Survey: PPE shortages continue for many nurses

Nurses continue to face substantial challenges more than 6 months into the COVID-19 pandemic, particularly with access to PPE.

On Tuesday, registered nurses at HCA hospitals in four states — Florida, Kansas, Missouri and Nevada — held public actions to call attention to practices such as reusing single-use N95 masks that put themselves, other health care workers and patients in jeopardy.

“It is shameful for HCA to put our lives, and the lives of our patients, our co-workers and our families at risk due to their failure and unwillingness to make workplace safety the highest priority, not a budget item to be constantly squeezed and cut,” Leslie Rogers, RN, of the Research Medical Center in Kansas City, Missouri, said in a press release.

The protest comes 1 week after the National Nurses United union filed a complaint to the Occupational Health and Safety Administration, asking it to inspect 17 hospitals owned and operated by HCA based on “willing violation” of safety hazards.

On the same day of the protest, the American Nurses Association (ANA) announced results from a survey of nurses conducted from March through August that found many in the profession are facing similar safety concerns.

“As our nation combats the COVID-19 pandemic, the American Nurses Association’s top priority is to ensure that the nursing workforce is prepared, protected and supported,” Ernest J. Grant, PhD, RN, FAAN, president of the ANA, said during a press briefing. “Doing so is vital to the nation’s ability to effectively respond to the virus, effectively recover, and restore health.

Survey findings

From July 24 through August 14, a total of 21,503 nurses responded to the ANA’s survey on PPE availability, reuse and contamination practices. Nurses from a variety of settings were asked to report their experiences from the previous 2 weeks.

Among respondents, 51% reported that they have treated patients who tested positive for COVID-19 or were suspected cases of COVID-19 in the last 2 weeks.

Shortages of PPE were common, with 42% of nurses experiencing a shortage, 16% reporting widespread PPE shortages and 26% reporting intermittent shortages.

While 42% of respondents said the PPE situation had improved since May, 53% said the PPE situation was worse.

The ANA found that N95 masks were in the shortest supply, with 37% of respondents saying they were “out” or “short” of these masks.

Reuse of N95s was also common, with 68% of nurses reporting that their facility requires them to reuse these makes, and 88% reporting that reuse of these masks is either required or encouraged.

Among those who reused N95s, 62% reported that they felt very or somewhat unsafe.

The ANA found that nurses often reuse masks, with 58% reporting that they reused an N95 mask for 5 days or more, and 14% reporting that they reused them for more than 2 weeks.

Among participants, 38% indicated that their facilities were decontaminating N95s, and 41% said that their facilities were not. Of those who said their facilities were decontaminating, 55% reported that the practice made them feel somewhat or very unsafe.

“Nurses say they feel unsafe given the ongoing issue with PPE and are concerned about the health of patients that they care for, their families, and themselves,” Grant said. “We cannot afford to have a nursing profession that is not supported, and one in which our nurses do not feel safe.”

Implications for practices, nurses’ health

Tener Veenema, PhD, MPH, MS, RN, FAAN, a professor of nursing at Johns Hopkins School of Nursing and in the department of international health at the Johns Hopkins Bloomberg School of Public Health, said during the briefing that “the N95 respirator is so critical to the protection of nurses and other health care workers because its edges are designed to form a tight seal that protects the nose and the mouth.”

The survey findings, she added, suggest that “greater than 6 months into the pandemic, we’re still seeing periodic, intermittent shortages of this PPE, and some nurses reporting being asked to decontaminate and reuse.”

Although the results are specific to nurses, she said the results suggest that other health care workers, including physicians and support staff, similarly do not have access to adequate PPE.

Veenema also said that the CDC has specific criteria for reuse of N95 masks, and that there are “pros and cons” to the options available to decontaminate them for reuse.

Therefore, when facing PPE shortages, health care facilities should consider alternative options, such as the Elastomeric respirator, which is reusable and can be cleaned, reused and stored, according to Veenema.

Jennifer Gil, BSN, RN, director-at-large and a staff nurse at ANA and a clinical nurse in the emergency trauma department at Thomas Jefferson University Hospital, said during the briefing that as a nurse responding to the COVID-19 crisis, she was “alarmed” to learn that many nurses do not have sufficient access to PPE and is concerned for those who do not feel safe.

“Our service to patients and communities comes with an immense personal impact to our physical and mental health as we place ourselves and our families in harm’s way,” she said. “This is amplified when we do not have the support and protection that is critical to response and to recovery efforts.”

She said policymakers should make sufficient PPE supply chains “a top priority” in the U.S., and that all levels of government are needed to plan a coordinated response to ensure nurses have adequate PPE to properly take care of patients.

She also called for nurses to help these officials make informed decisions about health care.

“During these unprecedented times, what we ask for and what we must have in return is support and protection,” Gil said. “Again, for nurses, this includes access to the highest level of protection and adequate PPE, priority testing and treatment, and safe vaccination for nurses who are exposed to COVID-19, and very importantly, mental health wellbeing services and tools.”

References:

ANA. Survey reveals alarming conditions. https://www.nursingworld.org/~4a558d/globalassets/covid19/ana-ppe-survey-one-pager---final.pdf. Accessed September 1, 2020.

ANA. New Survey Findings from 21K US Nurses: PPE Shortages Persist, Re-Use Practices on the Rise Amid COVID-19 Pandemic. https://www.nursingworld.org/news/news-releases/2020/new-survey-findings-from-21k-us-nurses--ppe-shortages-persist-re-use-practices-on-the-rise-amid-covid-19-pandemic/. Accessed September 1, 2020.

National Nurses United. HCA Nurses to Protest Unsafe PPE, Equipment, Staffing in Four States Tuesday. https://www.nationalnursesunited.org/press/hca-nurses-protest-unsafe-ppe-equipment-staffing-four-states-tuesday. Accessed August 31, 2020.