# 2110
It has been nearly 6 weeks since I last reported on the nurse's poll - ongoing on the Allnurses.com forum - asking if nurses would work without full protective PPE's (Personal Protective Equipment - masks, gowns, gloves, etc.) during a pandemic.
There are now more than 320 comments, and almost 1100 respondents to the poll. That is an increase of 300 votes since we last looked in.
Previous reports can be found here, here, and here.
While the polling question asked is whether nurses would work `during a severe pandemic with a shortage of PPE's', it is quite obvious from the responses that many nurses would be reluctant to work even with protective gear.
Many nurses have families, often including small children at home, and they believe their first duty is to their loved ones. Some fear being `locked down' inside a hospital, and unable to leave for weeks. Others fear taking the virus home if they are allowed to leave.
The comments are well worth reading in their entirety, particularly if you are a hospital administrator, charge nurse, or pandemic planner.
Although the numbers remain roughly the same as in late April, there has been a slow but steady downward drift in the percentage of nurses willing to work during a pandemic (ostensibly without PPE's). In April the number was 50.46% and now, with the addition of more than 500 votes, that number has eroded to 47.08%.
(click to enlarge)
With 30% of respondents saying `NO, I won't work', and another 23% undecided, the healthcare system could see substantial absenteeism before any nurses or techs are physically affected by the flu.
The assumption is 40% absenteeism due to illness or caring for an ill loved one. If this is subtracted from a pool of HCW's (Health Care Workers) already reduced by nearly 50%, then the number available to work could drop to 30% - that at a time when patient loads would be at their absolute highest.
If staff levels drop too far, it is possible that many of those who initially decided to remain would decide leave once they saw the impossibility of the situation.
If hospitals want to stay open, and not turn into modern day Bedlam's, they need to find ways to protect, and reassure, their staffs. Too few appear to be openly preparing for a pandemic, despite the ample warnings provided by the government.
The newly proposed pandemic guideline Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic , strongly recommends that very high, and high risk healthcare workers be provided 12 weeks of Outbreak Prophylaxis (Tamiflu) during a pandemic wave.
How many facilities will follow this recommendation is unknown.
Many facilities haven't stockpiled enough PPE's (masks, gowns, gloves, goggles) to last more than a week or two into a pandemic wave. It is hard to envision them rushing out to stockpile expensive antivirals.
Sadly, I've heard from several nurses that their places of employment `actively discourage' talking about pandemic preparations - that "it isn't good for their career".
This sort of attitude only engenders more mistrust among the staff, and will likely increase absenteeism during a pandemic. We need more openness, not less.
It is a big job preparing for a pandemic, particularly for hospitals, nursing facilities, and emergency response agencies. PPE's in large quantities are expensive. Even at today's wholesale price, 12 weeks prophylaxis of Tamiflu would run about $500 per employee.
And then there is the problem of storage and security. Roche's RAPP plan helps with some of these difficulties, but the price remains steep. The minimum order under that plan is 2500 courses, or at today's price - about $165,000 ($6 reserve + $60/course x 2500)
That's a heavy hit for any employer.
There will, of course, be some nurses who will work even without outbreak prophylaxis or adequate PPE's. But their ability to provide decent care will quickly erode as their patient loads go up and the number of staff goes down.
And hospitals do not run just with doctors, nurses, and techs.
Without adequate support staff; housekeeping, laundry, cafeteria/ kitchen, maintenance, clerical, lab, and security - many of whom may be reluctant to work during a pandemic - the ability of any facility to function is in question.
Hospitals and other health care facilities need to begin to talk openly to their employees about their pandemic plans. Some of them apparently are, but many are not. And that includes their support staff, as well.
They have a stake in this too.
Employee's deserve to know how their facility will protect them during a crisis, and they need to know how far along their preparedness is. Each department should be represented at the planning table, and they should be encouraged to solicit input from others in their department.
By being inclusive, sharing both the problems and decision making in their pandemic plan with their staff, health care facilities are far more likely to keep staff on hand during a crisis.
It isn't enough to say you have a pandemic plan, you need to share it as well.
Is the plan all on paper, with plans to purchase items at the last minute? Or are supplies currently being physically stored? Are there plans to buy or reserve antivirals? If so, who will get them? What about enhanced security during a crisis? What about extra patient supplies (IV's, disposables, meds)?
These, and many more questions, need to be answered publicly. And if the answers are not realistic ones that protect the staff, better solutions need to be found.
If hospital administrator's ignore the problems, or only discuss them behind closed doors out of earshot of their staff, they risk losing the confidence and support of their employees during a crisis.
And if that happens, they will have no one to blame but themselves.
