Healthcare Protection and Benefits Act 2020 or The Year of The Nurse Act

One Statement, from a collective, united front. Once existing in silos, are nurses capable of creating one single statement for the profession? Are the over 100 nursing specialty organizations able to agree on supporting and endorsing one statement at the State and Federal level?

Nurses, we are human beings. We are your mothers, fathers, daughters, sisters, brothers, sons and daughters. We have families to support, children who depend on us… personal responsibilities just like everyone. Yet we are ready to fight relentlessly and jump into a warzone unprotected to defend helpless people against a formidable enemy. We are afraid, in fact we fear for our lives and that of our own families, knowing that we may be the next victim.

We, as a part of the healthcare team, have chosen a profession, Nursing, a calling of service, of dedication, of self- surrender to something bigger than ourselves. All of us, Nurses, look to your unending words of encouragement and appreciation, generosity, prayers, and unwavering trust. With the public’s support we are able to look past all our fears and doubts. 

As we continue to struggle through the healthcare challenges brought about by this pandemic, we are asking you, the public for your support and commitment to help us Nurses in reaching out to state legislators to pass the Year of the Nurse Act 2020 or the Healthcare Protection and Benefit Bill. This bill will protect all Nurses (RNs, CNAs, LPNs, APRNS who work in all clinical settings, with limited or no PPEs, and have the potential for exposure and infection, disability and death from COVID19. The stimulus bill will be paid into healthcare organizations that we work for. Without this bill, there will be no guaranteed protection for us and our families should something happen to us and our family members in the event of illness, disability or as a result of inadequate protection and sanitation of our work environments during the COVID19 pandemic.

With continued commitment now and always, for the community, the nation, first line workers, healthcare colleagues, and fellow nurses...this is for us.

The HealthCare Worker Protection and Benefits Act :The Year of the Nurse Act

    As of April 6, 2020 there are 362, 573 documented positive cases, 10, 720 deaths and 19, 313 deaths. But this is just the tip of the COVID 19 iceberg. Its documented incidence was in late November -early December 2019, in Wuhan Province, China. China’s Wuhan Province is a center of trade, education and culture that after the virus was detected and caused its deadly havoc on many, travelers (able bodied, students, healthy people), who (because of some type of innate immunity possibly MMR or chicken pox) remained possibly contact who remained asymptomatic carriers, have already have left the country and proceeded to destinations around the world.

    The World Health Organization in early February 2020 created a statement warning countries worldwide to prepared for a potential pandemic, considering the epidemiological presentation of the disease i.e. although the rate of spread is very fast as evidenced by the number of cases reported by China, the fatalities are only those who have pre-existing medical conditions, and older population, it was very important for countries around the world to understand that this disease can remain covert, with a 14 day incubation period. With these factors in mind, experts in biostatistics and epidemiology should be able to understand that many people in the United States at this time could be potentially asymptomatic positives, carriers, infecting many others, spreading the disease and at any time, an outbreak will happen. In early February, masks, gloves, cleaning supplies, toilet paper, were already running out in retail and wholesale markets. This country and its healthcare infrastructure has already been ailing from the flu season. This country’s healthcare leaders have not taken into consideration the events that are happening globally to prepare the public for the onslaught of the virus. Healthcare organizations and its business leaders, were not able to evaluate its resource PAR levels, equipment to meet the demand for the COVID19 pandemic. The public health system was not prepared with the number of test to identify positive carriers to prevent the spread of the disease; the Centers of Disease Control was not consistent with its recommendations on personal protective equipment, and the public was not prepared to take responsibility to protect themselves and follow guidelines for self isolation.

