Metaphors of war are often used to describe COVID-19 nurses: they’re “our front lines,” combatting “an invisible enemy” in an existential global battle. But when nurses lack adequate personal protective equipment they can become not only the valiant hero, but the weapon itself if they are infected.
“Nurses are the staff members who are with patients the most. If nurses don’t have PPE, then we are going to get sick. That’s what we’ve seen in California and New York: providers and nurses getting sick because they ran out of PPE. Nurses don’t want to get sick, then we can’t take care of the people who are sick,” said Rebecca, an El Paso nurse who asked that her real name not be used because she feared retaliation from her employer.
On May 1, nurses in El Paso staged protests at the Hospitals of Providence, Las Palmas and Del Sol medical centers as part of a national day of action organized by National Nurses United. One week later on May 8, nurses again protested at Las Palmas, after alleging a nurse was suspended by the hospital administration in retaliation for speaking out about unsafe working conditions.
Through protest, Rebecca and other El Paso nurses wanted to send a strong message to their hospital administrations about worker safety.
“For me, the main goal of our protest was to put pressure on the hospitals to give nurses access to the PPE, or at least information as far as the amount of PPE that we have. How careful do we need to be? And why do we get so much pushback when we ask for an N95 mask in a situation that feels unsafe to us?” Rebecca said.
Hospital administrations say nurses are being given adequate PPE, and that recent demonstrations are a union attempt to increase membership, rather than a reflection of actual conditions within local hospitals.
“While our hospital currently has adequate supplies of PPE, we continue to provide safeguards that are consistent with (Centers for Disease Control and Prevention) guidelines to help ensure the protection of our colleagues, not only today, but into the future as the pandemic continues to evolve,” said Jerry Gonzalez, chief nursing officer of Las Palmas Medical Center.
To explore nurses’ concerns, El Paso Matters spoke to eight nurses from Del Sol Medical Center, Providence Memorial Hospital, Las Palmas Medical Center and The Hospitals of Providence Sierra Campus. Some nurses asked to remain anonymous out of fear of retaliation by hospital administrations. In those cases, their names will be changed and which hospital they work at will not be identified.
Reasons for protesting
Nurses at all four hospitals identified lack of adequate personal protective equipment and unsafe PPE protocol as the main reasons they joined public demonstrations. PPE access varies not only by hospital, but also by department and unit.
Sylvia said PPE protocol changed dramatically in her unit when the COVID-19 pandemic began
“We used to have everything readily available. The gowns were right outside the door, disinfecting wipes, masks too. We knew that as long as we took the necessary precautions, we had a lower risk of contracting any illness. Now, everything has disappeared off the walls. There’s no more gowns. Even the disinfecting gel is gone. Now all day long I’m running around in what I would consider very limited PPE.”
Idali Cooper, a pediatric ICU nurse at The Hospitals of Providence Memorial campus, said PPE is being rationed at her hospital.
“They’re not giving us the sufficient amount of PPE — asking us to reuse gowns and N95s and even the surgical masks. As soon as those masks get moist, which can be anywhere from two to four hours, they don’t protect you the way they should be protecting you. Providence is asking nurses to use one gown per shift per patient, and that has never been the protocol before this COVID pandemic. Or the N95 mask with the surgical mask — these have always been single use equipment.”
The N95 masks used at Providence (Halyard* N95 respirators) are labeled as single use and are not designed for extended use. However, with the COVID-19 pandemic has come a relaxation of CDC safety standards for PPE, designed to mitigate shortages of protective equipment. Halyard’s website directs users to the CDC’s guidance for extended use and reuse of face-piece respirators.
New CDC guidance to conserve PPE resources contrasts sharply with pre-COVID standards, and some medical professionals are worried that these new standards are putting medical workers at unnecessary risk of illness.
Several nurses said that colleagues in their unit had purchased their own PPE, because PPE provided by the hospital was inadequate. Emily, an ICU nurse, said she bought her own N95 masks. “A lot of the nurses here have done that, they’ve gone out and bought their own respirators, their own face shields, their own bunny suits,” she said.
A Providence hospital memo warned nurses that if they bought and used PPE other than what was already provided, the hospital would not be liable if the nurse tested positive for COVID-19.
In addition to lowered standards for PPE safety protocol among nurses, nurses at multiple hospitals in El Paso describe heightened barriers to accessing PPE when a nurse determines he or she needs it. The rationing of PPE has involved it being locked up, moved to different (sometimes far away) parts of the hospital, and added requirements of justification and paperwork to access.
“Why are (N95s) locked up? Why isn’t it just a standard, if we’re doing aerosolizing procedures and we know that this is an aerosolized virus. (The hospitals are) clearly putting profits over PPE, where you want to resume elective surgeries as fast as possible to make money, but at what cost?” said Hector, an operating room nurse.
Ethical dilemmas from lack of PPE
Insufficient PPE can put nurses in the position of having to choose between themselves and their patients. Isabel Cabatic, a charge nurse in the ICU at Del Sol, says she has not experienced PPE shortages in her unit but said nurses who experience it face ramifications.
