National Nurses United (NNU), the largest union of registered nurses in the United States, today applauded the Occupational Safety and Health Administration (OSHA) for taking a critical step in protecting health care workers in Arizona, South Carolina, and Utah who had been left behind when their states failed to adopt the OSHA Emergency Temporary Standard (ETS) on Covid-19 in Health Care issued in June. The OSHA ETS on Covid-19 mandates optimal PPE and other critical protections for health care workers.
Twenty-two states across the country that have state-based OSHA programs are legally required to have those state plans be at least as effective as federal OSHA. When Arizona, South Carolina, and Utah failed to implement the Covid-19 ETS in their state plans, however, they abrogated their legal requirements. Federal OSHA announced today that it is reconsidering and potentially revoking the final approval for these three noncompliant states.
“It’s unconscionable that some states think they can just ignore their responsibility to protect health care workers. Registered nurses had been demanding the OSHA ETS since day one of this pandemic, and we finally won our fight in June of 2021. At that point, Arizona, South Carolina, and Utah had the duty—legally and morally—to come into compliance and protect workers. They did not, and we could not be more proud that OSHA is standing up to hold them accountable today,” said NNU President Deborah Burger, RN. “We are beyond grateful to OSHA for the work they are already doing to enforce this standard, and to the Biden administration for standing up for nurses on the front lines of this pandemic.”
After leading the campaign to win the OSHA ETS, NNU has been campaigning to ensure health care employers across the country comply. When NNU nurses in Arizona filed complaints about their hospitals’ non-compliance, Arizona’s state OSHA plan stated they will not enforce the requirements of the federal OSHA ETS. So NNU nurses testified at the most recent meeting of the Industrial Commission of Arizona (ICA). The ICA voted against emergency rulemaking needed to protect nurses and other health care workers, and NNU filed a Complaint About State Plan Administration (CAPSA) with federal OSHA.
“Nurses and other health care workers in Arizona, Utah, and South Carolina must be assured the same protections as they would receive in other states that have already adopted and begun enforcing the ETS,” said Burger. “We urge federal OSHA to act expeditiously to put in place the necessary elements for federal OSHA to resume enforcement in Arizona, Utah, South Carolina, and any other states which fail to enforce the ETS to ensure protections for health care workers. We will never emerge from this pandemic if we don’t make sure nurses and health care workers are safe at work.”
National Nurses United is the largest and fastest-growing union of registered nurses in the United States with more than 175,000 members nationwide.
The California Nurses Association (CNA) today welcomed Gov. Gavin Newsom’s signature Friday enacting landmark legislation to require implicit bias education and training for nursing students and new graduates in California, an important step in addressing persistent racial disparities, particularly in health care.
CNA-sponsored AB 1407, by Assemblymember Autumn Burke, will require nursing schools and programs to include implicit bias education as part of their curriculum, and hospitals to implement an evidence-based program on implicit bias as part of new graduate training. Additionally, verification of implicit bias training will become part of the licensure requirement for all new California RNs.
California is now believed to be the first state in the nation to require implicit bias training as a graduation requirement for nursing students. Michigan has similarly mandated implicit bias training for all health care workers seeking licensure effective next June.
“Awareness and then education are critical first steps toward eliminating implicit bias,” said CNA Director of Government Relations Stephanie Roberson. “AB 1407 is a preemptive approach, starting with educating our future nursing workforce prior to entry into practice. There is no better way to start.”
“Long-term racial disparities in health care access and treatment continue to be a deplorable stain on our nation,” said CNA President Cathy Kennedy, RN. “Biases, whether intentional or unconscious, directly contribute to those disparities, especially in a context in which we continue to see corporate health care disparities for which health care services are provided, and what services are prioritized.”
Racial gaps in health care have been increasingly documented from maternal and infant mortality to diagnostic procedures to prescription of medication to interactions with medical professionals and institutions generally. A report from the Urban Institute this July, for example, found that Black patients are significantly more likely to suffer dangerous bleeding, infections, and other surgery-related problems than white patients who received care in the same hospital.
“Health care facilities and educators must demonstrate their commitment to ending racial health disparities and working toward health equity by aggressively pursuing strategies that eliminate implicit bias within the health care system. This bill is a part of the solution,” said Roberson.
