Elected Officials in 26 States Have Successfully Neutered Public Health Departments

Elected Officials in 26 States Have Successfully Neutered Public Health Departments

Republican legislators in more than half of U.S. states, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases.

A KHN review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the covid-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.Originally published in Kaiser Health News.

In Arkansas, legislators banned mask mandates except in private businesses or state-run health care settings, calling them “a burden on the public peace, health, and safety of the citizens of this state.” In Idaho, county commissioners, who typically have no public health expertise, can veto countywide public health orders. And in Kansas and Tennessee, school boards, rather than health officials, have the power to close schools.

President Joe Biden last Thursday announced sweeping vaccination mandates and other covid measures, saying he was forced to act partly because of such legislation: “My plan also takes on elected officials in states that are undermining you and these lifesaving actions.”

All told:

  • In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease.
  • At least 17 states passed laws banning covid vaccine mandates or passports, or made it easier to get around vaccine requirements.
  • At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.

Much of this legislation takes effect as covid hospitalizations in some areas are climbing to the highest numbers at any point in the pandemic, and children are back in school.

“We really could see more people sick, hurt, hospitalized or even die, depending on the extremity of the legislation and curtailing of the authority,” said Lori Tremmel Freeman, head of the National Association of County and City Health Officials.

Public health academics and officials are frustrated that they, instead of the virus, have become the enemy. They argue this will have consequences that last long beyond this pandemic, diminishing their ability to fight the latest covid surge and future disease outbreaks, such as being able to quarantine people during a measles outbreak.

“It’s kind of like having your hands tied in the middle of a boxing match,” said Kelley Vollmar, executive director of the Jefferson County Health Department in Missouri.

But proponents of the new limits say they are a necessary check on executive powers and give lawmakers a voice in prolonged emergencies. Arkansas state Sen. Trent Garner, a Republican who co-sponsored his state’s successful bill to ban mask mandates, said he was trying to reflect the will of the people.

“What the people of Arkansas want is the decision to be left in their hands, to them and their family,” Garner said. “It’s time to take the power away from the so-called experts, whose ideas have been woefully inadequate.”

After initially signing the bill, Republican Gov. Asa Hutchinson expressed regret, calling a special legislative session in early August to ask lawmakers to carve out an exception for schools. They declined. The law is currently blocked by an Arkansas judge who deemed it unconstitutional. Legal battles are ongoing in other states as well.

A Deluge of Bills

In Ohio, legislators gave themselves the power to overturn health orders and weakened school vaccine mandates. In Utah and Iowa, schools cannot require masks. In Alabama, state and local governments cannot issue vaccine passports and schools cannot require covid vaccinations.

Montana’s legislature passed some of the most restrictive laws of all, severely curbing public health’s quarantine and isolation powers, increasing local elected officials’ power over local health boards, preventing limits on religious gatherings and banning employers — including in health care settings — from requiring vaccinations for covid, the flu or anything else.

Legislators there also passed limits on local officials: If jurisdictions add public health rules stronger than state public health measures, they could lose 20% of some grants.

Losing the ability to order quarantines has left Karen Sullivan, health officer for Montana’s Butte-Silver Bow department, terrified about what’s to come — not only during the covid pandemic but for future measles and whooping cough outbreaks.

“In the midst of delta and other variants that are out there, we’re quite frankly a nervous wreck about it,” Sullivan said. “Relying on morality and goodwill is not a good public health practice.”

While some public health officials tried to fight the national wave of legislation, the underfunded public health workforce was consumed by trying to implement the largest vaccination campaign in U.S. history and had little time for political action.

Freeman said her city and county health officials’ group has meager influence and resources, especially in comparison with the American Legislative Exchange Council, a corporate-backed conservative group that promoted a model bill to restrict the emergency powers of governors and other officials. The draft legislation appears to have inspired dozens of state-level bills, according to the KHN review. At least 15 states passed laws limiting emergency powers. In some states, governors can no longer institute mask mandates or close businesses, and their executive orders can be overturned by legislators.

