Roughly half of SEIU Nevada’s members work in healthcare, most for the 11 hospitals across the state that we represent. Below is advice offered to these and other frontline workers by Mark Catlin, SEIU’s Occupational Health and Safety Director.
Healthcare Employers Must Develop and Implement Specific Occupational Health and Safety Policies and Procedures to Protect Workers
The first case of Ebola transmission to a healthcare worker in the United States was to a nurse at Texas Health Presbyterian Hospital in Dallas who had cared for the Liberian man who died from Ebola. The hospital has claimed that all CDC guidance had been followed. Public health officials originally suggested that a breach in protocol must have occurred, although this has since been retracted. This statement has led many to the conclusion that the nurse made a mistake which led to her infection. The response to this has been a call for more training to help healthcare workers protect themselves.
More and better training is crucial, as are drills to practice the strict infection control procedures recommended by CDC and needed to protect healthcare workers when caring for suspected or known patients with Ebola. However, training is only one part of the picture. Hospital management must develop site specific comprehensive programs that integrate the CDC Ebola guidance, at a minimum. Simply referring workers to the CDC website, passing out a print out of the CDC guidelines or showing a short slide presentation is not what is needed. Without a comprehensive infection control program with occupational health and safety built in, just training healthcare workers won’t be enough.
Hospital management should review infection control policies and procedures and incorporate plans for administrative, environmental, and communication measures, as well as personal protective equipment (PPE) and training and education. Hospitals should also define the individual work practices that will be required to detect the introduction of a patient with Ebola or other emerging infectious diseases, prevent the spread of Ebola, and manage the impact on patients, the hospital, and staff. Everyone inside a hospital, from the CEO to the management team to frontline workers, has a responsibility in meeting the following guidelines:
- Strict compliance with OSHA’s Bloodborne Pathogens (BBP) standard is crucial, including the use of safer needles and sharps, as required in the BBP. SEIU fought for and won the BBP standard in 1991 and the safer needle requirement in the federal Needlestick Safety and Prevention Act signed into law in November, 2000. The OSHA Bloodborne Pathogens standard explicitly requires the use of safety-engineered sharp devices and the active involvement of front-line workers in the evaluation and selection of these safer technologies. A 10-minute 2001 SEIU video, The Fight for Our Lives: How We Won Safer Needles, highlights our history with these victories and can be viewed at http://youtu.be/g51WkB9zpEk.
- The CDC guidance for Healthcare calls for standard, contact, and droplet precautions for management of hospitalized patients with known or suspected Ebola virus disease. As a part of the guidance, the CDC recommends the use of respiratory protection (at least an N95) during all aerosol-generating procedures performed on a suspect/known patient.
- Facilities must have a clear policy on pay and benefit protection for all workers placed on precautionary removal from their normal work because of possible Ebola exposure. Language requiring this is part of the California OSHA Aerosol Disease (ATD) Standard, which specifically covers Ebola. SEIU and the Nurse Alliance of California fought for and won the ATD standard in 2009, a unique occupational health standard protecting healthcare workers in California. Outside California, this or similar language should be in a facility’s plan:
“Where the Physician or other licensed health care professional (PLHCP) recommends precautionary removal, or where the local health officer recommends precautionary removal, the employer shall maintain until the employee is determined to be noninfectious, the employee’s earnings, seniority, and all other employee rights and benefits, including the employee’s right to his or her former job status, as if the employee had not been removed from his or her job or otherwise medically limited.”
Local unions and our members should be included in the development, periodic review and implementation of the plans. Our members’ involvement and experience are key to a plan that is effective in providing care for these patients while protecting the health and safety of our members.
This is a beginning. As information and guidance changes, we’ll provide updates and additional information to assist local unions in understanding issues around addressing the Ebola outbreaks and ways to help our employers during this public health emergency.
SEIU Nevada unites healthcare workers in our commitment to provide the safest and highest quality of care for our patients and the public we serve. Our history in defending our bedside staff and protecting our patients has been at the very principal of our organizing the healthcare systems throughout the state. As well, we have built a Healthcare Committee that not only brings together nurses but all the ancillary staff throughout the hospitals and from around the Silver State.
We conducted Statewide Healthcare Summits to address the current healthcare crisis in our state. Last year, in our Healthcare Workers 2012 Summit, we reviewed our universal frustration with staffing levels within our facilities and our lack of enforcement power. We put forward a staffing bill that we felt would address both issues. We renewed our efforts to implement state-wide minimum staffing ratios to address the staffing level and the protection of our patients. We kicked things off by collecting hundreds of Assignment Despite Objection forms which supported our cause for a great need for legislative change.
Senate Bill 362
In our efforts to ensure patients receive quality care, we sought sponsorship and support for a Minimum Nurse Staffing Ratios Bill. Staffing Ratios has been a long standing battle between SEIU Nurses and hospital administrations not only in Nevada but throughout the country. A Safe Staffing Bill would have required hospitals to create an acuity system and annual staffing plan, including minimum nurse-to-patient ratios, and provide for penalties if such ratios are not met. In Nevada, we have submitted Staffing Bills in 2003, 2007 and in 2009.
We still believe staffing is the right solution. Although we were able to make tremendous gains and secure groundbreaking legislation, unfortunately, we did not win Senate Bill 362 in its original format. However, after a long drawn out debate, Senator Spearman found a common interest with all parties to increased protection of the patients and the staff who cares for them.
SB 362 Will:
· Establish the power within the Staffing Committees for health care workers to set the matrixes for all the units in order to provide quality patient care.
· Develop the necessary policies to ensure the hospitals adhere to the established matrixes.
· Identify how Nurses and Certified Nursing Assistants ARE PROTECTED from retaliation if they exercise their right to refuse an assignment.
· Reiterates provisions already in Nevada Administrative Code NAC 632 that authorizes RNs and CNAs the right to refuse an assignment.
· Establishes investigations, penalties and fines for medical facilities that do not develop and implement staffing plans.
· SB 362 authorizes the Health Division to oversee at the Staffing committees, policies, and patient ratios as part of the medical facilities licensing process.
· Note RNs and CNAs who are in labor unions already have additional provisions in their negotiated contract to utilize Acceptance Despite Objection Forms – Now SB 362 gives that right to everyone whether they are in a Union or not!
• Under SB 362, we will have a neutral entity, the Nevada Division of Health, overseeing and logging the complaints. We increased our powers within our Staffing Committees, hospitals will have to develop appropriate matrixes and nursing care requirements for each unit and tie these provisions to the licensing processes of our facilities in Clark and Washoe County.
A big thank you to our President Al Martinez and the many RN and healthcare leaders and professionals who advocated on behalf of this bill. We are pleased the Governor has signed this groundbreaking legislation and look forward to being part of the implementation and part of the solution!