Hospitals, health care facilities, and health care educators offer very little, if anything, to bring awareness to or address this phenomenon and problem. Even structural characteristics such as an institution’s physical space project how welcoming an institution might be to patients of color. Too often, facilities fail to look at the communities they serve, those communities’ needs, and the resources facilities need to tap to fill those needs.
“The legacy of structural racism in medical care has been deadly, and has contributed to distrust of medical services among medically underserved communities and patients. It is essential that we guarantee that our future health care workforce is fully aware of the debilitating consequences of implicit bias to bring this scourge to an end and ensure equal, high quality medical care for everyone,” Kennedy added.
National Nurses United’s (NNU) new nationwide survey of more than 5,000 registered nurses reveals that employers must do more to be fully compliant with the Occupational Safety and Health Administration (OSHA) emergency temporary standard (ETS) and to implement optimal standards to protect nurses and other health care workers from Covid-19.
This survey is the sixth national survey of nurses during the pandemic by NNU, the nation’s largest and fastest-growing union of registered nurses. Most of the requirements for the ETS went into effect on July 6 and all requirements went into effect on July 21. The ETS is the first-in-the-nation enforceable federal Covid-19 standard, which nurses have fought for since the beginning of the pandemic. The ETS includes requirements on personal protective equipment (PPE), patient and visitor screening, and employee notification within 24 hours of the employer becoming aware of the exposure.
“We are more than 18 months into the pandemic, yet hospitals are still not doing enough to ensure the safety of nurses, patients, and other health care workers. Covid cases are surging to their highest levels yet in some areas of the country, and some ICUs are over capacity.
Nurses need optimal personal protective equipment. Health care employers must notify nurses as soon as possible when they are exposed and make it easier for RNs and other health care workers to get tested.”
—NNU Executive Director Bonnie Castillo, RN
NNU’s latest survey reveals that nurses still face problems with access to testing, being notified in a timely manner when they are exposed, inadequate respiratory protection, unsafe staffing, mental health, and workplace violence. RNs also reported inadequate Covid screening and testing rates for patients who enter or are admitted to a health care facility and a decrease in dedicated Covid units compared to the last survey (March 2021).
More than 75 percent of hospital nurses are not being notified of exposures to Covid in a timely way. Only 23 percent of hospital RNs reported timely notification of exposure by their employers, down from 31.6 percent reported in March 2021. Prompt notification is essential for hospital infection control.
Access to testing is an issue at some hospitals. About 41 percent of RNs at hospitals reported that any staff who asks for testing has access; nearly 20 percent said access to testing is limited at their facility, and 7 percent said testing is not available where they work. Of the nurses who answered additional questions on employer testing, 58 percent said that only staff who are symptomatic can get tested, a troubling statistic as scientific research has found that about half of all Covid transmissions are from asymptomatic and pre-symptomatic individuals who were infected.
Not all patients and visitors are screened for Covid. Only two-thirds of hospital RNs report that all patients are screened for Covid-19 signs and symptoms before or upon arrival at the facility. Less than a third of hospital RNs reported that every patient is tested for Covid before or upon arrival at the facility. For visitors, screening and testing was reported to occur at even lower rates: Only 53 percent of hospital RNs report that every visitor is screened for Covid-19 signs and symptoms before or upon arrival at the facility and a mere 4 percent of RNs reported that all visitors are tested for Covid before or upon arrival. Screening for Covid-19 symptoms, in combination with reliable diagnostic testing and screening for recent exposure history, is necessary to effectively identify and isolate individuals who may be infectious to prevent spread of the virus within health care facilities.
Hospital nurses are still not provided optimal PPE when caring for Covid-positive patients or patients suspected of having Covid. About 61 percent of hospital RNs reported wearing a respirator for every Covid-positive patient encounter, down from nearly 75 percent in our March 2021 survey. In addition, only 40 percent of hospital RNs reported that respirators are worn when they are caring for patients who are suspected of having Covid or whose tests results are not completed; and about 62 percent reported using surgical masks for patients suspected of having Covid or awaiting test results. All nurses should be wearing a respirator for every encounter with a Covid-positive or suspected Covid-positive patient, in addition to eye protection, isolation gown or coveralls, and medical grade gloves.
