JOINT STATEMENT FROM THE AMERICAN HOSPITAL ASSOCIATION, THE AMERICAN MEDICAL ASSOCIATION AND THE AMERICAN NURSES ASSOCIATION: As our nation’s strategy to address the Ebola virus continues to evolve, hospitals and their partners in nursing and medicine are coming together to emphasize that a solution-oriented, collaborative approach to Ebola preparedness is essential to effectively manage care of Ebola patients in the U.S. Ensuring safe care for patients, healthcare workers, and communities demands the combined efforts of inter-professional, state, and federal organizations. In addition to domestic efforts to prepare for and treat Ebola, an enhanced focus on the part of the United States and the international community to contain the outbreak in West Africa is fundamental to stopping the spread of this virus.

Hospitals, physicians, and nurses have the same goals in addressing any Ebola case: to ensure that all hospital and clinical staff are able to safely provide high-quality, appropriate, patient care. We are committed to ensuring that nurses, physicians and all frontline healthcare providers have the proper training, equipment and protocols to remain safe and provide the highest quality care for the patient. As the Centers for Disease Control and Prevention (CDC) updates the protocols and procedures involved with patient care and personal protective equipment, we will review and share updated guidance with our collective memberships as it becomes available.

Our nation’s hospitals, physician and professional nursing organizations remain in communication with one another and with our nation’s public health institutions at the local, state and national levels. We are committed to maintaining a strong collaborative effort to address this public health threat.

In a call with nurses nationwide, the Centers for Disease Control and Prevention (CDC) announced revised emergency preparedness and treatment guidelines to prevent transmissions of Ebola in the United States. The changes come after two nurses from Texas Health Presbyterian Hospital in Dallas became infected with Ebola while caring for Thomas Eric Duncan. Duncan had recently traveled to Dallas from Liberia and died from the disease on Oct. 8.

“At this difficult time, we continue to offer our support to the two nurses, their families, colleagues and communities,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.

“We also offer our support to the brave nurse who publicly revealed that a lack of clarity, protocols and guidance contributed to system issues at Texas Health Presbyterian Hospital, critical lapses that have been acknowledged by hospital officials.

“Today’s CDC call was a step in the right direction. However, while we understand this is a rapidly evolving situation, we are concerned that today’s call did not fully address to our satisfaction concerns we have heard from our members.

“Clinical health care settings, such as hospitals, are unpredictable environments. Instead of variability, we need clear-cut standards and guidelines in place that nurses and health care team
members can follow consistently to ensure the highest levels of care and protection for patients and health care professionals.

“ANA advises the CDC to provide the following information quickly to ensure the safety of workers, patients and communities:

• Clear and specific standards for personal protective equipment (PPE) at the point of patient presentation as well as diagnosis.
• Emphasis on current or revised training techniques proven to be effective for proper use of PPE.
• Full disclosure of findings of events at Texas Health Presbyterian Hospital that can be used to improve practices and prevent further infections.
• More rapid dissemination of any changes to procedures, guidelines and recommended care.

“Further, ANA recommends that health care organizations adopt PPE standards that have been demonstrated to provide effective protection for nurses and other health care workers in the clinical setting when caring for Ebola patients, such as those used by Doctors Without Borders and the protocols developed by Emory University Hospital.

“CDC officials plan to release revised PPE recommendations in the near future. Once the recommendations are released, ANA will review them and provide additional feedback, as necessary.

“While we believe nurses are obligated to care for patients in a non-discriminatory manner, with respect for all individuals, we also recognize there may be limits to the personal risk of harm nurses can be expected to accept as an ethical duty.

“We strongly encourage nurses to speak up if they believe there is inadequate planning, education or treatment related to providing care to these or any patients, and seek to resolve any conflicts of risk and responsibility swiftly. Nurses should have the right to refuse an assignment if they do not feel adequately prepared or do not have the necessary equipment to care for Ebola patients.

“ANA believes that a solution-oriented, collaborative approach that includes interprofessional, state and federal organizations is essential to manage care of Ebola patients effectively in the United States.

“Additionally, appropriate funding for public health and preparedness must be addressed in order to ensure that response systems and infrastructure are in place to respond to any emergency situation.

“As we address these important issues related to the U.S. Ebola response, we must also keep focused on the global response needed to address the crisis in West Africa. Until we have sufficient systems and resources there to appropriately manage patient care and stop its spread, Ebola will remain a global concern.”