When North Dakota’s legislative session began in January, a long slate of bills sought to rein in public health powers, including one with language similar to ALEC’s. The state didn’t have a health director to argue against the new limits because three had resigned in 2020.

Fighting the bills not only took time, but also seemed dangerous, said Renae Moch, public health director for Bismarck, who testified against a measure prohibiting mask mandates. She then received an onslaught of hate mail and demands for her to be fired.

Lawmakers overrode the governor’s veto to pass the bill into law. The North Dakota legislature also banned businesses from asking whether patrons are vaccinated against or infected with the coronavirus and curbed the governor’s emergency powers.

The new laws are meant to reduce the power of governors and restore the balance of power between states’ executive branches and legislatures, said Jonathon Hauenschild, director of the ALEC task force on communications and technology. “Governors are elected, but they were delegating a lot of authority to the public health official, often that they had appointed,” Hauenschild said.

‘Like Turning Off a Light Switch’

When the Indiana legislature overrode the governor’s veto to pass a bill that gave county commissioners the power to review public health orders, it was devastating for Dr. David Welsh, the public health officer in rural Ripley County.

People immediately stopped calling him to report covid violations, because they knew the county commissioners could overturn his authority. It was “like turning off a light switch,” Welsh said.

Another county in Indiana has already seen its health department’s mask mandate overridden by the local commissioners, Welsh said.

He’s considering stepping down after more than a quarter century in the role. If he does, he’ll join at least 303 public health leaders who have retired, resigned or been fired since the pandemic began, according to an ongoing KHN and AP analysis. That means 1 in 5 Americans have lost a local health leader during the pandemic.

“This is a deathblow,” said Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health. He called the legislative assault the last straw for many seasoned public health officials who have battled the pandemic without sufficient resources, while also being vilified.

Public health groups expect further combative legislation. ALEC’s Hauenschild said the group is looking into a Michigan law that allowed the legislature to limit the governor’s emergency powers without Democratic Gov. Gretchen Whitmer’s signature.

Curbing the authority of public health officials has also become campaign fodder, particularly among Republican candidates running further on the right. While Republican Idaho Gov. Brad Little was traveling out of state, Lt. Gov. Janice McGeachin signed a surprise executive order banning mask mandates that she later promoted for her upcoming campaign against him. He later reversed the ban, tweeting, “I do not like petty politics. I do not like political stunts over the rule of law.”

At least one former lawmaker — former Oregon Democratic state Sen. Wayne Fawbush— said some of today’s politicians may come to regret these laws.

Fawbush was a sponsor of 1989 legislation during the AIDS crisis. It banned employers from requiring health care workers, as a condition of employment, to get an HIV vaccine, if one became available.

But 32 years later, that means Oregon cannot require health care workers to be vaccinated against covid. Calling lawmaking a “messy business,” Fawbush said he certainly wouldn’t have pushed the bill through if he had known then what he does now.

“Legislators need to obviously deal with immediate situations,” Fawbush said. “But we have to look over the horizon. It’s part of the job responsibility to look at consequences.”

Nurse of the Week 2020: A Year of Extraordinary Nurses

Nurse of the Week 2020: A Year of Extraordinary Nurses

In a year in which so many nurses displayed bravery, suffered hardships, and shone in countless ways, DailyNurse might easily have featured a “Nurse of the Day” instead of a Nurse of the Week.

Nurses have always gone the extra mile to communicate with patients and make them feel more comfortable and cared for, and we all know former patients who were so inspired by their nurses that they decided to enter the profession themselves. As 2020 raised the curtain on the Year of the Nurse, though, no one could have anticipated it would be a watershed year in which nurses became global icons of hope and courage.

Whether You’re a Hero, or Merely Awesome, Take a Bow…

Boston HCWs celebrate arrival of Covid-19 vaccine in December.

