Nurses ‘frightened,’ confused by lack of PPE, changing policies

The year started out with energy and excitement as nurses across the country, including Iowa, engaged in planning and activities to celebrate the “Year of the Nurse.” Within weeks, attention turned to concern for nurses as the COVID-19 outbreak evolved into a pandemic.

On April 7, the Iowa Department of Public Health announced that 23% of the COVID-19 cases in Iowa are health care workers.

The Iowa Nurses Association (INA) receives nurse testimonials daily about the COVID-19 outbreak. INA has chosen to share some of these testimonials with Iowans. Nurses share their fears; confusing and evolving personal protective equipment (PPE) guidelines and shortages; and COVID-19 testing availability. Yet they remain brave and show up for work every day to care for those most ill.

Nurses hope that sharing COVID-19 testimonials with the public and health care systems will assist everyone in finding ways to reduce confusion, produce adequate PPE supplies, solve the testing issues, and assure Iowans follow the public health messages to reduce the spread of the COVID-19 virus.

Editor’s note:  INA has withheld the names of the nurses who have given testimonials to avoid endangering their jobs.

Nurse Testimonial 1:  ‘I am scared’
I was discussing the pandemic with a former colleague when something she said to me really hit home. “When ER nurses are scared, THAT is when I am scared.” I am an ER nurse, and I absolutely, without a doubt, am truly and completely frightened.

I am scared because two weeks ago, it was absolutely frowned upon not to immediately throw away gown and mask after coming out of a contact/droplet patient’s room, and this week “wear your same mask all day” is the new norm. I am scared because two weeks ago, there was an abundance of PPE, boxes of N-95s, surgical masks, gowns, gloves. And today, we were handed paper bags with one shield face mask, and several surgical masks, and a single fitted N-95 with the instructions “do not share these, sanitize after use and do not throw away.”

I am scared that two weeks ago, no one turned a head if I needed to change into OR scrubs because I spilled something on my own scrubs and today, when I tried to wear surgical scrubs to protect myself, I was told “You can’t do that. We don’t have enough. You have to wear your own scrubs.”

I am scared that we all know that an N-95 mask only lasts for five on/off uses, yet we have to wipe it down and use it indefinitely. I am the MOST scared that prior to this pandemic, if you had a cough, a runny nose, or a fever you were told not to come to work. And today, even if you test positive for COVID-19, you are to come to work as long as you are fever free. So, in reference to my former colleagues’ statement, you should be scared. I am an ER nurse and I AM SCARED.

Nurse Testimonial 2: Lack of PPE has been a ‘gut punch’
COVID-19 has literally taken our world and turned it upside down. As health care providers we know this better than anyone. We are working in such a time of uncertainty. We don’t know what to expect from week to week, day to day, hour to hour, minute to minute or even second to second. Guidelines, policies, and procedures have changed so many times we aren’t quite sure what or who to believe.

While I have never felt more appreciated as a nurse than I do right now (the abundance of treats, cards, and love we have received has been amazing) I have also never felt so unsettled and unsure about my job and my health. The lack of personal protective equipment (PPE) has been a gut punch to us all and put a lot of us on edge.

After all, a few short months ago it would have been an infection control nightmare to wear the same mask to several different patients’ rooms. However, today, we are wearing a mask when coming into contact with every patient and asked to use that same mask multiple shifts or until it becomes “soiled.” That mask is stored, along with other PPE, in a paper sack from shift to shift.

And just when you think things couldn’t get crazier, a few days ago the Centers for Disease Control and Prevention (CDC) changed its guidelines to say that health care personnel can use homemade face masks (i.e. bandanas or scarves) with COVID-19 patients as a “last resort.” There are people within our communities who are literally sewing masks and donating to our hospitals in case this becomes our reality. The lack of PPE and other supplies that are necessary for us to safely and effectively perform our jobs is unacceptable. Our front-line health care personnel deserve better. After all, we wouldn’t let a police officer patrol our streets without the adequate amount of bullets.

