Nurses face obstacles on front lines against Ebola

In the fight against Ebola, nurses are on the front lines, risking their own health to care for others. Now they want hospitals to have their backs.

With two U.S. nurses already stricken, several nursing groups and safety advocates argue that the risk at hospitals across the USA is higher than necessary because of widespread problems with preparedness training, infection control gear, workplace culture and nurse staffing levels.

The threat of Ebola lays bare these larger issues while underscoring the overall danger of working in health care.

The U.S. Occupational Safety and Health Administration reported 653,900 on-the-job illnesses and injuries in the health care and social assistance industry in 2010, more than in any other field, even manufacturing and construction.

Still, OSHA inspected only 138 of more than 5,000 U.S. hospitals in 2011, and state safety agencies inspected another 233, according to the National Council for Occupational Safety and Health, a Massachusetts-based coalition of worker safety advocates.

"In some respects, the Ebola outbreak has highlighted the need to have better safety programs in place in hospitals," says Mary Vogel, the coalition's executive director. "Ebola is one example of where they're falling short."

Hospital officials insist they're doing all they can. The American Hospital Association, along with the American Medical Association and the American Nurses Association, pledged in a statement to ensure "nurses, physicians and all front-line healthcare providers have the proper training, equipment and protocols to remain safe."

Some nurses do say they feel fully prepared. Ashley Britt, a charge nurse at University of Louisville Hospital, says nurses there frequently must isolate patients with severe, infectious diseases and care for them while wearing personal protective equipment. They take part in Ebola preparedness drills, gather for "safety huddles" at the start of each shift, and get the latest Ebola information from their hospital system, KentuckyOne Health.

"As nurses we're really confident," she says. "We have the proper protective equipment, the proper training. We're really ready."

But that's hardly true across-the-board, some nurses and nurse groups say. A national survey of nearly 3,000 registered nurses by the California Nurses Association found as of Tuesday that 84% said their facility hadn't educated them on responding to Ebola beyond a handout or an e-mail telling them to go to the U.S. Centers for Disease Control and Prevention website.

"There's a lot that's lacking," said Deborah Burger, co-president of the National Nurses United union. "In Liberia, Ebola is called 'the nurse killer.' ... Nurses (everywhere) are more at risk for contracting it because they are taking care of the patient with hands-on, intimate contact."

Burger says some nurses, for instance, lack proper equipment. Dallas nurses treating Ebola patient Thomas Eric Duncan, who subsequently died of the disease, have said their gear left skin on their necks exposed. And some nurses haven't received hands-on training with the equipment, safety advocates say — a big risk given the sheer volume of vomit, diarrhea and blood they may be exposed to with Ebola patients.

Burger's group, and Deena Brecher, president of the Emergency Nurses Association, are calling for proper training and equipment at all hospitals. The American Nurses Association and the American Academy of Nursing say nurses also need up-to-date information and must be involved in Ebola-related decision-making.

Kevin Kavanagh, an infection-control activist who leads the watchdog group Health Watch USA in Somerset, Ky., says training with infection-control gear is sorely needed, with advice on its use is still evolving. On Monday, the CDC released new guidelines, including wearing gear that exposes no skin and being supervised by a trained observer while putting it on and taking it off. A day later, a survey of 1,900 nurses by the online networking site allnurses.com found only 23% believe their facility can effectively implement them within a month.

Beyond training, safety advocates say hospitals must ensure there are enough nurses to provide safe care. Challenger, Gray & Christmas, a Chicago-based global outplacement and career transitioning firm, has seen rising healthcare job cuts, with 52,637 jobs eliminated in 2013 compared with 36,212 in 2012. Nurses were among them, although statistics didn't break this out.

"Many hospitals are down to bare-bones as far as nurse staffing," says Kavanagh. "Studies point out that nursing staffing, when it becomes stressed, is related to more (overall) infection."

Burger says it also means more nurses work overtime and extra shifts, risking fatigue. John Kauchick, a traveling operating room nurse who works mostly in Texas and New Mexico, says he once worked 23 hours straight.

Kauchick notes that workplace culture can also present challenges. Some nurse managers resist even science-based suggestions by front-line nurses, he says, relying instead on how things have always been done, and whistle-blowers are often punished. OSHA, in a 2010 request for information on exposures to infectious agents, pointed to "a weak culture of worker safety" in healthcare overall.

The bottom line, Kauchick says, is that nurses need support as well as the best equipment and training.

"We have to do many things, and we have to do more with less," he says. "My saying is: 'Give me what I need to do my job.'"