More than a dozen registered nurses at Blake Medical Center in Bradenton, Florida, protested outside the hospital Friday, the third such protest since the pandemic began, saying hospital owner HCA Healthcare won’t give them N95 masks unless they are working with known COVID-19 patients, and doesn’t tell them when their patients later test positive.
As case counts in Manatee County climb, many patients have been admitted to the 383-bed hospital for other reasons, but later turn out to have COVID-19, said Candice Cordero, a telemetry nurse who works with stroke and cardiac patients in a step-down unit.
“We’re seeing more random patients test positive, and some have symptoms, but some don’t, or some are admitted for one thing, and start having (COVID) symptoms a few days later,” she told MedPage Today.
“We’re having a problem with the hospital being transparent with their numbers, and letting staff know when they’ve been exposed.”
The hour-long protest was called by members of the Blake Medical Center’s bargaining unit of the National Nurses Organizing Committee-Florida, an affiliate of National Nurses United. NNOC said in a news release that it has filed complaints about unsafe conditions at the hospital with the Occupational Safety and Health Administration. The statement said that at least four RNs at Blake have tested positive since late May.
The union further alleged that Blake Medical Center management requires RNs who have been exposed to COVID to continue working until they have COVID symptoms, does not test all patients prior to a procedure or operation, fails to provide PPE replacements for broken masks, and threatens RNs with discipline for raising safety concerns.
Officials for Blake Medical Center eleased this statement in response to the protest:
“In the midst of a global shortage of personal protective equipment (PPE), Blake Medical Center has been doing everything in our power to protect our caregivers and patient care teams throughout the pandemic and equip them to provide safe, effective care to our patients by following or exceeding Centers for Disease Control and Prevention (CDC) protocols.
“We have provided appropriate PPE, including a universal masking policy requiring all caregivers in all areas to wear masks, including N95s, in line with CDC guidance. While we currently have adequate supplies of PPE, we continue to provide safeguards that are consistent with CDC guidelines and help ensure the protection of our colleagues, not only today, but into the future as the pandemic evolves. The NNU fails to recognize the reality all hospitals nationwide are facing, that this pandemic has strained the worldwide supply of PPE, including masks, face shields, and gowns.”
Cordero said that recently one patient “was not properly screened in the ER who should have been on a COVID unit. That potentially exposed several nurses and the other patient in that room.”
When she complained to human resources officials, she said, she “was reprimanded verbally for speaking up and was told that if I did it again, I would receive discipline.”
The hospital should be testing all of its frontline workers regularly, she said. “We’re much more at risk of being exposed while at work than many other jobs out there. We really should be screened better than we are.”
Kim Brooks, who works in an ICU step-down unit for trauma and cardiac patients, assumes all of her patients are infected with COVID-19 and because of that, she said, she has bought her own N95 masks since the hospital won’t buy them for her.
“We know some of the nurses who are on non-COVID units are getting exposed to positive patients and now [some] are getting sick because they didn’t have N95 masks,” she told MedPage Today.
At the very least, the hospital should inform frontline workers when patients ultimately test positive on our floor, “so we can take precautions with our family,” Brooks said.
“Once we find out someone is positive, we do move them to a COVID unit. But sometimes there’s been a situation where that patient has been rooming with a COVID patient, and that patient is sometimes left on our unit to see if they turn out to be positive.”
By Cheryl Clark, MedPage Today
Emily Brown was stretched thin.
As the director of the Rio Grande County Public Health Department in rural Colorado, she was working 12- and 14-hour days, struggling to respond to the pandemic with only five full-time employees for more than 11,000 residents. Case counts were rising.
She was already at odds with county commissioners, who were pushing to loosen public health restrictions in late May, against her advice. She had previously clashed with them over data releases and had haggled over a variance regarding reopening businesses.
But she reasoned that standing up for public health principles was worth it, even if she risked losing the job that allowed her to live close to her hometown and help her parents with their farm.
Then came the Facebook post: a photo of her and other health officials with comments about their weight and references to “armed citizens” and “bodies swinging from trees.”
The commissioners had asked her to meet with them the next day. She intended to ask them for more support. Instead, she was fired.
“They finally were tired of me not going along the line they wanted me to go along,” she said.
