As nurses at Signature Healthcare Brockton Hospital continue to go to work every day utilizing substandard personal protective equipment (PPE) in a city considered to be a hotspot for COVID-19 exposure, with more of their colleagues being exposed and becoming positive with a potentially deadly virus, they are now sounding the alarm in an effort to convince their administration to finally provide them with the protection they need for themselves, their families and their patients.
The nurses decision to go public with their concerns follows a concerted effort to convince management to heed their demands for appropriate personal protective equipment and the establishment of safer protocols for the placement and care of patients within the facility to reduce exposure and spread of the virus.
“For months, our community has been at center of this pandemic, with a rate of infection that ranks second highest among cities in the state, with a population at significantly higher risk for infection and poor patient outcomes,” said Nicole Tanner, RN, a critical care nurse at the hospital and co-chair of the nurses local bargaining unit with the Massachusetts Nurses Association (MNA). “Our nurses rise to this challenge every day, struggling to provide the best care possible under these unprecedented circumstances, yet we do so without appropriate personal protective equipment, and without the support from our senior management to keep us safe and to ensure the safety of our patients and this community.”
The nurses concerns came to a head two weeks ago, after an outbreak of exposure on the hospital’s psychiatric unit, where at least five nurses were exposed to the virus, on a unit where nurses were refused access to N95 respirators due to the mistaken assumption that these patients did not pose a risk for exposure to the virus. This claim is made despite the fact that the population, many of whom are homeless, live in shelters or other circumstances that place them at extremely high risk. This is also a population that, due to their behavioral health conditions, oftentimes refuse to comply with mask wearing or social distancing requirements, and because of DMH requirements, cannot be isolated as other patient populations might. As a result, the nurses have asked that this unit be treated as a COVID-19 unit, with negative pressure and with all staff provided with full PPE including N95 respirators.
In response to the situation, hospital management insulted the nursing staff by making the ridiculous claim that this exposure was caused by the nurses themselves, by sitting to close together during their lunch break.
On May 20, the MNA, on behalf of the nurses, sent a letter to hospital CEO Kim Holland outlining their concerns and stating:
“The real problem is lack of proper PPE, specifically N95 masks as well as the hospital’s position that the N95 masks are only available if there is an aerosolization procedure in the patient’s room. The union’s position to cut down on these multiple exposures, is to have everyone wearing proper PPE which includes a N95 mask.
Having multiple exposures on C-3 [the psychiatric unit] because the patient’s refuse to wear masks or self-distance demands a different approach from Hospital Administration. We suggested full PPE and consider C3 as a COVID floor. We have heard no response to our suggestions.” (to receive a copy of the letter, email dschildmeier@mnarn.org)
“Management’s position makes absolutely no sense, “Tanner explained. “We know other hospitals have implemented a higher standard for PPE use, and as of last week, the DPH came out with a new guidance to hospitals calling for full PPE for nurses caring for any patients at all times, be they COVID positive or presumptive.
“While our management repeatedly claims they have an appropriate supply of PPE, they refuse to provide our nurses with access to it. Every day we are forced to reuse N95 respirators, or in many cases, are refused access to N95 respirators due to policy positions in direct violation of long-established infection control protocols,” Tanner explained. “Every day we are forced to use N95 respirators supposedly decontaminated by an unproven process that leaves them soiled, ill fitting, and that pose a danger to every nurse who wears them because of management’s failure to secure appropriate equipment.”
In the letter to Holland, the nurses highlighted the complaints by nurses with mask reuse, reporting, “staff are complaining of dizziness, headaches and nausea with use of the chemically and UV cleaned masks.” Below is a photo of one of the highly soiled masks provided to one of the nurses for reuse (note, it was not in this condition when sent for cleaning).
The MNA has issued a position statement opposing the use of unproven, decontamination methods, employed by hospitals, which have no scientific basis for their use, or information on the short and long term health impacts for nurses and other caregivers forced to use these products.
