NY Nurses March [All Regions]

nurse New York

New york state edition | march 2020

RNs on the frontlines

Courage and committment, p. 3

Unleashing the Defense Production Act, p. 9

Organizing for Action, p. 13

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New York Nurse march 2020

THE CATACLYSM

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By Judy SheridanGonzalez, RN, NYSNA President

Advocating for patients. Advancing the profession.SM Board of Directors President Judy Sheridan-Gonzalez, RN, MSN, FNP judy.sheridan-gonzalez@nysna.org First Vice President Anthony Ciampa, RN anthony.ciampa@nysna.org Second Vice President Karine M. Raymond, RN, MSN karine.raymond@nysna.org Secretary Tracey Kavanagh, RN, BSN tracey.kavanagh@nysna.org Treasurer Nancy Hagans, RN nancy.hagans@nysna.org Directors at Large Anne Bové, RN, MSN, BC, CCRN, ANP anne.bove@nysna.org Judith Cutchin, RN judith.cutchin@nysna.org Seth Dressekie, RN, MSN, NP seth.dressekie@nysna.org Jacqueline Gilbert, RN jackie.gilbert@nysna.org Robin Krinsky, RN robin.krinsky@nysna.org Lilia V. Marquez, RN lilia.marquez@nysna.org Nella Pineda-Marcon, RN, BC nella.pineda-marcon@nysna.org Verginia Stewart, RN verginia.stewart@nysna.org Marva Wade, RN marva.wade@nysna.org Regional Directors Southeastern Yasmine Beausejour, RN yasmine.beausejour@nysna.org Southern Sean Petty, RN sean.petty@nysna.org Central Marion Enright, RN marion.enright@nysna.org Lower Hudson/NJ Jayne Cammisa, RN, BSN jayne.cammisa@nysna.org Western Chiqkena Collins, RN chiqkena.collins@nysna.org Eastern Vacant Executive Editor Pat Kane, RN, CNOR Executive Director Editorial offices located at: 131 W 33rd St., New York, NY 10001 Phone: 212-785-0157 Email: communications@nysna.org Website: www.nysna.org Subscription rate: $33 per year ISSN (Print) 1934-7588/ISSN (Online) 1934-7596 ©2020, All rights reserved

write this, wiping away tears, confronting fears, at the nightmare that gets worse every day. One week feels like a year. I cringe every time the phone rings: another nurse sobbing uncontrollably about conditions in the ICUs—so many make-shift ones now—where all bets are off; about a colleague who is positive and sick; about one who is intubated; about another one who’s succumbed to this dreaded plague…

HOW MANY TIMES did we warn our hospitals, government, bosses, the media: “We’re not prepared for a disaster.” We pleaded for staff, supplies, space, beds, training, nursing schools. “Don’t close hospitals. Don’t cut health care. Stop the for-profit frenzy.

Support our public health infrastructure. Provide free nursing education.” We were accused of being alarmists, unrealistic, unreasonable—even greedy.

Nurses were functioning at bare bones before COVID-19 hit, pushing ourselves to the limit. We’ve now learned a new definition for “limit” in COVIDspeak—there is none. The rules for infection control change with the wind—and the whims—of corporate forces and the political “leaders” who depend on their campaign contributions, who value liability concerns and optics over human lives.

How dare they!

HOW IS IT POSSIBLE that the wealthiest country in the world is incapable of producing protective gear? Wuhan was a warning: so many lives lost in one province. Did we learn nothing from that? From the measures taken to contain, control and combat the virus? Is our nation so arrogant that it cares little for people in other nations?

That we think we can’t learn from their experiences?

Over three months have passed since the virus was named. But over the past 50 years we’ve seen manufacturing relocate into countries with cheap labor, few safety rules and repressive anti-union policies.

This was promoted in spite of the damage it did to the paychecks of US workers and the lives of those in outsourced nations. And so, much of our PPE is produced elsewhere.

While American workers had no say in outsourcing, we and our patients are the victims of the practice. Hospitals refused to listen to us, and so, again, we are the victims. Many of our elected leaders chose to side, not with us, but with the hospital industry and insurance companies, allowing draconian cuts and closings…and so we are the victims. And now, we not only have to fight the virus, we have to fight our employers and our government to safely care for patients…and to survive ourselves.

The CDC, the government, our hospitals, the health care system itself—all have failed us. They missed the boat but left us to drown in the water. So many people are dying that we‘re mastering new techniques in double-shrouding more often than in calculating new drips. What we thought was unimaginable a week ago, is the new reality: our docs deciding who gets actively coded in an arrest and who doesn’t—based on prognosis-and age—and the need not to “waste” precious PPE. How can we live with ourselves in the aftermath of such things?

We are afraid to go home. We can’t take care of our own parents for fear of infecting them. We don’t see our kids. We tremble at the simplest mistake in removing soiled— but totally insufficient—gowns and masks. We have strategies to strip off our clothes on porches, stoops and yards. We worry about family, neighbors and friends. We assume we’re COVID-19 positive but testing is backlogged and not always accurate. And we wonder, as we

have overlong waits for test results: is a positive result a death sentence or a reprieve, because we are alive.

The president has the power to implement the Defense Production Act (DPA) to mandate industries to retool and manufacture nothing but PPE and hospital supplies like vents. But he says, instead, “the market should rule.” The market has led us down this rabbit hole.

The crazy beauty of this horror is that we have seen coworkers and neighbors, community groups and unions, families and strangers, assemble (virtually) to support us and one another. Our faith in good people is reinforced. Volunteers sew masks, procure N95s and gowns, raise funds to get materials, cook meals, offer their homes. We are blessed in that way. And we have each other, our heroes alongside us, who pronate patients with us, deliver precious oxygen, medication and nourishment, share newly obtained PPE, food, liquids, allow us to cry, even if not on shoulders.

