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Features highlights from Executive Director of NNU, Rose Ann DeMoro’s Rally Speech

Nurses are celebrating California’s recent announcement of precedent-setting Ebola patient care guidelines that call for strong healthcare worker protections and provide a model for federal and state action for all U.S. hospitals. The new guidelines came in the wake of the Nov. 12 worldwide Day of Action for Ebola Safety by 100,000 registered nurses (see more on the Day of Action below).

The new California standards, an elaboration of existing Cal/OSHA regulations on Aerosol Transmissible Disease and other existing regulations, go well beyond the faulty procedures and protective gear employed by hospitals across the U.S., and the current, unenforceable recommendations of the federal Centers for Disease Control and Prevention.

By contrast, California regulations are mandatory and hospitals that fail to comply will face civil penalties. The regulations stipulate requirements for the optimal level of personal protective equipment (PPE) and rigorous training and drills. They break new ground in identifying modes of possible transmission of the virus and clarifying when safety precautions must be engaged for nurses and other front line health workers who encounter patients with the deadly Ebola virus.

“These rules are a testament to the outspoken efforts of nurses who have repeatedly pressed for the highest level of mandatory safety precautions to protect nurses, patients, and the public. Nurses have raised their voices, and California has now listened, acted, and once again set a benchmark for the nation,” said NNU and CNA Executive Director RoseAnn DeMoro.

“With the hospital industry dismissing the concerns of the nurses, and the federal government failing to order the hospitals to implement the optimal level of Ebola protection, California, under the stewardship of Gov. Brown, has heard the voices of nurses, and established a model that all should follow,” said CNA Co-President Zenei Cortez, RN.

Learn more about this exciting news here:

• Overview of the New California Standards on Ebola
• Press Release: Dramatic New California Ebola Mandate Inspired by RN Actions
• Nurses urge you to sign the Petition to President Obama and Congress Demanding that the Federal Government Adopt the Same Standards

Global Day of Action Energizes Nurses Campaign to
Protect Nurses and Stop Ebola

 
Nurses in Washington DC march near the White House on the Day of Action

Across the US, from the White House to the Federal Building in Oakland, CA, thousands of nurses took part in National Nurses United actions Nov. 12, demanding that US Hospitals dramatically ramp up preparedness for Ebola. The Nurses also called on the President to mandate the highest Ebola safety standards citing the laxity and unenforceability of current CDC guidelines. Nurses and healthcare worker unions also held actions in Australia, Canada, Ireland, the Philippines and Spain.

In over 150 locations in 16 states nurses held strikes, die-ins, rallies, candlelight vigils, bake sales, “walk-ins,” and pickets in front of hospitals and Federal, State and OSHA office buildings. Each action site featured red banners and life-sized placards of a nurse wearing a full-body HAZMAT suit illustrating the optimal standard of PPE/personal protective equipment RNs require to safely care for Ebola patients.

DC nurses die-in at the White House

Nurses from the DC area staged a “die-in” in front of the White House to underscore the urgency of providing healthcare workers with the optimal standard of personal protective equipment. “I put my heart into being a nurse every day and I want my patients to get the best possible care,” said Donna Fleming-Cobey, an RN at Providence Hospital, who participated in the die-in.

Rally and n95 respirator action in Oakland, California

Over two thousand nurses in red scrubs marched on Kaiser Headquarters and then rallied at the Federal Building in downtown Oakland, California. Nurses chanted “n95, We deserve better, n95, We deserve better,” and then tossed the shoddy respirators into large boxes that were shipped to the President after the action. You can watch some of the rally here: https://www.youtube.com/watch?v=oX5Q1Tny4gQ

Snapshots of some of the many other actions across the country:

In New York City nurses held a candlelight vigil in front of the Federal Courthouse.

Nurses braved 18° wind chill for actions at several sites in Chicago, IL including the University of Chicago Medical Center.

At the Hines VA action, nurses were joined by Iraq Veterans Against the War (IVAW) and Disabled Veterans of America  (DVA). The veterans thanked NNU for standing up for what’s right, and speaking out when everyone else was quiet, or, worse, complicit in purposefully doing nothing to protect nurses, veterans and the public at large.

Members of the Michigan Nurses Association paid a visit to the state Capitol accompanied by a mobile billboard message to Governor Snyder.

Nurses held a vigil outside St. Louis University Hospital despite VERY cold weather.

