Demanding that the hospital industry invests in safe staffing and that President Biden fulfills his campaign promise to protect nurses and prioritize public health, National Nurses United (NNU), the largest RN union in the United States, is calling for nurses to take part in actions across the country on January 13. Among the activities planned for this Thursday, the NNU will conduct a national virtual press conference at 1.00 PM EST and hold a candlelight vigil in Washington, D.C. for nurses who lost their lives to Covid-19.
“This is a vicious cycle where weakening protections just drives more nurses away from their jobs.”
—Zenei Triunfo-Cortez, RN, President, NNU
A perfect storm is brewing, according to NNU nurses. The Biden administration has “ripped away critical protections“ from health care workers and the public, the Centers for Disease Control (CDC) has weakened Covid isolation guidelines, and the Occupational Safety and Health Administration (OSHA) plans to withdraw critical Covid protections for health care workers—right when the Omicron variant is exploding across the country and hospitalizations are skyrocketing. The NNU states that leaving nurses unprotected by the government and by profit-driven hospital employers which have failed to invest in safe staffing and critical health and safety protections, has created unsafe working conditions that are driving nurses out of the profession.
Nurse retention will rise when hospitals set safe staffing levels
NNU President Zenei Triunfo-Cortez, RN suggests that the nurse staffing crisis—while it may have been exacerbated by the pandemic—is primarily a consequence of hospitals prioritizing dollars above human lives. In a statement, Triunfo-Cortez said, “As we enter year three of the deadliest pandemic in our lifetimes, nurses are enraged to see that, for our government and our employers, it’s all about what’s good for business, not what’s good for public health. Our employers claim there is a ‘nursing shortage,’ and that’s why they must flout optimal isolation times, but we know there are plenty of registered nurses in this country. There is only a shortage of nurses willing to work in the unsafe conditions created by hospital employers and this government’s refusal to impose lifesaving standards. So this is a vicious cycle where weakening protections just drives more nurses away from their jobs.”
NNU conducted a survey of thousands of registered nurses across the country from October to December 2021. Of the nurses who responded, 83 percent said at least half of their shifts were unsafely staffed, and 68 percent said they have considered leaving their position. RNs say nurses would stop leaving the profession if hospitals immediately improved working conditions by increasing staffing levels and followed nurses’ advice to grow the pool of available nurses. According to nurses, hospitals must actively hire permanent staff nurses and consider a wider range of educational qualifications; stop canceling nurses; properly cross-train current staff nurses so that they are competent to work in other departments, especially critical care, and institute optimal occupational health and safety protocols to protect nurses, other health care workers, and patients.
Schedule for Thursday, Jan 13
What: Virtual press conference, featuring national nurse stories
When:Thursday, Jan. 13, 1 p.m. ET/ 10 a.m. PT
Who: Registered nurses from across the United States
Nurses also call on the CDC to strengthen isolation guidelines for health care workers and the public, and on OSHA to institute a permanent Covid health care standard without delay. On Jan. 5, NNU joined leading labor organizations and unions representing the country’s nurses and health care workers to petition the United States Court of Appeals for the District of Columbia Circuit to order OSHA to issue a permanent standard and to retain the emergency temporary standard until the permanent standard goes into effect. Without the protections of a permanent standard, RNs emphasize that the health and well-being of nurses, other health care workers, patients, and the general public is in grave danger.
“Everyone will need medical care at some point in their lives, and when our loved ones are in the hospital, we want nurses to be able to deliver the focused care that all patients deserve,” said Bonnie Castillo, RN, NNU executive director. “But the working conditions that our employers and the federal government are telling nurses and health care workers to endure are both grossly unfair and unsustainable, and we are standing up on Jan. 13 to say, ‘Enough!’ We need permanent protections based on science, and we need them now because when nurses and health care workers aren’t safe, we cannot keep our patients safe.”
Data from a new survey of more than 4,500 nurses nationwide conducted by the American Nurses Association (ANA) in conjunction with the COVID Vaccine Facts for Nursescampaign, highlights that the majority of nurses stand behind the science of the COVID-19 vaccines and support mandatory vaccinations for all employees. Comprised of ANA and 22 other leading nursing and health care organizations, COVID Vaccine Facts for Nurses is an education campaign that provides critical, current and culturally sensitive COVID-19 vaccine information for the nation’s nurses.