The public has long admired nurses, but this year, the world has watched nurses brave the pandemic to work in seemingly impossible conditions, act as stand-ins for patients’ absent families, and leave home to speed to the relief of overwhelmed hospitals all over the US.

Nonetheless, many of our 2020 Nurses of the Week (NotW) eschewed the word “hero.” If you glance at remarks from our 2020 Nurses of the Week, you might note that while they take pride in their work, few sound like they are ready to accessorize their mask with a Superman cape. Naturally, they are happy to see their work recognized, but nurses constantly go out of their way to make patients feel less frightened and alone. As frontliner Tabatha Kentner said, “This is what we do. This is why we’re here.” Nurses save lives—and when they cannot, they comfort patients in their final hours and console distraught families. It’s not an occasional phenomenon; it is an everyday occurrence. The name and photo in Wednesday’s NotW feature could easily be your own because your expertise and empathy make you a Nurse of the Week every day of the year.

On the last Wednesday of 2020, DailyNurse salutes the Nurses of the Week who made their mark during the Year of the Nurse!

Great (and Caring) Communicators

Nurse of the Week Emily Fawcett is an RN at Lenox Hill Hospital
RN Emily Fawcett, Lenox Hill Hospital, NYC.

A recurring theme is nurses who use their unique talents to raise patients’ and staff members’ spirits. Some, like Marc Perreault and Lori Marie Kay, shared their musical gifts. At Lenox Hill Hospital during the height of the New York City outbreak, Emily Fawcett helped boost morale in her ICU by meeting with staff for positive-thinking “hope huddles” before starting their shifts.

Danielle Fenn applied her language skills to comfort non-English speaking Covid patients. Others, like Tabatha Kentner, have been acting as “angels” (the word angel comes from the Greek angelos, which means “messenger”) and facilitating virtual visits so patients and their loved ones can commune even in isolation (and when necessary, say their final goodbyes).

Advocates and Public Servants

RN Andrea Dalzell on Good Morning America.

2020 was a year in which nurses stepped forward, spoke up, and got involved in public and civic health. Expect to see more of this in 2021 and years to come (we hope!). Metastatic breast cancer survivor Stephanie Walker is tirelessly advocating for cancer patients and patient education in North Carolina. Another indefatigable advocate, Andrea Dalzell, is on a mission to invite wheelchair-bound people to enter the nursing profession.

NYPD’s new Special Victims Unit head Michael King is a veteran SANE—and he is determined to improve the treatment of rape victims by police and other first responders. American Academy of Nursing (AAN) “Living Legend” Mary Wakefield is sharing her public health expertise and experience in the Obama administration with the Biden-Harris transition team.

Another AAN “Living Legend,” 85-year-old Marie Manthey, is promoting frank, open dialogues between Black and White nurses, and calling upon all White allies to combat structural racism and unconscious bias.

Frontline Troopers

Nurse Anna Slayton
Anna Slayton, BSN, RN-BC

Tens of thousands of nurses this year packed their bags and took off to lend a hand in the nation’s hotspots. Reports on horrific conditions in hard-hit city hospitals were a virtual Bat-Signal for many nurses. They stashed extra masks in their suitcases, said goodbye to their loved ones, and flew to the most dangerous hotspots in the country (even nurses who had never been on a plane before!).

Texas nurse Anna Slayton, who parted from her family to spend 77 days on the New York frontlines, felt compelled to help, telling DailyNurse, “I ultimately knew it was my duty.” And in April, after flying from Tennessee to a desolate—but noisily grateful—NYC, ED nurse Kirsten Flanery declared , “I made the right decision on coming up here. I’m ready to make a difference!”​

Difficult Takes a Day, Impossible Takes a Week

Nurse of the Week Felicia Shaner with her two daughters.
LPN Felicia Shaner and daughters.