“Nurses across the state have been reporting negative reactions when wearing these decontaminated masks, and they report masks being degraded by the process that makes them ineffective,” stated Judith Pare, RN, PhD., Director of Nursing Education and Health and Safety at the MNA. “They vehemently object to placing their lives and their families lives in jeopardy from these unproven processes.”
Another major health concern voiced in the letter to Holland was the hospital’s change in policy regarding the comingling of patients who are or may be COVID positive, writing:
“Another issue is with presumptive patients. At the beginning of the pandemic, the Hospital policy was to keep all these presumptive patients separate. At some point that has changed, why? When 2 presumptive patients are waiting for test results and one test is positive there is a very good chance the other patients will test positive, in the meantime the virus is spreading among patients and staff. This is a terrible policy that needs to change.”
The Massachusetts Nurses Association, from the inception of the emergency order for the pandemic, has called for universal use of full PPE protection for all nurses providing direct patient care, communicating those concerns directly to the Governor and the Secretary of Human Services, precisely because of the state’s and hospitals’ failure to provide adequate rapid testing of patients. “We have to assume that every patient presenting to a hospital during this pandemic is a potential carrier of the virus, and the safest means of protecting staff and the public is to have all staff armed with an N95 respirator, gown, face shield and gloves,” said Donna Kelly-Williams, RN, MNA President who authored the letter to state officials.
Amy Smith, an emergency department nurse at the hospital, who has seen too many patients enter the emergency department, and only later found to test positive for the virus, agrees “that the only viable means of containing this virus and protecting all concerned is to have staff fully protected at all times. Especially in a community like ours that serves the population most at risk for exposure and harm.”
Despite the seriousness of the issues raised in the letter to Holland, the management at Brockton Hospital continues to maintain the same unsafe practices. The nurses’ concerns are heightened given the fact that hospitals across the state, including Brockton Hospital, are now proceeding with preparations to reopen services for non-COVID patients, including eventually reopening for elective surgeries.
“The process for reopening for non COVID care raises serious concerns for nurses at this hospital, as how this is implemented could have a significant impact on our ability to contain the virus,” Smith explained. “Given Mr. Holland’s disregard for our concerns during the initial phase of the pandemic, we are even more concerned that he listen to us and implement the changes we seek going forward if we are to protect this community.”
Brockton Nurses Are Not Alone
The concerns and the alarm raised by nurses at Brockton Hospital are far from unique, and in fact they are symptomatic of a growing firestorm of outrage throughout the state and national nursing community as employers, state and federal governments, and even the CDC and the Department of Public Health have taken active steps to undermine the safety of frontline workers throughout this pandemic. All stakeholders are responsible for failing to prepare for and respond to the pandemic, to utilize all available resources to ensure the production of appropriate PPE, and when the resulting shortages emerged, regulatory bodies purposefully lowered standards under lobbying pressure from a hospital industry hellbent on avoiding responsibility for the situation. Now, health systems, like Brockton Hospital , cite those lowered standards to justify their provision of substandard protection for staff.
“They need to stop calling us heroes and starting treating us like the vulnerable human beings working in an extremely stressful and hazardous environment,” said Kelly-Williams, RN, “They are using unproven, half measures, willfully experimenting with our lives and the lives of our families, and it is obscene.”
In the last two months, nurses working at hospitals from Pittsfield to Worcester to Cape Cod; from Salem to Wareham have gone public with their concerns for their safety and the safety of their patients due to lack of PPE, poor staffing, unnecessary furloughs and staffing cuts, as well as the closure of needed services as their employers have continued to fail to heed nurses concerns and calls for a safer approach to confronting this unprecedented crisis.
“This virus is not going away anytime soon, and if we don’t listen to our frontline caregivers and provide them with the tools they need to keep us safe, thousands more of us will suffer, and many will die from our negligence,” Kelly-Williams concluded.
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