“Nurses are heroes” is a statement that every American has heard repeatedly in the past few weeks because it is absolutely true. But while our health care workers appreciate the sentiment, praise does not necessarily translate into actions to support them. In fact, the Wisconsin Federation of Nurses and Health Professionals (WFNHP) has been sounding the alarm about the treatment of nurses in the Badger State.
“We see the signs that say, ‘Heroes work here,’ and we hear this celebration of nurses and health care workers on the front lines; we call them heroes, but we’re not actually treating them like heroes,” WFNHP Executive Director Jamie Lucas declares in an exclusive interview.
Worldwide, an estimated 90,000 health care workers—and possibly twice that amount—are believed to have been infected by coronavirus. In Wisconsin, more than 10,000 people have tested positive for the virus, and 1,250 of them—at least 12% of all positive cases—are health care workers, according to the state’s Department of Health Services. The exact number is unclear, but, as the Milwaukee Journal Sentinel reported, “Many area hospital systems have been tight-lipped about the number of staffers infected with COVID-19.”
‘Don’t Talk to the Media’
“All the health care employers are putting out statements to their employees that say, ‘Do not talk to the media without talking to our communications team first. Make sure that you communicate within our values.’ It scared people into not wanting to put themselves out there, which is why we are unfortunately seeing a lot of feel-good stories from nurse managers, but there are not a lot of front-line nurses actually talking,” according to Jamie Lucas. This journalist can confirm that hearing the experiences of nurses on the front lines has proven extremely difficult. Much of it could be attributed to the workload required by the current pandemic, but some hospitals have been actively denying access to their workers for interviews.
While Milwaukee hospitals are publishing feel-good stories about heroic nurses, such as the Milwaukee Veterans Affairs Medical Center (Milwaukee VA) and Froedtert Hospital, nurses themselves sing to a different tune.
“We had a nurse from the Milwaukee VA who participated in the daily City and County briefing; he is an ICU nurse working directly with COVID patients. He talked about his experience caring for them, what it's like to wear the personal protective equipment (PPE) for long periods of time, and how important it is for people to stay home,” Jamie Lucas retells. “Then, he got word that the Human Resources wanted to conduct an investigation into him and possibly discipline him.”
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“I think that the perspective of front-line caregivers is one of the most powerful things that could push us in the right direction. I believe that, if nurses were able to decide what our health system look like, we would have a better system. I think the CEOs know that as well, and that’s why they’re not as interested in allowing that perspective to be heard.”
Staffing Issues
As the country suddenly finds itself in dire need of critical care workers, several strategies are being employed to provide the necessary services. Nurses are made to work longer shifts and reduce their time off, new staff members are brought in, and workers from other services are asked to care for coronavirus patients in the intensive care unit (ICU). This is why they are called “heroes,” although many of them don’t have much of a choice because they care.
“Paradoxically, one of the issues we are dealing with are furloughs,” Lucas points out. He blames a health care system more concerned with short-term profit over long-term reliability for this. “Some people who work in elective procedures have been reassigned to take care of COVID patients, so they’re being redeployed throughout the hospital to provide direct care. But there are folks who are just being told, ‘Sorry, there's no work for you,’ and they’re sent home without pay.”
At the same time, the WFNHP reports cases of nurses from other units who have to take care of ICU patients while not receiving ICU wages. “The standard is that ICU nurses make a higher salary as a recognition of the difficulty their jobs,” Lucas reports, “but they're not being compensated as ICU nurses.”
The Milwaukee VA Medical Center has a different point of view: “The medical center is providing a monetary reward to specific employees who were instrumental in providing direct care or supporting the care of COVID-19 patients through very specific activities,” Milwaukee VA spokesman Gary Kunich shoots back. He explains that nurses redeployed to intensive care function as support for ICU nurses, rather than taking on the full responsibility of caring for coronavirus patients. While these nurses will not receive regular ICU wages, “nurses who routinely provide care to COVID-19 positive Veterans will be eligible for special retention bonuses.”
The Wisconsin Federation of Nurses and Health Professionals does not consider this sufficient. Their recommendation is to “make staffing the priority,” which means going above and beyond to care for front-line workers regardless of costs. “Money should be reinvested back directly into the people who provide care, not to reward CEOs and directors of medical centers with lavish salaries,” Lucas says. “I think there’s an effort that needs to be undertaken in this country to make sure that caregivers are taken care of because, that way, patients are well taken care of. If you take care of nurses, you take care of patients, and we’re all going to be a patient at one time or another.”
PPE Shortages
Front-line workers are more endangered by COVID-19 than anyone else, as they willingly expose themselves throughout the day to care for patients. As such, their survival is directly linked to the availability of proper equipment. The Centers for Disease Control and Prevention (CDC) recommends that health care personnel wear a N95 respirator, a face shield or goggles, clean gloves and a clean isolation gown to keep themselves safe.
The supplies of masks have been front and center in the news, and the issue has been addressed by numerous actors since the beginning of the pandemic. On Thursday, April 30, Gov. Tony Ever announced that “Wisconsin has received a delivery of 230,000 N95 respirator masks from the Federal Emergency Management Agency,” as well as technology to help decontaminate the masks.
