Hey P4P this is Kylie the Krankenschwester reporting from California. I am currently working at a hospital in the Bay Area treating COVID19 patients on daily basis. The practices are completely unacceptable here. I emailed 15 politicians-local and national, and 10 local and national news outlets this piece. Read it, be disgusted, share it, and make sure this is not happening in your community!
All on Fire, Please Bring Water
Nurses are NOT like firefighters who run into the house on fire.
To make the scenario analogous, we are firefighters who are ON FIRE running into the house on fire.
Nurses are NOT like firefighters who run into the house on fire.
To make the scenario analogous, we are firefighters who are ON FIRE running into the house on fire.
I am a nurse at a Kaiser hospital in Solano County. I want to tell you what is going at this hospital that is completely appalling. From friends who work in hospitals around the bay area of California, this is happening all over and needs to publicized so that it can be addressed.
Acute healthcare facilities are NOT in compliance in deed nor spirit with the country’s or state’s efforts to slow COVID-19 from spreading. When patients enter an emergency room, they are required to sign documents consenting to treatment and more recently many hospitals require patients to sign documents releasing the hospital of any liability of lost or stolen property during their stay. I believe that a new document will soon be required by patients to sign at hospitals stating, “you may be cared for by a healthcare provider- doctor, nurse, nurse’s aide, dietary specialist, physical therapist, respiratory therapist, etc.- who is presently contagious with COVID-19, and that’s not our fault” as a way for hospitals to release themselves of the liability they have been setting themselves up for by not protecting their staff enough.
Currently the Solano County guidelines for healthcare providers state that healthcare workers should be a priority population for testing for COVID-19 and that symptoms that qualify a healthcare worker to quarantine or be tested are different and more general than those of the general population because of the potential of exponential transmission in hospital settings. As of the March 17, 2020 update the following symptoms would screen a healthcare worker positive for possible COVID19- “fever (either measured temperature ≥100.0°F or subjective fever), cough, shortness of breath, sore throat or rhinorrhea,” and even expands symptoms that may be considered to include “muscle aches, nausea, vomiting, diarrhea, abdominal pain, headache or fatigue” (Solano Public Health, 2020).
To show you how serious Solano County is about preventing spread in acute care hospital settings, I will only share with you here the recommendations for a symptomatic healthcare that has had NO KNOWN EXPOSURE to a COVID-19 positive patient- “Healthcare provider may return to work 7 days after symptom onset or after resolution of all symptoms, whichever comes first,” and “healthcare provider must wear a surgical mask at all times while at work until 14 days after symptom onset.” The guidelines get stricter and include isolation for non-symptomatic healthcare providers when exposure to a positive COVID-19 patient has occurred.
To outline my next sections, I want to emphasize two areas in which my hospital is not in compliance with above standards for its county and then offer a suggestion for what we should be demanding from hospitals to help quell this pandemic.
First area in which hospitals are failing to reduce transmission
Firstly, my example is taken from just a couple days ago when I assisted a nurse’s aide in calling her unit manager to explain her ill symptoms and advocate for herself what is required by the Solano County guidelines. The manager’s response was pathetic.
A nurse’s aide had called out sick twice during the previous few days because of feeling ill. Not only her, but her three-year-old son had symptoms “like I’ve never felt before.” The symptoms of sore throat, weakness, headache, sudden, repeated, intermittent fever were some of the complaints. She had contacted her primary care doctor who said she did not qualify for a COVID-19 test and could return to work. On the day she returned to work she was still feeling those symptoms but felt she “needed” to come to work, especially since she was having to use her own sick time to call in. I showed her the Solano County’s updated guidelines for healthcare providers that clearly state her symptoms were inclusive to test for COVID-19 and that she should stay home for 7 days and wear a mask for 14 days. I was right by her side when she called her unit manager to discuss it. The manager said she could not grant her any time off of work and that she could let her wear a mask for one day but not fourteen. The manager’s reasons included the facilities short supply of masks and, also, that this nurses’ aid likely got the virus from the community, not the hospital, and so she as the manager could not take any responsibility for it.
To summarize, healthcare workers are being required to use their own sick time to take days off from work with no guidance from the hospital as to how long when it is clearly stated in the Solano County guidelines. Secondly, the way this hospital is choosing to ration masks during this time is exacerbating the spread of the virus in the healthcare setting.
Second area in which hospitals are failing to reduce transmission
Last week our hospital announced that surgical masks were not to be worn by staff at all unless caring for a flu- or COVID-19- positive patient while in their room. Prior to this, it has been common practice for staff to wear masks when interacting with patients who have not been tested for either but have respiratory symptoms, for staff to wear them if they have not received the flu shot (FYI did you know Solano County ended flu season early to preserve masks that were being used for this reason), or even staff to wear them out of precaution all day while they interacted with so many different patients and people. Last week we were informed we would be “written up” and disciplinary action would be taken against us if we were seen wearing masks in the hallways or at the nurses’ stations. Nearly all the staff I work with object to this given the risks associated with working in our facility at this time and the risks of transmission to our families and loved ones when we leave work. We were told last week we could not buy and bring in our own masks to wear. We were told this week that while it is trending right now, homemade masks, bandanas, and scarves cannot be used or worn by staff while at work because it “sends the wrong image” to our patients.
To summarize, healthcare providers wear masks for two reasons- to protect ourselves from the patient and protect patients from ourselves. When we can only wear masks with the few patients that are fortunate enough to be tested for flu or COVID-19, we are exposing ourselves, patients, and families to all pathogens.
My suggestion
With the above as our reality, you can see we are a hotbed for the virus to spread. We know the virus can be transmitted by asymptomatic people who have not been tested, thus the nationwide need for social distancing. What we need now is to have all healthcare providers tested, symptomatic or not, for COVID-19 and have those that test positive quarantine per recommendations. Then next week, we need to test every one again, and the next week. This is where you will get accurate statistics of the spreading disease and if hospitals are doing their part to prevent the transmission of this virus. There is much emphasis on the cleaning and disinfecting practices at our hospitals, but it means nothing if the carrier of the pathogen is in and out of a patient’s room 100 times a day in the form of doctors, nurses, aids, etc.
Something we need to realize and accept is that healthcare providers are going to test positive for COVID-19 and eventually come back to work (of course, if they do not die from the virus). If we are not going to test and quarantine healthcare worker right now then we might as well end all of our social distancing and isolating practices. According to the management at my hospital, COVID-19 “is just the flu, we’re all going to get it anyway” so they claim healthcare workers can work through their symptoms without providing them PPE to protect against the spread of the virus. If this is the case, then let all of society out of their houses and tell them “it’s just the flu, we’re all going to get it anyway.”
My hospital management has compared the work of healthcare providers at this time to that of “firefighters running into a house or forest on fire to save it.” I think they are wrong. To make that scenario analogous, we are firefighters who are ON FIRE running into the house or forest on fire. We are making it worse because the hospitals are choosing public image over protection of their workers which then extends to purposefully exposing patients. Even with COVID-19 taking the spotlight, there are still ailing Americans that require hospitalizations. There are people still having strokes, heart attacks, gallbladder issues, car accidents, appendicitis. We are still taking care of those patients, but without any PPE or isolation measures to prevent the staff from transmitting it to the patients, like I said, we are all on fire running into the fire trying to stop it. It just won’t work.
Reference
Solano Public Health. (2020, March 17). Solano county COVID-19 management of general community and healthcare personnel-Updated guidance [PDF file]. Solano County.
Solano Public Health. (2020, March 17). Solano county COVID-19 management of general community and healthcare personnel-Updated guidance [PDF file]. Solano County.