But even as we fear for our lives, our patients’ lives, our family’s lives—we’re angry. We’re disgusted. And we’re fighting back.

We invent our own PPE when the hospital can’t—or won’t—provide it. We have the media’s ear…and we’re talking. We’re organizing, to make do, and to make noise.

We’re not only the canaries in the mine of this catastrophe, we’re the witnesses to the neglect, incompetence and criminality of the insufficient, inexcusable response to the greatest challenge facing us in our lifetime.

Silence is not an option.

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Courage and commitment

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s of this writing, we are grieving the loss of two fellow NYSNA nurses and one former NYSNA member, who died prematurely from COVID-19— Freda Ocran, Theresa Lococo and Kious Kelly.

Our colleague and friend Freda Ocran was an outstanding RN with a long career in nursing. She worked at several hospitals in the New York City area, including North Central Bronx, Bronx Lebanon Hospital and, most recently, at Jacobi Medical Center.

A pediatric nurse at Kings County Hospital Center, Theresa Lococo was known for her professionalism and compassion. She was a 48-year NYSNA member, and a veteran of New York City’s public hospital system, where she had worked since 1972.

We are also deeply saddened by the death of Kious Kelly, an assistant nurse manager at Mount Sinai-West, and NYSNA member for several years, who died on the frontlines last week from a COVID-19 infection. Kelly was the first RN in New York killed by coronavirus.

These nurses are a somber reminder of the courage and commitment our nurses bring to work every day in this crisis.

You may wish to visit a memorial page on NYSNA’s website to honor these nurses, and any others who fall victim to COVID-19. Pictures or remembrances of colleagues you would like to share can be sent covidmemorial@nysna.org.

Losing colleagues to this pandemic is devastating for all of us on the frontlines, and our hearts go out to their families.

Defence Production Act

The tragic element of these deaths is in knowing that our government has failed to harness all of its resources to stop the spread of the virus. There is no question that the White House refused to invoke and utilize powers given the president under the Defense Production Act (DPA). Even after acknowledging the DPA, President Trump has hesitated to use its powers.

The DPA was passed by Congress in 1950, and reads, in part, as follows: An Act to establish a system of priorities and allocations for materials and facilities, authorize the requisitioning thereof, provide financial assistance for the expansion of production capacity for supply… and by these measures facilitate the production of goods and services necessary for the national security, and for other purposes….

President Trump is not unfamiliar with the DPA. He invoked it on June 13, 2017, to address two sets of products he deemed “critical to national defense”.

“Hopefully there will be no need”

However, on March 18, 2020, well into the COVID-19 outbreak, having defined ventilators and protective equipment as “essential to the national defense”—the standard required by the DPA, the president took a fateful pause, saying, “Hopefully there will be no need.”

But the need was already pervasive.

In the meantime, our members have experienced the virus entering and infesting their hospitals— a lethal presence with horrid consequences. Without adequate PPE, ventilators—even basic supplies, NYSNA’s selfless nurses continue to work, in a spirit of dedication to patients that inspires the entire nation.

Our members recognized that the time to fight is now.

NYSNA members at Albany Medical Center are fighting management stonewalling with all the legal tools in our toolbox. Members filed an OSHA complaint about inadequate PPE, and in the week

of March 30 OSHA sided with the nurses and cited the hospital.

Erie County Medical Center’s NYSNA nurses joined with members of the Communications Workers of America on April 1 in a car caravan around Buffalo’s Niagara Square. Healthcare workers from across western New York were there to protest PPE shortages and call on the Trump Administration to unleash the DPA. Less than 24 hours before a scheduled speak out of NSYNA members at Mount Sinai Hospital, management scrambled to announce much-needed improvements, including expanded testing for frontline caregivers and reasonable accommodations for immunocompromised or pregnant staff.

NYSNA members at Montefiore Medical Center joined with other hospital staff on April 2 to speak out about the dangerous shortages of PPE and lack of training for nurses being shifted from different parts of the hospital into critical care.

Over 20 town halls were held to date, with a schedule of them going forward, connecting thousands of members. The focal points of union discussions and collaboration consisted of the fight to end the virus.

Member education on DPA is moving the dial in the national conversation, DPA becoming a regular talking point in the PPE supply chain on city, state, and national levels due to member advocacy.

Inspector General report

The Inspector General of the U.S. Department of Health and Human Services issued a report after surveying hospitals nationwide. He concluded that shortages of testing kits, PPE, ventilators—even thermometers, are real, widespread and dangerous. He was alarmed to discover that expired equipment from federal reserves was being shipped to hospitals.

We can only help but conclude that the solution to this appalling shortfall is new production under the DPA. Your unity has raised the volume of our message to national resonance. Your courage and commitment to patients is an inspiration to all.

By Pat Kane, RN, NYSNA Executive Director

Union care In the midst of this unprecedented and incredibly stressful public health crisis, I want to highlight our Union Assistance Program (UAP), which offers grief counseling and related mental health supports, available 24/7.

800-252-4555 https://www.theeap.com/union-ap

Go to nysna.org/covid for COVID resources, updates, actions, and reporting tools.

Editor’s note You are receiving your March edition of New York Nurse late. The COVID-19 pandemic has required our full attention on a daily basis. Please excuse the delay in publication. PK

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We need to be angry

F “We all deserve better than this.

Every single healthcare worker death is preventable.”