Nurses in South Florida rallied at the OSHA office in Fort Lauderdale

Nurses and their families gathered at the Minnesota State Capitol for a candlelight vigil to honor those frontline healthcare workers who have been caring for or have pledged to care for Ebola patients. Nurses asked the state for mandatory standards to be enforced by OSHA that will protect them from all infectious diseases, and they pledged to make complaints to OSHA if hospitals aren’t ready.

In El Paso, TX nurses visited Congressmember Beto O’Rourke’s office. His staff pledged to support nurses’ efforts to win stronger federal standards for Ebola safety and offered to sponsor legislation toward that end.

Nurses from Reno and Las Vegas met with the Chief Administrative Officer of Nevada OSHA in Las Vegas to discuss nurses’ demands for optimal Ebola safety protocols including equipment and training while nurses conducted a bake sale outside to raise money for HAZMAT suits.

Nurses who work for hospitals operated by St. Joseph Health Systems “walked-in” on management at SJHS headquarters in Irvine, Ca to discuss their concerns about the lack of Ebola preparedness at SJHS. The nurses followed their surprise visit with a press conference in front of the headquarters.

Nurses at Kaiser San Francisco on one of many strike lines on the Day of Action

Many children joined the strike lines showing enthusiastic solidarity on the Day of Action!

More photos and media coverage of the Day of Action:

• Washington Post: Nurses win battle in California for mandated protections against Ebola
• Washington Post: Nurses go on strike for proper gear, training to protect them against Ebola
• Reuters: U.S. nurses hold strikes, protests over Ebola measures
• US Nurses strike over Ebola protection
• Sacramento Bee: Nurses Strike is Park of Larger Labor Push
• 18,000 Northern California Kaiser nurses walk out over contract talks

Visit National Nurses United’s Flickr site to see more Day of Action photos!

The state of California, at the insistence of registered nurses, has set an Ebola safety standard for the nation. In the face of the disease known as “nurse killer,” CNA/NNU has defeated efforts by the hospital industry to limit the protection of nurses to the voluntary, unenforceable guidelines put forth by the Centers for Disease Control. Instead, we have collectively ensured an optimal standard for personal protective equipment (PPE) and respiratory protection that will enable nurses to safely treat Ebola patients. 

• For any nurse in direct contact with a suspected or confirmed Ebola patient, mandatory, enforceable requirements under Cal-OSHA on hospitals, including emergency departments, to provide coverall PPE full-body suits, along with nitrile gloves and non-slip cover boots;
• Requirement that hospitals provide a powered air-purifying respirator (PAPR) with a full hood or cowl for any nurse in contact with a suspected or confirmed Ebola patient;
• PPE and PAPR requirements apply to employees providing care to suspected or confirmed Ebola patients, employees cleaning contaminated areas, and staff assisting employees with the removal of contaminated protective gear in all hospital departments, including the ER;
• All PPE must meet or exceed the NNU-supported ASTM standards on blood and blood-borne pathogen penetration;
• Continuous, hands-on interactive training is required for nurses and other healthcare workers, with demonstrated competency, on donning and doffing, transmission, and other procedures, before treating any suspected or confirmed Ebola patient. Computer-based learning does not meet the training requirement;
• Hospitals are required to actively involve nurses in the development of the exposure control plan;
• Nurses have the protected right to express their health and safety concerns without fear of retaliation, and hospitals must investigate and report back on any reported concern;
• Nurses exposed to potential infection may be relieved of work duties, or placed in an alternative job, but otherwise must receive full pay and preserve all benefits and seniority rights until incubation period ends and they are returned to their original position.

Nurses can enforce this guidance under their union contract through their professional practice committee (PPC) or by taking other collective action against hospital management. Cal-OSHA is the state agency that enforces these standards and will investigate complaints made directly to them at the Cal-OSHA district office closest to the workplace (list of offices here: www.dir.ca.gov/dosh/DistrictOffices.htm). Nurses can also file whistle-blower complaints about inadequate patient safety and non-compliance with these standards to the California Department of Public Health, which licenses hospitals.  

How did NNU win new Ebola and infectious disease safety requirements to protect nurses?

Overcoming lobbying by Kaiser and other hospitals, CNA/NNU fought to establish stronger enforceable standards for personal protective equipment (PPE), including respiratory protection, training, and medical services.  Kaiser Permanente, the largest healthcare corporation in the United States, led the fight by the healthcare industry against stronger patient safety requirements. They only wanted voluntary guidelines or multiple-choice options that would leave it up to them and their budget as to how nurses were protected. Kaiser unabashedly took this position notwithstanding the overwhelming public health consensus that healthcare workers in direct contact with Ebola patients have been identified as being at increased risk of contracting the disease.

