National Nurses United

18 www.NationalNursesUnited.org NNU's advocacy to get the CDC to improve their Ebola guidelines. Whatever the arena, nurses know there are certain ele- ments that must be a part of every standard, guidelines, and employer prevention plan in order for nurses and patients to be fully protected. These elements include: • Staffing — Ensuring that every employer and any standard, guideline, or policy understands that nurse staffing levels are key to patient safety and nurse safety. • Training and education — Ensuring that training and education are effective, hands-on, and in-person. Nurses are increasingly being given computer mod- ules to complete while on shift. This is not effective training. Nurses should know what their employers' plans and policies are, how to know whether they are working or not, and how to inform their employer so that the employer will fix the problem. Hands-on training can be vital for many elements, including donning and doffing (putting on and taking off) PPE procedures. • Transparency and reporting for employers — Standards and guidelines should always ensure that nurses and other health care workers have access to their employers' written prevention plans, training modules, records of incidents, records of investiga- tions, and other related information. This ensures transparency in the employer's process and allows nurses full access to the information that they need to practice safely. Additionally, standards and guide- lines may call for employers to report directly to state agencies to ensure that there is public knowledge of conditions in health care facilities and accountability for employers. • Precautionary principle — All employer preven- tion plans and standards and guidelines should incor- porate the precautionary principle. This ensures that nurses and patients are protected even in the face of the unknown, such as an emerging disease epidemic. • Employee involvement — Employers must engage the expertise of nurses when creating effective pre- vention plans. All standards and guidelines should include this requirement. • Medical service and other protections — Employers should provide a medical services pro- gram at no cost to employees that provides medical evaluation and surveillance for employees with potential exposure to infectious diseases. The pre- sumption should exist that exposure occurred in the workplace. • Prohibitions on retaliation or discrimination — Nurses and other health care workers should be able to raise concerns about their employers' preven- tion plans without fear of retaliation or discrimina- tion. These protections should always be explicitly included in every standard and guideline. In addition to this organizing and advocacy that directly addresses infection prevention, nurses can continue to look at the bigger picture in which infectious diseases emerge, are transmitted, and prevented. The public health infrastructure in the United States is fragmented and underfunded. Nurses encounter the impacts of this system on patients every day. Health care workers are most often the first line of contact for infectious travel- ers. The lack of protections for health care workers was demonstrated clearly in the SARS and the Ebola epidem- ics. The profit-driven health care system typically reacts to infectious disease outbreaks rather than taking a pre- cautionary approach to protect workers and patients. The US needs a single-payer health care system to reorder priorities in health care system, economic and political reforms, the simultaneous funding of public health systems including vector control and emerging disease research and vaccine/diagnostics development. This sys- temic change is necessary to protect global health.

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