‘Wildly unprepared’: survey of nurses highlights coronavirus concerns

As the number of US coronavirus cases and deaths continue to increase, healthcare workers on the frontlines of fighting the outbreak are finding themselves increasingly concerned over what they have described as a shocking lack of preparedness across the healthcare sector.

Supply and staffing shortages, combined with conflicting guidance and lack of information, have created a perfect-storm situation that’s poised to perpetuate illness, they told the Guardian.

National Nurses United (NNU) released results from a survey of more than 6,500 nurses across 48 states, Washington DC, and the Virgin Islands. Less than half of nurses surveyed – 44% – said their employers provided them information on novel coronavirus and “how to recognize and respond to possible cases”.

Just 63% of nurses surveyed had access to N95 respirators in their units, while a mere 27% had access to powered air purifying respirators.

Only 30% of survey participants said that their employers had enough personal protective equipment (PPE) stocked in the event of a quick uptick in potential coronavirus patients, while 38% didn’t know.

Sixty-five percent of nurses in the survey said they had been trained in safely using PPE in the year prior.

During an NNU news conference Thursday, organization officials read one northern California nurse’s shocking description of her own healthcare ordeal stemming from Covid-19.

“As a nurse, I’m very concerned that not enough is being done to stop the spread of the coronavirus. I know because I am currently sick and in quarantine after caring for a patient who tested positive,” the unnamed nurse said in her statement. “I’m awaiting permission from the federal government to allow for my testing, even after my physician and county health professional ordered it.”

The nurse said that she volunteered to be on a team caring for this patient, who was known to have coronavirus.

“I did this assuming that if something happened to me, of course I, too, would be cared for,” the statement said. “Then, what was a small concern after a few days of caring for this patient, became my reality: I started getting sick.”

Q&A

How can I protect myself from the coronavirus outbreak?

The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the Wuhan coronavirus, for which there is no specific cure or vaccine.

The UN agency advises people to:

  • Frequently wash their hands with an alcohol-based hand rub or warm water and soap
  • Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
  • Avoid close contact with anyone who has a fever or cough
  • Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
  • Avoid direct, unprotected contact with live animals and surfaces in contact with animals when visiting live markets in affected areas
  • Avoid eating raw or undercooked animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination with uncooked foods.

Despite a surge in sales of face masks in the aftermath of the coronavirus outbreak, experts are divided over whether they can prevent transmission and infection. There is some evidence to suggest that masks can help prevent hand-to-mouth transmissions, given the large number of times people touch their faces. The consensus appears to be that wearing a mask can limit – but not eliminate – the risks, provided it is used correctly.

Justin McCurry

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The nurse’s employer placed her on a 14-day self-quarantine because her symptoms matched potential coronavirus. While her doctor and local public health officials approved a test, she said, “the national [Centers for Disease Control and Prevention] would not initiate testing”.

“They said they would not test me because if I were wearing the recommended protective equipment, then I wouldn’t have the coronavirus,” she said in her statement.

The nurse said that the CDC called back, claiming there was “an issue with something called the identifier number.”

“They claim they prioritize running samples by illness severity and that there are only so many to give out each day. So I have to wait in line to find out the results,” her statement said. “This is not the ticket dispenser at the deli counter; it’s a public health emergency! I am a registered nurse, and I need to know if I am positive before going back to caring for patients.”

An emergency room nurse at a private hospital in New York City’s Bronx borough told the Guardian that her department – already stretched thin from handling 300 to 400 patients daily on scant staff – was “wildly unprepared” for coronavirus. As of Thursday afternoon, this state has 22 confirmed coronavirus cases.

Hospital administrators recently restricted practitioners’ access to N95 masks, claiming it was “because of the national shortage”, this nurse said. Now, healthcare workers there have to seek a manager’s permission to obtain one of these respirators – even if someone walks into the ER who presents coronavirus concerns.

Upon being screened in the triage area, patients with concerning symptoms would be isolated. Logistically, this means that nurses’ requests for masks would come after potential exposure.

Right after access to N95 masks was curtailed, nurses would have to find the day’s supervising nurse, who would have to call a unit manager, who would then have to call the supply room for masks. At that point, somebody would have to get these masks from the supply room, and bring them to the ER, she said.

After nurses protested the onerous process, some N95 marks were placed in a locked cart on the floor, and some with the supervising nurse. But they were only size regular, which would be too big for her and some other nurses – rendering them useless, she said.

Several patients with respiratory symptoms who tested negative for common respiratory ailments – a red flag indicating that testing for coronavirus might be necessary – never got tested. One was released from the hospital, while several more wound up being treated for general respiratory symptoms, she said.

When this nurse voiced concerns to management, she claims to have been warned: “stop freaking out and stop scaring everybody”.

David Pratt, a health and safety representative at the New York State Nurses Association, said that, due to policies on the federal and local hospital level, “there is increasing concern among our members, among nurses, about the lack of preparedness of many of our facilities”.

New York State only recently received permission to conduct its own coronavirus tests, which had delayed diagnoses. In addition to supply concerns, staffing issues remain key.

Hospitals would need to dedicate one nurse and one aide to a coronavirus patient, Pratt said. “With that, you’ve really taken a couple of staff people out of the mix. Who’s making up for that?”

“It makes it much more difficult if your system is already overwhelmed,” he continued.

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