During this pandemic, COVID 19, with the declaration of a State of Emergency, front line workers, a majority of whom, who are collectively known under the umbrella, licensed and registered under each professional state board of “Nursing,” have worked and still continue to actively work in various clinical settings. Our profession has rendered us vulnerable to direct or indirect exposure, or contact with a person under investigation (PUI) or a positive COVID-19 patient during this pandemic, in our place of employment which includes but is not limited to private, for profit and non- profit, government and non government institutions located in all states, in all rural and or urban areas, including the professional designated certifications:

1.  Registered Nurses (Associate’s degree, BSN)

2.  Licensed Practical Nurses

3.  Certified Nursing Assistants

4.  Advanced Practice Nurses

Nurses collectively call to action at both the State and Federal level, the following legislation to protect Nurses who continue to support and serve health care organizations, and the community during the COVID 19 pandemic:

I. Protection

All nurses and other health care workers must receive the highest level of protection as recommended by OSHA and the latest evidence based guidelines. Recommendations should be periodically reviewed by each healthcare organization, with active participation and input of Nursing staff. Masks, gowns and gloves provided should not be re-used as recommended.

·     Provide the highest level of PPE to nurses and other health care workers who are providing care to patients with possible COVID-19 infections. Based on the precautionary principle, the highest level of PPE includes a powered air- purifying respirator (PAPR), coveralls that are impervious to viral penetration (meeting ASTM F1671/ISO 16604 standards), and gloves.

·     Healthcare employers should have in-person, hands-on training and education for all nurses and other healthcare workers regarding PPE and safe donning and doffing practices.

PPE, cleaning supplies, sanitation of work environment and stations used in patient care (sanitizers, surface cleaning etc.) should be provided by employers and healthcare organizations, be considered to be a priority. There should be housekeepers on standby for infection prevention and also in the event that an influx of infected patients is expected or are admitted to the facility or department and after the discharge and transfer of infected or PUI’s (person under investigation). Cleaning/sanitation protocol should comply with the recommended OSHA guidelines (see attached).

Disposable scrubs, gowns, shoe, covers, stethoscopes should be provided by healthcare organizations to all nurses working directly with COVID-19 patients and those who are potentially infected patients/PUI.

Free testing for all nurses who work without the proper PPE, who report exposure to a PUI and/or COVID 19 patient (regardless whether the patient is symptomatic or not). If the nurse report symptoms then they have to be tested ASAP and quarantined, and receive the latest, most effective treatment available ASAP per protocol; their family members receive the same.

Nurses who initially test negative, after an exposure to a PUI or known COVID19 patients, will be retested prior to release to work considering the virus’ incubation period and documented false negatives.

Nurses, considered as vulnerable population because of exposure, receive priority for vaccination and treatment if test positive symptomatic. We also urge Congress to require paid sick leave for so that they can stay home from work in order to prevent transmission. This should include paid leave to care for sick relatives including dependents and the elderly.

II. Reimbursement/Hazard Pay

It is a fact that all Nurses have been working in documented unsafe clinical conditions (see OSHA guidelines attached) including but not limited to improper recommended personal protective equipment, sanitation and cleaning supplied and equipment.

Nurses should be reimbursed for PPE and related supplies bought for use during COVID 19 Pandemic.

An established algorithm for testing nursing staff who converts into a PUI, test positive and/or a staff who start having symptoms; a due process for paid leave and hospitalization. Establish a standard paid leave of 14 days after exposure with or without symptoms and re-testing prior to return to work.

National Emergency service life insurance policy for all front line workers and their family members should death occur as a result from exposure or contact with a PUI and positive patients.

 Financial protection for Nurses, who work in healthcare organizations, who suffer from short term, or long term disability, death as a consequence of exposure/contact, and being unprotected, under protected and continuously exposed to COVID-19 . 

Establish a health care worker fund which including economic losses, potential earning payout, attorney fees, wrongful death, funeral expenses (James Zadroga fund established for 9/11) first responders to protect frontline health care providers including but not limited to physicians, nurses, respiratory therapists, lab, transporters, security guards, ER techs, radiology technicians, emergency medical service providers, fire department and other first responders, advanced practice providers (e.g., physician assistants, nurse practitioners), certified nursing assistants, mental health nursing staff/MHTs and nursing home staff, and their families from financial harm resulting from exposure or infection.

Financial protection of families of healthcare workers who were exposed to family members above, who consequently suffer from short term and or long term disability, from complications COVID 19 and or death from exposure to a family member who is an asymptomatic positive carrier, who may or may not have been tested ASAP, because of lack of testing supplies, and eventually tested positive, or symptomatic positive Nurse who work in a healthcare organization who work with COVID 19 patients.

