ANA-VT COVID-19 Survey Responses and Recommendations
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Coalition of Vermont Nurse and Nurse Practitioner Leaders Responds to the ANA-VT Survey on COVID-19:
Themes and Recommendations
On March 20, 2020 the American Nurses Association began a survey of nurses nationwide about their access to PPE and other work environment concerns. According to findings from more than 20,000 respondents released with a message from Ernest J. Grant, Ph.D., RN, FAAN, President, American Nurses Association:
- 76% reported being extremely concerned about PPE,
- 66% reported being out or short of N95 respirators,
- 62% were out or short of full-face shields, and 61 percent were out or short of surgical masks.
- 69% reported concerns about working short-staffed.
- 85% also worry about keeping their families safe from becoming infected.
Between March 26 and April 10, 2020, ANA-VT conducted an on-line survey of VT ANA members and non-members (about 600 nurses). The survey was also shared by multiple leaders, and was pinned on the ANA- VT website, so response rate is unknown. Data was received from 135 respondents. The survey was a 10-question survey with the last two questions having text responses. Question #9 asked, what are the most urgent needs, challenges, or concerns for information, resources or other that would help you in this environment; while, Question #10 asked, about rationed PPE.
- 72% reported feeling properly trained and prepared in PPE use.
- 66% reported being knowledgeable and prepared to work with COVID-19 patients.
- 71% indicated employer support in protecting themselves and others.
- 47 % of respondents feel protected in their workplace.
- 32% indicated the workplace is equipped to handle COVID-19.
- 49% feel concerned or afraid to go to work due to COVID-19.
A second one sentence survey open from 4/6 - 4/9 inquired:
“Nurse parents have told me they are afraid their children will be left alone, parents are afraid to go home to families. Some have inadequate protective equipment. Tell me your story or sentence to share, so others will know what you are experiencing. You are not alone.”
Vermont Nurse and Nurse Practitioner Coalition members Hendrika Maltby PhD, RN, FACN, Professor at UVM Department of Nursing, and Carol Conroy DNP, RN, CENP, FAAN, president-elect of ONL MA-RI-CT-NH-VT conducted a qualitative analysis of the ANA-VT qualitative survey responses and found the following themes. The themes are like those identified in the national survey.
- Infection control: mostly lack of PPE supplies and having to use single-use equipment for longer time periods.
- Impact on families and patients: inability to keep their own families and patients safe.
- Communication: changing messages ALL the time.
- Moral support: need/want more of this.
The first theme showed that nurses were extremely concerned about infection control. Many of the comments revolved around reusing N95 masks, face shields, and gowns. Statements here included “N95 masks being told to keep "indefinitely" if not visibly soiled which has changed from 5 hours, to 8 hours, to end of shift to now indefinitely…Masks and surgical gloves are dwindling too”; “wondering how safe reusing n-95 masks is when continually dealing with COVID positive patients”; and, “We are reusing PPE that is hung on a wall near COVID rooms”.
The next theme also showed that nurses were extremely concerned about keeping their own families and patients safe. Nurses stated “I’m afraid to go home after my shift because I am afraid to pass something to them even if I’m being extremely careful”; “There is no one to raise my child if I die, no family;” and, “having to decide not to see my kids in the meantime. I have not seen them for three weeks. Everything feels unbalanced.” They were also worried about the impact of the COVID-19 on cancer patients as well as staffing needs in the ICU. “I worry that the PPE I have available at work is inadequate. I fear that I will expose patients in my care to COVID-19, or that I will bring it home to my children or immunocompromised family member.”
Communication was seen as an important theme, with comments ranging from “Communication coming from too many sources,” needing more communication, but wanting to be reassured that the information they did get was reliable and evidence based. “The sheer volume of information and practice change that I deal with on an hourly basis is overwhelming;” “communication coming from too many sources. Daily changes make it difficult to keep up;” and “while I know things are evolving rapidly and more is known each day. Regardless it seems that sound evidenced based principles and thinking are not always prevailing.”
