Local coronavirus case numbers and hospitalizations have gradually declined this month, yet many Southern Nevada hospital workers say they still face high workloads and worries over workplace safety despite their employers’ assurances.
Nicole Koester, a representative with National Nurses United who works as a labor and delivery nurse at MountainView Hospital, said regionwide case spikes in June and July led to staff shortages at her facility that have not yet abated.
Nurses she’s spoken with at the hospital remain concerned about the reuse of personal protective equipment, or PPE, access to COVID-19 testing for staff and what she describes as a lack of communication from management.
“It’s discouraging. The morale within the units in the hospital is going down at a drastic pace because you feel so undervalued,” she said.
National Nurses United, a union and professional organization, and SEIU Local 1107 have been among the most vocal groups calling for increased attention to hospital workers’ safety during the coronavirus pandemic in Southern Nevada.
Members of both groups have taken part in protests of local hospitals, including demonstrations at facilities owned by Dignity Health-St. Rose Dominican Hospitals and MountainView operator HCA Healthcare.
SEIU members employed by HCA delivered more than 400 forms Friday to the state objecting to working conditions they say place themselves and/or their patients at risk.
“Since the pandemic began we have been told: Wash your hands, wear a mask, sneeze into your elbow,” registered nurse and HCA employee Michael Forson said in an SEIU news release. “But why then as a frontline healthcare worker am I told after I’ve tested positive with no symptoms to come back to work and possibly get my patients and coworkers sick? Why am I not provided the right PPE to prevent me from getting sick?”
The union members’ concerns include provisions outlined by the Centers for Disease Control and Prevention that allow for workers who test positive for the virus to return to work without receiving a negative test result first.
According to the CDC website, testing is no longer a viable strategy because it prevents individuals from working when they are no longer infectious but still shedding virus. Viral RNA may result in a positive test for weeks after a patient’s “apparent clinical recovery,” but “detection of viral RNA does not necessarily mean that infectious virus is present,” according to the CDC.
The national health protection agency’s guidelines have been updated throughout the pandemic to give consideration to new scientific developments. However, the CDC also devised exceptions to those guidelines based on organizations’ staffing concerns.
Koester argued that the CDC’s new guidelines on use of personal protective equipment, or PPE, fail nurses and jeopardize their health. She said sterilization and subsequent reuse of typically single-use masks by hospitals is of great concern to her and her fellow nurses.
“The CDC has made it acceptable for (employers) to utilize PPE in a way that it was not intended,” she said. “PPE is something that is designed and manufactured to be a single-use product.”
Data from March 16 to August 5 show that of 50 complaints to the Nevada Occupational Safety and Health Administration regarding workplace COVID-19 safety at general medical facilities and surgical hospitals, 10 investigations have been closed.
No citations have been issued in those cases, and many of the investigations were closed without inspections of the worksites, said Teri Williams, public information officer for the Department of Business and Industry Director’s Office, via email.
Many of the closed inspections included complaints of insufficient personal protective equipment from March through May.
Those coronavirus-related complaints can be closed if employers provide evidence of compliance in response to a letter from OSHA. By contrast, an allegation involving both COVID concerns and accusations of a violation of pre-coronavirus OSHA standards would lead directly to an in-field investigation.
“If the response satisfies the inquiry, the complaint is closed. If officials determine that the response is inadequate or contains false or misleading information, an in-field investigation can be opened with the employer,” Williams said.
Citations are issued only if violations are found during the investigation and inspection processes.
Ongoing staffing shortages
Worker safety concerns are being heard publicly as multiple Clark County hospitals “continue to experience ICU saturation with occupancy rates above 90” percent, according to an Aug. 12 report from the Nevada Hospital Association.
The number of facilities affected by these high saturation numbers appears to have dropped in recent weeks as Southern Nevada experienced an overall decrease in cases and hospitalizations, according to the report.
However, “several facilities continue to indicate ICU staffing shortages.” Staffing has been an ongoing issue for Southern Nevada hospitals.
HCA Far West Communications Manager Antonio Castelan said in an email that the hospital is requiring mandatory overtime in certain cases.
University Medical Center of Southern Nevada, North Vista Hospital and Dignity-Health St. Rose Dominican Hospitals confirmed some of their employees are also working overtime or picking up extra shifts to deal with heavier caseloads.
The extra work in the summer season is atypical and precedes what may be an unusual flu season — normally a busy time for local hospitals that also leads to added caseloads.
HCA “has all the protocols in place to make sure staffing is not affected,” Castelan said of the hospital’s response. “The situation is constantly changing. All our hospitals are prepared for worst case scenarios, and are ready to deal with them promptly.”
In a separate statement, HCA said the company is “taking prudent steps now to conserve PPE because we do not know what our future needs will be.”
“HCA Healthcare currently has adequate supplies of PPE, and we are doing everything in our power to ensure we continue to have enough to protect our colleagues as they provide care to patients.”
The company has been heavily criticized by unions across the country for its increased profits during the second financial quarter of the year, which included hundreds of millions in federal stimulus funds.
However, HCA isn’t the only local hospital operator struggling with staffing or workforce concerns over safety practices.
Hospitals have argued that screening processes and work environments offered to their staffers are in line with CDC guidelines, but safety gaps persist.
A worker at one Southern Nevada hospital, who asked not to be identified due to the risk to her employment, told the Nevada Current she was tested for COVID while feeling ill. Though she ultimately tested negative, she was allowed to work while awaiting the test results, which were returned in roughly 12 hours.
Valley Health System, University Medical Center of Southern Nevada, Dignity Health-St. Rose Dominican Hospitals and HCA all conduct temperature and verbal screenings of employees for COVID symptoms, according to their respective representatives.
Valley Health confirmed the hospital system provides coronavirus testing to employees who were exposed at work but requires those exposed elsewhere to visit their primary care doctor for testing.
“If an employee develops any symptoms consistent with COVID-19, they must cease patient care activities, notify their supervisor and go home,” said Gretchen Papez, VHS director of public relations and media, via email.
At UMC, employees with “symptoms of COVID-19 are not allowed to come to work, including those who are awaiting test results,” said public relations manager Scott Kerbs in an email.
National Nurses United has pushed for OSHA to issue a national emergency temporary standard aimed at ensuring “employers protect workers during the COVID-19 pandemic,” according to a May news release. Nevada Sen. Catherine Cortez Masto is among those who have voiced support for the measure.
Ultimately, fears surrounding worker safety are tied to concerns that the quality of patient care drops when staff are stretched too thin, Koester said.
“People believe that we’re taking good care of their family,” she said. “I don’t know that many nurses right now will tell you that they feel they’re giving good care because they simply can’t.”