“Nursing practice is both an art and a science. Nurses are highly skilled and knowledgeable health care providers, scientists and researchers, so they understand the rigor and effort behind developing the COVID-19 vaccines.”
—ANA President Ernest J. Grant, Ph.D., RN, FAAN
Nurses Support COVID-19 Vaccine Mandates
Many nurses who responded (58%) support mandatory COVID-19 vaccinations. This aligns with nursing’s own professional standards, which ethically obligate nurses to model the prevention measures recommended to their patients. According to findings of the survey, the majority of nurses (90%) are vaccinated against COVID-19 or plan to get vaccinated and say they are comfortable recommending COVID-19 vaccines (91%).
Nurses Say an FDA Approval Does Not Influence Their Support of the Science
Over half of nurse respondents (64%) say the Food and Drug Administration’s (FDA) approval of COVID-19 vaccines does not influence their current position. The three COVID-19 vaccines currently being administered have received an “emergency use authorization” from the FDA and full approval is currently being sought. Nurses trust the science behind COVID-19 vaccines. Ongoing clinical trials, research, and evidence have demonstrated the safety profile of the COVID-19 vaccines – that they are stable and effective in preventing the spread of the virus as well as mitigating the impact of the highly transmissible and contagious Delta variant.
Nurses Will Get a COVID-19 Vaccine Booster Shot, if Recommended
Overwhelmingly, the nurses surveyed reported that they are willing to get a booster shot of the COVID-19 vaccine if recommended (85%). While COVID-19 vaccine boosters have yet to be authorized in the United States, nurses’ willingness to take them, if necessary, underscores their support for taking all recommended actions to protect themselves and those they encounter from the risk of serious illness and possible death from the virus.
Nurses Encourage the Public to Follow the Guidance of Health Officials
A majority of nurses surveyed (86%) say they have access to the most current and reliable information on COVID-19 vaccines. As nurses continue to respond to the COVID-19 pandemic, most of the nurses surveyed say they (87%) understand the urgent need to stay up to date on the latest developments and are referring their patients to trusted and credible authorities like the CDC and NIH.
“Nurses’ knowledge, coupled with their frontline experience caring for those with COVID-19 over the past 16 months, is evident by these survey findings,” said Dr. Grant. “By getting vaccinated themselves, supporting vaccine mandates, and ensuring that their patients have the most accurate and reliable information possible about the COVID-19 vaccines, nurses nationwide are fulfilling their professional and ethical obligations. We continue to urge the public to follow nurses’ example and get vaccinated to reduce the risk of further hospitalizations and deaths to end this pandemic.”
Vaccination is both a significant public health victory and a scientifically proven strategy to slow the spread of COVID-19 and prevent the loss of more lives, and nurses are playing a critical role in the monumental recovery efforts. For 19 consecutive years, nurses have been ranked as the most honest and ethical professionals in the nation. Americans trust nurses, and these latest survey findings demonstrate that the vast majority of nurses trust the safety and efficacy of COVID-19 vaccines.
By the time Kiki Radermacher, a mental health therapist, arrived at a Missoula, Montana, home on an emergency 911 call in late May, the man who had called for help was backed into a corner and yelling at police officers.
The home, which he was renting, was about to be sold. He had called 911 when his fear of becoming homeless turned to thoughts of killing himself.
“I asked him, ‘Will you sit with me?’” recalled Radermacher, a member of the city’s mobile crisis response team who answered the call with a medic and helped connect the man with support services. “We really want to empower people, to find solutions.”
Missoula began sending this special crew on emergency mental health calls in November as a pilot project, and next month the program will become permanent. It’s one of six mobile crisis response initiatives in Montana — up from one at the start of 2019. And four more local governments applied for state grants this year to form teams.
Nationwide, more communities are creating units in which mental health professionals are the main responders to psychiatric crises instead of cops, though no official count exists of the teams that are up and running.
More support is on the way. The covid relief package President Joe Biden signed in March offers states Medicaid funding to jump-start such services. By July 2022, a national 988 hotline, modeled on 911, is slated to launch for people to reach trained suicide prevention specialists and mental health counselors.
Protests against police brutality in the past year have helped propel the shift across the United States. While one rallying cry has been to “defund the police,” these crisis intervention programs — the sort that employ therapists like Radermacher — are often funded in addition to law enforcement departments, not drawing from existing policing budgets.
Studies suggest such services enable people in crisis to get help instead of being transported away in handcuffs. But the move away from policing mental health is still a national experiment, with ongoing debate about who should be part of the response, and limited research on which model is best. Even then, not all communities can afford and staff separate mental health teams.
“I don’t know that there’s a consensus of what the best approach is at this point,” said Amy Watson, a professor of social work at the University of Wisconsin-Milwaukee who has studied such crisis intervention. “We need to move towards figuring out what are the important elements of these models, where are the pieces of variation and where those variations make sense.”
The federal Substance Abuse and Mental Health Services Administration sets minimum expectations for teams, such as including a health care professional and connecting people to more services, if needed. Ideally, the guidelines suggest, the team should include a crisis response specialist who has personally experienced mental health challenges, and the team should respond to the calls without law enforcement.
Still, crisis response teams vary significantly in their makeup and approach. For more than 40 years, the Los Angeles Police Department has deployed teams in which police officers and mental health workers respond together. It boasts the program is one of the nation’s earliest to do so. A program out of Eugene, Oregon, which has been copied across the U.S., teams a crisis intervention worker with a nurse, paramedic or emergency medical technician. In Georgia, 911 emergency dispatchers steer calls to a statewide crisis center that can deploy mobile units that include professionals with backgrounds in social work, counseling and nursing. In Montana, teams are based within law enforcement departments, medical facilities or crisis homes.
“Mobile crisis response, in whatever format it looks like, is becoming more and more the norm,” said Kari Auclair, an area director for Western Montana Mental Health Center, a nonprofit treatment program. “In some communities, it’s going to be the church group that’s going to be part of a crisis response, because that’s who people go to and that’s what they’ve got.”
Defenders of the various models tout reasons for their teams’ makeups and match-ups: Medics can recognize a diabetic blood sugar crash that might mimic substance misuse or a mental health crisis; police can watch for danger if tensions escalate; and crews tethered to hospitals’ behavioral health units have a team of doctors on standby they can consult.
Many crisis teams still work directly with law enforcement, sometimes responding together when called or staying on the scene after officers leave. In Montana, for example, 61% of the calls that crisis teams handled also involved law enforcement, according to state data.
Zoe Barnard, administrator for Montana’s addictive and mental disorders division, said her state is still establishing a baseline for what works well there. Even after they’ve worked out a standard, she added, local governments will continue to need flexibility in how they set up their programs.
“I’m a realist,” Barnard said. “There will be parts of the state that are going to have limitations related to workforce, and trying to put them into a cookie-cutter model might keep some from doing something that really does the job well.”
In some areas, recruiting mental health workers to such teams is nearly impossible. Federal data shows 125 million people live in areas with a shortage of mental health professionals, a problem exacerbated in rural America. That lack of expertise and support can fuel the crises that warrant emergency help.
In Helena, Montana’s capital, for example, a crisis crew that formed in November must still fill two positions before services can run round-the-clock. All across the U.S., with these sorts of high-stress jobs often paid through cobbled-together grants, retaining staff is a challenge.
Being flexible will be key for programs as they develop, said Jeffrey Coots, who directs an initiative at John Jay College of Criminal Justice in New York City to prevent unnecessary imprisonment.
“We’re trying to figure our way out of historical inequities in mental health care services,” Coots said. “The best thing to do is to run that demonstration project, and then adapt your team based on the data.”
And for the people in these crises who need help, having an alternative to a police officer can mean a big difference, said Tyler Steinebach, executive director of Hope Health Alliance Inc., which offers behavioral crisis training for medics across Montana. He knows firsthand because he has both bipolar and post-traumatic stress disorders and has had to call 911 when his own mental health has plummeted.
“You know cops are coming, almost certainly,” Steinebach said, from his personal experience. “You’re trying to figure out what to say to them because you’re trying to fight for yourself to get treatment or to get somewhere where you can talk to somebody — but you’re also trying to not get hauled off in handcuffs.”
Gallatin County Sheriff Dan Springer also noticed the benefits after two mental health professionals started to respond to 911 calls in Bozeman and the surrounding area in 2019. Although deputies in his department are trained in crisis intervention, he said that goes only so far.
“When I hear deputies say the mental health provider is a godsend, or they came in and were able to extend the capabilities of the response, that means something to me,” Springer said. “And I hear that routinely now.”
Erica Gotcher, a medic on the mental health response team in Missoula, recalled a day recently when her team was wrapping up a call and received three new alerts: A man was considering suicide, a teen was spiraling into crisis and someone else needed follow-up mental health services. They knew the suicide risk call would take time as responders talked to the person by phone to get more details, so they responded to the teen hitting walls first and saw all three people before their shift was done.
Gotcher said being busy is a good sign that her team — and teams like it — are becoming just one more form of first response.
“Sometimes we roll up on a scene and there are three cop cars, an ambulance and a firetruck for one person who is having a panic attack,” Gotcher said. “One of the best things that we can do is briefly assess the situation and cancel all those other resources. They can go fight fires; they can go fight crime. We are the ones that need to be here.”
But gaps still exist, such as not always having somewhere to take a patient who needs a stable place to recuperate or get more help. The team’s shift also ends at 8 p.m., meaning, come nighttime, it’s back to police officers responding alone.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
SILVER SPRING, MD—The American Nurses Association (ANA) advocated for and supports the Occupational Safety and Health Administration (OSHA) Emergency Temporary Standard (ETS) that requires employers to better protect nurses from COVID-19 hazards in the work environment.
This standard, published in the July 6th Federal Register, recognizes that nurses must have the most stringent levels of safety protections to provide the highest quality care to their patients. Critically, the ETS requires that employers provide better protections for nurses by developing and implementing plans to identify and control COVID-19 hazards in the workplace. Nurses who care directly for patients with confirmed or suspected COVID-19 must also be protected by approved respirators, which include single-use N95 respirators, elastomeric respirators, and powered air-purifying respirators (PAPR). Employers must also provide gloves, gowns, and eye protection. This requirement applies regardless of the nurses’ vaccination status. Employers are also required to screen health care personnel daily for COVID-19, provide COVID-19 tests at no charge to the employee, and to support employees to receive COVID-19 vaccinations.
The ETS also empowers nurses to advocate for meaningful safety improvements during the duration of the emergency standard, as well as providing whistleblower protections for employees who raise safety concerns.
“While ANA is pleased that OSHA took the rare step to issue this new emergency standard, it is long overdue as nurses have been—and continue to be—at high risk for exposure to COVID-19.” said ANA President Ernest J. Grant, PhD, RN, FAAN. “ANA has been calling for specific safety protections from COVID-19 since the start of the coronavirus pandemic and while this ETS is beneficial, it is not a replacement for a permanent standard with strong respiratory protections, which remains a necessity. According to OSHA’s own materials, by the end of May 2021 nearly 492,000 health care personnel had contracted COVID-19 and more than 1,600 had died. More must be done to protect our nation’s nurses and frontline health care workers from the ravages of this pandemic.”
A comprehensive survey in February 2021 by the American Nurses Foundation (the Foundation) found that 74% of respondents said that consistent and better executed national health policies and public intervention plans will better prepare for future crises or pandemics. Nurses understand the critical role the federal government plays in ensuring their safety. They also know that this pandemic is not over, and that the future will inevitably bring new pandemics and public health crises. Nurseslives must not be endangered because policymakers have failed to take actions to adequately prepare. ANA is committed to protecting nurses and frontline health care workers. It will engage with OSHA on the implementation and enforcement of this ETS and continue to advocate for permanent protections from infectious agents in health care delivery.
Except for a few requirements, OSHA expects employers to comply with the ETS as of July 6, 2021, and nurses are able to comment on it through July 21, 2021. ANA encourages nurses and health care personnel to learn about the new requirements and to understand how to report violations, by visiting OSHA’s website. ANA members can also access our Policy Brief on the ETS here.
Labor Department officials on Thursday announced a temporary emergency standard to protect health care workers, saying they face “grave danger” in the workplace from the ongoing coronavirus pandemic.