Nurses diagnosed with Covid have faced lasting symptoms. Nearly a quarter of RNs who contracted Covid experienced symptoms from zero to three months, a third had symptoms lasting three to nine months, 12 percent had symptoms lasting nine to 12 months, and 12 percent more than a year. The most common symptoms reported included tiredness or fatigue, joint or muscle pain, memory or concentration difficulties, headaches or migraines, and difficulty breathing or shortness of breath.
Short staffing remains a persistent problem in hospitals, with more than 57 percent of RNs reporting that staffing has gotten slightly or much worse, up from 47 percent of nurses in our March 2021 survey. Also, nearly half of hospital RNs (49 percent) reported that their facility is using excessive overtime to staff units.
Nearly 42 percent of hospital RNs fear they will contract Covid.
Slightly more than 50 percent are afraid they will infect a family member.
More than a third (35.1 percent) are having more difficulty sleeping.
More than half (53.5 percent) feel stressed more often than before the pandemic.
About 42 percent feel sad or depressed more often than they did before the pandemic.
More than a third feel traumatized by their experiences caring for patients.
Hospital RNs reported an increase in workplace violence. About 31 percent of hospital RNs said that they faced a small or significant increase in workplace violence, up from 22 percent in our March 2021 survey. RNs attribute the increase in workplace violence to decreased staffing levels, changes in the patient population, and fewer visitor restrictions.
NNU’s four surveys in 2020 covered hospitals’ lack of preparedness for Covid-19 (March); government and employers’ disregard for nurse and patient safety (May); the devastating impact of reopening too soon (July); and hospitals’ and health care employers’ lack of preparation for the fall/winter surge, despite more knowledge about the dangers of the virus and effective measures to prevent spread (November). The fifth survey (March 2021) highlighted the continuing disregard that hospitals and health care employers show for the safety of nurses and health care workers, more than one year into the pandemic.
The sixth survey results were gathered from both NNU unionized nurse members as well as non-union nurses in all 50 states plus Washington, D.C. and Puerto Rico. The results cover the period June 1 to July 21, 2021.
National Nurses United asserts that the United States is not experiencing a nursing shortage, only a shortage of nurses willing to risk their licenses or the safety of their patients by working under the unsafe conditions the hospital industry has created. By deliberately refusing to staff our nation’s hospital units with enough nurses to safely and optimally care for patients, the hospital industry has driven nurses away from direct patient care. When we add the complete failure by the hospital industry to protect the health and safety of nurses and patients during the Covid pandemic, many nurses have made the difficult decision to stop providing hands-on nursing care in order to protect themselves, their nursing licenses, their families, and their patients.
The hospital industry is crying false tears over the lack of nurses willing to stay in direct care when these untenable working conditions are entirely of their own making.
To ensure a strong pipeline of new nurses for the sustainability of the profession, NNU has long advocated for more funding for public nursing schools and better pay for nursing faculty; one of the main barriers to becoming a nurse is the exorbitant expense and lack of admission slots in nursing education programs.
Hospitals are Understaffing
The hospital industry is crying false tears over the lack of nurses willing to stay in direct care when these untenable working conditions are entirely of their own making. For decades and even before Covid, the hospital industry has driven nurses away from direct nursing care in multiple ways.
Hospitals intentionally understaff every unit, every shift with fewer numbers of nurses than is actually required to safely and optimally care for the numbers of admitted patients and their severity of illness. Hospitals do this to maximize profits and excess revenue. Hospital administrators prefer to staff shifts with a bare-bones number of nurses, which often fails to account for deterioration in patient conditions; new admissions, transfers, and discharges; coordination of care with other departments; the need for nurses to safely take meal and rest breaks; and other complicating factors. Instead of scheduling greater numbers of nurses to ensure that each RN has a manageable workload and patients are safely and properly cared for, hospitals have historically routinely forced the nurses on duty to sacrifice their own health and safety and make morally distressing choices about how to allocate their available time for nursing care.
In addition to deliberately failing to provide safe RN staffing on each shift, hospitals are not maintaining a robust pool of nurses from which to draw when scheduling shifts. From our experience, hospitals often cancel or “call off” nurses who are scheduled to work on a daily contract basis, will send nurses home who have reported for their scheduled shifts, are not hiring or are extremely slow to hire for open positions, and will cancel contracts with travel or agency nurses.
