Most US hospitals unprepared for coronavirus cases, only 31% nurses say there’s plan in place to isolate patients
In a nationwide survey of over 8000 registered nurses, just 19% report that their employer has a policy to address employees with suspected or known exposure to novel coronavirus
The vast majority of US hospitals and healthcare facilities are unprepared to handle and contain cases of COVID-19. This is according to a nationwide survey in which only 31% of nurses report that there is a plan in place to isolate a patient with a possible COVID-19 infection, while another 23% say they do not know if such a plan exists.
The nationwide survey of registered nurses, the country’s frontline healthcare staff, was conducted by the National Nurses United (NNU) and includes responses from more than 8,200 from all 50 states, as well as the District of Columbia, Puerto Rico, Marshall Islands, and the Virgin Islands. It reveals that high percentages of hospitals do not have plans, isolation procedures, and policies in place for COVID-19, and that communication to staff by employers is poor or nonexistent.
According to the survey results, just 46% report that their employer has provided them information about novel coronavirus and how to recognize and respond to possible cases. Another 58% say that their employer has instituted travel or exposure history screening for all patients with fever and/or respiratory symptoms.
“Only 13% report that their employer has an overflow plan to place additional, trained staff to enable safe care provision to patients on isolation for possible novel coronavirus, and 42% report they don't know. Only 19% report that their employer has a policy to address employees with suspected or known exposure to novel coronavirus. 42% said they don't know,” says the survey results.
While health experts and doctors have been sounding alarm regarding the shortage of personal protective equipment (PPE), and the urgent need to stock up, the survey throws some light on ground realities. It shows that hospitals are lacking sufficient stocks of personal protective equipment or are not making current stocks available to staff. Many have also not provided training and practice to staff on how to properly use PPE.
According to the analysis, only 24% report that their employer has sufficient PPE stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections, while another 38% said they were not aware.
Personal protective equipment can include respirators (for example, N95), coveralls, gloves, gowns, and goggles. “Only 63% report having been trained on safely donning and doffing PPE in the previous year. 65% have been fit tested in the previous year; 34% have not been fit tested in the previous year,” says the report.
What is further shocking is that just 55% of the nurses said they have access to N95 respirators on their units. An even smaller number -- 27% -- said they have access to powered air-purifying respirators (PAPRs). Effective masks are critical because the virus is often absorbed through the mouth or nose from droplets when an infected person coughs or sneezes.
At a White House briefing on March 19, President Donald Trump had said that millions of masks are currently being made. At the same time, he also emphasized that it was up to the states to obtain masks and that the federal government was not a shipping clerk.
To deal with the shortage of personal protective equipment, the US Centers for Disease Control and Prevention (CDC) have also issued guidelines, which recommend wearing homemade masks such as scarves and bandanas as a last resort for healthcare workers. “In settings where facemasks are not available, healthcare personnel might use homemade masks (for example bandana, scarf) for the care of patients with COVID-19 as a last resort,” say the CDC guidelines.
When the initial results of the survey were released, nurses spoke about the lack of readiness indicated by the analysis. “The lines of communication between our employers and frontline staff on protocols for coronavirus and suspected coronavirus patients are not open for all shifts and all units,” said Cathy Kennedy, a neonatal intensive care unit registered nurse and NNU vice president, who works at Kaiser Permanente in Roseville, California.
She added, “What happens when there is a lack of clear communication both ways between staff and management? Rumor and falsehoods fill the void, stoking unnecessary fear and anxiety. And the information nurses do get is contradictory.”
Nurses are also calling for a coordinated effort to release and distribute PPE equipment from state and federal stockpiles to ensure that healthcare workers on the front lines are benefiting from them, because currently they are not seeing these supplies making it to their facilities. The nurses recently launched a national petition calling on public supporters to sign on in favor of protecting nurses.
“Nurses across the country report that they are not receiving the proper staffing, personal protective equipment, education, and communication from their employers, or isolation rooms they need to safely care for COVID-19 patients. This is unconscionable. At a moment when we are asking nurses and other health care workers to step up and protect people, we must be able to protect them as well,” says the petition.
In a letter to Vice President Mike Pence, the American Medical Association (AMA) had recently called for a war against COVID-19 akin to the Manhattan Project which produced the first nuclear bombs during World War 2. “We strongly urge you to strengthen these efforts and undertake a Manhattan Project-type effort to expand manufacturing capacity and produce the supplies needed to ensure the health security of our country during this national emergency,” said the letter.