As the COVID-19 pandemic spreads across the country, health care workers find themselves on the front lines.
The rapid spread of the novel coronavirus has led hospitals and clinics to upend their routines and made the people who work in them risk their health and their lives. Shifts have been extended and staffers have been reassigned to new duties during the emergency.
And through it all, there’s been a common concern: personal protective equipment (PPE) has been in short supply, calling for unexpected conservation measures to extend the life of things that were supposed to be used one time and then thrown away.
“We are now wearing masks with every patient interaction as well as a face shield,” says Allison Sorg, a nurse in the newborn intensive care unit at Meriter Hospital in Madison. “It’s meant to protect us from splashes if someone were to cough or sneeze. At the moment we are not aware of exactly what the length of existing supplies is. What we are receiving is being rationed.”
The crisis is also challenging a growing trend in hospitals, which in the last decade or more have been tightening staff in the name of efficiency.
“Our health care system is not equipped to staff up and meet these challenges, because there’s an allegiance to the bottom line,” says Jamie Lucas, executive director for the Wisconsin Federation of Nurses and Health Professionals. “That’s a problem that’s being exposed this pandemic.”
The union represents nurses and other health workers at hospitals and other healthcare facilities in Milwaukee and Racine counties as well as northern Wisconsin. Lucas says the bottom-line focus at the expense of staff robustness has been replicated across for-profit and nonprofit healthcare systems alike.
“The impressions from administrators are very different from the impressions of the front line staff,” he says. “We’re just not well situated to meet the challenges at this time because of cuts and cuts and cuts — seemingly small ones over a period of time that have whittled away staffing numbers.”
Waiting for the surge
In Dane County, where the number of people infected with the virus has now topped 200, with three deaths, the big surge hasn’t yet arrived, but the patient caseload is growing. In Milwaukee, it’s already more intense, with more than 830 cases and 16 deaths according to figures posted by the county late Wednesday, April 1.
In both communities, and elsewhere in the state, the daily work of hospital and clinic employees has already changed, in response to the first wave of patients and in anticipation of larger waves to come.
Dr. Tony Sturm of the Wildwood Clinic, an independent medical practice in Madison, says COVID-19 has changed how the office operates day to day, starting with implementing long-distance health care, known as telemedicine.
“We’ve been telling a large number of our patients to not come in,” says Sturm. “We don’t want to put them at risk of infection or person-to-person contact.” Many clinic patients are worried about being exposed, but with a shortage of test materials, Wildwood has largely restricted its tests to patients who are pregnant or who are health care workers.
At St. Mary’s Hospital in Madison, “it has been a bit dizzying,” says Laura Vowels, an emergency room nurse. “There have been daily updates and changes to work flow. It’s been overwhelming to keep up with all of the changes that we’ve seen, in terms of the number of cases in Wisconsin, and also what we’ve had to shift and alter in our work environment to provide the safest patient care possible.”
In Milwaukee, nurse Mary Milton would normally work on routine elective procedures at Ascension St. Francis Hospital. But those have been put on hold, so she has been reassigned to the emergency room.
“I have not been on my feet for that much time in years,” she says. “It’s very busy but the ER staff is phenomenal. The people are working together well. They’re really a good team.”
Milton monitors and assists coworkers in the use of personal protective equipment — PPE for short — including cleaning equipment that can be reused.
“We are, at this time, getting the PPE required to take care of our patients,” she says. The nationwide shortage of PPE requires careful conservation of the equipment, following guidelines from the Centers for Disease Control and Prevention (CDC).
Masks that are normally single-use items can be reused so long as the patient a nurse or other worker who is attending has not been diagnosed with COVID-19. “If you go into a patient’s room and they are a confirmed COVID-19 patient, the gowns and the mask get dumped [afterward],” Milton says.
“This is all extremely stressful on all of us,” she says. “Everybody knows it’s going to get worse before it gets better. You take it one day at a time is what you do. You work, you do your job, and you have to push your worries to the back of your head for the time you’re there.”
“I think the real fear is nobody knows when it’s going to end,” says Connie Smith, an operating room tech at St. Francis who has been reassigned to the emergency room and assists with PPE. “Nobody knows when that virus is going to run its course, and you just can’t predict it.”
‘Calm before the storm’
Over the last several weeks, the UW Hospital and Clinics — a key component of Madison’s largest health system, UW Health — has been reassigning staff throughout its facilities, says Dr. Jeff Pothof, chief quality and safety officer.
