Overall, 42% of responding nurses still are experiencing widespread or intermittent PPE shortages. Slightly more than half (51%) of nurses had treated a positive or suspected COVID-19 patient in the last two weeks. Nurses in long-term care, hospice, and staff nurses in general were most likely to be experiencing PPE shortages, the ANA reported.1
“The top on our list has been and remains ensuring a sufficient supply of the highest level of PPE,” Ernest J. Grant, PhD, RN, FAAN, president of the ANA, said during a press briefing. “This is an imperative and nonnegotiable. It is troubling that six months — six months — into the COVID-19 pandemic, nurses continue to report that PPE shortages persist. Reuse practices of single-use PPE are on the rise.”
From July 24 through Aug. 14, 2020, 21,503 nurses responded to the ANA’s survey on PPE availability, reuse, and contamination practices. Nurses from a variety of settings were asked to report their experiences from the previous two weeks. Not all nurses responded to all questions, so the percentages reflect those responding to individual questions. Based on the survey results, the ANA calls for:
- the full use of the Defense Production Act to increase the domestic production of PPE;
- passage of the Medical Supply Chain Emergency Act of 2020;
- expanded investment in testing and public health infrastructure.
“The key findings are alarming,” Grant said. “Over half — 58% — said they are reusing single-use PPE like N95 masks for five or more days. [In addition], 68% say the practice of reusing single-use PPE like N95 masks is required by their facility’s policy.”
These practices and the overall shortages continue to put nurses under mental and emotional stress. Nurses say they feel unsafe and they are concerned about exposing their families.
“The conversations that are occurring with my colleagues include, ‘I’m not sure I can do this much longer’ or ‘I never thought would consider leaving nursing,’ said Jennifer Gil, BSN, RN, a staff nurse at ANA and a clinical nurse in the emergency department at Thomas Jefferson University Hospital in Philadelphia. “These comments are occurring every day. I never thought that would happen, or even that those words would come out of my mouth.”
Saying it was a moral and strategic imperative for the nation to protect its nurses, Grant said reusing single-use N95 masks was begun as a crisis response and should not become accepted practice.
“The ANA does not support this as a standard practice,” he said. “We understand it has to be done because of the continued shortage, but there needs to be a better way. We need to reach a point in this pandemic where nurses do not have to function in a crisis mode. We need make certain that we have enough PPE.”
Grant cited the example of a nurse in Texas who was assigned five N95 respirators in March and was reusing them months later. “That gives you some idea of the anxiety nurses feel — this is why they feel uncomfortable and unsafe having to reuse these,” he said. “Yes, they have undergone decontamination, but there is the protentional that as they are continuingly [reprocessed] there could be breakdown in the structure that may allow the virus to penetrate.”
Disturbingly, 14% of responding nurses, said they re-use N95s for more than two weeks.
“[That is] beyond the [Centers for Disease Control and Prevention] contingency limit of five additional days,” says Tener Veenema, PhD, MPH, MS, RN, FAAN, a professor of nursing at Johns Hopkins School of Nursing. “That is very concerning. Masks may be contaminated with other things than SARs-COV-2. [Methicillin-resistant Staphylococcus aureus] and C. diff are in hospitals. Things splash on masks — blood, saliva, body fluids. All of these things were the rationale for the single-time use.”
The health of nurses has such a direct effect on patient health that it makes sense to spend the money needed to ensure adequate PPE and staff retention, she says.
“All efforts to ensure the protection and sustainment of this workforce are a sound investment that will translate into positive health outcomes for all of us,” Veenema said. “Science saves lives.”
Although the pandemic caught the healthcare system largely unprepared, it is time to start thinking of lessons learned before the next one hits, she says.
“Think of this pandemic, in all honesty, as a harbinger of what is to come,” Veenema said. “This will not be the last infectious disease outbreak that we are forced to deal with. It’s really critical that we be forward-thinking.
“This is a [biological] event has really rendered the U.S. vulnerable across a number of different levels — public health, economics, and security. This is a critical opportunity to think how we can do things better. PPE is one of those issues that can be addressed and corrected,” she said.
For example, an alternative respirator that has been highly recommended by the National Academy of Sciences is the elastomeric filtering facepiece respirator, which is reusable and can be cleaned, disinfected, and stored, she said.
Although these survey results are specific to nurses, other healthcare support staff, environmental services, and nutrition workers may have access to adequate PPE. “We also need to be looking at the design and engineering of new innovative types of PPE that provide nurses and other healthcare workers with better comfort and tolerability while maintaining high filtration efficacy that doesn’t require fit testing,” Veneema says. “[We need] affordable, adequate inventories and a robust vendor supply chain to ensure the continuation [of PPE].”
- American Nurses Association. PPE Survey #2 Final Report. Sept. 1, 2020.