Press items show nurses pushing for safety in Covid settings and beyond
April 2020 pieces highlight nurses advocating for safer practices, despite efforts to silence them. Buzzfeed reported that a California hospital had suspended 10 nurses for refusing to care for Covid-19 patients without N95 masks, which the physicians had. The nurses later got the masks. And the New York Times ran Theresa Brown’s op-ed about how she was forced to quit a clinical position because she kept advocating for safer practices. That dynamic seems widespread in the Covid era.
April 22, 2020 – Recent press items have shown nurses speaking out about serious problems in the clinical setting, particularly the lack of personal protective equipment (PPE) needed to care safely for Covid-19 patients. On April 16, Buzzfeed News posted a good report by Emmanuel Felton about a California hospital that had suspended 10 nurses for refusing to care for Covid patients without N95 masks—masks that the hospital had provided for physicians to wear. Many press sources ran a strong Associated Press piece about this. But Buzzfeed had good quotes from nurse Chelsea Halmy, such as: “We spend significantly more time with these patients than doctors. It just made us feel like they are valuing the lives of the doctors more than the nurses.” Halmy also faulted the Centers for Disease Control (CDC) for setting inadequate standards for masks and other PPE, echoing the concerns of her union, National Nurses United. The hospital—Providence St. John’s in Santa Monica—finally relented and agreed to provide the N95 masks for nurses. And as Time reported today, the suspended nurses returned to work. Meanwhile, on April 21, nurse-writer Theresa Brown had a strong op-ed in the New York Times about why hospitals try to silence care givers who raise the alarm about serious problems, like shortages of staff, PPE, and tests. In Brown’s view, it may relate in part to litigation and regulatory concerns, but it’s mainly about the corporatization of U.S. health care, with its “branding” and ruthless competition. Brown herself was forced to resign from the hospital where she practiced not too long ago because she wanted to keep writing about issues in the clinical setting, which her employer thought made it look bad. Like the California nurses, Brown persisted. These stories show nurses advocating forcefully for their patients and themselves, despite the apparent efforts of hospitals to silence them and pretend all is well. We thank those responsible for these pieces.
Some health workers are more equal than others
The April 16 Buzzfeed piece relates the basic story of the suspension of the 10 nurses at Providence Saint John’s Medical Center—a Catholic hospital—for insisting on having N95 masks to care for Covid-19 patients. But it also includes some great details. First, there is a priceless photo of many of the diverse group of nurses. The photo captures them as seen down a hallway of the hospital, dressed in scrubs and masks (looks like surgical masks, not N95s), each with one arm raised in a fist of solidarity. And way down the hallway, basically in the middle of the group as the photo is framed, appears to be a statue of Jesus. His arm is not raised in a fist, but the implication seems to be that He is standing with the downtrodden against the oppressor.
The piece notes that the hospital’s nurses say they got inferior surgical masks while the more effective N95s were reserved for physicians. It quotes Halmy:
We spend significantly more time with these patients than doctors. It just made us feel like they are valuing the lives of the doctors more than the nurses.
The article says Halmy told her charge nurse that she would not work with Covid patients unless she had an N95. But instead, “senior management” appeared, asking her to sign a form that reportedly read:
Failure to accept a direct order is a violation of our Hospital policy and is considered insubordination. In addition, we would need to consider if it is reportable to your licensing body as patient abandonment or other professional misconduct.
Halmy wrote on the back of the form that she wanted to care for patients, but did not feel safe without an N95. Within a few days, the hospital released a statement to the Associated Press saying that despite the national shortage, it would be providing N95s to all nurses caring for coronavirus patients. The piece adds helpful context, noting that Halmy also blames the CDC, which “has lowered its standards for nurses and other health care providers working with coronavirus patients.” Halmy asks how the same type of masks the public wears to the supermarket can be proper protection for nurses caring for critically ill Covid patients in a small room for 12 hours. The article also quotes National Nurses United (NNU) copresident Jean Ross as saying the CDC guidance is part of the Trump Administration’s larger failure to protect health workers during the crisis; Ross attributes the relaxing of the standards for masks to pressure from the American Hospital Association. And on April 22, Time had a story credited to “Martha Mendoza/AP” saying that the nurses had been reinstated, based on a statement by NNU. Evidently the hospital had set up a system to “disinfect and reprocess” the scarce N95 masks.
