National Nurses United

"At this point, 11 months into the pandemic, they could start improving the 'care work' by reducing the Covid-19 risk by giving us the PPE we need and by enforcing the OSHA standards, such as they are," Burger said. "They can also start improving the policies that would address the risks." W hen forced by employers and the government to work under crisis standards of care, then, nurses are the ones at their ends of their shifts stuck with the deep psychological distress that comes from knowing what they should be doing to take best care of their patients, but are constrained and prevented by their employers from doing so. In some cases, some have even been attacked for their advocacy. "These standards include rationing care because of an insufficient number of qualified staff and rationing resources such as PPE, ICU beds, ventilators, and medications," according to the report. And not only are nurses torn between their obligations to their patients and the realities of how much work one nurse could pos- sibly take on, they are often also caught between the need to protect themselves and their families and their job duties. In NNU's latest survey, some 80 percent of nurses reported fearing that they will infect a family member. In numerous cases doc- umented by NNU, nurses have infected household members and some have even died. "For many [nurses], their greatest fear is infecting their own families," according to the paper. While this concept of moral distress and moral injury is not new, the "Deadly Shame" paper thoroughly applies these concepts to what nurses are experiencing during the Covid-19 pandemic. Many nurses have spoken up about their trepidation in wearing PPE between Covid-positive patients' and unknown-status patients' rooms, fearing that they could be the very ones spreading Covid. "The first rule in medicine is to 'Do no harm,'" said Lee. "But [when we wear the same PPE] I feel like I'm doing harm. There, I said it. I feel like I'm doing harm." Lee is not alone. Such concerns have been echoed by scores of NNU members who have participated in the union's collective actions in recent months, including RNs who took part in an Aug. 30 protest at HCA's MountainView Hospital in Las Vegas. The day's action was to protest understaffing and the controver- sial policy of forcing nurses to use "decontaminated" N95 masks, a practice which NNU has determined to be neither safe nor effective and therefore threatens both nurse and patient safety. Nicole Koester, an RN at the protest, told a local TV station that "nurses don't feel like they're able to provide very good care for their patients simply because the hospital will not provide the resources and staffing that we need to do our jobs." The paper states that such stress could lead to mental health con- ditions such as insomnia, psychological distress, depression, anxiety, post-traumatic stress disorder, and cautions that "these effects may persist long after the pandemic ends." It's critically important that nurses are educated about these con- cepts of moral distress and injury, and the underlying reasons why this is happening—employer prioritization of profits over patients and workers and government that has been heavily influenced by corporate interests—so that they can properly assign blame where it should reside: with their employers and government. Research shows that it can be common for nurses to internalize their moral distress and injury as feelings of guilt and shame; somehow they were not good enough. But nurses who externalize their moral dis- tress and properly ascribe it onto the "responsible actor(s)" often feel anger and resentment, which can be much more easily channeled into constructive action. "I have an 11-year-old son at home. I just don't want to take this Covid home to my family," said Juan Anchondo, an RN and chief nurse representative at Las Palmas Medical Center in El Paso, Texas. "We are mentally, physically, and emotionally tired. But we do get energized when we fight back and speak up." O f course, the first and foremost priority is to properly value registered nurses, other health care workers, and all essential workers by protecting them and reducing their risks of expo- sure to Covid. 16 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G O C T O B E R | N O V E M B E R | D E C E M B E R 2 0 2 0

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