National Nurses United

were enough because they were not working in a hospital setting. Their hospital colleagues got N95s and other PPE first. "We were the orphans," Melissa Stroud recalled. "The hospital didn't want to give us any PPE. They didn't feel that we needed it. In the hospital, nurses got one mask per day unless it was visibly soiled." In Chicago, VA nurse Carolene Hill had a similar experience. "The focus for PPE was on ER and ICU frontline nurses," remem- bered Hill who has been a nurse for 32 years, including 20 years in home care. "We were overlooked. The department only offered gloves. My own physician advised me not to work there. He told me, 'You are on the front line.' " Hill said the nurses lobbied management, demanding PPE and training on properly donning and doffing the equipment. As a former ICU nurse who had worked during AIDS and Ebola, she knew the importance of PPE during an infectious outbreak. "I also had to keep my veterans safe," recollected Hill who demanded PPE at the beginning of the pandemic and began wearing it right away. Meanwhile, her department waited until two months after the pan- demic began to send nurses to PPE classes. They gave home health RNs only one N95 to use for an entire month and a paper bag to store it in, suggesting that they spray the respirator with bleach to disinfect it. Hill demanded more than one N95 a month and was able to get a new one to use every week. The VA never officially adopted a PPE policy for home-based pri- mary care. The PPE policy adopted late last year was essentially, "You can use it if you want to." Now Hines VA nurses can get an N95 whe- never they want, but Hill noted, it took two years to get to that point, including letter writing, a march, going to the press, and an outbreak. Stroud bought her own PPE because she didn't feel comfortable going to homes with dirty masks. "I was in different homes every day," remarked Stroud. "I wanted five masks a day. In the beginning, N95s were only for Covid-positive cases. Now we get an N95 or KN95 for any direct patient care. It doesn't matter if they are posi- tive or negative. I love that." Glynn Cascolan said that it wasn't until he spoke up at a profes- sional practice committee in March 2020, that Palomar home health RNs even got N95s. Hospital RNs got PPE first. "We only had surgical masks, goggles, and paper gowns for aerosolizing proce- dures," recalled Cascolan, adding that infection control told home health that that was sufficient. In November 2020, he says his department got powered air-purifying respirators. Fast forward to today and they have access to N95s, but Cascolan says management would like nurses to reuse their N95. He refuses to do that and tosses it after each patient encounter. Kathleen Longwell, the main preceptor for Kaiser San Jose's home health RNs, said her employer initially limited the number of N95s nurses could get. And at the beginning of Covid, she noted that home health RNs were the only people seeing the patient. "No one else was going into the patient's home, not the social workers, doctors, no one else," said Longwell. Most of Longwell's patients are seniors, including some in their 80s and 90s, and many are hard of hearing. When Longwell is wea- ring PPE, they cannot read her lips when she's wearing a mask and a face shield plus they have a hard time understanding what she is saying. She recalled her manager telling her she only needed a surgi- cal mask to check on a particular patient. But to be safe, Longwell wore an N95 and it later turned out that the patient's PCR test was positive. "Thank goodness I had an N95," exclaimed Longwell who says Kaiser RNs can now get N95s whenever they want. Fortunately, not all home health nurses had to fight for PPE. Mary Beth Gagne has always had plenty of PPE during the pandemic and never had to reuse anything when caring for her pediatric, prenatal, or post-partum patients. Colleen Lunsford spends part of her time in the field seeing patients and the rest of her time in the office where she answers patient calls and checks orders from RNs, doctors, wound care, and follows up on labs, and more. "I always had enough PPE because I don't work as often in the field," said Lunsford, who worked as a psychiatric nurse for a decade and then in the ED and trauma unit before landing in home health. Dominican home health nurses only get one N95 to use per day and use alcohol wipes to clean their face shields between visits. Donning and doffing for home health nurses, PPE comes with its own unique chal- lenges because there is no designated area to don or doff it, plus they have to contend with weather. Chicago-based Carolene Hill said that whenever it is raining or snowing, she will take off her coat, don her PPE in the car, and bring whatever supplies she needs in a big plas- tic garbage bag. To avoid possible contamination, she leaves her coat in the car, which means she could arrive cold or wet (or both), par- ticularly when she is unable to park nearby. Hill said she and a colleague created a donning and doffing process and presented it to the department: 1. Put everything the RN needs in a plastic bag: yel- low gown, N95 in a paper bag, shoe covers, gloves, and another plastic bag; 2. Don in the car. 3. After visit, remove PPE at the door, putting all of it in a plastic bag, open the door with a clean glove, toss it into the bag and throw out the bag. Their proposal was never offi- cially adopted. In Maine, Mary Beth Gagne also faces harsh winters, with tem- peratures dropping to 5 degrees or even lower. She dons her PPE in the 22 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 A P R I L | M AY | J U N E 2 0 2 2 Glynn Cascolan, RN Palomar Home Health, Escondido, Calif. 27 years in home health; 29 years in nursing; Previous experience: behavioral health

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