23 December 2020
Australian nurses show solidarity with Californian counterparts fighting to protect nurse-to-patient ratios during COVID-19
The Australian Nursing and Midwifery Federation (ANMF) is encouraging Australian nurses to show their support towards their overseas counterparts who have put their lives at risk while working during the pandemic over the past 12 months.
Many nurses working in countries where COVID-19 is rampant have not only contracted the virus but lost their lives while working in unsafe conditions.
In response, the ANMF has written a letter of solidarity to the Californian Nurses Association and National Nurses United in support of US nurses working in conditions that are particularly dire. The ANMF has also set up a Facebook page where Australian nurses and are encouraged to connect with their overseas counterparts by posting messages of compassion and support.
ANMF’s Acting Federal Secretary Lori-Anne Sharp said she was shocked and outraged by the conditions that many nurses had endured during the pandemic.
“Nurses deserve to be respected, their livelihoods and welfare matters and they should be protected, but this is far from reality. They work tirelessly on the frontline to care for and save thousands of lives who are infected by the virus, yet they work under-resourced and exposed, placing their own lives and the lives of their families at serious risk,” Ms Sharp said.
“In California alone, more than 63,000 healthcare workers have been infected with COVID-19, and tragically 240 have died, according to recent records. And this has come at a time when hospital administration are seeking to reduce staffing ratios in ICU. It just makes no sense.
“This situation is intolerable, and as nurses, we stand by and support our overseas comrades and acknowledge their efforts and courage in dealing with this crisis.” Ms Sharp said.
In California, nurses are standing up against the rollback of nurse-to-patient ratios in the thick of the COVID-19 pandemic, warning that unsafe staffing levels will inevitably lead to further patient, nurse and healthcare worker infections and deaths.
Earlier this month, the state government announced hospitals could apply for “expedited waivers” due to the pandemic that if granted, will let them increase the number of patients nurses can treat at one time.
Across the US, nurses continue to face a range of challenges as the COVID-19 pandemic rises again during winter, including unsafe staffing levels, lack of access to personal protective equipment (PPE), inadequate infection and control policies, and scarce access to testing for themselves and patients.
As more than 63,000 healthcare workers have been infected with COVID-19 to date, with 240 deaths, a recent survey conducted by National Nurses United found just 42% of registered nurses in hospitals across the country reported they had ever been tested for the virus. As of last week, however, the California Department of Public Health (CDPH) has directed all general acute-care hospitals to begin weekly COVID-19 testing of all healthcare staff and patients, and immediate testing for healthcare personnel displaying symptoms.
Critically, California nurses are now rallying against the new threat to the state’s landmark nurse-to-patient ratios, a violation of safe staffing standards at a time when nurses are already at breaking point that will cause more deaths and suffering.
At a virtual press conference held last week, registered nurses and union leaders shared first-hand accounts of the toll the COVID-19 pandemic had taken. They spoke out on how blanket waivers of safe staffing standards would impact their ability to deliver patient care and lead to more mistakes, infections and poorer patient outcomes.
President of California Nurses Association (CNA) and National Nurses United and registered nurse, Zenei Cortez, said frontline nurses and other healthcare workers had been putting their lives on the line during the pandemic and were advocating for safe staffing and patient safety.
“There could not be a worse time to let our guard down. There could not be a worse time to take dangerous steps that will make this crisis more severe and that will create more tragedies for our communities,” Ms Cortez warned.
“To roll back the protections Californians fought for years to achieve and defend is a disaster on top of the calamity that is the worst pandemic in a century.”
Ms Cortez said nurses have urged hospitals to ensure staffing and safety measures were put in place before the pandemic surged. She blamed the lack of preparation for triggering the closure of hospital units and creating working conditions so dangerous that scores of nurses have left the profession.
After battling the pandemic for ten months, Ms Cortez said nurses had already paid an “unbearable price” and had nothing left to give. They have been going to work with the fear of being infected, have had to plead for PPE, and are working under unsafe conditions caused by the “negligence and failure” of hospitals to prepare.
Yet despite calling for greater protections, nurses faced ongoing resistance from hospital employers, sparking 2,000 protests across the country.