Nurse Testimonial 3: ‘Policies are changing by the hour’
I am scared every single day that I go into work. Policies are changing by the hour some days. I am told that I get ONE N95 mask to use for the year. I am required to turn my N95 mask into the charge nurse after every shift in order to track I am not using more than my one mask. This mask is placed in a brown paper bag with my name on it and kept under lock and key at the charge desk.

Nurse Testimonial 4: I have two co-workers in the hospital with COVID-19
Not only is this virus being brought home to our families, it is now affecting our work families. I have two co-workers who are in the hospital due to contracting COVID while treating patients in the ED.

We knew full well that the possibility of being exposed was almost 100% but what we did not know was that we would be hindered from protecting ourselves to the fullest. How can we be denied PPE for “suspected” or “rule out” COVID patients and only allowed full PPE for confirmed COVID. If the results come back positive in 24-72 hours were they not positive from the beginning when I was initially with that patient?

Nursing is my calling, there is nothing that would keep me from fighting this “war” alongside my co-workers but I want to protect them as fiercely as I would protect my own family at home and we are not allowed to do that. This is heartbreaking and we aren’t even close to the peak in Iowa yet.

While specific health status of our RN workforce is not collected, a survey of nearly 20,000 nurses from around the country indicated that 70% of nurses put their patients’ health, safety and wellness before their own (American Nurses Association, 2019). It’s an admirable quality, however one which often leads to a decline in the health of the nurse. Nurses want families, who cannot be with their loved one during an ICU illness, to know we will care for them.

Iowa is home to 47,812 active registered nurses (Iowa Center for Nursing Workforce, 2019). Nearly half (49%) of Iowa’s nurses work in a hospital setting (Iowa Center for Nursing Workforce, 2019). Even within the hospital, most do not work in intensive care or critical care units. However, nurses of all specialties will be stepping up to help with many learning or relearning skills as they go. Nurses should prepare and be supported to work to their highest level of training and licensure. Even those who lack intensive care knowledge or are not working within a hospital setting can be prepared to help in new ways as this crisis calls for all hands on deck and innovation.

Everyone must recognize that false negative COVID-19 results create a false sense of security for nurses and the public. The Wall Street Journal (April 2, 2020) reported that currently available COVID-19 tests have a sensitivity of 70%, which means nearly one of three positive patients receive a reassuring negative result.

These findings correlate with research from Wuhan, China, where, in patients with negative COVID-19 nasal swab tests, more than 70% had typical manifestations on chest scans considered diagnostic for COVID-19. Compared to nasal swabs, chest scan imaging may be a more reliable, practical, and rapid method to diagnose and assess probable COVID-19, especially in the epidemic area, and should lead to implementation of infection control precautions.

It is essential to detect the disease at an early stage, and immediately isolate the infected person from the healthy population. False negatives provide false reassurance and further contribute to community spread of the disease. Early presumptive diagnosis of COVID-19 is crucial for disease treatment, control and safety for our nurses.

As a state, Iowa needs to stress physical distancing versus social distancing. The verbiage of social distancing is giving the public a sense of false hope. Physical distancing is where we physically stand apart from each other, at least six feet, to help prevent the spread of COVID-19. Following physical distancing will help the community get ahead of the virus and “flatten the curve.” As nurses, we ask everyone to practice physical distancing to slow and decrease spread of the virus.

The concern for nurses will not end when the war against the COVID-19 pandemic diminishes and is eventually over. Nurses will be at risk for mental health concerns, including post-traumatic stress disorder (PTSD), after working in conditions that threaten their own health.

Being compelled to practice without essential protective equipment increases the fear of putting patients, friends, and families at risk and will intensify both physical and emotional stress. The strain on nurses’ mental health and physical wellbeing is real. The war against COVID-19 will have lasting effects, and nurses are on the front lines, waging the war but without the armor that is so essential to the safety of both the healthcare workforce and the public with whom they interact.

We must protect our nurses if we want to protect Iowans. We call upon our elected leaders, including Gov. Kim Reynolds, to mandate “stay at home” orders to slow the spread of COVID-19. We implore our elected officials, public health leaders, healthcare leaders, and anyone with the power to influence the supply chain to step up and protect our nursing workforce. We are critical in this fight against COVID-19 and protecting us will save lives.