In the battle against COVID-19, public health workers spread across states, cities and small towns make up an invisible army on the front lines. But that army, which has suffered neglect for decades, is under assault when it’s needed most.
Officials who usually work behind the scenes managing everything from immunizations to water quality inspections have found themselves center stage. Elected officials and members of the public who are frustrated with the lockdowns and safety restrictions have at times turned public health workers into politicized punching bags, battering them with countless angry calls and even physical threats.
On Thursday, Ohio’s state health director, who had armed protesters come to her house, resigned. The health officer for Orange County, California, quit Monday after weeks of criticism and personal threats from residents and other public officials over an order requiring face coverings in public.
As the pressure and scrutiny rise, many more health officials have chosen to leave or been pushed out of their jobs. A review by KHN and The Associated Press finds at least 27 state and local health leaders have resigned, retired or been fired since April across 13 states.
From North Carolina to California, they have left their posts due to a mix of backlash and stressful, nonstop working conditions, all while dealing with chronic staffing and funding shortages.
Some health officials have not been up to the job during the biggest health crisis in a century. Others previously had plans to leave or cited their own health issues.
But Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, said the majority of what she calls an “alarming” exodus resulted from increasing pressure as states reopen. Three of those 27 were members of her board and well known in the public health community — Rio Grande County’s Brown; Detroit’s senior public health adviser, Dr. Kanzoni Asabigi; and the head of North Carolina’s Gaston County Department of Health and Human Services, Chris Dobbins.
Asabigi’s sudden retirement, considering his stature in the public health community, shocked Freeman. She also was upset to hear about the departure of Dobbins, who was chosen as health director of the year for North Carolina in 2017. Asabigi and Dobbins did not reply to requests for comment.
“They just don’t leave like that,” Freeman said.
Public health officials are “really getting tired of the ongoing pressures and the blame game,” Freeman said. She warned that more departures could be expected in the coming days and weeks as political pressure trickles down from the federal to the state to the local level.
From the beginning of the coronavirus pandemic, federal public health officials have complained of being sidelined or politicized. The Centers for Disease Control and Prevention has been marginalized; a government whistleblower said he faced retaliation because he opposed a White House directive to allow widespread access to the malaria drug hydroxychloroquine as a COVID-19 treatment.
In Hawaii, U.S. Rep. Tulsi Gabbard called on the governor to fire his top public health officials, saying she believed they were too slow on testing, contact tracing and travel restrictions. In Wisconsin, several Republican lawmakers have repeatedly demanded that the state’s health services secretary resign, and the state’s conservative Supreme Court ruled 4-3 that she had exceeded her authority by extending a stay-at-home order.
With the increased public scrutiny, security details — like those seen on a federal level for Dr. Anthony Fauci, the top infectious disease expert — have been assigned to state health leaders, including Georgia’s Dr. Kathleen Toomey after she was threatened. Ohio’s Dr. Amy Acton, who also had a security detail assigned after armed protesters showed up at her home, resigned Thursday.
In Orange County, in late May, nearly a hundred people attended a county supervisors meeting, waiting hours to speak against an order requiring face coverings. One person suggested that the order might make it necessary to invoke Second Amendment rights to bear arms, while another read aloud the home address of the order’s author — the county’s chief health officer, Dr. Nichole Quick — as well as the name of her boyfriend.
Quick, attending by phone, left the meeting. In a statement, the sheriff’s office later said Quick had expressed concern for her safety following “several threatening statements both in public comment and online.” She was given personal protection by the sheriff.
But Monday, after yet another public meeting that included criticism from members of the board of supervisors, Quick resigned. She could not be reached for comment. Earlier, the county’s deputy director of public health services, David Souleles, retired abruptly.
An official in another California county also has been given a security detail, said Kat DeBurgh, the executive director of the Health Officers Association of California, declining to name the county or official because the threats have not been made public.
Many local health leaders, accustomed to relative anonymity as they work to protect the public’s health, have been shocked by the growing threats, said Theresa Anselmo, the executive director of the Colorado Association of Local Public Health Officials.
After polling local health directors across the state at a meeting last month, Anselmo found about 80% said they or their personal property had been threatened since the pandemic began. About 80% also said they’d encountered threats to pull funding from their department or other forms of political pressure.