The threat to California’s historic nurse-to-patient ratios is considered the last straw.
“To roll back those standards now means we are running from patient to patient.” Ms Cortez explained.
“It means we do not have the time to respond to each patient’s rapidly changing care condition to monitor their subtle changes that may mean living to see another day or dying that day. It means making us more fatigued and more prone to making mistakes. It will mean more of us will become infected, and become patients in their own hospital intensive care units and die.”
Tinny Abogado, a registered nurse who works in a step-down unit at Kaiser Permanente in Los Angeles, told viewers the expedited waivers would jeopardise her ability to provide proper care.
“Under the new expedited waiver process, the hospital can now give me another step-down patient,” Tinny said.
“This is so, so risky. I’m already working so hard just to keep my three patients safe. To say ‘oh it’s just one more’ is totally wrong and ignorant. COVID patients in our units are very sick. It only takes one unstable patient to take up all of my time. They crash so fast. Multiple times every shift we are transferring step-down patients back to the ICU.”
Tinny believes hospitals are using COVID-19 as an excuse to cut down ratios.
“They [my hospital] saw the opportunity to get around ratios and are taking it. They have only themselves to blame for any lack of staff and for how exhausted and overworked we are. Everyone knew it [the pandemic] was going to re-surge during winter and they had almost a year to prepare. They have not done what it takes to build a strong staff pool but instead have done what is best for their bottom line.”
Tinny revealed the stark impact of working through COVID-19 with insufficient resources and protections. She is provided with only one N95 mask to wear for an entire 12-hour shift. There is no contact tracing and nurses are not tested unless they are symptomatic. On one occasion, battling fatigue, she stopped short of entering a COVID-19 patient’s room without an N95 mask on.
She is adamant enough is enough, and that hospitals do have options to improve staffing and must take all measures to protect the existing workforce.
“Piling more patients onto my assignment would only endanger my patients’ safety and my own safety. When I’m overworked I get fatigued and my thinking and judgement gets clouded,” Tinny said.
“Nurses catching COVID and dying of it is real. So far, on my unit alone, we’ve had five positive cases, four nurses and a ward clerk. And just this Tuesday, I learned that one of my dear colleagues at LAMC, a paediatric nurse, died of COVID.”
In a similar vein, Mawata Kamara, an emergency room nurse at San Leandro Hospital, said nurses, already exhausted, are being asked to take on extra shifts.
“Safe staffing is not just about how many patients a nurse has to care for; it’s about acuity,” she pointed out.
“Acuity is about how sick a patient is and what kind of care they need. It’s not just about numbers, the ratios are actually the bare minimum.”
Like many other nurses across the country, Mawata and her colleagues went on strike during the pandemic to call for more staff and resources.
“It was difficult but it was necessary for our patients and for our nurses,” she recalled.
“We are struggling to manage the patients we have now. We know that safe staffing saves lives. Some of our hospitals are requiring nurses to care for more patients and we know that it is unsafe. Removing safety standards will only increase the suffering and the death count for our patients, our nurses and other healthcare workers.”
Nerissa Black, a telemetry RN at the Henry Mayo Newhall Hospital, said the expedited waiver process would leave her with just 10 minutes to spend caring for each COVID-19 patient.
“Before the pandemic, I took care of four patients at most,” she said.
“During this pandemic, that number has remained the same, but my patients are so much sicker than before.”
Under the changes, Nerissa would be assigned six patients. She said resources are already stretched to their limit, after the hospital laid off 100 employees in June, including 35 RNs, and closed an entire unit. Not long ago, 72 out of the 133 acute-care patients were COVID-19 positive.
Nerissa’s message was not to let employers use the pandemic as an excuse to overturn safe staffing, especially during such a pivotal time.
“It’s impossible to keep our patients or ourselves as safe as possible under these conditions. We’re already short-staffed now and who will care for the patients if nurses are constantly at risk of getting sick or dying? How will we ever get out of this pandemic?”
To send a message of support to Californian nurses and nurses around the world working in unsafe conditions during the pandemic go to: www.facebook.com/GlobalNursingSolidarity
Published and written for ANMJ by Robert Fedele and Kathryn Anderson | 23 December 2020