Financial assistance to nurses and their families at the time illness, disability or death of nurses and not to pursue extraordinary collection efforts (including liens, garnishment of wages, or seizure of real or personal property) in connection with claims related to COVID-19 or conditions related to complications arising from COVID-19.

Hazard pay for nurses working with COVID 19 patients. It could be a sliding scale based on risk of exposure to COVID 19 patients (acute care vs rehab vs nursing home etc)

Reimbursement of hotel/temporary housing and daily meal allowance for Nurses who directly work with COVID 19 patients who decide to self isolate or those who are under required quarantine during COVID -19.

 Full insurance coverage of medical and mental health services of Nurses without cost sharing during COVID 19 for COVID related care; and the same coverage for medical and mental health services as a consequence of PSTD and anxiety after COVID 19. This would include including care for complications arising from COVID-19, without cost-sharing. In the case of Medicare Advantage plans, require plans to provide coverage at no out-of-pocket cost, and regardless of whether treatment is obtained from in-network providers, with payment at a plan’s median in-network rate in the case of out-of-network care.

 Mental health care. Provide support to boost mental health workforce capacity beyond the period of a declared public health emergency in order to allow for care related to the consequences of COVID-19.

Provision of Federal funding to nurse led non profit organizations that would assist nurses during COVID19 and COVID19 related issues, research, mental health support etc.

Nurses will be reimbursed for immune system support such as vitamins, glutathione, vit C, B complex, thymosine etc. infusions while during COVID 19.

Debriefing be provided by healthcare organizations either through EAP or as provided by independent practitioners as an option for nurses for support and prevention of mental stress.

 V. Nursing Involvement in Decision Making

Nurses DO NOT have the intent to HARM anyone. We come to work to do the best we can to provide the safest care possible given the resources and environment provided to us. Over the years, we have been practicing under a healthcare framework that has, over time shifted from a caring model to that of a business and profit margin trajectory. It is high time, that the we would like to take the lead in decision making on how we can create transparency in healthcare organizations, so much needed change toward a more wholistic, preventive, caring, innovative, evidence based, integrated, technology based approach can be achieved. This will drive healthcare cost down and delivery safer and more efficient and proactive.

Require all healthcare organizations to involve staff nurses (not in a leadership role) from each department (following a Shared Governance Model) to have input in improving patient care processes, staffing ratio, staff evaluation and safety.

During this pandemic, staff input should be welcomed in establishing COVID 19 risk assessment, screening, diagnostic, reporting, treatment guideline, follow up, isolation protocol for every patient under investigation, positive asymptomatic patient, symptomatic patient (admitted and discharged);  as active member of an interdisciplinary team.

Patient Care Ratio Guidelines:

 Staffing: Maintain safe patient staffing ratio based on patient acuity, tasks, time involved to perform tasks, to ensure that nurses and other healthcare workers are given ample time to care for the patients safely and appropriately. Using infection control principles:

·      Consider the use of tasker with the primary RN.

·      COVID 19 patient be a 1:1 or 1: 2

·      Allow input from nursing staff regarding effective staffing ratio

·      Provide an opportunity for debriefing/and feedback regarding staffing in a non threatening environment

Staffing Expectations and Exemptions:

 Based on disease epidemiology, nurses who have co morbidities, such as chronic medical conditions, immune deficiencies, belong to the older age group (55 and above) and are pregnant are considered high risk in terms of morbidity and mortality. These nurses will be assigned in areas that render them to be least exposed to COVID 19 patients.

COVID 19 virulence is dependent on the person’s immune system. Regardless of the person’s state of health, constant exposure, stress level, among other factors. With the current limitation in PPE and cleaning supplies healthcare organizations should not penalize nurses who ask for breaks and split shifts to allow time to recup physically and mentally. As a part of Emergency stimulus pay that will be afforded to healthcare organizations, nurses and hospital staff should be provided with uniform allowance if not disposable scrubs to prevent the possible spread of infection in the healthcare worker’s households.