Many nurses combine massive multitasking efforts with hard work to pursue their studies, and some fight to overcome dire health and financial obstacles in their quest to start a nursing career. Felicia Shaner was so drawn to the profession that she embarked on her nursing studies while living in a homeless shelter… with a toddler and a baby on board! degrees while working as hospital custodians. Rebel Nurse Jalil Johnson (of Show me Your Stethoscope fame) had spent his last $5 when he enrolled in an LPN program. And Brianna Fogelman had a lung transplant in her junior year of nursing school and took her nursing finals with a tube in her chest.​

Is There a Nurse in the House?

Former CCN/Cardiac Care nurse Hollyanne Milley and spouse.
Former CCN/Cardiac Care nurse Hollyanne Milley and spouse.

2020 was also a year in which nurses acted as first responders in unexpected times and places. Pamela Zeinoun saved the lives of three premature infants after the devastating August 4 explosions in Beirut. Indiana trauma nurse Colby Snyder rushed to the assistance of two people who collapsed in public within a 3-week period: the first had a seizure at her grocery store, and the second fell while Snyder was volunteering at the polls on Election Day. ​​ ​

Former CCN/cardiac care nurse Hollyanne Miley (whose husband is Joint Chiefs of Staff Chairman Mark Milley) is also a good person to have at hand when out-of-the-blue seizures occur. And VA nurse Maria VanHart impressed “official” first responders by her swift, efficient, and empathic treatment of survivors at the scene of a fatal highway accident.

DailyNurse salutes all of its readers, and all nurses. If you know of someone who warrants a Nurse of the Week nod, send your suggestion to [email protected]. Best wishes for a happier, healthier, evidence-based New Year!

$8k a Week in Fargo: Desperate Hospitals Break Their Piggybanks to Hire Travel Nurses

$8k a Week in Fargo: Desperate Hospitals Break Their Piggybanks to Hire Travel Nurses

In March, Claire Tripeny was watching her dream job fall apart. She’d been working as an intensive care nurse at St. Anthony Hospital in Lakewood, Colorado, and loved it, despite the mediocre pay typical  for the region. But when COVID-19 hit, that calculation changed.

She remembers her employers telling her and her colleagues to “suck it up” as they struggled to care for six patients each and patched their protective gear with tape until it fully fell apart. The $800 or so a week she took home no longer felt worth it.

“I was not sleeping and having the most anxiety in my life,” said Tripeny. “I’m like, ‘I’m gonna go where my skills are needed and I can be guaranteed that I have the protection I need.’”

In April, she packed her bags for a two-month contract in then-COVID hot spot New Jersey, as part of what she called a “mass exodus” of nurses leaving the suburban Denver hospital to become traveling nurses. Her new pay? About $5,200 a week, and with a contract that required adequate protective gear.

Months later, the offerings — and the stakes — are even higher for nurses willing to move. In Sioux Falls, South Dakota, nurses can make more than $6,200 a week. A recent posting for a job in Fargo, North Dakota, offered more than $8,000 a week. Some can get as much as $10,000.

Early in the pandemic, hospitals were competing for ventilators, COVID tests and personal protective equipment. Now, sites across the country are competing for nurses. The fall surge in COVID cases has turned hospital staffing into a sort of national bidding war, with hospitals willing to pay exorbitant wages to secure the nurses they need. That threatens to shift the supply of nurses toward more affluent areas, leaving rural and urban public hospitals short-staffed as the pandemic worsens, and some hospitals unable to care for critically ill patients.

“That is a huge threat,” said Angelina Salazar, CEO of the Western Healthcare Alliance, a consortium of 29 small hospitals in rural Colorado and Utah. “There’s no way rural hospitals can afford to pay that kind of salary.”

Surge Capacity

Hospitals have long relied on traveling nurses to fill gaps in staffing without committing to long-term hiring. Early in the pandemic, doctors and nurses traveled from unaffected areas to hot spots like California, Washington state and New York to help with regional surges. But now, with virtually every part of the country experiencing a surge — infecting medical professionals in the process — the competition for the finite number of available nurses is becoming more intense.