Kelley Cabrera, RN, LBU President, Jacobi Medical Center

riday the 13th. I can remember the exact day it became abundantly apparent to me that we were never going to be prepared for the pandemic the World Health Organization had just declared two days prior. Our hospitals were always going to fail because when you have a healthcare system that incentivizes budget cuts and prioritizes profits, there is no room for patient safety- let alone compassionate care. How is it that the country that outspends every other nation on Earth in healthcare costs, could be this far behind?

How did we allow it to get this bad?

That weekend, the first one of the pandemic, will always live in my mind. Because it was then, when money hungry administrators were out of sight enjoying their precious weekend, that I saw true leaders take action. These being the nurses and doctors and all other frontline staff who are and have always been the most valuable members of our healthcare teams. Nobody can advocate for us, better than us. That weekend I watched doctors whom I’ve known since their residency, step up into roles that our other administrative “leaders” will never be able to fulfill. Nurses who rarely spoke up before, began to share their ideas regarding how to best prepare for what was to come while knowing we were looking at a dwindling supply of PPE and medical equipment.

It has been 17 days since my own panic started setting in. I’ve watched my coworkers expose themselves to this deadly virus over and over and over again and the only thing that worries me more than their repeated exposure, is this nation’s history with complacency. Now more than ever before, healthcare workers have been given a small spotlight in the media.

Issues like safe staffing, lack of equipment, and corporate greed have all received attention now, even though as nurses we know we’ve been screaming this from the rooftops for years. A crucial point that seems to be missing however, is anger. As we hear of more nurses dying from COVID-19, I plead that you all do not lose sight of the fact

Kelley Cabrera, RN, Jacobi Medical Center

that these deaths are preventable.

We cannot just become martyrs.

We cannot allow our frontliners to just become names read aloud by politicians who should have, and chose not to do better by us. We are irreplaceable. Who will care for the sick when we are all gone?

We all deserve better than this.

Every single healthcare worker death is preventable. We need to constantly remind the politicians and our communities of this. The politicians work for US—not the other way around. We cannot sit back and accept this. We did not sign up to go into this fight without proper protection. This is inexcusable and unforgivable. It is a crime and we need to start calling it that.

We need to take action. There are people to blame and we have the right to do so. We have every right to be angry.

Kelley Cabrera, RN, BSN NYSNA LBU President Jacobi Medical Center

(Top and bottom) Jacobi Medical Center protest, March 27

NEW YORK NURSE march 2020

Upstate nurses beat back downsizing

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s New Yorkers went on “PAUSE” and hospitals braced for a surge of COVID-19 patients, Champlain Valley Physician’s Hospital (CVPH) in Plattsburgh, and St. Elizabeth Medical Center in Utica notified dozens of nurses with the New York State Nurses Association that they will be forced off the job.

Nursing shortages are anticipated in the COVID-19 pandemic, and Governor Cuomo recently put out a call for retired nurses to return to service to help manage the influx of COVID-19 patients expected in New York State, the epicenter of the Coronavirus pandemic in the U.S.

Nurses are essential

At the same time, CVPH identified 59 RNs as “non-essential.”

St. Elizabeth’s placed four OR nurses on indefinite leave, and took over 50 additional nurses off their scheduled shifts.

“Nurses are essential. It makes no sense to furlough nurses right now,” said CVPH RN and Executive Committee Co-Chair Dea Lacey, RN. “We met with management and relayed our concerns about downsizing nurses and other ancillary staff. After we insisted through daily meetings, we finally heard that all nurses would be retained.”

CVPH also informed nurses that they would begin receiving COVID-19 patients from downstate hospitals that are filled beyond capacity.

St. Elizabeth nurses insist on helping prepare for the COVID-19 surge

The St. Elizabeth nurses that were threated with furlough are critical care certified and have requested multiple times to be cross-trained to staff units anticipated to surge with COVID-19 cases in the coming weeks. Their requests had gone ignored by hospital management until recently.

Bill Ferguson, RN, who works in St. Elizabeth Medical Center’s PACU unit and is the LBU President shared his concerns at emergency Labor-Management meetings in March.

“How can my hospital be preparing for a surge of COVID-19 patients when nurses are worried about losing their jobs?” said Ferguson. “We know this pandemic is serious and it’s only a matter of time before we have PUIs or COVID-19 positive patients in Utica.”

St. Elizabeth backed down, and promised to follow the contract limits on low census days and keep

nurses on their shifts. These RNs are now in the process of cross-training to Med-Surg and Telemetry units to assist in the surge.

“I’m just glad that management saw the light and is working with us to keep on our dedicated nurses and prepare for this thing together,” said St. Elizabeth’s Concetta Reginelli, RN.

Around the state 9

Nurses ready to act

NYSNA is hearing reports from nurses at other hospitals in Upstate New York that volunteer furloughs, lay-offs or other reductions of the nursing workforce are being considered by hospital administration.

Nurses are ready to make them reconsider, especially since earlier this month Congress passed a COVID-19 stimulus bill, which gave $100 billion in emergency funding to hospitals bracing for coronavirus, partly to offset the loss of revenue from elective procedures.

Harlem Hospital demontration April 6, see story on page 7

Nurses win in Western NY

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e are seeing an increase in hospitalized cases across the region. The recent increase was higher in areas that are in closer proximity to NYC. Erie County has a high number of COVID-19 cases (380) but very few requiring hospitalization for the time being. North Country and Central New York Hospitals are starting to get positive cases in their counties and continuing to prepare for what’s to come.

We have several facilities (ECMC, CVPH, VBMC, Ellis,

Elizabethtown, Adirondack Medical Center and PHC) that are having daily meetings (some many times a day) to discuss the concerns of the members and to keep us informed of the most recent information. There are still employers who outright refuse to involve the RNs and the union in the day to day planning (Albany Med, Nathan Littauer).

