Deborah Burger, co-president of National Nurses United, says hospitals are still unprepared for Ebola and are hoping it just goes away. She told Congress that the federal government should order hospitals to comply with protection guidelines.
This article first appeared in the December 2014 issue of HealthLeaders magazine.
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Deborah Burger |
Deborah Burger, RN, is co-president of 190,000-member National Nurses United, the influential labor union that has loudly amplified nurses' fears that hospitals are not adequately preparing them for patients with Ebola and are placing healthcare workers in harm's way.
Last Friday, she was a centerpiece in a House Committee on Oversight and Government Reform hearing, insisting to lawmakers that hospitals should not be allowed to voluntarily comply with guidelines. Instead, she argued, the government should order it. Burger, who also represents the California Nurses Association, says President Obama should force hospitals to provide optimal protective gear for healthcare workers.
Afterward, in a 50-minute interview, Burger maintained that a lot of hospitals are still unprepared, are wishing Ebola will go away, and hope they won't have to spend much money. The interview was edited for brevity and clarity.
HLM: It appeared during the hearing that some lawmakers think the federal government, for example the Centers for Disease Control and Prevention, already has power to regulate or mandate hospitals to provide training and equipment. But the administration can't just snap its fingers and say what hospitals should stock without going through a lengthy rulemaking process. Is that your understanding?
Burger: Federal agencies, the Secretary of Health and Human Services, and the groups that are working together, don't want to mandate these guidelines, although there is some regulatory authority under CMS regulations for hospitals to receive Medicare funding.
But the reality is that it would take an Act of Congress or the president to mandate this. President Obama could justify an executive order. [Major General James M.] Lariviere [Deputy Director, Political-Military Affairs, Africa, for the Department of Defense] said Ebola is a threat to national security but somehow the CDC and HHS don't think so.
HLM: What, exactly, do you want to happen?
Burger: The quickest thing would be for President Obama to have an executive order specifying optimal protections, hazmat suits that are impermeable to blood and virus and PAPRs [powered air purifying respirators] with a filtration of 50 [cfm] or more. And we want a conditions change, so that if at some point they say Ebola can be aerosolized, the optimal standards would follow the principle "first, do no harm." If you protect to the maximum, you don't have to worry.
It would be nice if Congress actually did something, too, but after the hearing, I worry it would end up being counterproductive, like closing [international] borders.
HLM: It's not enough that CDC has revised its guidelines, and that now most everyone is satisfied. Is that what you're saying?
Burger: The CDC has issued many guidelines, but whatever number it is, they're still voluntary. It's like you have a cafeteria-style plan. You pick one of this, a couple of booties, a different mask. A hat. And each hospital, 5,000 hospitals in the U.S., each one gets to pick and choose what they are going to buy to protect their healthcare workers from an infection. And most are going to pick the cheapest protection they can get by with that will, quote, satisfy CDC guidelines. The CDC is helping them. But I want to look out for our interests.
And they don't all fit. Some of the gowns that were recommended initially, depending on body type, don't fit all the way around. When you're providing care, you're not just facing patients. You're helping them get out of bed, sit up and eat; they're hanging on you. And you're constantly at risk for exposure. I don't know if you've ever dealt with explosive vomit or diarrhea—it's all over the place. You have to wear an outfit with no seams.
The CDC has been forced to move on education and training for healthcare workers providing care. They had to because it was obvious what happened in Dallas was not optimal.
HLM: What do you mean "forced" to move?
Burger: Briana Aguirre [the Texas Health Presbyterian nurse] went public that the hospital had equipment but it was suboptimal, and the nurses didn't know what to do and there were no protocols in place, and they had no training. There were many nurses that didn't want to speak because they were afraid they'd lose their jobs. If they had not told us [NNU] what was happening, all we would have heard in the media from Texas Health was that everything was fine. And it wasn't. We have actually protected those nurses, given them a spotlight to make things safer for all healthcare workers.
HLM: It sounds like you see this as a free speech issue too.
Burger: It's a public health issue.
HLM: What about the equipment expense? A hospital might argue it's expensive to buy a lot of this protective gear now, when it may never be needed.
Burger: It's funny. When we were lobbying for needle-less syringes, hospitals said they would go bankrupt. And then it became standard and nurses were prevented from getting HIV, hepatitis, and other blood borne pathogens.
The California Hospital Association said nurse-patient ratios would put hospitals out of business. Guess what? It reduced workers' comp claims and nurses weren't getting injured moving 300-pound patients around by themselves.
You'd think somebody who cared would want to protect workers, but it doesn't feel that way when you have hospital officials handing you what they call an Ebola kit, and it's a gown that when you go to write on it—nurses make notes on their gowns to remember things—the ink leaks through.
And just to give you an idea, Texas Health Presbyterian had $152 million in net income profit in the last five years. And as part of the 25-facility chain Texas Health Resources that recorded an aggregate $2.1 billion in the last five years, they've got the money. Whether a suit costs $500 or $5,000, I think most people would say if a nurse doesn't get infected, that's a good investment.
HLM: How do you feel about the idea that confirmed Ebola patients should be transferred to special Ebola medical centers like Emory?
Burger: Some people say that's a great solution; we ship them off to a hospital that will give them the best care. But the reality is most care for Ebola patients is really comfort care: keeping the bed dry after they've had diarrhea or vomiting, and supporting IV fluids to make sure they don't dehydrate. And giving nutrition either through an IV or gastric tube. There is no special equipment or magic treatment. Any hospital can safely care for these patients.
Any registered nurse or healthcare worker, given the opportunity to train and practice, can use these skills not just for Ebola, but for swine flu, SARS, H1N1, rotavirus, etc. It's not a skill that would go unused. And if you give us the proper equipment, we're more than happy to take care of Ebola patients. We can do the right job as long as we're staffed and educated.
HLM: But I want to make sure I understand. Are things better now than they were a month or so ago for nurses' protection?
Burger: It might be marginally better. … What I think is that a lot of hospitals are hoping Ebola will die down and they won't have to spend any money to purchase this equipment.
HLM: If you could speak directly to hospital administrators, what would you say?
Burger: They need to get off the pot. Get the suits. We've been working on this for three months, and the World Health Organization declared an international emergency Aug. 8. It's not a surprise. But we just had a meeting with [California] Gov. Brown, and coincidentally, a lot of hospital CEOs and the California Hospital Association were outside the governor's office letting them know they didn't need to implement protocols because they already had everything covered.
So I'd say stop lying to the public saying you're doing everything, and that we're being hysterical. Do what's right for your community and for your patients.