This is a tremendous victory. It is a demonstration of our power and demonstration of why nurses must fight hard for improved patient care conditions. It is a precedent-setting victory for disaster preparedness now and in the future.

Which regulations and standards for Ebola preparedness apply to my facility?

The federal Centers for Disease Control (CDC) issues guidelines that U.S. hospitals often rely upon, but they are voluntary and not enforceable. By contrast, the new California standards requiring hospitals to protect employees against exposure to Ebola virus disease are enforced by the state Division of Occupational Safety and Health, commonly known as “Cal-OSHA.” For Ebola, these regulation sections cover: Blood-borne pathogens (BBP); Aerosol Transmission Diseases (ATD – unique to California); Personal protection of the body, eyes, nose, and mouth; Respiratory Protection, and Injury and Illness Prevention Program.

What are the specific requirements California hospitals must meet?

Employees must use PPE that is a full-body suit and covers all surfaces of the body so that absolutely no skin is exposed. The entire PPE must meet or exceed the ASTM standards for blood or bloody fluid penetration F1670 and F1671 for blood-borne pathogens penetration.  In addition, the Cal-OSHA ATD standard requires powered air-purifying respirators – PAPRs with a long hood or cowl. PPE and PAPR requirements apply to employees providing care to suspected or confirmed Ebola patients, employees cleaning contaminated areas, and staff assisting employees with the removal of contaminated protective gear in all hospital departments, including the ER. The burden of proving no risk for exposure to aerosol-generating activity or events falls upon the employer. 

Specifically, the PPE must be a full-body suit that prevents the penetration of fluids from reaching an employee’s clothing, undergarments, skin, eyes, mouth, or other mucous membranes; the head and neck must be protected, including coverings for the eyes, mouth, nose, and skin, the hair must be completely enclosed; include two or more pairs of nitrile gloves; undersocks (or equivalent protection) integrated into the coverall with fluid-protective boots or coverings over the feet and lower legs that prevent slipping; it must be reasonably comfortable and not impede necessary movements.

For Emergency Departments, the guidance says, “If isolation and transfer procedures and protocols, along with engineering and work practice controls, are insufficient to prevent employee exposure, the employer must ensure that employees at risk of exposure use appropriate PPE including respiratory protection…”

How is the hospital required to conduct training on PPE and procedures?

Under the new Cal-OSHA enforceable standards, hospitals must fully train and supervise employees with the donning, doffing, and use of PPE. Employees must be fully capable of donning and doffing. The donning and doffing of full-body protection requires assistance. Employees assisting in removing contaminated PPE must also use their own PPE, including a PAPR. Hospitals must assure that the trained employee understands the content of the training and can correctly perform the required tasks. Employees must be given an opportunity for interactive questions and answers with the person conducting the training on the BBP and ATD standards. Hospitals must also ensure that employees can demonstrate how to put on, use, and remove PPE and respirators. This requires hands-on practice sessions. Training that only uses printed materials or computer-based learning does not satisfy the training requirement.

Should the hospital designate distinct areas to limit exposure?

Yes, to avoid exposing employees to infectious materials, hospitals must designate three distinct areas: 1) a clean area for donning clean PPE, 2) the patient care area, and 3) a decontamination area where an employee can progressively remove the PPE. And readily accessible hand-washing areas. 

Is my hospital required to have an exposure control plan that involve nurses?

In California, yes. Each plan must include an effective procedure for obtaining the active involvement of employees at risk of exposure in reviewing and updating the exposure control plan, and no plan is valid without the hospital requesting and considering employee input.

Am I protected if I report problems with Ebola preparedness in my facility?

California law provides that no health facility can discriminate or retaliate in any manner against any patient or employee of the health facility because that patient or employee or any other person has presented a grievance or complaint, or has initiated or cooperated in any investigation or proceedings of any governmental entity, relating to the care, services, or conditions of that facility. The Cal-OSHA Injury and Illness Prevention Program standard requires that employers institute a comprehensive health and safety program that addresses all potential hazards and encourages employees to report hazards without fear of reprisal.

What if my hospital says they cannot obtain the needed PPE? 

To address a potential shortage of PPE for U.S. hospitals treating Ebola-infected patients, the CDC has obtained a limited number of kits that will help address short-term PPE needs. Purchases include impermeable coveralls and aprons; boot covers; gloves; face shields and hoods; powered air-purifying respirator systems and ancillaries; and disinfecting wipes.

What happens if I am exposed to the Ebola virus?

