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Wednesday, April 1, 2020

Fearful Cleveland Clinic Nurse On Hospital's PPE Policies: "The Clinic Should Be Creating the Standard of Care, Not Lowering It"

Posted By on Wed, Apr 1, 2020 at 11:31 AM

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As the calendar turns to April and, as Dr. Amy Acton has said, we exist in the "calm before the storm" of impending surges of coronavirus cases, Ohio's hospital systems are struggling with shortages of personal protective equipment, including N95 masks.

That's factoring in what was already on hand, what's been donated, and this week's shipment from the Strategic National Stockpile (271,450 N95 masks, 672,100 surgical masks, 131,808 face shields, 107,670 gowns, 483,575 pairs of gloves, 552 coveralls), which Dr. Acton called insufficient on Tuesday night.



“The supplies we received, and the state’s reserve will not meet the immediate or future needs of Ohio’s healthcare providers and first responders,” she said.

Different models put Ohio's peak at different levels and at different times, but they generally range from a minimum of 6,000 new cases a day up to 10,000 with a peak in late April or early May. The storm is not only coming, but it's going to be unlike anyone's ever seen.

So, yes, there is fear among healthcare workers — who make up almost 20% of confirmed coronavirus patients in Ohio thus far — for their patients, for themselves, for their families. And there's fear of talking about that fear.

Bloomberg this week rounded up the long list of hospital systems across the country that have threatened, and in some cases gone through with threats to fire any staff members who talk to the media. The guiding principle, at least before the coronavirus pandemic, was that all requests are best handled and approved by a hospital's communications department, both to protect the image and reputation of said hospital but also to create and operate by a codified process to protect patient confidentiality. As Bloomberg noted, it's a different world now, and those processes, and threats, are not in the interest of preserving patient confidentiality but in making sure that nurses and doctors don't give honest evaluations of their workplace safety to the public.

And they're asking anyone who can help get the information out. Via Bloomberg's story:

Nisha Mehta is a 38-year radiologist from Charlotte, North Carolina, who runs two Facebook groups for physicians with around 70,000 members. She’s fielded numerous requests from health-care workers hoping to get their stories into the public arena.

“I’m hearing widespread stories from physicians across the country and they are all saying: ‘We have these stories that we think are important to get out, but we are being told by our hospital systems that we are not allowed to speak to the press, and if we do so there will be extreme consequences,” she said.

Which is why when you read a story about PPE and precautions in Ohio hospital systems, you'll rarely see a nurse quoted by name. You might see nurse's unions, where they exist, advocating for their members — like Rick Lucas of the Ohio State University Nurses Organization did in this Columbus Dispatch article where he said critically low supplies of protection equipment mean nurses are “going to work every day in fear” — but you'll see nurses themselves having to resort to anonymous quotes, like the two interviewed for that very same Dispatch report, out of fear of repercussions.

The same problem exists here.

"I have to remain anonymous. I am risking my career," said one Cleveland Clinic nurse who spoke to Scene about the hospital system's current policies and supplies, information that they thought the public should know.

"Nurses were initially eager and proud to do their part in fighting the pandemic and caring for patients and we were reassured we would be provided with adequate protection," the person said. "But days later leadership announced we would no longer get N95 masks, just surgical masks. N95 masks would only be supplied while conducting aerosolizing procedures, which is only a tiny fraction of what caring for a COVID-19 involves. When a person infected with COVID-19 coughs, a terrifying amount of aerosolized viral particles are hurled into the air for bystanders to inhale and become infected. Health care personnel are inches from these patients’ faces providing them with around-the-clock care. A simple face mask will not protect health care personnel from inhaling viral particulate. Many will soon become infected and thereby spread the infection to otherwise healthy individuals."

When some nurses have complained, this person said, leadership has replied, "This is what you signed up for."

"Nurses and other health care personnel did not sign up for caring for patients in unsafe working conditions," the person said. "As nurses, we love our jobs and our patients. Our patients deserve the best possible care that we can provide. The Clinic has always provided us with the resources necessary to meet that goal. These policy changes, however, are uncharacteristic of the values and mission. We are not unionized and have little power to influence leadership. Health care workers are dying trying to care for patients across the globe. We will be next if the Cleveland Clinic does not provide their employees adequate equipment. We will continue to infect ourselves, patients, and our families. The Clinic should be creating the standard of care—not lowering it." 

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