Nurse of the Week Andrea Dalzell was just 5 years old when she was diagnosed with transverse myelitis, a neurological disorder caused by inflammation in the spinal cord. Before long, she needed a wheelchair to get around, but that simply meant she would move forward on wheels instead of on her feet—and she hasn’t stopped moving since.
As she grew up, Dalzell became deeply involved in advocacy for the disabled and received a number of awards in recognition for her work, including the Cindy Loo Disability Rights Advocate Award in 2015. In 2018, the Brooklynite became New York City’s only wheelchair-bound RN and attained her bachelor’s degree. In a special interview on the September 10 broadcast of Good Morning America (GMA), Dalzell made it clear that her mission is to bring more disabled people into nursing and other healthcare professions. She told GMA, “You have to have people with these disabilities, these diagnoses, being in healthcare.”
Easily navigating hospital corridors in her wheelchair, Dalzell became a dedicated nurse, and threw herself into work on the NYC frontline when the city was stricken by the pandemic in Spring 2020. Now, she’s a nurse and department head at the Manhattan Quad school for gifted children with disabilities, where “the kids absolutely love her,” according to school founder Kim Busi.
Sitting in her wheelchair on the GMA stage, Dalzell said that she is trying to spread a message of hope and aspiration: “People with disabilities aren’t living a death sentence. They’re living life, and I get to prove every day that I’m going to do that. I need to be able to change that narrative for others so if they know that they’re diagnosed with something… that life doesn’t stop there. Life still happens, and it’s up to them to decide if they want to live it.”
At the conclusion of her interview, GMA host TJ Holmes awarded a teary-eyed Dalzell a $1 million dollar Visionary Prize from the Craig H. Neilsen Foundation in honor of the “extraordinary determination, inexhaustible passion, and ability to inspire” the wheelchair-bound RN has displayed in her advocacy for the disabled.
Dalzell wants to put some of the money toward advancing her education, but she is devoting most of the award to advocacy: “I want to start a whole program for people with disabilities to get into health care. They should be given a chance,” she told GMA.
Visit this page to see the full Good Morning America feature on Andrea Dalzell.
Although health workers constitute about 3% of the population in most countries, they comprise 14% of COVID-19 cases reported to the World Health Organization (WHO), and in some countries account for up to 35% of COVID cases. WHO Director-General Tedros Adhanom Ghebreyesus noted this in a September 17 statement and added, “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives.” As “one of the keys to keeping patients safe is keeping health workers safe,” on Thursday the Director-General issued a 5-point charter on healthcare worker safety in conjunction with Patient Safety Day.
The 5-point WHO charter urges its partner countries to:
1. Develop and implement national programs for the occupational health and safety of health workers
WHO recommends that education and training programs for health workers at all levels include health and safety skills in personal and patient safety and that healthcare licensing and accreditation standards incorporate requirements for staff and patient safety. Member countries should also review and upgrade national regulations and laws for occupational health and safety to ensure that all staff members have regulatory protection of their health and safety at work.
2. Protect health workers from violence in the workplace
Promote a culture of zero tolerance to violence against health workers. Labor laws, policies, and regulations need to be strengthened, and all healthcare workers should have access to ombudspersons and helplines to enable free and confidential reporting and support for any health worker facing violence.
3. Improve the mental health and psychological well-being of healthcare workers
Healthcare facilities must establish and maintain safe staffing levels, and ensure fair duration of deployments, working hours, and rest breaks. Mental and social support services, including advice on work-life balance, risk assessment, and mitigation should be readily available to all staff.
4. Protect healthcare staff from physical and biological hazards
Health care systems must implement patient safety, infection prevention and control, and occupational safety standards in all health care facilities. Facilities need to ensure availability of personal protective equipment (PPE), adequate quantity, appropriate fit, and acceptable quality. All facilities should maintain an adequate, locally held, buffer stock of PPE and provide workers with adequate training on appropriate use and safety precautions. Further, at-risk healthcare staff should receive vaccinations against all vaccine-preventable infections, and in the context of emergency response, be given priority access to newly licensed and available vaccines.