To Anselmo, the ugly politics and threats are a result of the politicization of the pandemic from the start. So far in Colorado, six top local health officials have retired, resigned or been fired. A handful of state and local health department staff members have left as well, she said.
“It’s just appalling that in this country that spends as much as we do on health care that we’re facing these really difficult ethical dilemmas: Do I stay in my job and risk threats, or do I leave because it’s not worth it?” Anselmo asked.
In California, senior health officials from seven counties, including Quick and Souleles, have resigned or retired since March 15. Dr. Charity Dean, the second in command at the state Department of Public Health, submitted her resignation June 4. Burnout seems to be contributing to many of those decisions, DeBurgh said.
In addition to the harm to current officers, DeBurgh is worried about the impact these events will have on recruiting people into public health leadership.
“It’s disheartening to see people who disagree with the order go from attacking the order to attacking the officer to questioning their motivation, expertise and patriotism,” said DeBurgh. “That’s not something that should ever happen.”
Some of the online abuse has been going on for years, said Bill Snook, a spokesperson for the health department in Kansas City, Missouri. He has seen instances in which people took a health inspector’s name and made a meme out of it, or said a health worker should be strung up or killed. He said opponents of vaccinations, known as anti-vaxxers, have called staffers “baby killers.”
The pandemic, though, has brought such behavior to another level.
In Ohio, the Delaware General Health District has had two lockdowns since the pandemic began — one after an angry individual came to the health department. Fortunately, the doors were locked, said Dustin Kent, program manager for the department’s residential services unit.
Angry calls over contact tracing continue to pour in, Kent said.
In Colorado, the Tri-County Health Department, which serves Adams, Arapahoe and Douglas counties near Denver, has also been getting hundreds of calls and emails from frustrated citizens, deputy director Jennifer Ludwig said.
Some have been angry their businesses could not open and blamed the health department for depriving them of their livelihood. Others were furious with neighbors who were not wearing masks outside. It’s a constant wave of “confusion and angst and anxiety and anger,” she said.
Then in April and May, rocks were thrown at one of their office’s windows — three separate times. The office was tagged with obscene graffiti. The department also received an email calling members of the department “tyrants,” adding “you’re about to start a hot-shooting … civil war.” Health department workers decamped to another office.
Although the police determined there was no imminent threat, Ludwig stressed how proud she was of her staff, who weathered the pressure while working round-the-clock.
“It does wear on you, but at the same time we know what we need to do to keep moving to keep our community safe,” she said. “Despite the complaints, the grievances, the threats, the vandalism — the staff have really excelled and stood up.”
The threats didn’t end there, however: Someone asked on the health department’s Facebook page how many people would like to know the home addresses of the Tri-County Health Department leadership. “You want to make this a war??? No problem,” the poster wrote.
Back in Colorado’s Rio Grande County, some members of the community have rallied in support of Brown with public comments and a letter to the editor of a local paper. Meanwhile, COVID-19 case counts have jumped from 14 to 49 as of Wednesday.
Brown is grappling with what she should do next: dive back into another strenuous public health job in a pandemic, or take a moment to recoup?
When she told her 6-year-old son she no longer had a job, he responded: “Good — now you can spend more time with us.”
This story is a collaboration between The Associated Press and Kaiser Health News.
Nurses receive some disaster training, but as one New York nurse recently remarked, “We learned about a pandemic in school maybe for one day. Like it was literally one slide in one class…” Remedying this problem is a key concern in the Johns Hopkins report, “Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19” and educators are already taking steps to add pandemic coverage to disaster nursing curricula. DailyNurse spoke to one of these educators, a member of the reporting team, Dr. Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN, about her role in the effort to update disaster training and education for the COVID-19 era. Dr. Veenema is a contributing scholar to the Johns Hopkins Center for Health Security, Professor of Nursing and Public Health, and author of the textbook Disaster Nursing and Emergency Preparedness.
DailyNurse: You must be very busy.
TGV: It’s been insane. I can’t even begin to describe what it’s been like since the first of March—a lot of 12-hour days. Today, I’m actually getting ready for a webinar with the American Association of Colleges of Nursing (AACN), Improving Nurse Preparedness for Emergency Response: Implications for US Schools of Nursing. The webinar is all about the report findings as well as an overview of some of the recommendations we make in the report.