As clinics were closed and elective procedures canceled, some staff were moved around to areas of rising demand, ranging from an information hotline to the system’s employee health services.
“Every day we see more patients than the day before, but at this point it’s not what I would call a surge — a rate exceeding our ability to care,” Pothof says. “We’re able to manage them with the normal resources that we would have.”
For now, says UW Health nurse Shari Signer, “We’re preparing for the worst. So it’s the calm before the storm.”
Signer is among the nurses active at UW Health in seeking union representation through the Service Employees International Union. Since December they’ve been demanding that the administration voluntarily recognize their union and engage with them in setting hospital policy and practices that affect their work. To date UW Health management has rejected the demand.
Signer says that while some nurses have been reassigned to hospital service, others whose regular work has been put on hold have been told to stay home — and are losing pay as a consequence. “Any of those other clinics, where they don’t have a need for people, [the nurses who normally work there] are not allowed to work,” she says.
But that’s not the way it’s supposed to be, says Pothof.
“We have told people that they should not furlough staff,” he says. “If you’re not doing your normal job, we want to make sure that we are training you for whatever job we think you may need to play. …We think that would be a bad decision to have health care workers not working right now, when we might be facing a surge in a short period of time.”
Signer says at first, employees whose hours were cut back were given full pay to cover the shift they would have ordinarily worked, but that has since ended. And because of a change in how employees accrue vacation time over the course of the year, she adds, those who were put on hiatus in March were unable to use paid time off unless they had unused time from the previous year.
Search for safety gear
Pothof says UW Health has been following guidance from the CDC in assigning staff to use PPE, but also in setting protocols in their use and reuse.
“All health care providers who have direct patient contact are wearing a mask and a face shield,” he says. “That’s not something that we would do in the normal course of business — it’s really a COVID-specific intervention.”
The UW Health PPE inventory is “OK, but the thing that worries us every day is that, if you look at these health systems in other parts of the country where they’ve hit their surge, the usage of PPE goes up considerably,” Pothof continues. “If we hit our surge but we don’t have the supply on hand to meet that, that’s where we get in trouble.”
Face shields can be reused but must be frequently cleaned and sanitized, he says. As long as a patient is not confirmed or suspected to have COVID-19, masks, normally a one-use item, can be reused. “That is completely safe,” he says. “It’s just not normal.”
Every health care worker interviewed for this story brought up concerns about whether there would be enough PPE. None of them blamed employers; the shortage is nationwide, and several said they would like to see President Donald Trump invoke the Defense Production Act so that more companies start manufacturing and distributing the necessary masks, gowns and face shields.
On a media call Wednesday morning organized by Protect Our Care, a Washington, D.C., organization that has campaigned to preserve and strengthen the Affordable Care Act, Joe Maginn, a Madison emergency room nurse, echoed support for that approach.
“Every day we’re coming up with our own contingency plans to prepare for the days and weeks ahead,” said Maginn, an SEIU member, He credited the union with being able to engage in “difficult conversations with employers” about the need for PPE that non-union employees might not be able to.
Dr. Laurel Mark, a retired Madison physician who spoke recently on a media call marking the 10th anniversary of the ACA, said she’s worried about PPE reuse.
“My friends in urgent care are already using masks which were meant to be single use,” she said. “They’re using them all day or for several days until they fall apart. They are instructed to wash or clean materials that are not meant to be cleaned; they’re meant to be used one time. They are storing their masks in paper bags so that they breathe a little bit rather than throwing them away. This is really unsafe, and these are the workers that we need at the front lines taking care of people.”
For nurses and other health care workers on the job, the protocols for using and reusing PPE have seemed to change frequently, says Shari Signer.
For that reason, although the unionizing effort at UW Health remains intact, “we’re taking a step back” and focusing on ways to increase the PPE supply and clarifying the safety communication. Union activists are also seeking assurances that employees who test positive for COVID-19 and must go into isolation for 14 days will get paid sick leave.
Signer says the frustrations she and some of her coworkers share reflect larger issues that were part of their campaign for a union long before COVID-19 showed up in Wisconsin — including communication problems and staffing changes that have left nurses and other health care workers feeling overtaxed and stretched thin.
“A lot of the problems we’re having are really centralized around why we want a union,” Signer says. “Any of the changes that have occurred, we do not have channels to communicate our concerns.”