Nurses want more support from their administrations and from each other. “We have no options. In my case I have an elderly parent that is immune compromised. The thought of bringing it home to them broke me down because I only had one choice, to leave, which has given me guilt, and loss of the team I loved to work with, loss of income, loss of health insurance;” “Stay Calm; treat each other as if we are all victims;” “we need PPE, but the message from hospital leadership is that this is bankrupting us and we are losing our benefits, hours, and even jobs, do right as we are gearing up to face a pandemic;” and “we need more moral support.”
In collaboration with other VT Nurse and Nurse Practitioner Coalition members, Drs. Maltby and Conroy developed the following nursing leadership recommendations to address the concerns expressed by VT nurse survey respondents.
Identify the most recent and reliable information related to PPE to keep your front-line workforce informed.
- ANA’s COVID-19 Resource Center for nurses is your one-stop resource for all things COVID-19. org/coronavirus?utm_campaign=261605%20COVID-19%20MKT&utm_source=hs_email&utm_medium=email&utm_content=86359291&_hsenc=p2ANqtz
- In times of crisis management, difficult decisions are made under stress, and standard operating procedures and guidelines may have to be altered, as is the case in the Crisis Standards for PPE.
- It is important to conduct a daily crisis command center huddle and communicate clearly and effectively with frontline clinicians and other healthcare workers about important issues such as availability of PPE and the conservation strategies that may have to be in place.
Keep informed of the evidence-based practices to follow at work and at home.
- CDC Guidelines for Preventing Getting Sick can help in making decisions about returning home to families after work. In addition, as far as going home with work clothes, it’s back to nursing 101; have designated shoes for work, change clothes prior to going home, or once home remove, placed in laundry and wash hands (you may feel better with a shower too). No special precautions for laundry or food, it’s all about contact, hand washing, and social distancing.
- The American Medical Association provides the following guidance https://www.ama-assn.org/practice-management/physician-health/how-doctors-can-keep-their-families-safe-after-providing-COVID
- AMA’s Dr Mark Rupp, professor and chief of the infectious diseases division at the University of Nebraska Medical Center (UNMC) in Omaha, recommends safe practices in the workplace, handwashing and removal of work attire upon arrival at home, and judicious social distancing at home.
Keep informed of the most reliable sources for information.
- The American Organization of Nurse Leaders https://www.aonl.org
- In collaboration with the American Hospital Association, AONL maintains a comprehensive resource for updates and continues to monitor COVID-19.
- The CDC is another source of evidence-based updated information. https://www.cdc.gov/coronavirus/2019-ncov/index.html
- The Vermont Department of Health is an interactive and updated trusted source. https://www.healthvermont.gov/response/coronavirus-COVID-19
- The American Public Health Association has shared science-based information with the public and are speaking out for outbreak response funding and support. https://apha.org/topics-and-issues/communicable-disease/coronavirus
- The International Council of Nurses provides a COVID 19 portal which includes links to important COVID-19-related resources and is continually updated. The portal also provides an opportunity for nurses to share their learnings, experiences and stories during the pandemic. https://www.2020yearofthenurse.org/story/icn-COVID-19-update-17-april-2020/
- The American Association of Nurse Practitioners has a resource page updated Monday - Friday free to anyone https://www.aanp.org/news-feed/new-recommendations-for-health-care-providers-2019-novel-coronavirus
Seek out resources for stress reduction and self-care.
- ANA Vermont is hosting a series of on-line “nurse drop-in huddles” focused on providing an opportunity to explore the impact of the stress of the pandemic with a skilled facilitator. (Meredith to add link for session information)
- Contact your organization’s EAP for specific programs they are offering.
- Ask if your organization has a peer support group or start one with your colleagues.
- Write down a list of what kinds of things help relieve stress for you. Share them with others and make time to do them.
Consider contacting elected officials with comments, questions and concerns.
- Vermont’s government website enables one to find a legislator and send an email from the site. https://www.vermont.gov/
As one of the survey respondents stated: “I believe a strong, nurse led approach will be critical in driving solutions. We also need to listen to the voices in front of the front line: housekeeping, clerical and support staff, primary care, and others who see patients in the community before they ever set foot in a hospital or ER.” Now is the time to stay Nurse Strong!
Hendrika Maltby PhD, RN, FACN, Professor at UVM Department of Nursing
Carol Conroy DNP, RN, CENP, FAAN, president-elect of ONL MA-RI-CT-NH-VT