In 2014, two Texas hospital nurses who were caring for the first person in the United States infected with the Ebola virus became infected themselves. Both survived, but the administrators of the Texas hospital were unprepared to deal with Ebola, and they provided little guidance to staff on how to protect themselves from the deadly virus. According to a lawsuit brought by one of the nurses against the hospital, nurse managers on duty printed out information from the Internet to understand how to care for the infected patient while protecting their staff nurses — information that was insufficient to prevent the two nurses from becoming infected.
Today, as health care workers on the front lines expect to treat patients with Covid-19, many health care systems and many states are reported to be unprepared. Nurses accept risks as part of their daily work with patients and families, as do ER physicians, nurses’ aides, paramedics, physical and occupational therapists, and other health care workers on the front lines. But what degree of risks should they accept when resources are limited or not available?
Nurses often face what is called moral distress — defined as knowing what should be done for a patient while at the same time being unable to provide the appropriate care, often because of constraints imposed by organizations or practice settings. Nurses who experience moral distress report feeling powerless and emotionally and physically worn out. Today, more than 3,000 health care workers in China have been infected with the coronavirus, and their colleagues must care for them — with compassion, but also with distress and with fear that the systems are not providing them with enough support.
Did we learn any lessons from Ebola? Working in crisis mode with Covid-19 presents similar scrambling challenges of protecting nurses and others who will care for sick patients or their co-workers. A recent nursing survey exposed the worries that nurses share about Covid-19: About half didn’t have information on how to recognize or respond to Covid-19, about one in four didn’t know if a plan was in place to isolate Covid-19 patients, and only about two-thirds reported having access to N95 masks. And, many didn’t know if there was a policy in place for co-workers who were sick or otherwise exposed to Covid-19. We need to do better.
A surge of patients in an emergency department, primary health clinic, urgent care center, or other health care facility could overwhelm health care workers who are trying to prioritize care needs, protect other patients who are in waiting rooms or hospitalized with compromising illnesses, and protect themselves in the process. Staffing levels across the country already vary depending on the type of health care facility, the complexity of patients within the unit, and the geographical location of where one is working. And data tell us that hospitals with lower levels of staffing, less educated nurses, and poor work environments affect patient outcomes.
Patients and families are scared when they are ill, and they rely on nurses and other caregivers to tell them the truth, trusting that they are prepared to do what is necessary to address their illness, protect their rights while hospitalized, and advocate on their behalf. Sometimes nurses and others have to work around system-related issues to do what is right for their patients, but what should nurses and others do, knowing that Covid-19 is fast approaching and their system may be unprepared?
Two years after becoming infected with Ebola, one of the nurses in Dallas settled a lawsuit against the owner of the hospital. The lawsuit accused the hospital not only of negligence but also of deception in how it handled its lack of support for workers. Organizations have a moral responsibility to their patients and employees. Education, staff training, and organizational transparency are key to mitigating fear, controlling outbreaks such as Covid-19, and providing quality care to patients when they are at their most vulnerable, who expect and deserve excellence. Nurses and others have a professional and moral obligation to use their voices to speak out and demand that organizations gather the resources needed for full preparedness, communicate up-to-date changes on protective guidelines, and develop plans on how to allocate limited resources, including if, and when, staff become sick with Covid-19. Let’s not place our nurses and other clinicians in vulnerable, compromising, and morally distressing positions.
Connie M. Ulrich is a professor of nursing and bioethics at the University of Pennsylvania and the Lillian S. Brunner chair at the University of Pennsylvania School of Nursing.
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