If an employee experiences an exposure incident, they must be sent to a physician or licensed healthcare provider for evaluation and medical follow-up, which follows the CDC guidelines for medical services. If determined as possibly infectious, the employee may be removed from employment during the incubation period. If permitted, the employee may be assigned alternate work. Otherwise, per the Cal-OSHA requirements, the employee’s earnings, seniority, and all other rights and benefits must be maintained during that period, and the employee restored to her normal position when the period is over.

It doesn’t seem like nurses are asking for too much as fears escalate over the spread of Ebola. They’re concerned about safety — not just for themselves but for their patients and for the public.

But hospital management hasn’t responded. Neither has Congress nor the president.

That’s why some 100,000 registered nurses and nurse practitioners across the country, including 400 at a Washington, D.C., hospital, are going on strike, picketing or holding rallies and candlelight vigils as part of a national “Day of Action” Wednesday to protest their lack of protective gear and training for taking care of Ebola patients. In California, 18,000 nurses will strike for two days, starting Tuesday morning.

“It’s a women’s issue,” says RoseAnn DeMoro, executive director of National Nurses United, or NNU, the nation’s largest nurses union, which represents 185,000 registered nurses. “If this were a [predominantly] male profession, the dialog would be different.”

You wouldn’t send a firefighter into a burning building or a soldier to war without the proper equipment, DeMoro and other nurses have said to me. Yet nurses don’t have the kind of equipment or the training they need to deal with Ebola — and potential Ebola — patients. In a survey by NNU of more than 3,000 nurses at  more than 1,000 hospitals, 85 percent said that their facilities were not prepared to take care of Ebola patients and that nurses had not been trained adequately.

Strikes by nurses are legal as long as sufficient warning is given to the hospitals, where elective surgeries and procedures are rescheduled and “replacement” nurses are hired.

Nobody wants to go on strike, said registered nurse Megan Ottati, who’s worked at Providence Hospital in Washington for 18 months. “Unfortunately, it seems like the only way to get the attention of upper management at Providence on issues, especially safety,” she said. “You do what you have to do to ensure safety.”

Ottati is a telemetry nurse in a 22-bed unit for patients that have left the intensive care unit but are still being monitored closely. One nurse should have responsibility for four patients, she said, but too often there are only three, and sometimes just two, nurses sharing care for 22 patients. The thought of one of those patients having Ebola is almost overwhelming, considering the current staffing shortages.

“Ebola happens to be a microcosm of the bigger picture of the erosion of standards and conditions in patient care,” said Katy Roemer, a registered nurse for nearly 20 years who works at Kaiser-Permanente’s Oakland Medical Center in Oakland, Calif.

There’s been a dramatic shift in health care, explained DeMoro, as hospitals move from community-run enterprises to corporate institutions where the bottom line rules.

“Patients before profit — that’s what we believe in as nurses,” Roemer said. “What we see is profit before patients.”

Hospitals fail to maintain adequate staffing, compromising patient care while raking in “massive profits,” Roemer said. “But we aren’t given the resources to provide the standards of care we’re trained to…. It creates an impossible situation.”

“We’re tired of hearing, ‘We know what’s better for you than you do,’” from hospital management, DeMoro said. “And we’re tired of being considered expendable.”

Although the Centers for Disease Control and Prevention issued guidelines on equipment to protect against Ebola, they’re just that — guidelines –without any means of enforcement.

Deborah Burger, co-president of NNU, testified Oct. 24 before a Congressional committee asking for legislative mandates, and NNU sent a letter to President Obama requesting an executive order to force compliance with standards to protect nurses and other health-care workers.

DeMoro, who’s also executive director of the California Nurses Association, said she hoped a meeting with Gov. Jerry Brown would result in action that might serve “as an example for the nation.”

The nurses want full-body hazmat suits that meet the American Society for Testing and Materials F1670 standard for blood penetration and F1671 standard for viral penetration and that leave no skin exposed or unprotected, and they want National Institute for Occupational Safety and Health-approved powered air purifying respirators with an assigned protection factor of at least 50.

They also want training, including practice putting on and removing protective gear.

“We’re putting our lives on the line, but the hospitals are saying our lives aren’t worth it,” Roemer said. “You can’t imagine the questions from our families. One colleague’s 6-year-old asked, ‘Mommy, do you get to wear the suit that keeps you safe from bad germs?’”

Nurses have activities planned in Boston, Chicago, Houston, Las Vegas, Memphis, Miami, St. Louis and New York City; as well as Augusta, Ga.; Bar Harbor, Maine; Durham, N.C.; El Paso, Tex.; Kansas City, Mo.; Lake City, Va.; Lansing, Mich.; Massilon, Ohio; St. Paul, Minn.; and Tampa, Fla.; and the Philippines.

