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April, 2020 Nursing COVID-19 Survey


What the nurses said during the COVID-19 pandemic

During this COVID-19 pandemic in the US, there are multiple reports about the bravery of nurses and doctors taking care of patients who are ill with the COVID-19 virus. These reports also describe long working hours for hospital staff and shortages of N95 masks, surgical masks, gowns, and ventilators. As the virus continued to spread, news of inadequate staffing and insufficient hospital beds, particularly in the ICUs, flooded the media.

In a survey of 3,300 nurses in New York reported by the New York State Nurses’ Association on April 1, 2020, 64% of the nurses said they have inadequate protective personal equipment, and 72% said they had been exposed to COVID-19.

A report from the principal deputy inspector general’s office at the Health and Human Services Department, conducted from March 23 to 27, 2020, also indicated a shortage of protective personal equipment in hospitals.  The report includes information about increased use of masks, from 200 a day to 2,000 in one instance.  Also, the supply chain for more equipment is faulty. Hospital administrators report that shipments from the Strategic National Stockpile they had received were not sufficient in quantity or quality. Administrators described getting supplies from the federal stockpile that were less than requested. They received masks for children instead of adults and received masks that were outdated by 10 years, some with dry-rotted elastic bands.  They also received masks that were construction masks instead of N95 ones. The complete report is available at https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf. President Trump disagreed with this report and is seeking to replace Christi Grimm, the primary initiator of the study at HHS.

From April 3, 2020, to April 29, 2020, RnCeus Interactive asked nurses throughout the US about the accessibility to protective gear and ventilators as well as adequate staffing. The nurses who cared for patients with COVID-19 described from their experiences the signs and symptoms they saw, indicating a patient infected with COVID-19 was improving or worsening. A total of 100 healthcare professionals responded to the survey. 86% of the participants were RNs, 7% were LPNs, and 7% were other healthcare workers.

Results concerning PPE, ventilators, and staffing

The most significant findings included 33% of the participants saying they have scarce to no N95 masks. Also, 25% said they had scarce to no surgical masks available, and 23% said they had scarce to none of the protective gowns. Nurses who work in prisons and long-term care facilities also commented that PPEs were scarce. On April 28, 2020, The New York Times reported over 13,193 inmates have been infected with the coronavirus across the country. A greater number of infected inmates is possible since testing is limited. Nurses working in a variety of settings are at risk. During April of 2020, over 30% of the participants in the survey from across the nation, were inadequately protected from acquiring COVID-19.

There were 9% who said they had scarce to no ventilators available. Patients are also at risk because of lack of equipment.
Only 7% of the participants said staffing was scarce, but 80% said there was plenty or sufficient amount of staff.

We have concluded that nurses and other staff were able to meet the demand for patient care during this pandemic. However, between 23% to 33% of those nurses and healthcare providers lacked adequate protection from contacting the COVID-19 virus.

COVID-19 patients cue recognition

Eighteen nurses responded to the questions about cues that indicated a patient ill with the COVID-19 virus was improving or worsening. The responses focused on improving or worsening respiratory symptoms. Improving patients had a decreased need for oxygen as indicated by better oxygen saturation numbers. Worsening patients had increased respiratory distress with lower O2 stats despite interventions. The fever in the improving patients diminished but for those whose condition was getting worse, the fever was constant or increased. Nurses also noticed patients who were recovering reported feeling generally better. Those who were failing had additional symptoms such as course respiratory crackles bilaterally, agitation, lethargy, diminishing consciousness, and tachycardia.

General comments

Nurses are concerned about the lack of adequate PPE. Being front line responders, they know better than most the communicability and seriousness of COVID-19. They are worried they may not only contract the disease but may bring it home to their family. Besides, they are forced to use masks for an entire shift and then recycle them for later sanitization. All these approaches are contrary to the rules and regulations that have been standard practice.

Nurses are also concerned that testing of the staff for the virus is inadequate.

Nurses also find it heart wrenching to see patients be so ill and lonely without the comfort of friends and family members.

This preliminary survey indicates a need for more research in how this pandemic affects nurses in practice. More data can contribute to identifying what needs to be done to protect nurses from becoming ill from the coronavirus. More data from the experiences of nurses caring for these patients, can improve outcomes for patients.

Here are the statistical results of the survey

Demographics of participants

Registered Nurses = 86%
License Practical nurses = 7%
Other = 7%

  1. Kindly describe the accessibility of the following equipment in your healthcare setting.
    COVID-19 Survey of U.S. Nurses During April, 2020 (n=100)


    Plenty

    Sufficient

    Scarce

    None 

    *NA

    Total respondents

    N95 masks


    5%

    45%

    22%

    11%

    17%

    100

    Surgical masks

    15%

    46%

    23%

    2%

    13%

    99

    Protective gowns

    7%

    51%

    19%

    4%

    18%

    98

    Ventilators


    9%

    33%

    6%

    3%

    49%

    99

    Adequate staff


    30%

    50%

    7%

    0%

    13%

    100

    *NA – nurses not in clinical areas
    Additional Comments:
       a) Staffing down due to low census
       b) No goggles, face shields, hair covers, or shoe covers


  2. If you have cared for a patient with the COVID-19 virus, describe signs and symptoms that indicated the patient was improving.

    General decrease in symptoms
    • Decrease in cough
    • Decrease in O2 requirement
    • Decrease in respiratory distress
    • Decreased fever
    General improvement in symptoms
    • Improved O2 stats
    • No need for O2
    • Feeling better, no fevers, no coughing, less weakness

  3. If you have cared for a patient with the COVID-19 virus, describe signs and symptoms that indicated the patient was getting worse

    Worsening symptoms
    • Decrease in O2 stats
    • Increased work of breathing
    • Temperature elevation
    New adverse symptoms
    • Course crackles bilateral
    • Agitation
    • Tachycardia
    • Respiratory distress
    • Lethargy
    • Vomiting
    • Decreasing level of consciousness
    Need for additional treatment
    • Elevation of head of bed
    • Needs more O2
    • Increased ventilation requirements

  4. General comments

    Politics
    a) Recommendation to take hydroxychloroquine tries to put health professionals in the role of political operatives when patients ask about it. We took an oath to do no harm.
    b) Tax dollars and staff time spent on political initiatives while patients not able to get needed treatments, such as biopsies, heart catherization and so forth.

    Supplies
    a) We do not have proper protective equipment given the fact that this disease transmits asymptomatically.
    b) Although we have "enough" PPE now, it is concerning that we are being asked to use just one level 1 mask for the entire shift & recycle our used N95s for later sanitization if needed. Everything we have been taught is getting redirected by the new findings from the CDC or WHO.
    c) I am praying that we have enough supplies for our healthcare workers.
    d) Concerns that people are wearing gloves and masks that the nurses and doctors should have for their protections.
    e) Need more PPE
    f) Our facility is well staffed and prepared, just waiting for the surge if and when it happens?

    Concerns for themselves, their families and staff
    a) Concerned that no vaccine is available at this time
    b) Do not want to bring this virus home to my family
    c) Need more testing for all staff in hospital
    d) I am a school nurse furloughed without unemployment

    Additional concerns