DN: What sort of changes are you proposing in terms of disaster education and training?
TGV: I’ve been writing disaster nursing courses since before 9/11. And of course the focus after 9/11 was much more on deliberate acts of terrorism, and there was concern over natural disasters as always—pretty much the way the book [Emergency Nursing and Disaster Preparedness] was laid out—chemical, biological, and radiation events that may be human-caused. But now, because of the pandemic, the shift has really become much more public health focused.
Clinical nurses actually have to be public health nurses as well.
[At present], nurses get infection prevention and control coverage in school, but it’s at an introductory level. It’s not to the degree of what we’re experiencing now, where clinical nurses actually have to be public health nurses as well. So, we need to give nurses a better understanding of advanced concepts in infection control and prevention, and how to implement what we call intervention and containment strategies—non-pharmaceutical interventions, which includes things like social distancing, the use of masks, and frequent handwashing; closure of schools and businesses, and parks where people congregate.
More than anything else, the pandemic reveals where nurses did not have experience with the proper selection and use of personal protective equipment. It goes beyond nursing. Some of these problems were outside of nursing, for instance, the hospitals had failed to make a real commitment to emergency preparedness—to procure adequate supplies of PPE, or ensure that they had a vendor supply chain that would allow them to ramp up if they needed to order more. So, what I am advocating—and I’m working on a course right now—is to address these issues and strengthen prelicensure and nursing schools, and also continuing education to ensure that nurses have the knowledge and skills that they need not only to participate and survive, and protect themselves in this pandemic, but in future infectious disease outbreaks as well.
DN: As you mentioned earlier, there are many different sorts of disasters. Is there some sort of tool-kit that can increase nurses’ readiness in whatever emergencies might arise?
TGV: I define a prepared nursing workforce as a workforce that has the knowledge, the skills, the abilities, and the willingness to respond to these types of events. FEMA advocates what is called an “all-hazards” approach to disaster planning, which means that communities are charged with coming up with disaster response plans to address each and every hazard that might occur in their geographical area. Now for nurses, I think that they need to have a minimum knowledge base and set of skills on how to respond in an emergency and on how to continue to provide healthcare services within an environment that may or may not be safe.
The thing about a pandemic… is that it’s characterized by uncertainty…. Also, it’s everywhere.
I think that the challenge for the pandemic is, when a tornado or a hurricane hits, the event happens, and then it’s over. We move through the phases of the disaster lifecycle in a pretty straightforward manner. So, even the most horrific hurricanes that we’ve experienced over the past three years, they end. There have been extended periods of recovery—you can make the case that Puerto Rico has not yet recovered from Hurricane Maria—but you can plan for what’s going to happen. The thing about a pandemic, though, is that it’s characterized by uncertainty. For instance, we were anticipating a second wave this fall, but what we’re seeing is, we haven’t finished the first wave, and things are spiking again.
Also, [unlike most disasters, with a pandemic] it’s everywhere; it’s not geographically isolated in one region of the country. And of course, given the total absence of leadership at the federal level, now you have [states that are] basically 50 countries that are forced to address 50 different pandemics. That’s not the way you do it, so we’re failing there.
DN: Nurses have historically been on the front lines of response to disasters. What can be done to adapt the curriculum to provide them with better training and support for nursing in emergency and disaster situations?
TGV: I’m working hand-in-hand with AACN to help write an emergency preparedness competency to go into the revised Essentials document, so that schools of nursing will have a competency to teach to. AACN does a wonderful job with the Essentials documents, which basically serve as guides for curricula for nursing schools. I’m so proud to be working with them to help revise the essentials, publish this report, and then work on developing a five-module course with a company called Unbound Medicine. I produced a disaster nursing app with them back in 2015, and now I’m working with them to produce course content that schools can use to add to their existing courses or add as a standalone certificate to help provide this important information for schools that may not have the resources or the faculty who know how to develop this content or teach it—we’re hoping to do a great service for some of these schools.
DN: You mentioned the uncertainty of nursing in a pandemic. Where are we now?
