hospitals around the country: 84 percent of nurses say their hospitals have not provided any kind of interactive training, 68 percent say their hospitals have not communicated any sort of policy regarding the admission and care of patients with Ebola, 46 percent say their hospitals do not have an adequate supply of impermeable or fluid-resistant gowns and 44 percent don’t have enough protective eyewear.
“This is really a female profession,” she said, with at least 90 percent of registered nurses women. “But look at the protective gear worn by fire fighters and paramedics, even what the workers at the CDC wear when they’re dealing with a single vial of the Ebola virus.”
While physicians in West Africa are on the front lines of care, it’s a different story for some in the U.S., Burger said. She knows of two instances where physicians refused to enter the rooms of possible Ebola patients, choosing instead “to conduct interviews over the phone.”
But nurses can’t phone in their care.