“I heard from nurses that I've talked to this week that they’re not concerned about the supply of N95, right now,” Lucas says. “What they are concerned about is being told to reuse their gowns. Certain facilities are low on the reusable gowns, so they’re trying to reuse gowns that should not be reused. They’re having different procedures like hanging them outside, and you have to wear them one way, and if you accidentally reverse them, you put the side that was exposed directly up against your body. The longer that they’re told to ration, the more mistakes are going to be made.”
Due to nationwide shortages of PPE supplies, the CDC offers guidelines on strategies to optimize the use of PPE or alternatives to masks and gowns when supplies are exhausted. One such strategy is to “augment laundry operations” to wash and reuse washable gowns. This is a sticking point that WFNHP has been fighting for.
“This is something that’s true across all healthcare systems that I’m familiar with: Nurses and respiratory therapists who are actually in the room with COVID patients are not getting their scrubs collected and laundered at the end of their shift. They’re risking to infect their families when they come home at night because their facilities aren’t laundering their scrubs,” Lucas deplores. In particular, he points to a currently ongoing case with the Milwaukee VA: “We’ve requested that they collect and laundry the scrubs and issue clean scrubs at the beginning of the shift for health care professionals working directly with COVID patients, but this has been denied by the VA.”
“All new nurses are provided three to five scrub uniforms at no charge,” explains Milwaukee VA’s Gary Kunich. “When the scrubs become soiled or not usable due to normal wear and tear, nurses can exchange the scrubs for a new set at no charge. [...] Our procedures are consistent with CDC guidelines in keeping our staff safe from COVID-19.”
The WFNHP filed a grievance report specifically asking the VA to resort to exceptional measures to face the exceptional circumstances of a global pandemic, instead of only doing the minimum that is contractually required of them. The WFNHP requested that the hospital either provide new scrubs on a daily basis or augment laundry services to clean scrubs whenever they might have been exposed to coronavirus. Jamie Lucas says, “I think that we have a strong case that, with an aerosolized virus like COVID-19, any clothing or materials that's exposed during a procedure like an intubation should be considered contaminated.”
Despite the grievance being escalated several times, the Milwaukee VA repeatedly denied it on the grounds that they consider their current efforts sufficient. The VA initially did comply with union demands when the pandemic first broke out, but it stopped doing so because “within a few days, the ICU RNs had time to adjust and bring extra clothes to change into,” the VA’s Nurse Executive Annette Severson wrote in response to the union’s grievance. “The agency complied with its contractual obligation, but its actions did not establish a separate duty to provide scrubs on an ongoing basis to RNs who already receive a uniform allowance. [...] Accordingly, this grievance is denied in its entirety.”
“Our next step is arbitration, but that’s a month-long process. We could get a decision when it's no longer relevant,” Lucas laments.
‘Do More With Less’
The United States has the most expensive health system among OECD countries, costing the U.S. government $10,586 per year and per person, far above the OECD’s average of $3,994. The second most expensive health system in the organization is Switzerland’s, at $7,317. In addition to that, unlike citizens of countries with universal healthcare, the average American worker pays an astounding $7,000 per person or $20,000 for family coverage in health insurance premiums every year, according to research done by the Kaiser Family Foundation.
As Americans spend vastly more on health care than anyone else, it would stand to reason that the country’s health care system would be adequately funded and ready to face a public health crisis. That is not the case.
Despite paying several times as much as their European counterparts for health care, Americans have poorer health than inhabitants of peer countries. By comparing health outcomes with 11 other high-income countries, a 2018 Harvard study found that “life expectancy in the U.S. was the lowest of all 11 countries,” “the proportion of the U.S. population with health insurance was lower than all the other countries,” and “the U.S. has lower rates of physician visits and days spent in the hospital than other nations.” “The study confirmed that the U.S. has substantially higher spending, worse health outcomes and worse access to care than other wealthy countries,” it concludes.
This disparity between health costs and results became particularly glaring with the COVID-19 pandemic. The U.S. quickly became the country with the most coronavirus cases and the most deaths in the world, with almost 82,000 Americans with the virus having died. The U.S. has one of the lowest number of hospital beds per capita in the OECD, only 2.8 per 1,000 inhabitants. So, why is there such a massive gap between the cost and the results provided by the American health care system?
“One of the key reasons that stand out to me is that the private sector creates a delivery-of-care model that exploits the goodwill of caregivers. There are literally billions of dollars in private corporations, but they say, ‘Do more with less,’” Jamie Lucas says. “Over the years, they’ve ramped down staffing numbers to cut costs. Health care corporations are brands competing for customers, which disincentivizes cooperation; but in a public health crisis, you need a coordinated response. These are all things that make it really hard to respond to the current pandemic.”
“I think that there’s a disconnect between people who make the rules and the people who live in the reality of those decisions and who know the consequences. If there’s no profit incentive, it becomes harder and harder to get resources spent on the right things,” he adds.
“We need hazard pay. We need adequate PPE so we’re not sterilizing and reusing things beyond their intended use. We need free, affordable and safe childcare for health care and front-line employees. And we need free medical coverage and testing for all exposed people. We have to ramp up testing capacity, and that includes testing health care workers.”
The coronavirus pandemic could be the chance for the U.S. to rethink their health care system. “I’m hopeful,” Lucas admits. “I really hope that, when we come out of this, we will not go back to normal, but instead we will be going forward, towards something better.”