5. Connect the dots between policies on patient safety and healthcare worker safety
Institutions should integrate staff safety and patient safety incident reporting and learning systems, and define the linkages between occupational health and safety, patient safety, quality improvement, and infection prevention and control programs.
Regarding the latter point, the charter states that “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe.”
Who was Biddy Mason? After her portrait was found in a group of Works Project Administration (WPA)-era murals slated for destruction, a flurry of media reports has fostered a growing curiosity about Mason’s place in the pages of Black history and the history of nursing.
Biddy Mason is among the figures depicted in the “History of Medicine in California,” a 10-mural series completed by Bernard Zakheim in 1938. The murals, which have long been on display at the University of California, San Francisco, are housed in a building that is going to be demolished in 2022 to make way for a new medical center. The family of the artist was told that they would need to furnish the funds required for the preservation of the murals. As UCSF and the Zakheim family battled over the cost of preserving the murals, the conflict gathered a varied group of interested parties, including Mason’s descendants Cheryl and Robynn Cox. In June, the General Services Administration entered the fray. The GSA countered UCSF’s ownership claim, insisted that the paintings be preserved and stated that “ownership of the murals resides with G.S.A., on behalf of the United States.”
The debate over the fate of the murals continues, but one happy result is that Biddy Mason’s story has emerged from obscurity. And her story is a classic American journey. Mason began life as a slave in the Deep South. She toiled in slavery on the pioneer trail before gaining her freedom. Finally, after working as a free nurse and midwife, she became a wealthy (and charitable) community leader who improved the lives of her contemporaries and later generations as well.
Born enslaved in Mississippi, Mason ultimately became the property of a Mormon convert. As she traveled west in a caravan with her owner, his family, and their enslaved laborers, she performed midwife duties, herded cattle, and cooked. The caravan ultimately made its way to California. In 1856, five years after her arrival, Nelson successfully petitioned for freedom for herself and 13 members of her family. She then moved to Los Angeles, where she worked for $2.50 a day as a midwife and nurse for Dr. John Strother Griffin, one of the first formally trained doctors in Southern California. Eventually, she set up her own business.
She never learned to read, but Mason was canny with money. She invested her earnings in property in various locations around Los Angeles and became a wealthy woman. By the time she died in 1891, Mason was a prominent philanthropist, and left her heirs an estate worth 3 million dollars. In addition to donating time and money to relieve prisoners and the impoverished, Nelson founded LA’s oldest Black church, the First African Methodist Episcopal Church, a daycare for the children of poor working mothers, and a Traveler’s Aid center. She lived until 1891.
Visit here to see a more detailed history of Biddy Mason and her place in history. For an account of the debate over the UCSF WPA murals, see this article in the New York Times.
Before COVID-19 hit New York City, Mount Sinai Morningside Hospital had a flexible, 24-hour visitor policy for patients in the intensive care unit (ICU).
People would visit their loved ones at any hour of the day, coming and going as they pleased. Doctors and nurses said the constant support of family members was beneficial to these gravely ill patients.
Now, per New York State Department of Health guidelines that apply to all areas of the hospital, visitors are limited to one 4-hour session per day, and only one person is allowed at the bedside at a time. At Morningside, that has to be done between the hours of 10 a.m. and 6 p.m. so visitors can undergo temperature and symptom checks before being permitted on the floors.
Morningside ICU physicians and nurses told MedPage Today those visitation policies are too restrictive, especially as staff have become more adept at managing COVID-19 transmission risk.
“It’s particularly challenging for this community because these families have a lot of restrictions,” said Mirna Mohanraj, MD, an ICU physician at Morningside (formerly St. Luke’s Hospital), which predominantly serves minority patients from Harlem and the Bronx. “Not everyone has a flexible job they can leave for 4 hours. They don’t have the financial resources to hire childcare.”