ECMC has agreed to hotel rooms for RNs that are working with PUIs or COVID-19 positive patients. Ellis Hospital is working

on locking in hotel rooms for their staff as well, along with ensuring the designated COVID-19 units are being provided with food and showers for after shift.

The Employers that were trying to furlough RNs have backed off and are coming up with plans to cross train the nurses or are allowing for voluntary low census days. North Country facilities associated with UVHN want to give employees a bonus of one weeks pay.

Continued on page 6

“So why is it that during wartime, our country can mobilize essentially overnight to mass produce weapons, ammunition, guns, bullets, but during a time when we need to step up and protect our own citizens, we have waited months to even begin to mobilize to produce adequate PPE and ventilators and testing kit supplies...?”

–an RN tells Buffalo News

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New York Nurse march 2020

Western Continued from page 5

A universal concern is the limited supply of PPE and testing. Lack of ability to properly protect yourself and be tested once exposed or potentially exposed is compounding the concerns and anxiety sur-

rounding front line staff. Several facilities that have been waiting on supplies for weeks, stated they have not come in and that they were redirected to the city. The majority of facilities have their PPE locked.

Some area non union hospitals in the capital region have issued policies that ALL staff can wear

a surgical mask or even homemade ones. Our Employers are not allowing homemade masks or the use of personal supplies at this time. Many facilities will be receiving overflow COVID-19 patients from NYC facilities, which will only escalate the concerns over the limited supply of PPE.

At SIUH: Danger and Dedication in the ED

N Around the state

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YSNA member Christina Aviles works as a registered nurse in the ED at Northwell Health’s Staten Island University Hospital (SIUH). Working as a registered nurse is a demanding job. Working twelve hour shifts, most of it on your feet, caring for patients who are often old and, as their presence in a health care facility indicates, infirm. It can be physically exhausting and emotionally draining; more so if you happen to work in the emergency department of a level one trauma center.

On the frontlines

Now, as the COVID-19 pandemic sweeps through New York City like a wildfire through so much dry tinder wood, Christina finds herself on the frontlines in a battle against an intensely contagious and invisible threat that is ravaging much of the world.

Here in the United States, a shortage of Personal Protective Equipment (PPE) remains the single biggest issue registered nurses and other health care professionals have faced in the struggle to care for COVID-19 patients. You hear it from medical and health care providers everywhere: It’s like fighting a war without ammo.

SIUH nurses take a well deserved pizza break.

Many city hospitals are running dangerously low on PPE, including the N95 masks which are the most effective way to filter the droplets that are expelled when an infected person coughs; some RNs have been reduced to tying bandannas around their faces. Even facilities that appear to have enough of the masks are keeping a close eye on them. At SIUH’s Emergency Room, N95 masks are kept in management offices and must be signed out by

front line health care staff. They are told to reuse the masks for up to a week, but experts do not consider this a safe practice.

Professional judgement

NYSNA is telling members that they should use their professional judgment as RNs in assessing whether a mask has been compromised or soiled in any way, and to discard it if it has. Some RNs, in cohort situations, are opting for extended use of the mask—keeping the same mask on for an entire Continued on page 7

Bargaining unit Executive Committee members Dawn Cardello and Michelle Pittman lead a march on the SIUH Command Center to press NYSNA demands

(L-R) Maria Desantis, RN and Danielle Armetta, RN.

NEW YORK NURSE march 2020

SIUH Continued from page 6

shift—which is preferred over reuse as a way of maintaining a mask’s integrity.

In the meantime, RNs working in SIUH’s emergency room are worried: about exposing themselves; about exposing their families; about exposing their patients.

Within the first week of seeing PUI patients in the emergency room eight NYSNA nurses that work there were exposed and put on quarantine. The risks are real and so too are the stress and anxiety of the nurses working there.

Ms. Aviles states that she goes to bed thinking about it every night.

Then she dreams about it. And when she wakes up, it’s the first

thing she thinks about every morning. And with good reason: she’s three months pregnant. At present it’s unclear how much risk there is for a fetus carried by a mother who is exposed or infected with COVID-19. But for a nurse working in a busy emergency room it’s all too real. Still, Christina Aviles shows up for her shift, puts on her mask, and gets to work.

Harlem Hospital RNs demand more resources

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urses at NYC H+H/Harlem Hospital rallied on April 6 to demand more PPE, more nurses, and more resources to tackle the COVID-19 crisis. They were joined in solidarity by NYSNA nurses from other public and private hospitals, as well as respiratory therapists, social workers, teachers and other union members.

Sarah Dowd, Harlem Hospital RN, said “This is a tragedy, without a doubt. But we’re here to fight because we deserve better. We’re calling on Dr. Katz to provide us with some immediate assistance, including a new N95 mask for every shift. There’s no data that suggests that masks are effective with this duration of use. Right now there is a huge population of our hospital workforce that is out sick and that has reduced our capacity to care for the patients.”

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Nurses and supporters protest outside Harlem Hospital, April 6

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Nurses to Monty: Do the right thing!

D Around the state

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ozens of NYSNA nurses at Montefiore hospital demanded safe PPE at a press conference in the Bronx on April 2.

Maintaining the appropriate six feet distance, NYSNA nurse leaders demanded that the hospital and government send nurses into the battle against COVID-19 with the right equipment.

While nurse pressure has pushed Montefiore to move to daily distribution of masks, gowns, and shields in many areas of the facilities, some nurses still do not have what they need.

Putting nurses and patients at risk

Managers are sending nurses into unfamiliar areas without proper training, putting everyone at risk.