Two nurses contracted Ebola from caring for just one patient in a Dallas hospital in October and have been treated successfully. It doesn’t take a math genius to realize the danger not just to nurses but to the public.

“I want the public to understand we’re fighting for them, for the patients who are people at their most vulnerable,” Roemer said.

“Nurses have historically been leaders in public health issues,” DeMoro said. “Now they’re rising up again.”

Now that nurses, who have been sounding the alarm about Ebola for more than two months, finally have the attention of policy makers and everyone else, let’s have no more excuses and take the critical steps needed to contain and eradicate this virulent disease in the U.S. and globally.

You can help this effort by adding your voice to our new national petition, here.

In the U.S., long experience with our privately-run corporate hospital chains that dominate care delivery have made one sober reality abundantly clear — unless the health care industry is mandated to put the safety of patients, nurses, and other caregivers above their profit motive, the Ebola threat will only get worse.

That’s why we are asking all Americans to join us. Sign our online petition to tell Congress and the White House to mandate all hospitals follow the highest safety standards and protocols for Ebola – and if they don’t, you control their Medicare and Medicaid fund, the lever for a penalty for failure to comply.

Since Thomas Eric Duncan first walked into Texas Health Presbyterian, the hospital that sent him home despite being infected with an Ebola virus that would kill him just a few days later, the nation’s hospitals have continued to move slowly in adopting proper safety precautions – while paying little more than lip service to unenforceable recommendations from the Centers for Disease Control that have seemed to change every day.

Two Texas Presbyterian RNs, Nina Pham and Amber Vinson, who were subsequently infected with the virus must be the last nurses forced to pay the price of the lagging response of our hospitals.

The CDC now, finally, appears to be moving closer to what NNU has been long been calling for. That means the optimal protective equipment, including Hazmat suits as used by Nebraska Medical Center and other premiere institutions, and continuous interactive hands-on training for RNs and other frontline health workers, including practice, in teams, putting on and taking off the proper protective gear.

But the CDC still does not have the authority to compel hospitals, which have repeatedly shown they will pick and choose whatever protocols they like, usually based on their budget goals and profit margins.

It is essential, therefore, that we have an act of Congress or Presidential executive order, with their federal funding as a stick, to override that profit imperative.

More than 3,000 nurses from 800 health facilities in 48 states and the District of Columbia have responded to an NNU Ebola survey. A chilling 84 percent say their hospital is still not holding the essential, interactive training programs, and more than a third cite inadequate supplies of protective gear.

What that — and verbal and email reports we are hearing from RNs from coast to coast amplify — clearly signals is that what happened at Texas Health Presbyterian is a story that could be told in every hospital in this country. As nurses are now telling us, “we all work at Texas Presbyterian.”

Simply put, the status quo is indefensible if it puts nurses, other frontline health care workers, and patients’ lives in jeopardy. As the horrific experience in West Africa where thousands have now died from Ebola, including nurses and other health workers in what the World Health Organization calls “unprecedented” numbers, our nurses and other caregivers should not have to put their lives on the line for the failure of our policy makers to protect them.

We have the resources, just not the right national priorities.

Hospitals are a multi-billion industry in the U.S. Texas Health Presbyterian is part of a 25 facility corporate chain that made over $2 billion in profits the past five years. They could have been better prepared.

The drug giants are even wealthier. The past five years, global pharmaceutical corporations made nearly $600 billion in profits, enough to buy 1.8 billion Hazmat suits for every health care worker in the U.S. and West Africa, with a lot left over in reserve. The drug giants could have developed a vaccine or even a cure for Ebola, but apparently it wasn’t profitable enough.

Neo-liberal economists and politicians have for several decades employed what writer Naomi Klein called the “shock doctrine” in economic or political crises to push through sweeping policy changes that benefit the elite.

Now may be a moment for those who favor humanitarian social reform to say it is time to change our national priorities as well, starting with the overall direction of health care in the U.S.

Not one more nurse, not one more health care worker, not one more patient should be sacrificed on the altar of profit. We need a health care system, not an industry, that puts public health and patient need first, that is the only way to stop Ebola, and the other pandemics that are sure to follow.

In a conversation with me this week, MSNBC’s Chis Hayes concluded that the fractured Ebola experience is a reminder of why nurses especially need power and a voice, and today, we’re seeing the consequences of not listening to people on the frontline.

This is an inside story from some registered nurses at Texas Health Presbyterian Hospital in Dallas who have familiarity with what occurred at the hospital following the positive Ebola infection of first the late Thomas Eric Duncan and then a registered nurse who cared for him Nina Pham.