In an emailed statement, the New York State Department of Health said that hospitals “can authorize visits longer than four hours depending on a patient’s status and condition” and noted that labor & delivery patients, pediatric patients, and those with intellectual or developmental disabilities can have a support person at all times.
“This policy remains in place to safeguard and maintain the health and wellbeing of patients, staff and visitors while the need to contain the spread of COVID-19 continues,” the statement read.
The new visitation rules are a vast improvement from the disease peak, when visitors were barred from hospitals altogether and patients died alone. But while the policy may be sufficient for patients elsewhere in the hospital, it poses particular challenges for the ICU, Mohanraj said.
“The ICU is such a dynamic place, things change frequently and unexpectedly,” she said. “It’s traumatic for a family member not to be present when things are changing rapidly.”
Morningside ICU charge nurse Jessica Montanaro, MSN, RN, said while the visitation rules “make sense on regular floors, you have more grave situations [in the ICU]. You’re dealing with death and difficult decisions. In truly grave situations, people need more support. It should be a different situation for the ICU.”
Mohanraj said the literature “shows that having family at the bedside can be beneficial to patients” in the ICU, which is why many ICUs have adopted flexible visitor policies in recent years.
“Family members can provide emotional and psychological support,” she said. “Often, they’re the ones re-orienting patients, moving their legs, alerting the nurses to issues like pain control or a bedpan.”
“They’re also the constant reminder of the full lives that patients had before they got to the ICU,” she added. “And it helps the family develop trust in us as their healthcare team.”
Hospital administrators have allowed exceptions on a case-by-case basis, as called for by the state guidelines. But that means more time spent trying to cut through red tape, and the possibility of request denials.
Eric Gottesman, MD, medical director of the ICU at North Shore University Hospital in Manhasset, New York, which was also hit hard during the COVID-19 peak, said administrators there typically make exceptions to the visitor rule for end-of-life discussions.
“We follow the guidelines but if there’s an emergent issue, we do stray a little,” Gottesman told MedPage Today. “We try to bend, not break.”
Gottesman was similarly accustomed to a liberal visitation policy before COVID-19 hit. The new policy “puts more pressure on us by having to tell patients about the limitations,” he said. “Also, if we’re on rounds and no family member is present to take in the info, we have to come back and do it over.”
So what changes would ICU doctors and nurses like to see?
Family members should be able to stay for longer than 4 hours, Mohanraj said, especially if that person is the patient’s only visitor. That visitor should also be allowed to return to the bedside after they’ve left (right now, once a visitor leaves a hospital floor, they’re not allowed to return).
Finally, Mohanraj said nighttime visits would be especially helpful because ICU patients who experience delirium typically get worse at night, so the additional family support might alleviate related issues.
Safety is the first priority, she said, and thus far preventing transmission among visitors “has been perfectly manageable,” especially as very few patients with COVID-19 remain in the hospital, she said.
ICU providers in New York hospitals say the trauma of seeing families separated during the peak of the crisis has stuck with them, and makes their current push to have family members around more urgent.
In the beginning of the crisis, visitors weren’t allowed unless a patient was imminently dying — but that’s not always easy to call, Montanaro said.
“We had difficult cases where we would allow one family member to come up and stand in the patient’s doorway, say their goodbyes, and then the patient didn’t pass,” Montanaro said.
As policies eased over time, and patients could have two visitors, she recalled a case of a dying mother with three family members who wanted to say goodbye — her husband and two sons.
“That family had to choose which son would say goodbye to their mother,” she said. “So many things about that experience will haunt us for the rest of our lives.”
Data from National Nurses United (NNU) suggests that while only 4% of US nurses are Filipinos, some 30% of the nearly 200 RNs who have died from COVID-19 are Filipino Americans. NNU believes that overall, nurses are primarily endangered by PPE shortages and restrictive guidelines limiting access to tests, but Filipino nurses tend to face additional risks.