Nurses will be allowed to use an IPAD or a camera phone at their discretion using infection control practice to allow COVID19 patients on isolation to communicate with family members. Because this is about being human and this is the right thing to do.

 Supplies/Resources

Organizations are required to be transparent regarding status of resources and support for the healthcare team; and ask for government support/private organization support as needed

Organizations, for this pandemic, are required to request to create effective PAR levels for personal protective equipment (e.g. masks), ventilator equipment, IV saline, and other medically critical supplies to ensure our frontline providers can safely and appropriately care for patients with infection, with government decree if necessary. The Strategic National Stockpile and other similar resources giving priority to front line workers.

Organizations are required to create a plan for future pandemics to ensure that resources are adequate should a another pandemic happen. Infection control specialists/committee take the lead in serving as information liaison in tracking CDC guidelines and looking at other resources to recommend practices to prepare staff for similar events.

Healthcare organizations are required to create a contingency plan for a potential surge of patients with respiratory symptoms, which should include at least preparing separate waiting areas such as surge tents, preparing plans to deal with significant numbers of patients such as overflow areas, ensuring staff are aware of surge plans before implementation, establishing plans to respond if significant numbers of healthcare workers are exposed or sick and unable to work.

Whistleblower protection/no gag rule

Whistleblower protection and no gag rule; no workplace intimidation, threats/remove the culture of fear; due process and independent committee review of firing and suspension of Nurses.

Nurses, healthcare workers are allowed to file and sign an unsafe work environment form, to specify what PPEs, supplies are missing. This paperwork is filed and submitted in a general database without risk of retaliation or risk of being fired by the employee’s healthcare organizations.

Funding for Nursing Led Research Database, Registries

Healthcare organizations

Healthcare organizations required to report nurses/healthcare all healthcare providers who work during the pandemic, using de-identified data, identify those who were tested, when they were tested, symptoms if any and results, and outcome. (COVID19 Healthcare providers registry)

Nurses should be involved in community, county, state and national level planning for health and public health care related initiatives.

...As nurses we have adapted.a culture of selflessness. We have handed over our power to others, trusting and hoping that one day, when we are in dire straits, those people will do right by us. Clearly, we have now realized that there is no one defending us except for a handful of advocates. In order for the profession to survive and progress, we have to get out of our silos and experience the discomfort of confronting the reality that we have lost control of our profession. We are already defeated even if we haven't started the fight. There are over 500, 000 nurses in this country. If we are unable to unite, create a single statement and ask for the public to support us in demanding for protection for us and our families, then I would say the future of Nursing is bleak. On the other hand, with the courage and resilience that we all have shown in the last month, I believe that we are the sleeping giants in healthcare. With the knowledge, experience and lobbying power that we have, collectively, we can have this bill passed and create a better healthcare system that is efficient, cost effective, safe and innovative...

References:

Business Insider, Holly Secon, “At least 5 US health workers have gotten the coronavirus, and hundreds more are in quarantine. Hospitals may face staffing shortages as cases surge.” (March 5, 2020) https://www.businessinsider.com/us-healthcare-workers-have-coronavirus-hundreds- quarantined-2020-3

The EMS Infectious Disease Playbook, published by the Office of the Assistant Secretary for Preparedness and Response’s Technical Resources, Assistance Center, Information Exchange (TRACIE) is a resource available to planners at https://www.ems.gov/pdf/ASPR-EMS-Infectious-Disease-Playbook-June-2017.pdfpdf iconexternal icon.

“Health Care Priorities For A COVID-19 Stimulus Bill: Recommendations To The Administration, Congress, And Other Federal, State And Local Leaders From Public Health, Medical, Policy And Legal Experts, " Health Affairs Blog, March 12, 2020.DOI: 10.1377/hblog20200312.363618

Occupational Safety and Health Administration, “Guidance on Preparing Workplaces for COVID─19,” (2020) https://www.osha.gov/Publications/OSHA3990.pdf

Occupational Safety and Health Administration, Bloodborne pathogens, standard number 1910.1030, Full standard text can be found here: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS