National Nurses United

workers, who had to wade through the agency's constantly changing rules and practices, including failure to fit workers for N95 respira- tors, forcing RNs to bag their respirators to reuse after a certain number of days has passed, and even depositing masks for reuse after so-called "disinfection." There was even a policy mandating use of surgical masks, and only requiring N95s for aerosolizing procedures. Such policies, Risner said, were aimed at conditioning health care workers "to take shortcuts and not protect themselves." "They've trained nurses to just throw all infection prevention common sense out the window," Risner said. "They've all gotten used to not wearing proper PPE." Risner, who has been a nurse for more than 32 years, said she resisted "taking any of the shortcuts" the VA administrators wanted to impose. "There is no emergency to die over. You always have time to put on a mask, shield, and other PPE," said Risner, who has also been active in fit-testing colleagues for N95s. "A police officer doesn't go into a dangerous situation without a bulletproof vest and a gun, and a firefighter wouldn't go into a burning building without fire- retardant material. We are being forced to go into a global pandemic with a sheet of paper over our mouth." "Because of our union, we made demands and they were met because we rattled cages and made noise," Risner said. "They knew they had to change things because if not, we would be out in the streets staging protests and talking about what is happening inside there." Similar battles played out between RNs and University of Cali- fornia administrators who forced reuse of PPE or, in some cases, just surgical masks for health care workers. "They didn't think we needed it," said UCLA Medical Center emergency room nurse Mar- cia Santini about N95 masks. "They said it wasn't airborne or something we can worry about. [But] we knew from Italy and China that this was more than just droplets." That bad policy, however, was reversed after a sea of nurse-led protests and press conferences swayed administrators by "getting the public on our side," said Santini. "It was a tough battle but even- tually we won all these fights." But the return to facility-wide single-use policies is half the battle for some nurses who have to reprogram themselves as well as col- leagues to observe proper pre-Covid infectious control protocols. Muhindura said she has to remind herself to keep changing her PPE and thinks the facility management can do a better job encour- aging others to do the same. For example, her facility has not formally disclosed the single-use policy, which has muddied efforts to get all health care workers back to proper infection control practices. "Prior to Covid, there was a time when you would get disciplined for using PPE incorrectly," she said. "I would like to have more edu- cation from them to encourage the proper use of PPE and the way things were done before Covid-19 started." Amy Arlund, an ICU nurse at Kaiser Permanente Medical Center in Fresno, Calif. and a CNA/NNOC board member, said she believes that management at her facility is purposely not being explicit about stating or enforcing a single-use N95 standard. Management hasn't discouraged single use, but has given hints that could encourage reusing PPE. "Over the course of time, the corporate model has driven every- thing," said Arlund. "It all comes down to budget and money and the costs of expenses. They've had messaging like 'being a good steward of your PPE,' and that makes it seem like we [should try] to stretch our PPE to make sure it lasts." Still, Arlund said nurses are fighting to make sure single-use is the policy. "We are fighting back, and 99 percent of the nurses" will do the right thing if educated and feel solidarity with their union colleagues on the issue, Arlund said. U ltimately, single-use N95 respirator infection control practices cannot depend upon the policies of individual hos- pitals or chains, but upon national, enforceable workplace standards. That's why NNU continues to lobby the White House and OSHA to implement an OSHA emergency temporary Standard (ETS) that would require respiratory protection, plans, and other measures to prevent workers from becoming infected through aerosol transmis- sion of the virus. Securing an ETS was a primary goal during NNU's national lobby day during Nurses Week this year. When Michigan Nurses Association registered nurses virtually briefed two members of their state's Congressional delegation, Reps. Debbie Dingle (D-Mich.) and Rashida Tlaib (D-Mich.) in April 2021, more than a year into the pandemic, they described dangerous N95 and PPE practices still in place at various Michigan hospitals that the lawmakers and others had assumed must surely have been corrected by now. They assumed wrong. "The Michigan protection standard does not address the dangers of reuse; we need the federal government to issue a strong standard that prohibits reuse of N95 respirators and other single- use PPE," said Carie Babcock, an RN at McLaren Lapeer Region Hospital in Lapeer, Mich. "Yes, I signed up to be a nurse but I didn't sign up to work without the resources I need to do my job and stay safe." On International Nurses Day, NNU president Jean Ross, RN joined dozens of other RNs who helped place empty, white shoes to commemorate each of the 403 U.S. nurses who have died due to the pandemic. Ross urged the White House to pass the ETS as a "standard so that we could stay healthy, safe, and alive to care for our patients." The standard was due to be issued in March, but as of press time had still not been promulgated. Some NNU members are also pursuing reforms at the state level. In California, nurses are urging state lawmakers to pass AB 805, a bill that would create transparency for PPE procurement and distri- bution at a local level by requiring reporting about distribution of PPE to the California Office of Emergency Services. "While we carry the emotional scars of this pandemic, we also hold the insights on how best to address the failings that tragically led to the deaths of more than 62,000 Californians and 578,000 people in the United States," said Sandy Reding, RN and a president of CNA/NNOC. "The changes we seek will strengthen our ability to care for our patients, and lead to a healthier California." Ty Richardson is a communications specialist at National Nurses United A P R I L | M AY | J U N E 2 0 2 1 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 N A T I O N A L N U R S E 17 "You have to retrain your brain. We have been brainwashed for the last year, but now we have enough PPE on the floor. I am not doing the 12-hour shift with a single mask."

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