Even worse, management is saying they will collect used PPE and try experimental, unproven techniques to reuse the PPE. Nurses said they don’t want to be guinea pigs.

Members want the hospitals to secure the appropriate safety equipment, and if they can’t, they say that the government must put people to work making it.

“I am angry right now, because President Trump has the power to manufacture more PPE,” said Una

Montefiore nurses protest, April 2

Davis, RN, a Montefiore Moses NYSNA delegate. “He could have done it weeks ago, yet he continues to delay and play games with our lives.

We are appealing to our federal, state and local government and hospital administration to hear our pleas for personal protective equipment.”

Benny Mathew works in the Moses ED. He became positive for COVID-19 because frontline healthcare workers like him did not have appropriate masks and gowns along with strict protocols.

“Even though we knew the horrific accounts from Wuhan and Northern Italy, Montefiore executives were not proactive or even reactive when suspected COVID-19 patients started to arrive,” he said.

Fighting for everyone

Montefiore nurses protest, April 2

Monte Bronx nurses know the crisis in their communities started long before COVID-19 hit the scene. Even during a pandemic, Montefiore is trying to move ahead to close Mount Vernon hospital and the governor’s Medicaid Redesign Team is threatening to cut hundreds of millions from healthcare budgets.

Now, as they struggle to save lives, the fight is for everyone.

“This health care system is broken. And it is broken on purpose!

For too long, making money came before keeping our community safe,” said Patricia Armand, Hutch CRNA and NYSNA delegate. “We are in the middle of a crisis and we need to act like it. We need a health care system that prioritizes people not profits. GET ME PPE!!!”

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march 2020

(At left) Foluke Fashakin, a nurse and NYSNA member at Harlem Hospital speaks out about critical PPE shortages.

Unleashing the Defense Production Act “Why

is it that during wartime, our country can mobilize, essentially overnight, to mass produce weapons, ammunition, guns, bullets?” asked Rachel Larkin, a nurse and NYSNA member from Erie County Medical Center. “But during a time when we need to step up and protect our own citizens, we have waited months to even begin to mobilize to produce adequate PPE and ventilators and testing kit supplies?”

Larkin made those comments to the Buffalo News, during a speak out on Thursday April 2.

The event was part of NYSNA’s statewide campaign to push the Trump administration to get PPE and other equipment desperately needed to the frontlines.

Victoria Lanquah, an RN and NYSNA member at Montefiore Medical Center shared similar sentiments at a press conference the same day, “We are demanding [President Trump] invoke the Defense Production Act so that all of our factories can be spinning out PPE for us.”

Nurses Organize, Politicians Listen

For weeks, NYSNA members have been calling on President Trump to use the full force of the Defense Production Act, a law originally passed in 1950, in response to the Korean War. This law gives the President extraordinary power to organize and oversee production and distribution of

essential materials during national emergencies.

Our message is starting to break through.

On Thursday April 2, President Trump issued an executive order to commandeer the current stockpile of N95 respirators held by 3M, the nation’s biggest manufacturer. That same day, New Jersey Governor Murphy ordered state troopers to commandeer medical supplies and equipment stockpiled in businesses around the state.

On Tuesday April 7, Governor Cuomo issued an executive order that gives him the authority to collect PPE from all private sector businesses, including industries such as construction, ship building, and manufacturing. Now we need to use that authority!

United We Stand

NYSNA’s campaign is getting a boost from our allies in the labor movement. For example, NYSNA members in Buffalo worked together with nurses at Kaleida Health Systems, members of Communications Workers of America, Local 1168, along with other labor allies, to organize their recent speak out.

And we are also getting a boost from elected officials.

Congresswoman Grace Meng is spearheading a letter from almost the entire New York Congressional delegation to utilize the full force of the Defense Production Act.

As this pandemic progresses, it will be even more important that NYSNA members speak up, and let the world know what we need to keep our patients, and ourselves, safe.

(Below) On April 7 Governor Cuomo issued an executive order giving him the power to collect PPE from all New York businesses. (at bottom) Congresswoman Grace Meng has spearheaded a letter from New York’s Congressional delegation demanding President Trump use the full force of the Defense Production Act. Thanks to Senators Schumer and Gillabrand as well as the 17 New York Representatives who signed on.

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Hospitals must take other steps before limiting PPE!

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he Centers for Disease Control has made it clear that even during the COVID-19 crisis, hospitals should adhere to the hierarchy of controls (right) before implementing PPE conservation measures.

Below is a list of concrete changes your hospital should adopt before limiting access to or reusing N95 respirators or other PPE. If your hospital hasn’t implemented all these recommendations contact your NYSNA representative and local bargaining unit leaders so they can escalate these demands to the hospital command center immediately or file a COVID Protest of Assignment or OSHA compliant on your behalf:

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aving patients or their proH viders call ahead to determine who needs to be seen and who can be managed at home.

2.

(Top) A nurse enters a COVID screening tent; (Bottom) Screens are being used to limit COVID-19 exposure; (Right) Brooklyn Hospital sets up screening tents outside the hospital

alling patients ahead of time C (clinics, home health) to screen and better determine how to proceed with their appointments or care.

3.

ave separate screening areas H to keep patients out of the ED itself for screening and initial assessment purposes. Many

Source: Centers for Disease Control, Strategies for Optimizing the Supply of N95 Respirators, last updated April 3, 2020.

COVID-19 patients, even when isolation rooms are not available.

facilities have tents. Trailers are also an option.

4.

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Expanding telehealth options during this crisis.

Establish a protocol and system for getting a surgical mask on symptomatic patients ASAP and monitoring that they are able to keep wearing it. This reduces the hazard (COVID-19 droplets and airborne particles getting into the environment).

