Dec 05, 2014

“Safety is not negotiable”

Canadian Nurse asked Linda Silas, RN, BScN, president of the Canadian Federation of Nurses Unions, for her take on the role of health-care employers in preparing nurses for an Ebola outbreak and ensuring the safety of nursing staff

What should employers be doing?

Employers need to understand that this is an occupational health and safety issue. No nurse, or other health-care provider, should have unprotected exposure to Ebola. Employers must provide appropriate training and personal protective equipment before a nurse is assigned to care for a potential Ebola patient.

Employers must adopt the precautionary principle that safety comes first. Firefighters are provided with basic equipment to fight a fire, but when there’s even a possibility of dangerous chemicals being involved, they’re given enhanced protection. Why isn’t it the same for nurses?

We’re calling on employers to adopt the protocols and procedures recommended in CFNU’s policy directive on emergency preparedness for Ebola to ensure the safety of their staff:

  • Conduct initial and ongoing facility risk assessments to identify potential hazards and the risk of exposure to the virus, followed by the implementation of changes in policies, procedures, equipment and the environment to eliminate or minimize the identified risks. Share all the results with the facility’s occupational health and safety committee.
  • Commit to full training, testing and drilling for health-care providers in how to conduct a point-of-care risk assessment before each interaction with a patient and/or the patient’s environment to evaluate the likelihood of exposure to contact and/or aerosols in care procedures, equipment and treatment settings to determine the appropriate safe work practices
  • Ensure that screening and readiness protocols are in place across all hospital points of entry, including prominent signage, active screening by workers with access to appropriate personal protective equipment and EVD training, plus the ability to summon trained, equipped personnel when a suspect patient is identified and to implement isolation measures for those with symptoms.
  • Implement protocols for safe provision of care for patients. Staffing will be, at a minimum, two RNs per EVD patient, due to the acuity and complexities of caring for Ebola patients.
  • Implement cleaning and waste disposal protocols.
  • Implement a standardized, prescriptive Ebola PPE-specific donning and doffing procedure that includes a fully trained monitor to observe and correct the donning/doffing. Practical direction for activities such as changing gloves while in isolation (e.g., between care tasks) should be included.
  • Immediately implement a communications strategy for all management and staff. This strategy must clearly identify the steps to take when a potential EVD patient presents in health-care facilities, while maintaining patient/staff confidentiality. Similar communications must be developed for the public.

We have also made recommendations for employers regarding containment measures and duties for staffing and training. To date, Ontario has the most comprehensive directive with respect to these measures (see Ebola Virus Disease Directive #1 – Revised October 30, 2014 on the Ministry of Health and Long-Term Care website).

What should nurses be doing to keep themselves safe?

Individual nurses need to take the situation seriously. Of course, providing safe patient care is fundamental, but nurses need to prioritize their own safety as well. They need to conduct a personal risk assessment for each patient, and act accordingly. If the training, testing and drills haven’t been comprehensive, the nurse shouldn’t enter the patient’s room.

What’s the role of occupational health and safety in Ebola preparedness?

To me, we’re in the midst of an ongoing occupational health and safety crisis in health care. We spend so much time focusing on professional practice, yet we only hear about health and safety when we believe a crisis is imminent.

Every workplace is mandated to have an occupational health and safety committee, and we need to rely on the expertise and leadership of the members of these committees. We’re starting to incorporate occupational health and safety principles into preparedness planning — something we didn’t do quickly enough with the SARS outbreak. For example, the role of occupational health and safety committees is addressed in the latest PHAC statement. Safety must come first. We can’t await scientific certainty when it comes to potential risks to the health and safety of our nurses. All decisions must be based on the precautionary principle.

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