Alex Katsik: Hello, and welcome to Modern Healthcare Beyond the Byline, where we offer a behind-the-scenes look at our reports. I’m Alex Katsik, Senior Operations Reporter. Joining me today is our post-crisis and HR reporter Ginger Krist to talk about the workforce shortage and new federal guidance on COVID-19 return-to-work policy. Thanks for coming, Ginger.
Ginger Christ: Thanks for inviting me, Alex.
Alex Katsik: Last week we published this story about Guidelines from the Centers for Disease Control and Prevention, published Dec. 23., made recommendations to medical staff who tested positive for COVID. There are different protocol levels. The last two are contingencies in a crisis, in which case they recommended that organizations, when they are understaffed, return people who have tested positive after five days of isolation, even if they are symptomatic, with mild symptoms, that is, and if they did not produce a negative test. So we spoke to some industry supervisors, nurses, and frontline staff. What have you heard from medical professionals about how this is implemented and how it affects their work?
Read more: Nurses fear CDC guidance will bring more COVID-19 cases and deaths
Ginger Christ: Many of the healthcare professionals we spoke to and representatives of the associations were clearly concerned. They expressed concern about the conditions in hospitals and healthcare facilities throughout the pandemic, just in terms of infection control policies, personal protective equipment and the like. So what I’ve heard from nurses and others is that they’re worried about the idea of doing no harm. They are afraid to come to work and potentially expose a patient or colleague and then be held accountable for it. And then it could also potentially just spread COVID even more and make things even worse for the staff. Alex, I know that you have also spoken to nurses in various health care systems in several states and cities. What did they tell you?
Alex Kachik: I was talking to a nurse in Colorado who sent me an internal note that didn’t make her very enthusiastic. It states that “staff and healthcare providers with symptoms of a runny nose, sore throat, body aches, or loss of taste or smell may continue to report to work unless symptoms worsen and you do not need to be tested for COVID-19.” So hospitals are using CDC guidelines and this lack of staff to say, “Look, our backs are against the wall. There’s nothing else for us to do here. The CDC said everything is fine,” based on a study published in JAMA in August I. The most contagious stages of the new coronavirus are believed to be just before and after the onset of symptoms.
Alex Katsik: The guidance says hospitals are placing newly infected workers in wards without immunocompromised patients and informing patients and workers that they are operating to these standards in the event of a contingency or crisis and how this will change operations. So it’s tricky here, because the CDC is usually not a policy-making body, and these workers are already burnt out. Many of them have left the industry, exacerbating the shortage. As far as disclosure goes, Ginger, did you hear what they said in the hospitals? If they were to widely inform their staff and their patients about what this policy is and how their operations might change?
Ginger Christ: Yeah. The health care systems I contacted generally said they accept the CDC’s recommendations. However, when I asked about disclosure, none of them answered that question. They said they would try, many systems said they would try to prevent COVID-positive workers from working in areas with immunocompromised patients. But none of them actually answered if they were going to notify patients or staff if colleagues or staff came when they were infected with COVID. I know that you have spoken to Stanford Health. What did they say?
Alex Katsik: They first sent me a rather long statement saying that they accept the CDC standards that even if you have symptoms and they are mild and you don’t have a fever, you can get in. But then after a couple of sentences they said: “If you feel bad, don’t come in.” So I asked them about this contradiction and they said “Thanks for pointing it out” and they corrected it by saying “First of all, if you feel bad, don’t come in.” So it’s tricky here because hospitals in many cases want to do the best for their patients and workers, and they’re trying to digest this guidance and make rules accordingly.
Alex Katsik: But one of the nurses said it illustrated some long-standing problems in healthcare that show how fragile that workforce can be, especially when it comes to nurses and respiratory therapists. I know, Ginger, you’ve talked a lot about nurses leaving. You have written extensively about how nurses leave the profession and what contributes to staff turnover over the past year or two. What have your reports shown about why staff, doctors and nurses choose other professions, and what are your findings?
