The country’s largest nursing union is accusing hospitals of skirting mandates it fought hard for the Occupational Safety and Health Administration to temporarily impose amid the COVID-19 pandemic.
Infection control policies early in the pandemic rapidly shifted amid shortages and changing guidance from government agencies, spurring tension between healthcare workers and their employers. Concerns over safe staffing levels, equipment needs and other issues have led to numerous protests and strikes across the country.
The strain continues as front-line healthcare workers face high levels of burnout and refusal among some to comply with vaccination requirements — all amid surges of the highly-infectious delta variant that’s filling up ICUs.
After a campaign from nursing unions, OSHA in June issued an emergency temporary standard laying out masking, social distancing, testing and ventilation requirements for hospitals and nursing homes. The rules carry exceptions for vaccinated workers, and were met with pushback from industry groups that said they needed more time to make sense of the requirements.
Hospitals should now be in compliance with all of the ETS requirements, though nurses still face challenges with inadequate respiratory protection, COVID-19 testing and notifications when they’re exposed to the virus, according to a survey of more than 5,000 registered nurses across the country from National Nurses United.
The union calls on OSHA to make enforcement more robust amid surging cases of the delta variant straining some hospital resources. Last week the union applauded new recommendations from the Centers for Disease Control and Prevention that healthcare workers and others whose occupations increase their risk of exposure — if they received the Pfizer/BioNTech vaccine — get a third booster shot as immunity wanes.
“Covid cases are surging to their highest levels yet in some areas of the country, and some ICUs are over capacity,” NNU Executive Director Bonnie Castillo said in a release.
“Healthcare employers must notify nurses as soon as possible when they are exposed and make it easier for RNs and other healthcare workers to get tested,” she said.
In the NNU survey, nurses reported inadequate screening and testing rates for patients who enter or are admitted to healthcare facilities, along with a decrease in dedicated COVID-19 units compared to the last time the survey was taken in March.
Only 23% of hospital RNs reported timely notifications of exposure from employers in the latest survey, down from 31% in March.
And access to testing is still a major concern. While 41% of respondents said anyone who asks for testing at their hospital has access, 20% said access to testing is limited and 7% said testing is not available to them.
Issues with testing and tracing exposures are spurring new concerns around the use of personal protective equipment, too.
About 62% of nurses reported using surgical masks when caring for patients suspected of having COVID-19 or awaiting test results while 40% reported wearing respirators around those patients, according to the NNU survey.
Access to COVID-19 testing has greatly increased in the past year, though questions remain about random or regular testing for hospital employees, many of whom were the first to receive the vaccines, Mara Aspinall, who studies biomedical testing and is a professor of practice at Arizona State University’s College of Health Solutions, said.
“I think the healthcare environment really has their own questions as to what their tolerance for risk is, and how they want to work with their population,” Aspinall said.
“But it is true that we’re entering sort of a new stage of the pandemic,” she said.
Industry groups have opposed the ETS, saying their members have largely been following most of the guidelines over the past year or made their best attempts to do so.
The American Hospital Association, Association of American Medical Colleges and others pushed the agency to delay compliance dates in July, contending providers needed more time to make sense of the policy and implement its new requirements, though OSHA declined to do so.
And in an August letter, AHA urged OSHA to withdraw the ETS entirely or let it expire after six months without issuing a final rule. AHA laid out qualms including how difficult it is for some hospitals to notify employees within 24 hours of virus exposure, suggesting an extension to 72 hours is more feasible.
The lobby also contends ETS requirements around PPE could lead to the unnecessary use of respirators, impacting a hospital’s overall supply, according to the letter.