The Buzzfeed story and the other reports are very helpful because they show nurses advocating so forcefully for safe clinical environments. The masks don’t just protect the individual nurses, but also their patients, and ultimately the whole society, which needs health workers who are not infected so they can continue to provide care. Sadly, it’s also a picture of a hospital administration appearing to focus not on the critical health issues to which nurses alert them, but on squelching dissent, as if that would make the problem go away. Of course the PPE shortage puts hospitals in a difficult position. But surely the answer is to work collaboratively with staff on solutions, not pretend there is no problem and punish care givers for trying to protect themselves and their patients. And what really makes the Buzzfeed item stand out is how aggressively Halmy’s quotes go after the almost comically preferential treatment of physicians. For some hospitals, it appears that some health workers are more equal than others—even though, as Halmy has the temerity to point out, nurses spend far more time with patients than physicians do.
Theresa Brown’s op-ed is “The Reason Hospitals Won’t Let Doctors and Nurses Speak Out.” The New York Times identifies her as “a clinical faculty member at the University of Pittsburgh School of Nursing.” Her piece focuses on what she describes as “gag orders,” by which she means hospital policies barring health workers from speaking publicly about problems in the clinical setting. Brown explains that because of these policies, thousands of U.S. health workers fear that speaking out about shortages of PPE and staff may endanger their jobs. Yet they have a lot to lose if they don’t speak up, as they might infect their patients, their families, and themselves.
Brown says that although she is not currently on the front lines, she understands this dynamic well, because some time ago she herself was forced out of a clinical oncology position for her work writing about problems in the health care setting for publications like the Times. Apparently hospital administrators thought that, although she was careful to never identify the hospital, her writing was “making the hospital look bad.” She says the chief nursing officer claimed that Brown’s writing was compromising care and that several oncologists “who were never named and supposedly would not meet with me” had complained that they could not practice the way they wanted with her around. Brown was also subjected to intimidating meetings, while trying to care for critical bone-marrow-transplant patients, that left her with heart palpitations.
Why do some hospitals seem to value their public image more than their care givers and patients? Brown says potential reasons include fears of litigation and regulatory violations. But she believes the deeper answer is about the “corporatization of American medicine,” with health systems “focused on their ‘brand,’ outselling the ‘competition’ and making as much money as possible.” She describes her former hospital as being very hierarchical, with any questioning of policies and practices discouraged; she is not surprised that that hospital now has a “gag order” for the pandemic. This approach threatens patients: “The United States spends more on health care per person than any other industrialized country, but our patients overall do worse.” And not just patients—as Brown notes, nurses and physicians are also dying, as they lack needed supplies and tests. She praises the courage of those who speak out, but asks: “If the richest country in the world cannot care for its hospital workers, can’t we at least protect their speech?”
Brown’s piece shows readers a nurse advocating strongly and persuasively for health workers who are trying to save lives without proper equipment, only to have their managers respond with threats and disciplinary actions rather than any evident effort to fix the problems. There are grave shortages of equipment, but pretending otherwise does not improve the situation. However, experience shows that a public outcry might—as appears to have been the case with the hospital described in the Buzzfeed and AP stories. And Brown points out that this issue goes well beyond the current Covid-19 situation, as in her own case, where she was forced out for identifying other problems in the U.S. health care system. In addition, although Brown does not name names, she does not spare her former chief nursing officer or the anonymous oncologists. Sadly, that account of how a conscientious nurse’s clinical position came to an end is not unique. And it illustrates the power imbalance between nurses and physicians in the clinical setting—the same imbalance that might lead to a hospital issuing adequate PPE to physicians but not nurses. Brown’s op-ed is a timely reminder of issues driving some of today’s Covid-related conflicts.
See the article “These Nurses Were Suspended For Refusing To Work With Coronavirus Patients Without N95 Masks by Emmanuel Felton, posted on the Buzzfeed website on April 19, 2020.
See Theresa Brown’s op-ed “The Reason Hospitals Won’t Let Doctors and Nurses Speak Out,” posted on April 21, 2020 on the New York Times website.
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