The new standard would require employers to remove workers who have covid-19 from the workplace, notify workers of covid exposure at work and strengthen requirements for employers to report worker deaths or hospitalizations to the Occupational Safety and Health Administration.
“These are the workers who continue to go into work day in and day out to take care of us, to save our lives,” said Jim Frederick, acting assistant secretary of Labor for occupational safety and health. “And we must make sure we do everything in our power to return the favor to protect them.”
The new rules are set to take effect immediately after publication in the Federal Register and are expected to affect about 10.3 million health care workers nationwide.
The government’s statement of reasons for the new rules cites the work of KHN and The Guardian in tallying more than 3,600 health care worker covid deaths through April 8. Journalists documented far more deaths than the limited count by the Centers for Disease Control and Prevention, which through May tallied 1,611 deaths on case-reporting forms that were often incomplete.
The Lost on the Frontline project documented early calls for better respiratory protection for health care workers than loose-fitting face masks, noted serious complaints to OSHA from hospital workers that went unaddressed and revealed repeated employer failures to report dozens of worker deaths. It also found that health care employers were often remiss in notifying workers about exposure to the coronavirus on the job.
The new standard would address some of those problems.
The rules require workers to wear N95 or elastomeric respirators when in contact with people with either suspected or confirmed covid. They strengthen employer record-keeping requirements, saying employers must document all worker covid cases (regardless of whether they were deemed work-related) and report work-related deaths even if they occur more than 30 days after exposure.
Until now, employers were required to report a hospitalization only if it came within 24 hours of a workplace exposure. Now all work-related covid hospitalizations must be reported. The rules also mandate notification about exposure to a sick colleague, patient or customer if the worker was not wearing a respirator.
There is a lot to like about the new rule ― except for the timing, according to Barbara Rosen, vice president of the Health Professionals and Allied Employees union in New Jersey.
“It’s a little late,” she said. “If we had had this in place at the beginning, it would have saved a lot of lives and a lot of suffering that has gone on with health care workers and probably patients in hospitals because of the spread.”
She said she was pleased with the requirement that workers be paid when they isolate with covid and that employers formulate a detailed covid plan with the input of non-managers.
The day after he took office, President Joe Biden issued an executive order calling on OSHA to “take swift action to reduce the risk that workers may contract COVID-19 in the workplace.” The rule has been criticized for coming late — about which Labor Department officials said on a press call that such standards typically take years, not months, to formulate. It has also been derided for failing to enact requirements on employers outside of health care.
“OSHA’s failure to issue a COVID-specific standard in other high-risk industries, like meat and poultry processing, corrections, homeless shelters and retail establishments is disappointing,” according to a statement from David Michaels, a former OSHA administrator and professor with the George Washington University School of Public Health. “If exposure is not controlled in these workplaces, they will continue to be important drivers of infections.”
The new rule also cites 67,000 worker complaints during the pandemic, with “more complaints about healthcare settings than any other industry.” The rule would protect workers from retaliation for staying home when sick with covid, alerting their employer about a covid hazard or exercising their rights under the emergency rule.
Through March 7, about half of health care workers said they had received at least their first dose of a covid vaccine, according to a KFF-Washington Post poll. About one-third of those polled said they were unsure if they would get a vaccine. The issue has been controversial, especially in Houston, where workers at one hospital staged a protest over their employer’s vaccine mandate.
The new rules exempt some office-based health care workplaces where all staff members are vaccinated and measures are taken to screen people with potential illness. The rule summary estimates the measures will prevent 776 deaths and 295,000 infections.
The new rule also says it will “enable OSHA to issue more meaningful penalties for willful or egregious violations, thus facilitating better enforcement and more effective deterrence against employers who intentionally disregard … employee safety.”
Kristin Carbone said the measure came too late for her mother, Barbara Birchenough, 65, a New Jersey hospital nurse who’d asked family members to gather gardening gloves and trash bags to serve as makeshift personal protective equipment before she fell ill and later died on April 15, 2020. Still, she said, it’s a necessary step.
“If there is a silver lining,” she said, “I’m glad that out of this tragedy come positives for the people that are left behind.”