“There should never be a decision between the patient and you. You shouldn’t be having to make that neglectful decision of saying, well I don’t have the PPE, should I just jump in there? You should be saying, I need to make sure that I’m safe before going into that room. If you don’t have the PPE readily available within the unit, then yes of course, I will admit that is a huge problem.”
Sylvia has found herself in that ethical quandary. “Let’s say I run out of gowns because I have to go see different types of patients. If I run out of gowns or masks, I have to go and justify the reasons why I ran out and why I need more. And if we hear a bed alarm or a code blue, I can either run in there without safety gear, or go to the nurses station to pick up a gown and a mask, delaying the response time with the patient.”
Emily has also observed this delay connected to diminished PPE access.
“Last week we had a COVID patient that we needed to intubate. After intubation everyone had left, and this patient started to go into respiratory distress. I was not assigned PPE for that day, so I couldn’t go in there to help. Normally if a patient’s in distress, anybody can go in and help. But because we don’t have access to PPE, there’s a delay in care.”
Dispute over adequacy of CDC guidelines
Hospital administrations are placed in a difficult position when it comes to balancing the needs of worker safety against preparedness for possible PPE shortages. “We follow the guidelines recommended by the Texas Department of State Health Services and the Centers for Disease Control and Prevention for appropriate PPE use and conservation,” said Monique Poessiger, spokeswoman for The Hospitals of Providence.
But some don’t think following CDC guidelines is enough.
The American Hospital Association has lobbied Congress to lower safety standards for medical workers, and experts say that newly relaxed CDC guidance for PPE procedure endangers medical workers. Some nurses say that what the CDC now describes as “adequate” isn’t adequate at all.
“We’ve never had adequate PPE (since the start of the COVID-19 pandemic), and I don’t mean the same terms that hospital administrations will say are adequate PPE,” said Emily, an ICU nurse. “That’s going by the CDC guidelines, and they lowered all the standards. The only reason (the CDC) changed their recommendations is because they were lobbied by the American Hospital Association, and the AHA represents large corporations like Tenet and HCA. It was based solely on the fact that they didn’t have enough supplies and the financial burden that it would cost.”
Tenet Health owns The Hospitals of Providence, and HCA owns Las Palmas del Sol Healthcare.
Not all El Paso nurses feel that they are being unprotected by their hospital administration. Some say hospital leadership has undertaken significant measures to protect and help nurses through this period.
Christian Holguin, a charge nurse at Las Palmas Medical Center ICU, has been using the hotel service provided by Las Palmas Del Sol Healthcare to avoid exposing his grandmother (who he lives with) to COVID-19. Holguin says the protests caught him off guard: “I was surprised because as far as us, working in the COVID-19 unit, PPE is very accessible.”
Isabel Cabatic, a charge nurse at the Del Sol Medical Center ICU said, “If your mask is soiled or you feel like it’s compromised, you simply go and say, I need another one, and they give it to you. I have never met resistance with obtaining PPE. You have to be realistic in a pandemic, because PPE, there’s a shortage worldwide.”
Charge nurses like Holguin and Cabatic are considered part of hospital administration, and are not allowed to join nurse unions or publicly criticize the hospital.
Uneven protection among nurses
The May 8 protest took place in response to an incident at Las Palmas Medical Center in which an operating room nurse voiced concerns about safety protocol for elective surgeries.
“Last Monday they started doing elective surgeries again. Nurses were told that they were going to test every patient for COVID-19, and that ‘If they come out positive we’ll cancel the surgery,’” said Rebecca, another nurse at Las Palmas. “But then they were like, ‘well, we’re gonna test every patient but we’ll leave it up to the surgeon’s discretion even if it’s positive.’ The hospital is taking advantage of units that aren’t strong in the union to give them the most basic, least comprehensive, cheapest hospital protection that they can.”
Gonzalez, the chief nursing officer at Las Palmas, acknowledged the hospital did not have test results for the elective surgery patient in this incident, despite the previously stated protocol to test all patients for COVID-19 prior to elective surgeries. But he said the nurse’s union is misrepresenting the facts of the case in order to expand their membership. He said Las Palmas Del Sol Healthcare is the only hospital system in El Paso testing all patients for COVID-19 prior to procedures.
The protesting nurses reject suggestions that they’re simply out to build union membership. They say their fears are legitimate.
“We’re doing the same thing that we’ve always done. We’ve taken care of patients that were highly infectious before, it’s just that we’ve never had to protest for our safety before,” said Emily, the ICU nurse. “When there was West Nile, H1N1, we were risking our lives every day, risking taking it home. But before, we had what we needed to protect ourselves.”
Cover photo: Nurses from Las Palmas Medical Center and Providence Hospital protest the lack of personal protective equipment and other policies they say may put them at on May 8. (Corrie Boudreaux/El Paso Matters)