TGV: We’re not through this. You’ve got California, Texas, Florida, and Arizona on the brink of being completely overwhelmed, and the Carolinas are right behind them. So the next month is going to be very ugly in the United States.
DN: What can individual nurses do to increase their readiness for pandemics?
TGV: They can pursue ongoing education and training as it relates to pandemic preparedness and response. Some of the professional nursing organizations are now offering short courses. I developed one with the National Council of State Boards of Nursing (NCSBN), and we have more that will be coming out.
Dr. Veenema’s AACN webinar talk, Improving Nurse Preparedness for a Pandemic Response: Implications for U.S. Schools of Nursing is now online. Click here to register and gain access to the webinar.
Federal and state governments, national agencies, nursing schools, and hospitals need to create a better pandemic support structure for nurses, according to a new report from the Johns Hopkins Center for Health Security.
As nurses are expected to provide care in all sorts of extreme circumstances, what can be done to better prepare them and protect their wellbeing in a pandemic? This is the focus of the Johns Hopkins report, “Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19.”
The Johns Hopkins report examines the effects of the pandemic on the nursing profession, and proposes immediate and long-term actions to effect improvements in seven key areas:
• Clear and uniform academic nursing standards
• Nurses who are educated, trained, and clinically competent
• Safe workplace environments
• Adequate access to PPE
• Regulatory consistency across states
• Nurses cross-trained for various clinical settings
• Regular, transparent communications
Provide Nurses with Better Protection
Ensuring nurses’ safety during a pandemic is a vital concern, and the Johns Hopkins report proposes that Congress and government agencies institute programs to more effectively manage the PPE supply chain and ensure “equitable distribution across public and private hospitals.” On a local level, individual hospitals must conduct a rigorous self-examination of their staff safety procedures. “It will be challenging to remedy the distrust and betrayal many frontline nurses feel as a result of not being adequately protected by their institutions during the COVID-19 pandemic,” say the authors of the report. To alleviate this situation, they consider it imperative that hospitals promote more nurses to leadership and decision-making roles. The advice of leaders with nursing expertise is an essential step toward attaining “the best possible health system environment for providing and receiving health care during emergencies.”
Improve Staff Management in a Pandemic Situation
COVID-19 has also turned a spotlight on staffing issues. Obtaining sufficient ICU staff has been especially problematic, the report notes, owing to the specialized skills required on such units. To improve their ability to meet emergencies such as the pandemic, the authors suggest that hospitals adopt an “expertise migration approach” in which ICUs and EDs follow a “model of ongoing nursing continuing education and pandemic preparedness [that] reconceptualizes the experienced nurse as a generalist.” The report takes note as well of the widespread inconsistencies among state executive orders concerning regulations and scope of practice for nurses and advanced practice nurses. To avoid such confusion in the future, the authors urge that states “adopt legislature (such as the Nursing Licensure Compact and Model Advanced Practice Registered Nurse Compact legislation) that will remove regulatory variability over nurse licensure and allow registered and advanced practice nurses to be rapidly mobilized and deployed across state lines during pandemics.”
Correct the Lack of Pandemic Coverage in the Nursing Curriculum
The report directs close attention to reinforcing the nursing education system in light of the pandemic experience. The authors found that students need far more robust training in emergency and disaster preparation. Nursing schools failed to sustain the expanded emergency preparedness curriculum implemented in the wake of 9/11 and were caught unprepared by the school shutdowns during the COVID-19 outbreak. In the current nursing curricula, the authors state, “what is frequently absent is education around concepts in public health emergency response, disease surveillance and containment strategies, and mass vaccination operations… and instruction regarding the proper selection and use of PPE.” They call upon the American Association of Colleges of Nursing to provide a “tool kit” for improving emergency preparedness content in all baccalaureate and graduate nursing programs, and advise that the three nursing accreditation bodies “require the inclusion of teaching and simulation on emergency preparedness and response.” To ensure the continuity of nursing education in COVID-type situations, they advise that schools and state boards of nursing “develop a plan for the continuity of clinical education during public health emergencies.”
Research into nursing and emergency preparedness has so far contributed little to the study of pandemics. The report points out that funding is needed “to support research for pandemic planning in the nursing field,” and to encourage the training of nurse-scientists, “who are critical to strengthening the evidence base and improving the delivery of nursing care during a pandemic.” Among the short and long-term actions they propose are the creation of an emergency commission by the American Academy of Nursing and a CDC-directed “National Center for Disaster Nursing and Public Health Emergency Response to provide education and training, career development, and networking opportunities to early-career nurse scientists and nursing students.”
First Steps Toward Preparing Nurses for a Pandemic
DailyNurse spoke with a member of the reporting team, Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN, a specialist in emergency and disaster nursing education and a contributing scholar at the Johns Hopkins Center for Health Security. In an interview appearing on July 10, Dr. Veenema will discuss the COVID-19 first wave and the first steps toward building a pandemic training curriculum for US nursing schools.
“Time management has been my best friend,” says Nurse of the Week Cailly Simpson. Although she left nursing in 2017 to study law at Rutgers, when the pandemic hit, the 26-year-old immediately felt an instinctive need to help. While continuing to work two days a week at a law firm and attending six hours of classes, the future malpractice lawyer wielded her time management skills and expanded her schedule to add four 12-hour shifts a week at NYU Langone Health.
Langone was familiar ground to Simpson, who worked there in the pulmonary and step-down units after receiving her nursing degree in 2016. The decision to make a two-month return to nursing—despite being just a few months away from finishing her legal studies—was not difficult. Simpson told NJ.com, “I felt like this was something that needed to happen. I went to nursing school with the thought process that I wanted to help people and take care of patients so that’s just kind of how my brain works.”
Simpson’s shifts as a float nurse were grueling, and she saw little of her boyfriend, family, or friends during her COVID nursing stint. However, revisiting her old profession has its rewards: “People truly want to help. They want to send these people home to their families. The attitudes with everyone I have come into contact with is what really has struck me. Everyone has every right to be completely terrified and not want to do this and complain about it. That was never ever the case. I never came across that. Everyone was always up and ready to help and wanted to be there giving it their all. Walking into that attitude made everything so much less scary.”
Summing up her eight-week combination of law studies with nursing on the COVID frontline, Simpson told the Rutgers Law newsletter, “It was hard to balance with finishing up law school but I would not have changed my decision for anything. I have truly enjoyed being back, even during such challenging times. The nurses were incredibly thankful for all the extra help they received. . . They are incredible individuals who have powered through this crisis with a smile on their faces the whole time and have continued to put patient care first.”
For a full story and interview with Cailly Simpson, visit NJ.com.
When she was just four years old, Taylor had a hairsbreadth escape when her family’s apartment in New York City’s SoHo caught fire. After rescuing Taylor’s mother from the blaze, firefighter Eugene Pugliese rushed back into the building when the frantic mother informed him that her little girl was still inside. Finding young Deidre unconscious in the smoke-filled apartment, Pugliese carried her to safety and brought her around via mouth-to-mouth resuscitation. Following the rescue, in addition to the mother’s thanks, the doughty firefighter received the Walter Scott Medal for Valor… and became a hero to the toddler he saved.
Taylor explains, “The fire obviously shaped the rest of my life. I always knew I was given a second chance at life. The copy of the Daily News was in my keepsake binder since I was a young child. I’ve always had a copy of the cover.”
She saved the newspaper account of the fire and rescue and made many attempts to locate her childhood hero without success. While working a shift at NYU Langone Hospital during the coronavirus outbreak, though, Taylor met some firefighters who had brought pizza for her and her co-workers. As they chatted over their slices, she told them that she owed her life to one of their own. After Taylor informed them that her savior had worked with Ladder 20 in Manhattan, a firefighter phoned the station captain, who—despite the passage of decades—still had Pugliese on speed-dial.
Owing to the pandemic, Taylor and the 75-year old retiree were unable to meet in person and share an embrace. “The last thing I’d want to do is expose him,” Taylor told the Daily News. Nonetheless, the two had a satisfying and emotional reunion over the phone and video calls. Pugliese told CNN, “The two of us just sat there crying on the phone. She turned out to be a remarkable woman with a magnificent life.” Taylor’s hero was profoundly gratified by the course of the life he helped to save long ago, and declared, “You turned out to be a wonderful young woman. You’re a hero, too.”
For a complete account of this story, visit CNN or see the Daily News.