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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

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