“We all thought, ‘Well, when it’s Colorado’s turn, we’ll draw on the same resources; we’ll call our surrounding states and they’ll send help,’” said Julie Lonborg, a spokesperson for the Colorado Hospital Association. “Now it’s a national outbreak. It’s not just one or two spots, as it was in the spring. It’s really significant across the country, which means everybody is looking for those resources.”

In North Dakota, Tessa Johnson said she’s getting multiple messages a day on LinkedIn from headhunters. Johnson, president of the North Dakota Nurses Association, said the pandemic appears to be hastening a brain drain of nurses there. She suspects more nurses may choose to leave or retire early after North Dakota Gov. Doug Burgum told health care workers they could stay on the job even if they’ve tested positive for COVID-19.

All four of Utah’s major health care systems have seen nurses leave for traveling nurse positions, said Jordan Sorenson, a project manager for the Utah Hospital Association.

“Nurses quit, join traveling nursing companies and go work for a different hospital down the street, making two to three times the rate,” he said. “So, it’s really a kind of a rob-Peter-to-pay-Paul staffing situation.”

Hospitals not only pay the higher salaries offered to traveling nurses but also pay a commission to the traveling nurse agency, Sorenson said. Utah hospitals are trying to avoid hiring away nurses from other hospitals within the state. Hiring from a neighboring state like Colorado, though, could mean Colorado hospitals would poach from Utah.

“In the wake of the current spike in COVID hospitalizations, calling the labor market for registered nurses ‘cutthroat’ is an understatement,” said Adam Seth Litwin, an associate professor of industrial and labor relations at Cornell University. “Even if the health care sector can somehow find more beds, it cannot just go out and buy more front-line caregivers.”

Litwin said he’s glad to see the labor market rewarding essential workers — disproportionately women and people of color — with higher wages. Under normal circumstances, allowing markets to determine where people will work and for what pay is ideal.

“On the other hand, we are not operating under normal circumstances,” he said. “In the midst of a severe public health crisis, I worry that the individual incentives facing hospitals on the one side and individual RNs on the other conflict sharply with the needs of society as whole.”

Some hospitals are exploring ways to overcome staffing challenges without blowing the budget. That could include changing nurse-to-patient ratios, although that would likely affect patient care. In Utah, the hospital association has talked with the state nursing board about allowing nursing students in their final year of training to be certified early.

Growth Industry

Meanwhile business is booming for companies centered on health care staffing such as Wanderly and Krucial Staffing.

“When COVID first started and New York was an epicenter, we at Wanderly kind of looked at it and said, ‘OK, this is our time to shine,’” said David Deane, senior vice president of Wanderly, a website that allows health care professionals to compare offers from various agencies. “‘This is our time to help nurses get to these destinations as fast as possible. And help recruiters get those nurses.’”

Deane said the company has doubled its staff since the pandemic started. Demand is surging — with Rocky Mountain states appearing in up to 20 times as many job postings on the site as in January. And more people are meeting that demand.

In 2018, according to data from a national survey, about 31,000 traveling nurses worked nationwide. Now, Deane estimated, there are at least 50,000 travel nurses. Deane, who calls travel nurses “superheroes,” suspects a lot of them are postoperative nurses who were laid off when their hospitals stopped doing elective surgeries during the first lockdowns.

Competition for nurses, especially those with ICU experience, is stiff. After all, a hospital in South Dakota isn’t competing just with facilities in other states.

“We’ve sent nurses to Aruba, the Bahamas and Curacao because they’ve needed help with COVID,” said Deane. “You’re going down there, you’re making $5,000 a week and all your expenses are paid, right? Who’s not gonna say yes?”

