OSHA Emergency Standard Gives Nurses New Protections from COVID-19

  

COVID-19 protections for nurses and other health care personnel were long overdue on June 21, 2021, when the Occupational Safety and Health Administration (OSHA) published an Emergency Temporary Standard (ETS) in the Federal Register. In the notice, OSHA acknowledged that nearly a half million people working in health care had contracted COVID-19 by the end of May 2021, and more than 1,600 had died. It is reasonable to believe the standard is a little late, as some commenters have already responded to OSHA.

That said, the significance of OSHA’s action should not be overlooked. The ETS empowers nurses now to:

  • Advocate for increased safety in their work site;
  • Seek enforcement of concrete federal protections; and
  • Voice a chorus of support for strong standards that will have force and effect during future pandemics.  

A cornerstone of the ETS is the requirement for health care employers to develop and implement a safety plan to minimize COVID-19 risks to personnel. The ETS also specifies a number of concrete steps employers must take to reduce COVID-19 transmission in all areas of health care facilities. The ETS includes particular requirements in areas where nurses and other personnel have or may have contact with COVID-19 cases. For instance, on the issue of personal protective equipment (PPE), the ETS is very clear that effective respiratory protection means an N95 face piece, elastomeric masks, or powered air-purifying respirators (PAPRs).

Consistent with OSHA’s stance throughout the coronavirus pandemic, the ETS allows for contingency and crisis strategies when PPE is in short supply, such as limited reuse or extended use of N95s. However, OSHA believes that adequate PPE is no longer in short supply, citing the Food and Drug Administration and the Centers for Disease Control and Prevention. In the event of N95 shortages, OSHA says that employers should provide elastomeric masks or PAPRs as the preferred mitigation strategy.

In addition to PPE, the ETS spells out requirements on a number of COVID-19 protections in health care, including:

  • Screening for COVID-19 and appropriate management
  • Access to vaccination
  • PPE for aerosol-generating procedures with COVID-19 patients
  • Physical distancing and physical barriers on premises
  • Cleaning and disinfecting
  • Ventilation and air filtration standards

With the exception of a few requirements, OSHA expects employers to comply with the ETS beginning July 6, 2021. Nurses with information about violations of specific ETS requirements can contact OSHA with complaints. Complaints can be filed online or by calling 800-321-6742 (OSHA). The ETS warns that under federal law, employers must not retaliate against an employee who complains to OSHA. The ETA also provides that employers must not take actions against an employee who exercises their rights under the ETA specifically.

Nurses understand that the pandemic is not over, and there will inevitably be more pandemics and other public health emergencies. Nurses must not be on the frontlines of failed preparedness in the future. A permanent standard with strong respiratory standards is a necessity. ANA has urged OSHA to build on the ETS and develop a permanent standard that will protect health care personnel specifically from threats involving infectious diseases.

Nurses can comment on the ETS, through July 21, 2021.

ANA members can access our Policy Brief on the ETS here.

OSHA’s materials on the ETS are available here.

Workplace Violence Bill Introduced with ANA Endorsement

  
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As the coronavirus pandemic extends into a second year, nurses enter a second year of calling on Congress and the Administration to ensure an adequate supply of personal protective equipment (PPE) and prioritize COVID-19 vaccine distribution for health care providers. On these issues, the American Nurses Association (ANA) will remain a strong, clear voice until COVID-19 is no longer a threat to nurses on the job, wherever they provide care.

Throughout a challenging year of health emergency, though, nurses and their champions have not turned away from the serious workplace issues that pre-date and continue into the COVID-19 era. An example is workplace violence, which is shown to be highly prevalent in healthcare settings, causes harm to nurses and other health care providers, and undermines quality of care.

Violence and other abuses toward nurses are notably underreported. One reason that many nurses do not report incidents of violence is the belief that their experience will not be acted upon effectively by their facility’s leadership. Even so, the Government Accountability Office (GAO) reported in 2016 that violence against health care workers could be as much as 12 times higher than the overall workforce. This is a critical issue from ANA’s perspective, given that nurses are often the frontline providers in these settings.

The GAO concluded that more efforts are needed. Principally, federal workplace safety regulations should be strengthened. On February 22, 2021, Representative Joe Courtney of Connecticut introduced a bill, with bipartisan support, that would do just that. H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, is almost identical to a measure that passed the House, but was not afforded a vote in the Senate, in 2019.

The bill would require the Occupational Safety and Health Administration (OSHA) to have and enforce specific standards for health care and social service employers. Specifically, OSHA could hold these employers accountable under new safety regulations. The regulations would require health care and social service employers to create violence prevention programs, take concrete steps to reduce the risk of on-site assaults, and employ best practices to encourage reporting and employee engagement in prevention.

ANA has endorsed H.R. 1195, and is working toward speedy passage in the House, followed by Senate action in this Congress. Future posts on Capitol Beat will explore the issue and the legislation in more depth.