Listen to Nurses
During Covid, hospitals rejected nurses’ advice from the beginning of the pandemic to prepare and plan for predictable staffing needs, including hiring and training more nurses, and cross-training current staff nurses to work in critical care departments. Instead, hospitals cut and laid off staff from units that had temporarily low patient census, and canceled RN traveler contracts. Again, the industry was shortsightedly looking for immediate ways to cut costs and boost profits instead of planning for patient and public health needs. Hospitals’ actions, and inaction, have resulted in a lack of critical care staff during Covid.
National Nurses United has a simple and effective solution for encouraging the nation’s nurses to return to providing the direct patient care that we desperately need during this pandemic: ensure safe and optimal working conditions for nurses, including scheduling sufficient numbers of nursing staff on every shift, and implementing all the multiple measures of infection control that nurses need to protect themselves and their patients.
The hospital industry’s response to nurses unwilling to work under unsafe conditions is to overload the remaining nurses with more patients and, in states where it is not prohibited, try to force them to work mandatory overtime. This is dangerous for both nurses and patients and will only exacerbate the problem. And during Covid, working under unsafe conditions is even more likely to expose and infect nurses, further sidelining them from caring for patients.
It’s clear that hospitals have no excuse for a staffing crisis they have created. The solution we can start implementing today is for hospitals to immediately staff up every unit, every shift, and create a safe, sustainable work environment where nurses can feel confident about their ability to provide the best nursing care possible for their patients.
National Nurses United (NNU), the largest union of registered nurses, sent a letter to the Centers for Disease Control and Prevention (CDC) on July 12, urging the agency to update its Covid-19 guidance and reinstate “the recommendation for everyone to wear masks in public or in physical proximity to others outside their own household.”
“NNU strongly urges the CDC to reinstate universal masking, irrespective of vaccination status, to help reduce the spread of the virus, especially from infected individuals who do not have any symptoms,” wrote NNU Executive Director Bonnie Castillo, RN, in the letter. “SARS-CoV-2, the virus that causes Covid-19 disease, spreads easily from person to person via aerosol transmission when an infected person breathes, speaks, coughs, or sneezes.”
The letter noted that the “Covid-19 pandemic is far from over,” with a 16 percent increase in daily new cases over the previous week and more than 40 states seeing an increase in daily new cases over the previous two weeks as well as 25 states seeing an increase in hospitalizations.
NNU stated that the rise in cases is not surprising due to “the rapid reopening of many states and the removal of public health measures, including the CDC’s May 13, 2021 guidance update that told vaccinated individuals they no longer needed to wear masks, observe physical distancing, avoid crowds, or get tested or isolate after an exposure, within only a few exceptions.”
Unfortunately, the “CDC’s guidance failed to account for the possibility—which preliminary data from the United Kingdom and Israel now indicates is likely—of infection and transmission of the virus, especially variants of concern, by fully vaccinated individuals,” the letter continued. The Delta SARS-CoV-2 variant is already dominant in the United States.
The CDC’s May 13 guidance “also failed to protect medically vulnerable patients, children, and infants who cannot be vaccinated, and immunocompromised individuals for whom vaccines may be less effective.” Asymptomatic or pre-symptomatic infected people “can spread infectious SARS-CoV-2 aerosols during breathing and speaking, without coughing or other respiratory symptoms,” the letter noted.
Covid-19 vaccines are an important public health tool, but multiple measures are necessary to protect public health, as NNU noted in a May 17, 2021 scientific brief. However, only 48 percent of the total U.S. population have been fully vaccinated as of July 11, 2021, according to the CDC. The vaccines are effective at preventing serious illness and death from the virus for vaccinated people. However, no vaccine is 100 percent effective and the emergence and spread of variants of concern may reduce vaccine effectiveness.
“Masks are a simple and effective tool, especially when used in combination with other measures to reduce the risk of Covid-19,” noted Castillo in the letter. On June 25, 2021, in response to the spread of the Delta variant, the World Health Organization urged fully vaccinated people to wear masks.
In the letter, NNU also called on the CDC to:
update health care infection control and other Covid-19 guidance to fully recognize aerosol transmission,
require tracking and transparent reporting of Covid infections among health care workers and other essential workers, and
track infections in people who are fully vaccinated, including mild and asymptomatic infections.