Shortage of adequate personal protective equipment (PPE) for frontline health workers is being reported from nearly every country in the world as COVID-19 continues to spread. At the same time, there are reports of high rates of infection and deaths among nurses and other health care staff.
This is happening against a background of some politicians declaring that there are adequate supplies, and hospital administrators putting pressure on staff to work without proper safety measures and taking action against those who speak up about it.
Globally, nursing organizations are taking up the cause on behalf of their members with the Royal College of Nurses (RCN) in the UK even advising their members that, as a last resort, they have the right to refuse to work.
The RCN, the largest nurses’ union in the UK issued an advisory “Guidance for members: Refusal to treat due to lack of adequate PPE during the pandemic” on April 9. They said that they were satisfied with the government’s guidance on PPE but that ongoing reports from its members show that PPE was not reaching the frontlines.
The advisory provides a 7-step process that should be followed by nurses when they felt that the PPE provided was inadequate for the work they do. The final step, taken as a last resort, would be to refuse to work. A spokesperson of the union admitted that this would go against the instincts of every nurse but that “their safety must not be compromised.” No amount of PPR was “more precious a resource than a healthcare worker’s life,” said Dame Donna Kinnair, general secretary of the RCN.
Nurses were also reminded in the advisory that they should keep a written record of all their actions and use available incident reporting systems so that they could justify their decisions when needed. Nurses were also warned about the possible consequences of a refusal to work – including dismissal and being sued for negligence by patients – but assured their members that they would provide them with support and legal representation as necessary.
Action by US national nursing associations
A delegation of 12 national nursing organizations, including the American Nurses’ Association (ANA) met with President Trump and members of the Coronavirus Task Team as early as March 18. They emphasized the need for adequate and appropriate PPE to protect nurses, including the highest level of respiratory protection as advised by the Occupational Health and Safety Administration (OHSA).
“Our number one priority is keeping frontline health care professionals, including our nurses, healthy by making sure they have the personal protective equipment they need,” Debbie Hatmaker, Chief Nursing Officer at the ANA, stressed in a news release. “If frontline professionals are put into danger and become sick, it will exacerbate the crisis in the U.S.”
Furthermore, the delegation encouraged the government to provide incentives for factories to increase the production of N95 respirators. They also called for innovative staffing strategies to ensure adequate availability of nurses to care for patients during the epidemic.
Petition to Congress by US nursing unions
In March, a coalition of nursing unions led by National Nurses United (NNU joined together to petition congress to ensure the availability of life-saving PPE. They urged Congress to mandate OSHA to issue an emergency temporary standard for PPE for health care workers treating COVID-19 patients. This was to ensure that employers provided adequate PPE and other measures to protect staff.
“Instead of answering the demands nurses have been making for months to their employers and elected officials to ensure safe workplaces to protect themselves, their patients, and the public, hospitals have instead sent nurses to the frontlines of the COVID-19 pandemic with bandanas, scarves, and trash bags as protection,” said Bonnie Castillo, executive director of NNU.
“We now bear the full brunt of a healthcare system rendered dysfunctional after years of relentless funding cuts for public health, while generating obscene profits for corporate interests,” added Sheridan-González, president of the New Youk State Nurses’ Association.
From April 15 nurses were to meet virtually with US senators to continue lobbying for the emergency OSHA standard as well as to urge Congress to use the Defense Production Act to call for the mass production and procurement of PPE and other medical equipment.
International Council of Nurses
In a Call to Action, the International Council of Nurses published a list of its priorities for COVID-19 on April 9. The list was informed by feedback from national nursing associations and nurses on the frontlines.
Top of the list is access to PPE in sufficient quantities, providing all nurses with appropriate training for infection prevention and control, and protecting the health and well-being of nurses and other healthcare workers.
In a statement, the ICN emphasized that nurses and other health care staff have stepped up and saved thousands of lives, but that they were putting their own lives at risk by being “cruelly exposed to danger because of lack of sufficient, appropriate and high-quality personal protective equipment.”
Policymakers need to take urgent action
Across the globe, health care staff and the organizations that represent them have called for safe PPE for weeks and many have lost their lives after being infected with COVID-19. Despite this, many governments and health care administrators still don’t seem to be prioritizing the safety of frontline health care workers.
“Unless there is resolute action, more nurses will become infected and unable to work, and sadly, more nurses and patients will die,” said Howard Catton, ICN Chief Executive Officer. “We must see immediate steps to develop cooperation across borders so that PPE reaches the people who are literally putting their lives on the line to save the rest of us from the coronavirus. There is no time for debate about this – we need immediate action now.”
Use this link to join NNU petitions to the US government for adequate PPE.