Krucial Staffing specializes in sending health care workers to disaster locations, using military-style logistics. It filled hotels and rented dozens of buses to get nurses to hot spots in New York and Texas. CEO Brian Cleary said that, since the pandemic started, the company has grown its administrative staff from 12 to more than 200.

“Right now we’re at our highest volume we’ve been,” said Cleary, who added that over Halloween weekend alone about 1,000 nurses joined the roster of “reservists.”

With a base rate of $95 an hour, he said, some nurses working overtime end up coming away with $10,000 a week, though there are downsides, like the fact that the gig doesn’t come with health insurance and it’s an unstable, boom-and-bust market.

Hidden Costs

Amber Hazard, who lives in Texas, started as a traveling ICU nurse before the pandemic and said eye-catching sums like that come with a hidden fee, paid in sanity.

“How your soul is affected by this is nothing you can put a price on,” she said.

At a high-paying job caring for COVID patients during New York’s first wave, she remembers walking into the break room in a hospital in the Bronx and seeing a sign on the wall about how the usual staff nurses were on strike.

“It said, you know, ‘We’re not doing this. This is not safe,’” said Hazard. “And it wasn’t safe. But somebody had to do it.”

The highlight of her stint there was placing a wedding ring back on the finger of a recovered patient. But Hazard said she secured far more body bags than rings on patients.

Tripeny, the traveling nurse who left Colorado, is now working in Kentucky with heart surgery patients. When that contract wraps up, she said, she might dive back into COVID care.

Earlier, in New Jersey, she was scarred by the times she couldn’t give people the care they needed, not to mention the times she would take a deceased patient off a ventilator, staring down the damage the virus can do as she removed tubes filled with blackened blood from the lungs.

She has to pay for mental health therapy out-of-pocket now, unlike when she was on staff at a hospital. But as a so-called traveler, she knows each gig will be over in a matter of weeks.

At the end of each week in New Jersey, she said, “I would just look at my paycheck and be like, ‘OK. This is OK. I can do this.’”

Republished courtesy of Kaiser Health News. KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

Nurse of the Week: AAN Living Legend Mary Wakefield Joins Biden Transition Team

Nurse of the Week: AAN Living Legend Mary Wakefield Joins Biden Transition Team

An American Academy of Nursing (AAN) Living Legend honoree has been tapped to assist with the Biden-Harris Presidential transition team. Public health expert, educator, and former ICU nurse Mary Wakefield is serving as a volunteer member of the Health and Human Services team as they prepare to move to Washington, DC in January. HHS is familiar ground for Wakefield, who has substantial experience in Washington. During Barack Obama’s first term she was administrator of the U.S. Health Resources and Services Administration, and in 2015-2017 she was acting deputy secretary of the Department of Health and Human Services.

Mary Wakefield is joining the Biden-Harris transition team.
Mary Wakefield (photo courtesy of the UND Center for Rural Health)

Wakefield, who is also a former director of the University of North Dakota Center for Rural Health, returned to academia after completing her term at the HHS, but her background and expertise make her return to public service seem inevitable. Debbie Swanson, director of the Grand Forks Public Health Department (and a former student of Wakefield’s at UND), applauded her selection for the transition team: “I think she’s really well-positioned to significantly contribute to that team for the Department of Health and Human Services, and I think it’s especially important because of the vast experience that she’s had in health care and public policy. But one of the things I really want to state is that she’ll represent nurses who are on the frontlines of public health and health care in our country, and she’s greatly respected and admired by nurses, so we’re excited that she has a seat at the table to help with a smooth transition within a federal agency that impacts health and nursing.”

The current director of UND’s Center for Rural Health, Brad Gibbens, is delighted by the addition of Wakefield to the transition team. Gibbens stressed the value of Wakefield’s expertise in rural health care and her North Dakota roots, noting, “She very much keeps the idea of rural in front of everybody…. She understands rural at a national level, but she also really understands it at the North Dakota level. So some of the unique things that we deal with, as it relates to, say, critical-access hospitals, as it relates to rural health workforce, as it relates to addressing population health needs, she has that knowledge and awareness from a rural state that she can put in front of the people as they’re starting to take over for a new administration.”