6.

Another strategy is to designate separate areas, units, or even buildings, for the care of

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Separating COVID-19 patients from others (cohorting) will reduce transmission between patients and potentially reduce the number of staff who will require higher levels of protective equipment.

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ake sure a PPE program is in M place to ensure that workers are trained properly, respirator fittesting is taking place and the use of the equipment is monitored to detect shortcomings when they arise.

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Use different, better alternatives

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mployers should have a multi-pronged strategy for getting and conserving PPE. It’s not an option to work without PPE, and reusing PPE is dangerous. It will take a number of measures to make it through this difficult time.

If your hospital hasn’t implemented all these recommendations contact your NYSNA representative and local bargaining unit leaders so they can escalate these demands to the hospital command center immediately or file a COVID Protest of Assignment or OSHA compliant on your behalf.

1. Switched to higher level, reusable respirators. PAPR (powered air purifying) supplied air respirators are commonly used in EDs, operating suites and other settings in hospitals. They were standard for Ebola care, and there should be some in every hospital. For care of COVID-19 patients, start using the ones that are currently available and take steps to secure more for use going forward. There are also elastomeric reusable respirators with cartridges.

Duckbill surgical N95 respirator

2. Identified, secured and placed into service industrial N95, N99, P100 face filtering respirators. Facilities may have stocks of these industrial respirators already for use by plant operations, grounds and other workers. Facilities can make arrangements with other employers, construction and others, to have them share stocks of these respirators.

OSHA and the FDA have approved this measure.

3. Organize work and patient care to extend the use of equipment. Dedicated staff who exclusively care for COVID-19 patients and the cohorting of patients will make a difference and make it more possible to keep equipment on for an extended care session.

Extended use of N95s, for example, can be done safely (unlike reuse, which is unsafe).

4. Organize care in such a way that some tasks are done remotely from the patient without the use of protective equipment, provided the safety of the patient is not compromised and it fits into established standards of care.

Surgical n95

Powered air purifying respirator (PAPR)

Elastomeric reusable N95

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New York Nurse march 2020

Considerations for extended respirator use (Not reuse!)

“But can’t they be cleaned and sanitized?”

The answer is NO!

T

o minimize respirator exchanges, extended use of respirators is sometimes considered.

Extended use means that the healthcare worker keeps the respirator on while caring for patients with the same illness, for a continuous period of time.

According to the World Health Organization, these sessions should not last more than four hours.

If extended use is a practice in your facility, below are some considerations. If your hospital isn’t following these best practices, con-

Currently, there is no definitive evidence to support the idea that you can safely clean or sanitize single-use respirators. Any study purporting to support sanitizing must prove the following:

When doffing, handle respirator by straps, not by face piece.

2. E nsure a good fit to keep the contaminant out.

Perform a user seal check every time you put on a new respirator.

Keep wearing the same respirator as care is provided for multiple patients with the same illness (COVID-19). That means the healthcare worker exits one patient’s room and enters another without having touched the used respirator or face shield.

l Preservation of filtration performance

4. Keep it clean

l Structural integrity of respirator components

l No introduction of new hazards, such as potentially harmful residue from the disinfection process itself.

1. Use clean gloves to don and doff the respirator.

3. K eep it on during the extended sessions.

l Neutralization or removal of the viral agent

l Continued ability to form a tight seal to the wearer’s face

tact your NYSNA representative and local bargaining unit leaders so they can escalate these demands to the hospital command center immediately or file a COVID Protest of Assignment or OSHA compliant on your behalf:

Harlem Hospital

Protect the outside of the respirator by using barriers,

such as a face shield, to prevent droplet spray contamination.

Some healthcare workers are covering the respirator with a surgical mask. Please note: retrofitting the N95 with other equipment like surgical masks can have multiple effects. It can make it more difficult to breathe and can cause the respirator seal to be compromised.

5. Don’t Touch It – Remove and Replace with Each Break in Care

Do not touch or remove respirator during period of extended use. To use restroom or take a break, remove and replace respirator and PPE. 6. Staffing is Key to Safety

Work must be organized so that a caregiver can provide safe care to multiple COVID19 patients over a duration of time WITHOUT interruption or having to leave the immediate area. This means that staff should be dedicated to those patients, and that sufficient staffing is available, including ancillary staff.

Reusing respirators is not safe!

NYSNAs position is that disposable respirators, such as N95s commonly used in healthcare facilities, cannot be safely reused. lR euse is a major breach of

infection control protocols. lM anufacturers’ instructions

direct that they NOT be reused. l T he CDC initially stated that

reuse did not meet U.S. standards of care.

Last month the CDC caved in to pressure from healthcare lobbyists and allowed for reuse under certain conditions. But as the New York Nurse goes to press, the CDC still sets a host of restrictions on reuse, including: l I f no manufacturer guidance is

available, preliminary data suggests limiting the number of reuses to no more than five uses per device to ensure an adequate safety margin.

lD iscard N95 respirators following

an aerosol-generating procedure. lD iscard N95 respirators

contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. lD iscard N95 respirators following

close contact with any patient co-infected with an infectious disease requiring contact precautions.

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march 2020

Organizing for action NYSNA

members are taking action— on their units, in Albany, and in Washington, DC—to demand the PPE we need: Calling on the Trump Administration to unleash the Defense Production Act, and force manufacturers to produce the PPE, test kits, and other equipment we desperately need.

Successfully forcing Governor Cuomo to pass and Executive Order that empowers him to commandeer the PPE stockpiles of industrial N95 respirators and other equipment from industries like construction, shipbuilding, and manufacturing.

