Any nurse concerned about being ill-prepared to care for Ebola patients should be able to refuse the assignment. So says the leader of the American Nurses Association [ANA].
“We strongly encourage nurses to speak up if they believe there is inadequate planning, education or treatment related to providing care to these or any patients, and seek to resolve any conflicts of responsibility swiftly,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.
“Nurses should have the right to refuse an assignment if they do not feel adequately prepared or do not have the necessary equipment to care for Ebola patients,” Cipriano said in a news release.
At Texas Health Presbyterian Hospital where Thomas Eric Duncan — the first person to be diagnosed with Ebola in the U.S. — died last week, nurses publicly stated that nurses treating him lacked protective gear and that protocols constantly changed. Two of those nurses, Nina Pham and Amber Joy Vinson, were diagnosed with Ebola. Texas Health Presbyterian officials defended its Ebola procedures, saying it followed CDC protocols, USA Today reported.
Emory’s special isolation unit – one of five on the nation – has successfully treated three cases of Ebola without any medical professionals becoming infected. But even there, to allay fears, volunteers were sought and staff were allowed to decline the assignments, according to Forbes.
Around the world, about 400 health care staff have Ebola, and more than 230 have died, according to CNN.
Stopping Ebola in its tracks will require a global response to the crisis in West Arica and a collaborative approach involving interprofessional, state and federal organizations in this nation, said Cipriano.
Robin Farmer is a freelance content specialist with a focus on health, business and education. Visit her at www.robinfarmerwrites.com.
A recent survey by National Nurses United indicated that more than half of the 400 nurses surveyed weren’t confident that their hospitals could deal with an Ebola patient. The survey has certainly touched a nerve with nurses who will be on the front lines of caring for any patient with suspected or diagnosed Ebola.
And with two health care workers testing positive for Ebola, the stakes are high and the need for resolution and for action is immediate. Many nurse leaders have spoken out about Ebola preparedness, and each hospital offers varying stages of readiness. But as a nurse in your own setting, what do you think? Is your hospital ready if a potential Ebola patent walked into your ER or your clinic tomorrow?
If you have high confidence, you likely feel that your hospital is taking precautions and offering training and gear to protect staff. But what if you aren’t so sure?
In short, don’t be afraid to speak up and don’t delay in speaking up.
“Part of professional practice is based in knowledge and practicing in accordance with evidence-based guidelines,” says Tara Tehan, MSN, MBA, RN, NE-BC, SCRN, and president of the American Nurses Association Massachusetts. “Some nurses are looking at organizations and looking at gaps in preparedness.”
Nurses have a first-hand view of changing patterns among patient populations, so they are often among the first to spot areas that need improvements or that could pose a safety or health risk in cases like Ebola. As part of an interdisciplinary team, nurses should look at how the whole response effort would work.
“Nurses should make suggestions where they see gaps,” says Tehan. If there are missing elements of policy, equipment, or education, bring that forward, she says.
Because the Ebola situation is so new, people are in the process of becoming fully prepared. “Nurses play an important role in this,” says Tehan, noting nurses unique role. Patients trust nurses and may share information with them that they may not share with the rest of the team. Because of that, nurses know what the patients know and are feeling, and they know what they are experiencing.
Several recent surveys have shown that nurses are seeing gaps in preparedness and the gaps are potentially dangerous. Many reports have focused on having access to sufficient quantities of protective gear, but nurses also want education. For example, not only do you need access to the protective gear, but you need to know how to put it on and take it off as well.
As an advocate for their own safety and for patients’ health, nurses should bring attention to areas where they see critical responses lacking.
News that a second nurse in Texas has been struck with the deadly Ebola virus is likely to send an unprecedented sense of alarm through the public and health care community. It also renews focus on the CDC’s recently updated Ebola infection prevention and control guidelines for U.S. hospitals.
Nurses need to now how to treat patients and prevent the virus from spreading. Here’s a summary of the CDC guidelines:
Patient protection. Suspected Ebola patients should be placed in single patient rooms that have a private bathroom. The door should be closed and hospitals should maintain a log of everyone who enters the patient’s room.
Visitors should generally not be allowed to visit patients who might have Ebola. However, exceptions could be made on a case by case basis. If a visitor is allowed, they should be screened for Ebola and should also be given instruction on precautions, hand hygiene, and how to use protective clothing.
Personal protection equipment (PPE). Everyone entering a patient’s room should wear—at the minimum—gloves, a fluid resistant or impermeable gown, eye protection and a facemask. After exiting, the PPE should be carefully removed, and hands should be sanitized.
Patient care equipment. Wherever possible, dedicated, disposable patient care equipment should be used. Non-dedicated, non-disposable medical equipment should be cleaned and disinfected according to manufacturer’s instructions and hospital policies. The use of needles and other sharps should be limited as much as possible.