Ginger Christ: Yeah. As you said, there are long-standing disagreements between staff and employers. I think a lot of it came up during the pandemic, some of the problems that people were prepared for just… For example, problems in the workplace that were a problem but weren’t necessarily a matter of life or death like they are now. There was a lot of staff turnover because many nurses and other staff were burnt out. You know, they have been fighting the pandemic since the beginning of 2020, they are dealing with personnel issues, they feel like they are doing more and more and they are not being rewarded for it.
Ginger Christ: And you know that we started the pandemic with medical workers who were considered heroes, but now you also see a lot of hostility towards medical workers. So it takes its toll and there is this mental part. But at the same time, healthcare workers are in these dangerous positions every day, in these dangerous conditions, and doing the same thing over and over again, and it’s definitely taking a toll on them. So yes. I know you talked to the ICU nurse on duty, who I think said something similar.
Alex Katsik: Yeah. She is the head nurse and also the head of the Massachusetts Nurses Association. We didn’t include it in the story, but she works at Brigham and Women’s. She said they have been criticizing hospital administrators for years for not hiring enough nurses and for having too many patients on nurses. I covered the voting results in Massachusetts, I think, in 2019. They tried to become the second state after California to adopt a mandatory nurse-to-patient ratio, but this was rejected. She said that if it passed, they would probably be in a better position now. At the moment they are closing the beds. I don’t think it caused people to be turned away, but that’s only because they don’t have enough staff to look after those beds.
Alex Katsik: Most of the opportunity exists only in terms of infrastructure, but when it comes to staffing, this is where the real bottleneck lies. So, one of the things that we got into is the legal implications. And at least the lawyers I spoke to said that the CDC guidance was kind of designed and designed to protect or isolate some of these healthcare systems from possible lawsuits if some workers claim that they are at risk because of this policy. I don’t know if you also heard from your sources about whether it was a disclosure or other workplace lawsuits. Did you hear anything there?
Ginger Christ: Yeah. It looks like there might be some protection for workers just because it was a CDC recommendation. So there might be some protection there. However, when it comes to liking individual workers, this can be something that can vary from state to state just depending on their different rules in terms of it. Another issue that only comes up in terms of disclosure is the idea of ethics. As if it might be legal, but what should you ethically do and how should you notify patients or workers about some of these potential exposures to COVID-19?
Alex Kachik: For now, we’re hearing that more hospitals are moving into this crisis mode, which is outside the scope of this contingency protocol, which says you can return to work after five days of lockdown. It’s basically like no limits. I know the AP had a history earlier, it seems like it was yesterday, showing that some healthcare systems are recruiting COVID-positive workers. So some of these providers that we’ve spoken to are really concerned that not enough is being done to protect workers or patients in line with the CDC-listed recommendations here.
Alex Katsik: But I guess it will take some time to find out. We’ve heard some early reports of people who have contracted COVID after being admitted to the hospital. Not necessarily from the hospital itself or when they are there. It’s just that they weren’t hospitalized with this initial COVID diagnosis and later found out they had it. So it looks like it will be a permanent problem. Ginger, have you heard from your sources about the long-term changes in workplace conditions that could be caused by some of these causes?
Ginger Christ: Yeah. I mean, during the pandemic, there was a lot of labor activity and union action, and we saw a lot of places where unions came together that didn’t exist before. There were a lot of strikes and the like, where medical workers just stood up and demanded different conditions. Some of these things, as seen in some of the contracts we’ve seen and some of the strikes, we’ve seen that the workers do have a stronger voice than in the past.
Ginger Christ: Because they really show what some of their concerns mean and what they look like, so we see different… With some Kaiser contracts in California and some other western states, we’ve seen that they have certain staffing ratios and other things like that when healthcare workers feel more secure. Different infection control measures, different payment rules and making sure people get rewarded for the sacrifices they make.
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Alex Katsik: Excellent ginger. Thank you very much for sharing your reports and experiences with us. I appreciate it.
Ginger Christ: Thank you very much for having you.
Alex Katsik: Okay. And thank you all for your attention. If you’d like to subscribe and support our work, there’s a link in the show liner notes. You can subscribe to Beyond the Byline on Spotify or wherever you listen to your podcasts. You can stay up to date with our work by following Ginger and I and Modern Healthcare on Twitter and LinkedIn. We appreciate your support.