For more details on Mary Wakefield, see this article in the Grand Forks Herald.

US Healthcare Systems Struggle to Cope With Fall Covid Surge

US Healthcare Systems Struggle to Cope With Fall Covid Surge

As Covid-19 cases spike all over the country, many healthcare systems are in desperate straits. States that proudly saw thousands of their nurses fly out this spring to “frontline” hotspots like New York City, Seattle, New Orleans, and Boston are now starved for resources themselves. With the latest stage of the pandemic coursing through 48 states, the frontlines are often in smaller cities and rural states that tend to lack the amenities common at metropolitian hospitals. Local and state health care systems are struggling to treat patients amid dire shortages of staff, beds, and equipment.

Under the strain of the present surge, healthcare systems are assigning non-Covid patients to beds in convention centers, hospitals are canceling elective surgeries, ICU nurses are working 60-hour weeks, and nurses who sped to New York in April are now working overtime to treat Covid patients in their hometowns. Areas that are especially overwhelmed, such as El Paso, store their dead in mobile cooling units staffed by jail inmates , and airlift non-Covid patients to hospitals in cities that for the present have escaped the new surge. In addition to seeking aid from National Guard medics, the American Hospital Association’s vice president of quality and patient safety, Nancy Fosterome, told Stat News that some hospitals are even turning to local dentists, Red Cross volunteers, and people with basic health experience to help with tasks that require less training.

In North Dakota, the weight of the Covid caseload—currently the worst in the country and, per capita, one of the worst in the world—has effectively broken the state’s contact tracing system. Kailee Lingang, a University of North Dakota nursing student now helping with contact tracing in the state, told the Washington Post that “Test and trace went by the wayside. Even if we had enough staff to call up everyone’s workplace and contact, there are so many new infections that it wouldn’t be as effective. At this point, the government has given up on following the virus’s path through the state. All we can do is notify people, as quickly as we can, that they have the virus.”

In Indiana, the state and local healthcare systems are sputtering in the wake of a 60% increase in hospitalizations. One doctor in the state, Timothy Mullinder, told MedPage Today that patients “who need to go to the ICU have been stuck in the ER for 24 hours because there are no beds available. Post-operative patients are stuck in the PACU recovery area well over 24 hours because there are no beds available.”

With the entire state out of staffed hospital beds, Iowa’s healthcare system is also overwhelmed. Whitney Neville, an Iowa nurse, told the Atlantic on November 13, “Last Monday we had 25 patients waiting in the emergency department. They had been admitted but there was no one to take care of them.” The strain on the system, combined with the state’s relaxed social distancing policies, prompted one infectious disease doctor to speak in near-apocalyptic tones: “The wave hasn’t even crashed down on us yet. It keeps rising and rising, and we’re all running on fear. The health-care system in Iowa is going to collapse, no question.” The problem, however, extends well beyond North Dakota, Texas, and Iowa. A November 17 Atlantic article found that 22% of all US hospitals are facing staffing shortages, and added, “More than 35 percent of hospitals in Arkansas, Missouri, North Dakota, New Mexico, Oklahoma, South Carolina, Virginia, and Wisconsin are anticipating a staffing shortage this week.”

At the center of the system, nurses and other healthcare workers are working as many shifts as they can, while doing their best to attend to waves of incoming patients. The latest surge, however, has driven a growing number of nurses to express their frustration with incoherent policies and public intransigence on the matter of masking, social distancing, and incredulity over the very existence of the virus. Michelle Cavanaugh, a nurse at the Nebraska Medicine Medical Center, spoke for many when she told a Utah reporter, “We’re seeing the worst of the worst and these patients are dying, and you go home at the end of the night and you drive by bars and you drive by restaurants and they’re packed full and people aren’t wearing masks. I wish that I could get people to see COVID through my eyes.”