Monitoring and managing potentially exposed personnel. Nurses who have skin or membrane exposure to a suspected Ebola patient’s bodily fluids or secretions should stop working immediately and wash the affected skin surfaces with soap and water. (If contact was made through a membrane, such as the eye, the nurse should irrigate with water or eyewash). The nurse should also immediately contact health authorities.
Nurses who have unprotected interaction with a person who has Ebola (for example, if a nurse isn’t wearing PPE at the time of patient contact) should be evaluated and monitored for fever twice a day for 21 days after the last known exposure.
If a nurse develops symptoms of Ebola, including fever, he or she should notify a supervisor immediately.
Every hospital should have its own policy for dealing with patients suspected of having Ebola. As we learn more about this virus, the CDC’s guidelines and recommendations will likely be updated. Stay informed so that you can know the latest about how to help control this deadly disease.
Information about Ebola is coming fast and furious and in the midst of it all, nurses have lots of questions that need answers. In an effort to bring a national discussion about Ebola to nurses, National Nurses United is hosting a National RN Conference Call on Ebola on October 15.
The topic? Among other things, nurses will have a chance to weigh in on the pressing issue of if hospitals are really ready for Ebola patients. Nurses can call in at 3 pm EST (12 pm PST) to discuss the topics at hand or to listen. Click here to register for the call.
National Nurses United, a union and professional association of registered nurses, has been advocating for nurses and hospital staff to have full training and access to proper protective gear in case they encounter a potential Ebola patient. With more nurses reporting their low confidence in their own hospitals preparedness, the lack of communication about policy, communication, sufficient supplies, and proper access to effective gear is topmost on the minds of the nearly 2,000 nurses who have responded to a recent NNU survey.
Another recent survey by allnurses.com, an online networking community for nurses and nursing students, reflects similar sentiments.
Of the 3,000 nurses surveyed over the weekend, allnurses.com reports that 74 percent didn’t feel safe, as a nurse, with the unfolding Ebola situation. An equal number of respondents also didn’t feel safe with dealing with a potential Ebola patient. An almost identical amount also reported a virtual lack of communication or training about Ebola.
Nurses responding to the survey reported that what they most need is hands-on training and/or practice drills, better communication, and more education.
What do you think about these survey results? Do you feel ready to deal with Ebola?
With Ebola continuing to make worldwide headlines and affect thousands of lives across the globe, nurses in the United States are preparing for something unfamiliar. With the fluidity of international travel, a potential Ebola case is as likely to happen in a large city hospital as a small community one.
And while an alarming recent survey by National Nurses United revealed that 60 percent of surveyed nurses said their organizations weren’t ready to deal with Ebola patients, nurses on the front lines still have to be ready for something unexpected.
“It’s really about relying on the skills, education, and training all nurses have,” says Tara Tehan, MSN, MBA, RN, NE-BC, SCRN, and president of the American Nurses Association Massachusetts. “It’s about using your patient history skills and your assessment skills and gathering the information to get it right.”
Tehan says that while Ebola is not a new disease, cases on US soil are unprecedented. So health care teams must be on a higher alert to diagnose a patient’s symptoms, especially any in light of recent travel. According to the Centers for Disease Control and Prevention (CDC), symptoms generally appear within 8 to 10 days after exposure, but that period can be as short as 2 days or as long as 21. Ebola cannot be spread until a person begins to show symptoms, so early detection is critical to keep the disease from spreading.
Many Ebola symptoms can mimic other conditions, so it’s not an easy call when you’re faced with a patient who is exhibiting concerning symptoms. So what should nurses be aware of?
CDC guidelines say nurses need to watch for the following typical symptoms:
Fever
Weakness
Severe headache
Abdominal pain
Diarrhea
Vomiting
Muscle pain
Unexplained hemorrhage
The CDC has posted Information for Healthcare Workers and Settings on its site and also includes a checklist for health care workers who might evaluate any possible Ebola patients.
American Nurses Association President Pam Cipriano, PhD, RN, NEA-BC, FAAN issued a recent press release that calls for extra care and caution. “Now that the first travel-related case of the disease in the United States has been reported in Dallas,” Cipriano’s said in the release, “it is critical that all members of the health care team have appropriate knowledge, education, and personal protective equipment to effectively provide care to patients. ANA also underscores the need to practice meticulous infection control at all times.”
Being on a higher alert means following strict infection prevention measures and universal precautions, says Tehan. And Tehan advises nurses to have a low threshold for possible Ebola infections. The CDC, she says, is recommending that proper mechanisms be put in place if Ebola is suspected.
“We are relying on skills we already have,” says Tehan. “We haven’t had a patient in the US before but any time we see something we haven’t seen before and that has the potential for widespread transmission, we have to be alert.”
And although certain organizations and hospitals may be unprepared for seeing and treating Ebola effectively, Tehan says nurses are ready. “We are prepared,” she says. “This is what we do every day. Now it’s about applying it to Ebola.”
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