Lawmakers and government agencies are exploring greater protections for healthcare workers amid outcry over pandemic-related safety concerns that have persisted for a year.
During a House Education and Labor subcommittee hearing Thursday on strategies for protecting workers from COVID-19 infections, a registered nurse with National Nurses United urged greater federal protections for healthcare workers, first by recognizing aerosol transmission of COVID-19 and having the Occupational Safety and Health Administration issue an emergency temporary standard.
"If these recommendations had been implemented one year ago, my colleague Celia, along with thousands of other healthcare workers, would be alive today," Pascaline Muhindura, a registered nurse in the critical care unit at HCA's Research Medical Center in Kansas City, Missouri, told lawmakers.
As of Friday, the Centers for Disease Control and Prevention had counted more than 422,000 cases of COVID-19 among healthcare workers in the U.S and 1,397 deaths. That's almost certainly an undercount, however, as that occupation information was only available in fraction of the data.
There's still some uncertainty, though, about how at risk healthcare workers are to COVID-19 exposure at their jobs. A recent JAMA Network Open study found most healthcare workers who tested positive got the virus from community spread.
OSHA so far has declined to exercise its power to implement emergency standards, an option available to it under certain circumstances. Throughout the pandemic, hospitals and health systems have operated on guidance, not standards.
On Jan. 21, President Joe Biden issued an executive order asking the agency to consider an Emergency Temporary Standard, including with respect to mask wearing if necessary, and if so issue an ETS by Monday. It also instructs OSHA to launch a national program focused on enforcement for violators that put the largest number of workers at serious risk.
The American Hospital Association said in a letter to the committee such a move would create a rigid new standard that has "real potential to add for hospitals and health systems a new layer of conflicting and impractical regulatory burden at precisely the wrong time."
"Enacting these new standards could force hospitals and their staffs into a nearly impossible decision — to either not comply with the standards in order to treat all of the patients who need help or comply with the standards and stop treating patients when supplies of OSHA-required equipment are exhausted," AHA said.
But virus testing, personal protective equipment, safe staffing and workplace violence issues remain largely unchecked for working nurses, according to an NNU survey from 9,200 registered nurses, including both union members and non-union members, conducted in February.
More than 80% of nurses said they are forced to reuse single-use PPE, which is nearly unchanged from NNU's November survey. About half reported that all patients at their hospital are screened for COVID-19, and while more nurses have been tested since November's survey, that "still falls short of the regular and on-demand testing that nurses should be able to access," NNU said.
The survey also found that 22% of nurses reported facing increased violence on the job, which they attribute to decreased staffing levels, changes in the patient population and visitor restrictions.
"Violence has gotten worse in the past year," Muhindura said at the hearing. "You see an increase in anxiety and agitation in patients with COVID related to the strict isolation."
Rep. Joe Courtney, D-Conn., reintroduced the Workplace Violence Prevention for Health Care and Social Service Workers Act on Feb. 22, which would direct OSHA to create a national standard requiring healthcare and social service employers to develop and implement a comprehensive workplace violence prevention plan.
Courtney mentioned the Feb. 11 shooting at Allina Health Clinic in Buffalo, Minnesota, that left one employee dead and four others injured.
Hospital employees had "no sort of early warning systems or measures in place which OSHA has developed as volunteer guidelines for many, many years," Courtney said.
"But again because we don't have a national standard, are just not being implemented," he said.
Muhindura testified that her hospital has panic buttons in case of emergencies, but "not everyone has these protections throughout the country."