ND Nurses on Working While Asymptomatic: “Did You Really Think This Through?”

ND Nurses on Working While Asymptomatic: “Did You Really Think This Through?”

Nurses in North Dakota came out against a new policy that allows healthcare workers with asymptomatic SARS-CoV-2 infections to continue working at hospitals and nursing homes.

The policy was issued Monday by North Dakota Gov. Doug Burgum , who announced an amended order that allowed coronavirus-positive health workers to work in the COVID unit of a licensed healthcare facility as long as they remain asymptomatic and additional precautions recommended by the CDC and the North Dakota Department of Health are taken.

In a statement released Wednesday, the North Dakota Nurses Association objected to allowing nurses with the virus to continue working, emphasizing that a choice to work while infected should be up to individual nurses, not their employers.

The group also said all other public health measures to reduce the demand on the healthcare system should be implemented first, including a statewide mask mandate, which North Dakota does not have.

Neither the North Dakota Medical Association nor the North Dakota Hospital Association reacted publicly to the new policy as of press time.

On Wednesday, the North Dakota Department of Health announced a record number of active COVID-19 cases. “At this point, every county in our state is at high risk level,” said Tessa Johnson, MSN, RN, president of the North Dakota Nurses Association. “The governor has put this policy out and still, no masks are required. It feels like a slap in the face to nurses right now.”

“We really feel like if we’re going to make a big change, it needs to start with that,” Johnson told MedPage Today. “The governor has very much left it open to individual cities and counties, and some have chosen to have a mask mandate, but there’s no teeth behind it.”

On paper, the new policy appears to have protections built in for patients and co-workers, but that’s not the case in the real world, Johnson said.

“It’s not as simple as just putting a COVID-positive patient and staff member together,” she said. “There are shared spaces in hospitals, nursing homes, and clinics to be concerned about — bathrooms, break rooms, hallways, elevators.”

And in rural areas of the state, small facilities are connected to one another, Johnson pointed out. “You may have a long-term care facility, an ER, and a hospital all attached to each other, and the same RN may care for all those patients. How’s that going to work? No one has answers and there’s a lot of fear surrounding that question.”

When the governor’s statement was issued on Monday, the association reached out to nurses throughout the state and received immediate feedback. “A point they emphasized was make sure that, even with this order, nurses and their employers must have a choice: you cannot mandate any nurses to do this,” Johnson said.

The message the policy sends to the community is troubling, too, she noted: “We are a very ethical, trusted profession and people look to us for guidance. In this whole time, we’ve been saying wear your mask, socially distance, and stay home if you are in close contact. So how can we continue to be credible sources and tell people to stay home if we’re not?”

What’s happening in North Dakota may be due in part to the changing shape of COVID-19 patterns throughout the country, observed Cheryl Peterson, MSN, RN, vice president of the American Nurses Association, the national professional nursing organization based in Silver Spring, Maryland.

Early in the pandemic, nurses could move from one COVID-19 hotspot to another to help, but that’s no longer the case, she noted. “Because of how widespread the disease is circulating, there’s no place for that now,” she said.

“There’s no give in the system now to get more resources to these hospitals, and I think that is going to play out,” Peterson told MedPage Today. “We see it now in North Dakota,” she said. It wouldn’t surprise her if similar policies spread to other states “as we move higher up the spike or further into the pandemic,” she added.

“The piece we want to really focus on is that hospitals recognize it is up to the nurse as to whether or not they are interested in working when they are COVID-positive,” Peterson said.

“The CDC guidance says they have to be willing to work. It’s up to them whether they’re going to work and if they say, yes, they’ve made a decision. If they say no, that, too, is a decision and it must be respected by the facility and there should be no retaliation.”

By Judy George, MedPage Today