For more information about the ANA’s advocacy on workplace violence, click here.

ANA Leads Nursing Community to Strengthen COVID-19 Vaccine Confidence

  

On December 15, 2020, the American Nurses Association (ANA) joined with the American Hospital Association (AHA) and the American Medical Association (AMA) in an open letter urging health care professionals to take the COVID-19 vaccination when it becomes available to them. Since that time, ANA has been delighted to see the welcome images and stories shared of nurses stepping up to take the COVID-19 vaccine, and prepare themselves to vaccinate the general public when the time comes. In one of our favorite postings on social media, Reuters tweets a video of a nurse in New York receiving their second dose, on January 4. And here is ANA chief nursing officer Debbie Hatmaker cheering on nurse volunteers to go out and get the shots in the arms of the first tiers of vaccine recipients.

More recently, ANA, AHA and AMA released a public service announcement (PSA) calling for the American public to get the COVID-19 vaccination when it is their turn. The PSA emphasizes that COVID-19 vaccines are safe and effective, and will help us all as we work together to defeat COVID-19. 

Many people, including some nurses and other health care providers, are skeptical about taking the vaccine. Some are distrustful of the speed with which the vaccine came to market. Others, including many individuals from Black American, Latinx and other communities of color, legitimately distrust a healthcare system that has a history of discrimination, abuse, and neglect. This history not only points back to unethical and inhumane scientific experimentation such as the Tuskegee project, but is manifest in persistent disparities and systemic injustices in health care access and outcomes, even to this day in the COVID-19 pandemic. ANA along with the American Academy of Nursing has called for broad-based social action to address injustice and racial inequities in health care. Disparities must be addressed if the project to vaccinate the nation is to be successful.

In an effort to lead by example and show certainty of the science in the safe outcomes of COVID-19 vaccines, ANA President Dr. Ernest Grant participated in the Moderna vaccine trial. “It afforded me the opportunity to stand in solidarity with nurses on the frontline, battling the COVID-19 pandemic all across the U.S. Secondly, I recognized the urgent need for Black Americans to participate in vaccine clinical trials,” said Dr. Grant. The trial was unblinded earlier this year and Dr. Grant learned that he did receive the vaccine, as opposed to the placebo. He has elected to remain in the study for the full two years, as Moderna continues to gather data on the effects of the vaccine.

ANA leaders are confident in the capacity of the nursing profession to meet this moment. This confidence comes from knowing that nursing remains the most trusted profession, and that nurses hold themselves to high ethical and practice standards. Following these standards in the broadest sense means that a nurse will have an informed, considered approach to receiving and administering the COVID-19 vaccine. A nurse must consider their duties to optimize patient outcomes and promote the common good, along with the responsibility to safeguard their own well-being. In any situation, there is an ethical obligation to seek and obtain education and information, as well as advocate for answers when there are questions. Nurse leaders have a duty to provide nurses with accurate and accessible information so that individual nurses can make an informed decision for themselves and in turn assist in counseling their patients. 

In a survey of 13,000 nurses conducted last October, four out of ten nurses indicated a need for more information about the COVID-19 vaccine as a major reason for their skepticism at that time.  To meet that need, ANA set about to educate nurses and equip them with the tools they need to make decisions for themselves and for their patients. One key component is a set of Guiding Principles for Nurses, organized around themes of Access, Transparency, Equity, Efficacy, and Safety, approved by the ANA Board of Directors in 2020.

ANA continues to work to gather the most credible, evidence-based information about the vaccines, and share that information widely with members, nursing communities, partners in health, and policymakers.

Nurse-focused materials available now include:

  • FAQs created jointly by ANA and the pharmacist group ASHP, written with the clinician in mind.
  • A webinar and short-form videos featuring perspectives from a public health nurse and presenting the facts about COVID-19 vaccine development and distribution

ANA’s dedicated vaccine webpage also offers links to relevant information from partners such as the Centers for Disease Control and Prevention (CDC).  ANA is using its other distribution channels to share information helpful to nurses in the vaccination effort, such as the Vaccine Handling Toolkit recently released by ANA’s partner US Pharmacopeia. The toolkit informs operational issues on preparation and labeling, storage and transport, and waste and disposal of COVID-19 vaccine material.

Providing vaccine education and resources aligns with ANA’s commitment to immunization as a critical component of public health. In addition to providing information directly to nurses, ANA has advocated for public policies to address specific aspects of the vaccine roll-out that are important for nurses and their patients. In a letter to the transition team for the new Biden administration, ANA emphasized that nurses are central to vaccination efforts and their voices should be considered in distribution planning. ANA also called for federal resources to support mass distribution and administration. Advocacy on vaccines goes hand in hand with continued advocacy for policies to expand access to protective equipment and provide economic relief as strategies that are also key to slowing the spread of COVID-19.

For more information about ANA advocacy on issues that are important to nurses, visit RNAction.org.