The RNs contacted National Nurses United out of frustration with a lack of training and preparation. They are choosing to remain anonymous out of fear of retaliation.

The RNs who have spoken to us from Texas Health Presbyterian are listening in on this call and this is their report based on their experiences and what other nurses are sharing with them. When we have finished with our statement, we will have time for several questions. The nurses will have the opportunity to respond to your questions via email that they will send to us, that we will read to you.

We are not identifying the nurses for their protection, but they work at Texas Health Presbyterian and have knowledge of what occurred at the hospital.

They feel a duty to speak out about the concerns that they say are shared by many in the hospital who are concerned about the protocols that were followed and what they view were confusion and frequently changing policies and protocols that are of concern to them, and to our organization as well.

When Thomas Eric Duncan first came into the hospital, he arrived with an elevated temperature, but was sent home.

On his return visit to the hospital, he was brought in by ambulance under the suspicion from him and family members that he may have Ebola.

Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present.

No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.

Subsequently a nurse supervisor arrived and demanded that he be moved to an isolation unit– yet faced resistance from other hospital authorities.

Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated.

There was no advance preparedness on what to do with the patient, there was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department.  The Infectious Disease Department did not have clear policies to provide either.

Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields.  Some supervisors said that even the N-95 masks were not necessary.

The suits they were given still exposed their necks, the part closest to their face and mouth.  They had suits with booties and hoods, three pairs of gloves, no tape. 

For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own. 

Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.

Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.

Patients who may have been exposed were one day kept in strict isolation units. On the next day were ordered to be transferred out of strict isolation into areas where there were other patients, even those with low-grade fevers who could potentially be contagious.

Were protocols breached? The nurses say there were no protocols.

Some hospital personnel were coming in and out of those isolation areas in the Emergency Department without having worn the proper protective equipment.

CDC officials who are in the hospital and Infectious Disease personnel have not kept hallways clean; they were going back and forth between the Isolation Pod and back into the hallways that were not properly cleaned, even after CDC, infectious control personnel, and doctors who exited into those hallways after being in the isolation pods. 

Advance preparation

Advance preparation that had been done by the hospital primarily consisted of emailing us about one optional lecture/seminar on Ebola. There was no mandate for nurses to attend trainings, or what nurses had to do in the event of the arrival of a patient with Ebola-like symptoms. 

This is a very large hospital. To be effective, any classes would have to offered repeatedly, covering all times when nurses work; instead this was treated like the hundreds of other seminars that are routinely offered to staff.

There was no advance hands-on training on the use of personal protective equipment for Ebola. No training on what symptoms to look for. No training on what questions to ask.

Even when some trainings did occur, after Mr. Duncan had tested positive for Ebola, they were limited, and they did not include having every nurse in the training practicing the proper way to don and doff, put on and take off, the appropriate personal protective equipment to assure that they would not be infected or spread an infection to anyone else.

Guidelines have now been changed, but it is not clear what version Nina Pham had available.

The hospital later said that their guidelines had changed and that the nurses needed to adhere to them.  What has caused confusion is that the guidelines were constantly changing.  It was later asked which guidelines should we follow? The message to the nurses was it’s up to you.

It is not up to the nurses to be setting the policy, nurses say, in the face of such a virulent disease. They needed to be trained optimally and correctly in how to deal with Ebola and the proper PPE doffing, as well as how to dispose of the waste.

In summary, the nurses state there have been no policies in cleaning or bleaching the premises without housekeeping services. There was no one to pick up hazardous waste as it piled to the ceiling. They did not have access to proper supplies and observed the Infectious Disease Department and CDC themselves violate basic principles of infection control, including cross contaminating between patients. In the end, the nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own.

We want our facility to be recognized as a leader in responding to this crisis. We also want to recognize the other nurses as heroes who put their lives on the line for their patients every day when they walk in the door.

With reports that a nurse who treated Ebola patient Thomas Eric Duncan in Dallas has been infected, one thing urgently needs to be made clear: Our hospitals are not prepared to confront the deadly virus.

It is long past time to stop relying on a business-as-usual approach to a virus that has killed thousands in West Africa and has such a frighteningly high mortality rate. There is no margin for error. That means there can be no standard short of optimal in the protective equipment, such as hazmat suits, given to nurses and other personnel who are the first to engage patients with Ebola-like symptoms. All nurses must have access to the same state-of-the-art equipment used by Emory University Hospital personnel when they transported Ebola patients from Africa, but too many hospitals are trying to get by on the cheap.