Organizing to force hospitals to implement measures that management initially refused, including tents and improved screening; separation of COVID-19 patients from the general population; more N95 respirators; not having to reuse respirators; tighter visitor policies; access to PAPRs; reworking of clinic schedules to reduce exposure; improved sick time policy and much more.

Speaking out in the media—letting the world know that we are fighting the war with no armor—we

Benny Matthew, a nurse and NYSNA delegate at Montefiore Medical Center, speaks at an April 2 press conference.

need PPE to fight COVID-19 safely and effectively.

Demanding that New York State order the reinstatement of protective measures including safe quarantining of nurses exposed to COVID-19; the use of N95 or better respirators instead of surgical masks; and improved testing for frontline staff.

Working with relief organizations to speed up the collection of N95 and other equipment for use by nurses on the frontlines.

NYSNA members at Harlem Hospital speak out about critical PPE shortages.

Pushing Congress for an emergency OSHA standard on infection control in healthcare.

Linking up with frontline nurses nationwide, via chat groups and social media, to share ideas and solidarity.

Continuing our fight for adequate staffing—including nurses, MDs and ancillary staff—during this crisis and in the months and years to come.

Go to nysna.org/covid for more resources, updates, and tools for taking action.

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New York Nurse march 2020

COVID-19: Nurses on the record April 7, 2020 On why nurses at St. Joseph’s Medical Center and St. John’s Riverside Hospital organized an urgent community speak out,

NYSNA to lohud.com: “A growing number of healthcare workers at both hospitals are testing positive for the coronavirus, NYSNA said. Nurses are calling on the Trump administration and the federal government to enact the Defense Production Act to increase production of personal protective equipment, so healthcare workers can remain safe while caring for the communities they serve.”

Source: Coronavirus: Yonkers nurses rally to demand more personal protective equipment, lohud.com

April 6, 2020 On the NYC Health + Hospitals’s decision to advise staff to reuse the personal protective equipment, Kelley Cabrera re-quoted in

the Chief Leader to the DeBlasio administration:

day, and that’s lucky. Other hospitals don’t even have that.” … “If you’re wearing a mask, people are like, ‘Where did you get the mask?’

If you’re wearing a gown, people ask, ‘Where did you get that gown, who had it, where did you get it?’

The supplies aren’t given to you.

You have to go beg for them, go look for them.”

Source: Desperate health care workers rally for coronavirus gear at Harlem Hospital, NY Post; see also: Enfermeras del hospital Harlem protestan por falta de equipo de proteccion, Noticias

Source: DC37, NYSNA Pan NYC H+H Advice To Reuse Protective Equipment, The Chief Leader

Trisha Robinson and Wycoff Hospital RN Jillian Primiano to the New York Post: “We’re not here to cry,” surgical nurse Sarah Dowd said. “This is a tragedy without doubt. But we’re here to fight because we deserve better.”

“Right now on any given night, we are so inundated with patients that are positive or are suspected to be positive that we don’t have enough equipment, we don’t have enough staff,” said Trisha Robinson.

“We need more protection and staff to adequately do our jobs.”

Jillian Primiano, an emergency room nurse, said health care workers feel “left behind by the government.” … “I wear one gown per

Source: Covid-19 pandemic: ER doctor describes dire medical shortages in New York, CNN

March 31, 2020 In a NY Daily News cover story, NYSNA RN’s Kelly Cabrera, Sean

Petty and NYSNA ED Pat Kane to Jacobi Hospital, Trump and the CDC:

“We’re being asked to do something we would have been reprimanded for a month ago,” Kelley Cabrera told the New York Post.

On why almost 100 healthcare workers protested the lack of PPEs at Harlem Hospital, Harlem Hospital RNs Sarah Dowd and

department, we have an area cordoned off for the Covid-positive patients and the presumptive positive patients, but because of a lack of space, they’re all housed together, which is a big problem for infection control, said SheridanGonzalez.

Anthony Ciampa on Dr. Phil, in summary: Nurses in New York City, the epicenter of the outbreak in the United States, have died, and hundreds of medical care workers have become sick. Anthony Ciampa, Vice President of the New York State Nurses Association, joins Dr. Phil on Monday’s episode to give a firsthand view of what nurses are experiencing in New York.

Source: ‘We Feel That We’re Not In A Safe Situation, Says VP Of New York State Nurses Association, Dr. Phil

April 1, 2020 On medical shortages on the frontlines, NYSNA President and RN Judy Sheridan-Gonzalez to CNN: “In my particular emergency

“Our nurses are reporting to work every day knowing that their lives are at risk because federal agencies gave the green light to substandard protection.

Some nurses—we don’t know how many—will be infected by COVID-19,” Kane said. “We have lost three RNs to this virus already. New York’s nurses have shown great courage and commitment to the health of their patients.”

in the news Source: ‘We’re on a suicide mission’: Jacobi Hospital nurse charges lack of coronavirus protective gear endangers health care workers’ lives, NY Daily News; adapted for the Irish Sun

On the grim reality of life and death decisions in New York hospitals under siege, where do not resuscitate directives are under consideration, NYSNA president and RN Judy Sheridan-Gonzalez

NEW YORK NURSE march 2020

A NYSNA survey found two out of three nurses do not have the necessary PPEs. Source: ‘Outrageous’: Cuomo, de Blasio, and nurses blast Trump’s comments about NY face mask usage during coronavirus crisis, NY Daily News, March 30, 2020

On soaring rates of Covid-19 among healthcare workers on New York City’s frontlines, RNs Kelley

and RN Diana Torres to the Washington Post:

Cabrera, Kimberly Marsh, Thomas Riley and Lillian Udell to NYT:

It’s “post-apocalyptic—like in one of those movies I used to watch,” said Sheridan-Gonzalez, an ER nurse at Montefiore Medical Center, where over 1,000 Covid19 patients had been treated at the time of printing.

