As Conflicting Recommendations Sow Public Confusion, Nurses Still Lack Adequate PPE and Equipment

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. April 3.

One problem central to the experience of nurses during this pandemic is the disastrous lack of essential supplies and equipment. How different would your work days be right now if you had plenty of PPE and ventilators? In the parts of the country with the most COVID-19 cases, this problem is far from being resolved. In many other cities and states, unbelievably (after three months), you are likely to be faced with it soon.

Where is our PPE?

For weeks, nurses and physicians in states that were initially hardest hit by the pandemic (New York, California, Washington) have reported severe shortages of personal protective equipment. (See, for example, this ICU nurse’s anonymously published note to AJN.) Respiratory protection has been in particularly short supply. In many hospitals, staff are reusing one droplet mask or N95 respirator for an entire shift or longer. These dire circumstances were predictable. A  2015 article from researchers at the National Institutes of Health predicted that in a pandemic in which only 20 to 30 percent of the population is infected, up to 7.3 billion N95 respirators would be needed. COVID-19 is likely to infect a considerably higher percentage of the population. Where are our masks? […]

2021-01-21T11:08:39-05:00April 3rd, 2020|infectious diseases, Nursing, Public health|3 Comments
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COVID-19: On and On

A note from AJN’s editor-in-chief Shawn Kennedy.

Published: March 30. As I write this, the United States has over 140,000 COVID-19 cases and over 2,400 deaths, and we’re told those numbers have yet to peak. The US Navy hospital ship Comfort is on it’s way to New York City, bringing its 1,000 beds to be used as a supplemental hospital. Its sister ship Mercy is on its way to Los Angeles. Bedside nurses and CNOs alike talk about the “war zone” that their hospitals have become. And they’re exhausted: many ICU nurses are working five days of 12-hour shifts as they await help from nurses who are getting crash courses in ventilator management.

Perspectives for and by nurses, from many angles.

Our goals during this pandemic are to serve as a reliable and up-to-date source of information and advocacy for those on the front line, to bear witness and give nurses and other health workers a voice during these uncertain times.

We’ve been using this blog to bring you evidence-based information about the COVID-19 pandemic, mostly via posts by our clinical editor Betsy Todd, whose expertise is in public health and infectious disease. She has done a yeoman’s job, researching the latest information and ensuring what we publish on PPE and COVID-19 is in in accord with the most current state of knowledge at the time—even contacting study researchers to verify facts […]

2020-03-30T15:03:14-04:00March 30th, 2020|healthcare social media, infectious diseases, Nursing, nursing perspective, Public health|0 Comments
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Moral Courage in a Pandemic: a 14th Century Physician and Health Care Workers Today

What does it mean to be human? What values should we live by? How should we respond to those in need during a time of crisis? What would I do?

A physician during the Black Death.

Guy de Chauliac

As a hospice social worker who loves the humanities, I find that historical figures often come to mind when there’s a parallel with things that are happening with patients and their families. Amidst the COVID-19 pandemic, I’ve been thinking a lot about a 14th century French physician named Guy de Chauliac.

Although little known today, in his time he was one of Europe’s most respected medical practitioners. In fact, his text Chirurgia Magna was a standard part of medical education for 200 years.

I came across de Chauliac’s story years ago while researching the ‘Black Death,’ the plague that decimated Europe in the 1340s, killing up to a third of its population.

Those who have read Giovanni Boccaccio’s contemporary account of this plague in his work Decameron are often left with a cynical impression that, as Boccaccio puts […]

2020-03-27T12:15:38-04:00March 27th, 2020|Ethics, infection control, Nursing, nursing perspective, Public health|0 Comments
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Deserted: Note from a Young ICU Nurse as COVID-19 Pandemic Intensifies in U.S.

The following note came to us from a young ICU nurse in New York State. Based on other accounts we are hearing, her working conditions and the risks they put her and her colleagues in may be far from unusual at the current moment. 

Coworkers and I are feeling a vast array of emotions and one of the worst ones we feel is deserted—we hear very little from hospital administrators (except when management comes to sign out our daily masks to us).

Our earliest confirmed COVID case was not isolated or swabbed for COVID until the day he died (at which point countless staff had been exposed). Several of us nurses requested that the patient be tested earlier in his admission, but mostly due to lack of preparedness and testing protocols on the hospital’s part, the patient was not tested until the fifth day of his admission.

Meanwhile, hospital administrators had sent us text messages telling us that we were not allowed to use any masks in patient rooms unless the patient was officially ordered for isolation precautions, in anticipation of PPE shortages. So, despite our suspicions that the patient had COVID, we were not able to protect ourselves. Hospital staff like me who worked closely with the patient were not informed that he had become an official suspected case until after test results came back, resulting in widespread exposures to staff and their families. The overwhelmed occupational health department gave very little guidance […]

2020-03-25T11:19:40-04:00March 25th, 2020|infectious diseases, Nursing, nursing perspective, Public health|13 Comments
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Nurses and COVID-19: Into the Battle with All That We Have and All That We Lack

March 23: There is an important lesson to be learned from Italy, where COVID-19 has rapidly spread, placing a sophisticated health care system on the verge of collapse. Registered nurses (RNs) are suffering from exhaustion, contracting the disease, and leaving the workforce. As we bear witness to this unfolding tragedy, it is incumbent upon all U.S. nurses to take aggressive actions to protect our colleagues, our patients, and ourselves. Nurses who are ill or develop COVID-19 symptoms (fever, cough, shortness of breath) need to stay home. We can’t afford for nurses to infect other nurses. In fact, to ‘surge’ up to meet the anticipated demand for health care services due to the pandemic, still more nurses are needed. As a profession, now is the time to:

  • implement crisis staffing contingency plans,
  • expand the workforce as soon as possible,
  • and ensure the health and safety of all nurses through stringent observation of infection prevention and control measures and access to personal protective equipment (PPE). 

Crisis staffing.

Nurses should immediately make plans for surge capacity to address likely staff shortages. Facilities should consider polling nurses about their willingness to come to work; develop strategies to address the challenges that exist as barriers to coming to work (child care, pet care, transportation); and open conversations regarding the roles nurses are willing to play during the pandemic (see Table 1).

Table 1. Nurse Staffing Actions during a Pandemic (click table to expand)

2020-03-23T10:02:32-04:00March 23rd, 2020|infection control, infectious diseases, Nursing, Public health|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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