In addition, hospitals and other front-line providers should immediately conduct hands-on training and drills so that personnel can practice, in teams, such vital safety procedures as the proper way to put on and remove protective equipment. Hospitals must also maintain properly equipped isolation rooms to ensure the safety of patients, visitors and staff and harden their procedures for disposal of medical waste and linens.

We all count on nurses to be there for us when we’re at our sickest and most vulnerable, and it’s everyone’s problem if nurses are not protected. But according to an overwhelming majority of nurses surveyed by National Nurses United at facilities across the United States, many hospitals remain unprepared.

And Ebola is exposing a broader problem: the sober reality of our fragmented, uncoordinated private health-care system. We have enormous health-care resources in the United States. What we lack is a national, integrated system needed to respond effectively to a severe national threat such as Ebola.

The Centers for Disease Control and Prevention issues guidelines but has no authority to enforce them. Hospitals have wide latitude to pick and choose what protocols they will follow; too often in a corporate medical system, those decisions are based on budget priorities, not what is best for the health and safety of patients and caregivers. Congress and state lawmakers put few mandates on what hospitals must do in the face of pandemics or other emergencies, and local health officials do not have the authority to direct procedures and protocols at hospitals.

Where other countries — notably Canada, which took action after its vulnerabilities were exposed by the 2003 SARS epidemic — have empowered their public health agencies to coordinate local, state and federal detection and response efforts for pandemics, the United States cut funding for its already weak system. Federal funding for public health preparedness and response activities was $1 billion less in fiscal 2013 than 2002.

As one CDC official recently admitted to The Post: “We let our guard down a little bit. Now that we’ve seen this happen we know that we need to do more to make people feel prepared.”

We should have seen this coming. As recently as August, an inspector general’s report evaluating the Department of Homeland Security’s pandemic preparedness concluded that “the Department has no assurance it has sufficient personal protective equipment and antiviral medical countermeasures for a pandemic response.”

We know what works: a federal agency with the authority to ensure local, state and national coordination in response to outbreaks. In such an empowered public health system, local health officials are assured of having the resources to identify the source of an outbreak, isolate and treat the sick, and follow up with those who have had close contact with the sick. Only greater integration and the authority of a public health system with national, uniform standards can protect Americans.

It’s time to listen to our nurses. Let’s stop Ebola now and be better prepared for the next pandemic.

With the multiple threats of attacks on health workers, efforts to privatize public health services, austerity budget cuts especially in health care, widening inequality, and the effects of the climate crisis including escalating epidemics, nurses around the globe are stepping up coordinated efforts to fight back.

In a meeting in Las Vegas September 19, top leaders of Global Nurses United, which includes 20 nurse and health worker unions from the Americas, Asia, Africa, Australia, and Europe, further cemented their alliance through solidarity efforts on domestic health care battles and international work on harmful trade deals, the climate crisis, and confronting the Ebola outbreak.

Formed in June, 2013, GNU continues to grow, adding new members at the Las Vegas meeting, nurse unions from Greece, Kenya, Paraguay, Taiwan, Uruguay and the Dominican Republic, and adopting a founding constitution. The GNU now has 20 affiliates from 18 countries.

 “We know there’s an agenda that the health care corporations have, that Wall Street has, that the financial sector has, to take as much profit from public services as possible and to have that wealth transferred to themselves,” said RoseAnn DeMoro, executive director of National Nurses United, the U.S. “founding mother” of GNU, as she put it in a new video on GNU.

“That’s an international agenda and we have to have an international organization to offset that,” DeMoro said.

In Las Vegas, GNU leaders described the scope of what they confront at home in challenges that are key GNU priorities, from the campaigns for safer patient care especially with mandatory nurse-to-patient ratios, to challenging austerity, privatization, and the effects of the climate crisis and corporatization.

Julio Cesar García Cruceta, general secretary of the Sindicato Nacional de Trabajadores de Enfermeria of the Dominican Republic, reported how nurses and health workers have challenged the government of the Dominican Republic to act on issues “affecting safe care for the Dominican society.”

Judith Kjeda, Assistant General Secretary of the New South Wales Nurses and Midwives’ Association, described rollbacks in hospital staffing from the new conservative government in Australia and how nurses across the country are holding actions to push for safer staffing, including nurse to patient ratios.

From South Korea, Ji-Hyun Yoo, President of the Korean Health and Medical Workers Union, outlined the way nurses are promoting a Korean law for nursing ratios.

