by Joanne Disch, PHD, RN, FAAN, former president of the American Academy of Nursing

On Monday, November 9, North Dakota governor Doug Burgum issued a new policy that allows health care workers who are COVID-positive but asymptomatic to continue working at hospitals and nursing homes. This is in response to a dramatic increase of COVID cases, with hospitals at near 100% capacity and a shortage of an adequate supply of nurses across the state.

And on Wednesday, November 11, the state set its eighth-consecutive daily record for active cases, reaching 11,656. According to the Associated Press, North Dakota continued “to lead the nation in daily new COVID-19 cases per capita . . . , with one in every 83 residents of the state testing positive for the virus in just the past week.”

Unsurprising result of state’s laissez-faire approach.

While shocking, this is not surprising: North Dakota has been one of the states that has consistently rejected mask mandates or social distancing practices and been slow to reduce elective procedures or limit the business hours of restaurants and bars.

Without having taken these preventive steps, the state now faces a significant crisis. It’s unconscionable that nurses and patients are now being put in jeopardy without the state first having put into place measures to slow the spread of the virus that have proven to be effective in so many cities and states.

Nursing organizations across the country speak out.

In a statement released Wednesday, the North Dakota Nurses Association called for a statewide mask mandate and for other public health steps to be taken as well. Nurses from across the country have also spoken up in alarm, raising similar concerns. Ernest Grant, president of the American Nurses Association, stated:

“This is unacceptable that nurses and health care workers are being asked to risk their lives when we know measures that could help slow the spread of this virus have not been taken by state and local officials. I urge officials to consider mandatory implementation of measures that could help slow the spread of the virus.”

Finally, a mask mandate.

On late Friday evening, November 13, the governor reversed course and issued a mask mandate. In a news release, he said the state’s doctors and nurses “need our help, and they need it now.” This is a piece of good news, since previously the approach had been to urge “personal responsibility” and for there to be a “light touch” by government.

What is not clear is the extent to which people will adhere to the mandate, whether hospitals will in fact allow (or force) nurses who are COVID-positive but without symptoms to work, and whether it’s actually a good or a bad idea for individuals who are COVID-positive to be in the work setting at all. Nursing leaders are also expressing concern that this policy of sending nurses who have tested positive for COVID-19 to work may be the tip of the iceberg, with other states who are equally strapped for adequate staffing during the current surge turning to this as a viable option.

Actions to take as we go forward?

Nurses need to be vigilant as to what is happening in their states; speak up about the need for masks, PPE, and other mitigating strategies; connect with physicians and other health care groups; and write to their local newspapers and government officials. As John Lewis would urge, “Make some noise and get into good trouble, necessary trouble.’”