"Protocol breaches" are inevitable when nurses aren't properly trained on working with patients infected with Ebola and hospital supplies are lacking.
"Stop blaming nurses. Stop Ebola."
Those powerful words appeared on banner during a National Nurses United press conference over the weekend. As the Ebola crisis reaches a fever pitch here in the United States in the wake of the nation's first diagnosis and ultimately first death from the virus, it's becoming clear that we aren't prepared at the hospital level to deal with the disease.
As usual, nurses have taken the brunt of both the blame and the consequences.
First, a nurse was involved in the mishandling of Thomas Eric Duncan's initial ED visit when he was sent home, despite having been told of his symptoms and that he just traveled from West Africa. Commentators (including me) questioned that judgment: Why didn't the nurse tell a doctor in person?
Certainly he or she should have known that simply noting such information in the EHR wasn't sufficient.
And now, a nurse who cared for Duncan has tested positive for Ebola, despite wearing full protective gear. Although the CDC over the weekend blamed the nurse's infection on a "breach in protocol," director Tom Frieden apologized Monday for sounding like he was putting the blame on a single nurse or hospital.
But protocol breaches do seem to be easy to make. The protective gear not only has to be worn, but also removed in a certain order, and with meticulous attention to detail. Even one, inadvertent slip-up in the removal of the gear can spread the disease. In fact, experts recommend using a "buddy system" so healthcare workers will be more likely to do it correctly.
Ebola: Despite 'Full CDC Precautions,' Hospital Worker Infected
Did the nurse who's now infected with Ebola have a chance to practice and "ritualize," as Johns Hopkins Medicine recommends, the right way to remove the protective gear? Was there adequate training for the nurses before the virus reached their hospital?
It's easy to blame nurses and other healthcare workers for breaches in protocol that could potentially spread this disease, but how can they be blamed if they don't know what the protocol is?
National Nurses United says nurses aren't prepared to deal with Ebola crisis. It says that not only are nurses not properly trained, but that they often don't even have the right protective equipment or facilities to deal effectively with the disease.
"Nurses and other frontline hospital personnel must have the highest level of protective equipment, such as the Hazmat suits Emory University or the CDC themselves use while transporting patients, and hands-on training and drills for all RNs and other hospital personnel. That includes the practice putting on and taking off the optimal equipment," RoseAnn DeMoro, the group's executive director, said at a press conference Sunday.
She added that NNU has received "steady reports from nurses at multiple hospitals who are alarmed at the inadequate preparation they see at their hospitals."
What's more alarming are the results of a NNU national survey showing that a staggering 76% of nurses still say their hospital has not communicated to them any policy regarding the potential admission of patients infected by Ebola.
Really? Nothing?
The survey of 2,000 RNs at more than 750 facilities in 46 states and the District of Columbia also shows that even the availability of protective gear is sorely lacking. More than a third (37%) of respondents said their hospitals have insufficient current supplies of eye protection, and 36% say there are insufficient supplies of fluid-resistant/impermeable gowns in their hospitals.
A greater number, (39%) of respondents say their hospitals do not have plans to equip isolation rooms with plastic-covered mattresses and pillows and to discard all linens after use. Only 8% said they were aware that their hospitals have such plans in place at all.
NNU's demands for nurses and other healthcare workers are so basic, that it should be embarrassing for the United States healthcare system. They want:
- Full training of hospital personnel, along with proper protocols and training materials for responding to outbreaks, with the ability for nurses to interact and ask questions
- Adequate supplies of Hazmat suits and other personal protective equipment
- Properly equipped isolation rooms to assure patient, visitor, and staff safety
- Proper procedures for disposal of medical waste and linens after use
Protocols can only be adhered to if nurses know what they are. Protective gear can only be worn if it's readily available. And procedures can only go smoothly if they've been communicated and practiced. When that fails to happen, it's a recipe for disaster.
There is some movement on the horizon, however. At a press conference Monday, CDC Director Tom Frieden said his agency will "rethink the way we address Ebola infection control."
Alexandra Wilson Pecci is an editor for HealthLeaders.
