Last week, nurses at Kaiser Permanente Antioch organized a rally in the hospital parking lot to protest hospital policies restricting nurses’ access to personal protective equipment (PPE) — policies they say result in delays in patient care and increased risk to the health of hospital staff.
As cars circled the lot with their horns blaring, Monica Rizo, a registered nurse at the facility with 18 years of experience, expressed her concerns.
“Management keeps saying that we are going to get the PPE; we’re going to get the respirator masks,” she said. “They say that, but when we really get to work, they don’t have them. We’re just frustrated. We just don’t know really what else to do.”
The N95 respiratory mask is at the center of nurses’ complaints. Shortages of N95 masks have been widely reported since the COVID-19 pandemic reached the U.S. The shortage has influenced policies on the use of N95 masks for the treatment of patients with either a confirmed or suspected COVID-19 infection.
Guidance provided by the California Division of Occupational Safety and Health (Cal/OSHA) states, “In nonemergency conditions, covered employers must provide and ensure use of NIOSH certified respirators to all employees occupationally exposed to novel pathogens such as SARS-CoV-2.”
However, in light of supply shortages and anticipated patient surges, Cal/OSHA allows surgical masks to be substituted for N95 respirators during low-hazard patient contact. It’s unclear who decides when emergency conditions exist and when those conditions have passed.
A spokesperson for Contra Costa Health Services (CCHS) said in an email to The Press that no hospital in the county has yet certified a 30-day supply of PPE, but CCHS is not seeing a critical shortage of N95 masks.
Ann Wiliamson, regional chief nurse executive and vice president for Kaiser Permanente Northern California, responded to staff’s complaints this week.
“We understand the concerns and challenges we face during this most unprecedented time, but it’s important to know we are providing our staff with the personal protective equipment that is aligned with the latest science and guidance from public health authorities,” said Williamson. “These are the same supplies and equipment that are also being used by hospital systems in California and across the nation. We are prudently managing our resources to ensure this equipment is available for our health care workforce for the duration of this pandemic.”
According to Rizo, N95 masks are kept in a locked cart on the floor. If a patient suddenly requires chest compressions or other treatment that could result in the virus being aerosolized, an individual with a key to the cart, usually an assistant nurse manager, must be located and the cart unlocked. Once access to the PPE is made, treatment of the patient begins. Rizo said this process can result in the delay of patient care.
“Family members right now are not allowed to come to the hospital, rightly so,” she said. “We’re trying to protect them from us, and we’re trying to protect ourselves from them. So they’re not there. They’re not able to see that there’s a delay in care. I feel that the community needs to know that this is what’s happening when their loved ones code, and we’re scrambling to find the appropriate PPE to wear. It shouldn’t be this way. I’m completely appalled.”
Mike Marino is a recovery room registered nurse and chair of the Professional Performance Committee (PPC) at Kaiser Permanente Antioch. The committee fields reports from nurses who believe they’ve been given an assignment that is unsafe or cause for concern. The PPC then investigates the incident and may recommend policy or procedural changes to the hospital management. Marino noted a rise in reports about delays in care resulting from restricted access to PPE.
“We actually got a couple of (reports) that spoke of incidents that were time critical to patient care, and there was a delay, because the equipment wasn’t readily available to the nurses, meaning the PPE,” Marino said. “There was actually a delay in care that they actually filled out one of these reports after the fact saying, ‘Hey, if this ever goes to court, here’s what happened.’”
Williamson said Kaiser Permanente’s goal is to ensure access to PPE and medical supplies for staff members treating COVID-19 patients now and over the long run. For now, there’s evidence that her message may not have been received in all of the hospital’s units.
“I use my own PPE,” Marino said. “I have my own N95s stored away ready to go in my bag. I’ll still ask. I’ll still do the process. But I’m not going to risk my patient’s life because I’m standing around waiting for someone to come by with a key. It’s a shame I have to do that because I work for a multibillion dollar company. That’s what we’ve been reduced to.”