The odds of being exposed to the virus tend to be higher for Filipino nurses and healthcare workers. One reason for their vulnerability is based on sheer numbers, particularly in California and New York. One fifth of California nurses are Filipino, and according to a ProPublica analysis of 2017 US Census data, 25% of the Filipinos living in New York work in the health care industry. The types of jobs they take also increase the likelihood of exposure. A 2018 Philippine Nurses Association of America survey (cited by ProPublica) found a large proportion of respondents working in bedside and critical care, and a StatNews report noted that “because they are most likely to work in acute care, medical/surgical, and ICU nursing, many ‘FilAms’ are on the front lines of care for Covid-19 patients.” The StatNews story added that Filipino frontliners often “work extra shifts to support their families and send money back to relatives in the Philippines. Those extra hours, and extra exposure to patients, mean higher risk.”
Roy Taggueg, of the Bulosan Center for Filipino Studies at University of California, Davis recently told NBC News that in addition to the low rates of testing in their communities, Filipino nurses are also more likely to reside in multi-generational households, which makes them and their families more vulnerable to the virus. He explained, “One person might be going out, but they definitely are bringing everything back with them when they come home from work, because they’re forced to work out there on the front line. We’re talking about their parents, their kids, all of that. It’s a very particular position to be in, and it’s one that I think is unique to the Filipino and Filipino American community.”
While many nurses have been speaking out about the lack of tests and inadequate PPE, Filipino nurses usually find it more comfortable to remain silent. Cris Escarrilla at the San Diego chapter of the Philippine Nurses Association of America remarked, “We don’t really complain that much. We are able to adapt and we just want to get things done.” Zenei Cortez, president of National Nurses United and the California Nurses Association acknowledged this, saying “Culturally, we don’t complain. We do not question authority. We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare.” However, Cortez thinks that the younger generation of Filipino nurses seem to be finding their voices: “What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out. We love our jobs, but we love our families too.”
Immigrant women receive dubious hysterectomies and staffers openly neglect even basic COVID precautions at Georgia’s Irwin County Detention Center, says LPN Dawn Wooten in a complaint filed by four non-governmental organizations.
According to Wooten, the private immigrant detention facility has refused to test symptomatic inmates, has not been isolating those suspected of having the virus, and is disregarding mandatory CDC social distancing practices. Wooten’s complaint also notes that she and other nurses have been alarmed by the inordinate number of hysterectomy operations performed at the Center. In reference to the frequent and questionable hysterectomies one detainee described the detention center as “an experimental concentration camp.”
COVID-19 safety and treatment are given short shrift at the center, and Wooten says that even before the pandemic the facility was often dilatory in providing medical care for detained immigrants. Since the pandemic, the complaint alleges, the center has made almost no use of its two rapid-response COVID testing machines, and has instead sent swabs to be tested at a local hospital. Wooten was told she should not be “wasting tests” on people she suspected of being infected, and when she inquired about testing one detainee, a co-worker responded, “He ain’t got no damn corona, Wooten.”
In addition to failing to provide PPE for staff working directly with confirmed cases of COVID-19, Wooten’s complaint states that the facility forced symptomatic staff to continue to work in the facility and threatened them with discipline if they refused to work in dangerous conditions. Because she spoke out against such practices, Wooten says that she was transferred from her full-time position to a part-time job in which her shifts consisted of a few hours a month.
On Tuesday, September 15, House Speaker Nancy Pelosi called for an investigation. Regarding the alleged misuse of hysterectomies on immigrant women detainees, Pelosi said “The DHS Inspector General must immediately investigate the allegations detailed in this complaint. Congress and the American people need to know why and under what conditions so many women, reportedly without their informed consent, were pushed to undergo this extremely invasive and life-altering procedure.” She also called attention to the neglect of COVID safety measures and proper treatment, and referred to “ICE’s egregious handling of the coronavirus pandemic, in light of reports of their refusal to test detainees including those who are symptomatic, the destruction of medical requests submitted by immigrants and the fabrication of medical records.”
Project South, one of the organizations filing the complaint, states that “ICDC (Irwin County Detention Center) has a long track record of human rights violations.”
For more details on this story and quotes from Dawn Wooten, see the article in The Intecept.