The delegates at the GNU meeting joined together in calling on South Korean President Park, Keun-Hye to “stop her policy of “privatization of healthcare, including conversion of the public healthcare delivery system to private schemes and introducing a system of ‘remote patient care’ (also known as ‘tele-medicine’)…and recruiting foreign patients as an excuse to further privatize the healthcare system, and increased pressure to generate profit from healthcare.”  The delegates further gave support to the KHMU’s campaign to re-open the Jinju Medical Hospital and end the attack on South Korea’s public pension system.

Roberto Bomba, Treasurer of the Fédération interprofessionnelle de la santé du Québec, talked about the fight for RN ratios in Quebec, Canada, and cited what RNs in Quebec have learned from the experiences of California RNs who won the first ratio law in the U.S.

Maria Concepcion Chavez, President of Asociación Paraguaya de Enfermería, told about serious staffing shortages in new heath facilities across Paraguay that have resulted in widespread work load problems for nurses that put patients at risk.

Juan Andres Mastandrea Caballero, General Secretary of Sindicato Unico de Enfermeria del Uruguay, reported on the spreading use of technology being used to replace nursing staff in Uruguay.

Guatemala has among the most severe conditions for health workers. Luis Lara Ballina, General Secretary of Sindicato Nacional de los Trabadores de Salud de Guatemala, reported widespread shortages of provisions for vaccinations, medications, surgical materials, while health workers go unpaid. Nurses and health workers have responded with multiple mobilizations, he noted, and been met with rightwing threats.

In support of the Guatemalan struggle, GNU delegates adopted a statement of solidarity voicing concern for the deteriorating conditions for health workers as well as a growing food shortage and high level of malnutrition in the country. “For each ten children,” it noted “eight suffer chronic malnutrition which affects their brain development, learning capacity and physical development.”

The statement also called on the Guatemalan President, Congress, and other leaders to support a Robin Hood tax on financial speculation that would “provide economic resources to support the strengthening of community health clinics” as well as “strengthening Guatemala’s public health system.”

NNU’s Ken Zinn described the growing global campaign for a Robin Hood tax, which is a GNU priority.

Climate change and the Ebola fight

GNU delegates embraced the growing global movement to confront the climate crisis. In a presentation to the union leaders, Sean Sweeney, co-director of the Cornell Global Labor Institute, noted “the climate crisis is a health crisis.”

Health effects include the direct consequences of extreme weather events like storms, wildfires, and droughts, to what he called “secondary effects,” including skin cancers, dengue fever, malaria, higher asthma rates, and diarrhea and malnutrition which lead to stunted growth among children.

“Disaster happens fast and deep, and we need a much broader vision,” said DeMoro. One response, she noted, is NNU’s Registered Response Network, which, after Typhoon Haiyan/Yolanda, a storm intensified by higher deep ocean temperatures, ravaged the Philippines, sent RN volunteers to provide basic medical aid.

RNRN director Bonnie Castillo, RN, described that effort, carried out in collaboration with GNU partner, the Alliance of Health Workers in the Philippines.

The current project for RNRN is collecting assistance for the rapidly spreading Ebola outbreak in West Africa, which also has a climate connection, principally through deforestation and drought.

RNRN has received a donation of 1,000 Hazmat suits from a U.S. manufacturer, that will be heading to West Africa, and is also requesting donations for more protective suits for nurses and other health workers who have been infected and died in what the World Health Organization calls “unprecedented” numbers.

At the GNU meeting, the Canadian Federation of Nurses Union announced a donation of $33,000 for RNRN’s effort, and other delegates pledged to support the campaign as well, including a response to financial assistance from the Liberian health workers union.

GNU leaders then adopted recommendations on how to escalate the voice of GNU and nurses in the international climate fight, as well as resolutions on the threat to worker’s rights posed by pending global trade pacts, including the Trans-Pacific Partnership Agreement, and a letter to the UN High Commissioner for Human Rights on the ongoing Detroit water crisis. 

Next, GNU members will hold actions in Brisbane, Australia in November in concert with an upcoming meeting of G20 national leaders, and actions next May in conjunction with international nurses’ week.

Members of Global Nurses United – an international federation of nurses and health workers unions – gathered in Las Vegas on Friday for a historic meeting.  National Nurses United hosted the daylong event. The nurses and health workers shared stories of what’s happening in their countries. They talked about efforts to combat austerity measures, privatization of health services and erosion of patient care standards.  Other discussions focused on the need for mandated nurse-to-patient ratios, healthcare for all and how the climate crisis is impacting our health.  

GNU, which was created in June 2013, welcomed its newest members: Greece, Uruguay, Kenya, Taiwan and Paraguay. The federation now has 18 countries represented.