“People are dying by the minute,” said Diana Torres, Mount Sinai West, Manhattan. “If I have a patient and they crash, I’m going to do my best to save them,” Torres said. “I’m not sure what I would do if they told me to stop. I can’t imagine making that choice.”

“I feel like we’re just all being sent to slaughter,” said Jacobi Medical Center RN Thomas Riley, who has the virus along with his husband.

“It puts us in danger, it puts our patients in danger,” said Kelley Cabrera, RN, ER, Jacobi Medical, Bronx.

“I knew it was still in me.” … “I knew I wasn’t myself,” said Lincoln Medical Center (Bronx) RN Lillian Udell, whose chills and cough from Covid-19 returned after being pressured to work.

Even so, Kimberly Marsh, RN, Westchester Medical Center, says she has no intention of leaving the fight.

Source: Faced with a crush of patients, besieged NYC hospitals struggle with life-or-death decisions, Washington Post

On healthcare workers on Long Island diagnosed with coronavirus, NYSNA’s Long Island rep Michael Chacon to Newsday: Six nurses had been diagnosed positive and 24 were considered “PUI,” or persons under investigation for contact with the virus, said Michael Chacon, Long Island representative for NYSNA Source: Cuomo: More than 75,000 New Yorkers diagnosed with coronavirus; more than 9,000 of those overnight, Newsday

March 30, 2020 President Donald Trump suggests healthcare workers in New York City are stealing or hoarding face masks.

NYSNA ED Pat Kane to President Trump: Nurses have died … “He needs to come to New York. He needs to walk a day in our shoes … He needs to come here and tell me about pilfering,” the Daily News Pat Kane saying.

“We are out there and we are unarmed,” said Kane. “For the business community to not support the troops – it’s disgusting. We’re talking about people’s lives here.”

Source: Nurses Die, Doctors Fall Sick and Panic Rises on Virus Front Lines, NYT

March 28, 2020 On the desperate shortage of PPEs, specifically the risky reuse of N-95 masks at New York’s Jacobi Medical Center, Kelley Cabrera on CBS News to the Feds: “These recommendations are based on CDC guidelines and are not based on science,” Cabrera said. “But because our hospitals lack adequate supplies. This is a dangerous practice that puts healthcare workers and patients at risk.” … “We need public support to help us demand further action from the federal government” …

“We know there are several ways to ramp up production of PPE and ventilators, but the current administration refuses to use these powers, therefore leaving our frontline staff and patients at risk.”

Source: Nurses across the country protest lack of protective equipment, CBS News

March 27, 2020 On the death of Kious Kelly (48), the first nurse to die in New York

City, Westchester Medical Center RN Mary-Lynn Boyts to USA Today: Nurses are “being asked to do things that jeopardize their health and make it hard to take care of their patients,” said Mary-Lynn Boyts. “You wouldn’t ask police to go into a gun battle without a gun, but we’re being asked to put our lives on the line each day without the equipment that we need to do it.”

Source: NYC nurse on coronavirus front lines dies from COVID-19 after texting sister ‘I’m okay’, USA Today

March 26, 2020 On finding beds for hospital patients in the midst of a Covid-19 tsunami, NYSNA ED and RN Pat

Kane and Board Member Anne Bové to the New York Daily News: “Montefiore nurses are trying to put the beds in every nook and cranny,” Pat Kane. “In some of the public areas, they’re trying to put beds in there.”

Bellevue is opening up wings that were closed off and converting rented space, Anne Bove said. “The problem is they really can’t provide isolation,” she said. “It’s like a war.

It’s just unbelievable.”

The situation is dire. With only 20,000 beds, Mayor De Blasio has said the City will need to triple its existing capacity in order to meet the need.

Source: Coronavirus: NYC hospitals scour ‘nooks and crannies’ to add more beds, New York Daily News

In the Associated Press, nurses, patients and other healthcare workers are not getting what they need, NYSNA President and RN Judy Sheridan-Gonzalez to Gov. Cuomo: “In fact, personal protective equipment—from the hazmat suits seen in photos from around the world, to the impermeable disposable gowns, face shields and N95 respirators—the super-bare minimum needed to protect the nurses and patients from infection and/ or exposure to COVID-19—are clearly not being made available in any meaningful way to front line caregivers,” said SheridanGonzalez.

Source: Deaths, hospitalizations up in stark sign of virus’ reach, Associated Press

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NEW YORK NURSE

Non-Profit US Postage Paid NYSNA

march 2020

131 West 33rd Street, 4th Floor New York, NY 10001

PPE DONATIONS NYSNA is working with the Afya Foundation to manage donations of masks and PPE for frontline healthcare workers. Afya is the same organization NYSNA partnered with after Hurricane Maria devastated Puerto Rico. They’re seeking certified medical volunteers to organize and ship masks and other PPE to the frontlines. Afya’s warehouse in Yonkers remains open during this crisis;

register to volunteer! They’re also accepting donations to purchase PPE through their website, if you have inquiries from friends or family members: www.afyafoundation.org NYSNA is also thrilled to accept smaller scale donations from unions and local businesses who want to give protective masks and other PPE to NYSNA nurses. Contact Jeremy.Markman@nysna.org.

(Above) Rose Green, RN, receiving 720 N95 masks from China Labor Watch for Queens Hospital. She also received Its 2,700 surgical masks and approxomately 150 small bottles of hand sanitizer from Congresswoman Grace Meng's office.

We have also facilitated large donations through the Afya Foundation.