Feds must increase production of personal protective equipment and COVID-19 test kits
Nurses are on the frontline in the fight against the coronavirus and they’re not adequately prepared. It’s not due to a lack of nursing education, but rather a lack of institutional and governmental preparedness. The federal government is failing us.
Nurses are generally the closest to patients. There are 2.9 million registered nurses within the United States and 1.6 million of them work in hospitals. They generally work in a ratio of 1:4 to 1:1 nurses per patient. With 2.8 hospital beds per 1,000 people in the United States, health systems are on the trajectory to being overwhelmed. Increased hospitalizations will lead to the unavailability of hospital beds, depletion of personal protective equipment (PPE items like masks, goggles, gowns).
Nurses don’t have the supplies they need to stay in this fight. Failing to give them what they need threatens their health and that of the entire country.
National Nurses United, the largest organization of registered nurses, surveyed over 1,000 nurses directly and found that only 30 percent reported that their employer has sufficient (PPE) stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections. Moreover, only 29 percent said their employers had a plan to isolate possible coronavirus patients. This lack of planning and equipment highlights severe risks in healthcare preparedness and can increase the possibility of transmission.
Nurses are begging for protective gear and large institutional planning. The University of California Davis Medical Center revealed that up to 36 nurses were ordered to self-quarantine after being possibly being exposed to the coronavirus.
The CDC has emphasized PPE, training, and testing to prevent this number from rising so high. Unfortunately, many nurse leaders have reported training and preparation occurring in a rushed manner and have felt underprepared for a surge of patients.
A lack of PPE could be countered by distancing practices — f we knew who was affected by the virus but we don’t because we haven’t been able to test as many people as we should have. If we can’t test the people we need to test, we don’t know the actual number of infections and the risk of another provider transmitting this infection.
In short, we don’t know where the disease is and how to contain it. The Los Angeles Times reported that a transplant nurse, whose job is to work with immune-deficient patients, was refused testing due to shortfalls. If this same nurse experiences PPE shortages, this person becomes a perfect vector for transmission to others.
The lack of testing ceases to make sense in light of the fact that the federal government has actively discouraged testing nurses who wear the recommended protective equipment; the conclusion then is that PPE is sufficient to stop the virus. This refusal to test people with protective equipment only underscores the need for expanding access to PPE.
The CDC has been clear that nurses are at a medium to high risk of developing an infection of COVID-19 without appropriate PPE. If a nurse interacts with a patient suspected of coronavirus infection, they generally must self-quarantine for at least 14 days.
With the surge they are about to experience, healthcare facilities cannot afford to lose their nurses, but they shouldn’t be asking a nurse to return to work without the appropriate equipment and testing. If we can’t know that the person who cares for a patient is uninfected, we shouldn’t be telling them to return to work.
As nursing shortages worsen, the risk for nurse burnout increases. The lack of resources at work — resources like PPE — has been demonstrated to lead to exhaustion and illness. Increased patient acuity and decreased staffing will take a psychological toll on nurses. Exhaustion, inattention, and disorganization will only decrease effectiveness in keeping our patients healthy.
Even though the federal government has a duty to protect its citizens, it has already failed to accurately test patients in the early days of the response, which is why state officials fear the virus is spreading faster than testing can occur. Delays in manufacturing and distribution and have not prepared adequately for this.
Producing more test kits is of paramount importance but so is increasing the production and distribution of PPE. The United States government must invest in the PPE supply chain and not simply rely on hospitals to conserve resources. Failure to protect our nurses will lead to an increase in quarantines, reduced staffing, increased burnout, and systematic failure which, in turn, increases the risk of in-patient mortality.
The fragmented nature of healthcare in the United States makes it more difficult to organize a rapid response effectively. This is why federal assistance with PPE is particularly essential right now.
Dallas M. Ducar is a psychiatric-mental health nurse practitioner and a researcher at Massachusetts General Hospital, Transgender Health Program.
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