DiversityNursing Blog

Personal Protective Equipment (PPE) is essential for protecting healthcare workers on the frontlines of the COVID-19 pandemic. However, with prolonged use of PPE, comes skin damage.

According to a study by the Journal of American Academy of Dermatology, 97% of staff working in two different COVID-19 units reported PPE-related skin damage. The incidence increased when PPE was worn continuously for longer than six hours, and especially with N95 masks and goggles.

Hand irritation is common when frequently using gloves. The hands become irritated from constant sanitizing and hand washing. Also gloves trap moisture and heat, causing side effects such as eczema and dermatitis on hands. 

Pat hands dry or allow hands to air dry instead of rubbing to avoid further irritation. Also use warm water instead of hot because frequent use of hot water can lead to excessively dry skin. Moisturize but make sure the skin fully absorbs it before putting gloves back on. 

Nurses wearing air tight N95 and N99 masks for many hours often end up with red indentations on their faces. On the other hand, Nurses who wear non airtight masks have reported getting acne and evidence of skin irritation from pressure or chafing of the mask over the bridge of the nose.

Make sure your mask isn't too tight and is fitted comfortably on your face. You should relieve pressure regularly. If possible, try removing your mask, goggles, and or face shield at least every four hours. Relieving pressure for a few minutes to allow for normal blood flow can prevent lasting skin damage.

Filmmaker, Carolyn Jones released The American Nurse in 2012, Defining Hope in 2017, and now In Case of Emergency: Without You, We Don’t Stand A Chance.

Jones teamed up with the Emergency Nurses Association (ENA) to create a documentary that celebrates emergency Nurses and the impact they have on patients across the country.

ENA President Patricia Kunz Howard said, "Emergency Nurses do amazing things every single day. They put their patients first without any thought of reward or recognition. With Carolyn's unique style and approach to storytelling, this documentary will pay a proper tribute to that selflessness by showing the world the complicated, yet rewarding, work that defines emergency Nursing and the people who are committed to care."

“When COVID hit, we realized that it is all nurses that we can’t live without,” said Jones. “The role you play is really critical for us in finding our way to a better way of living. I applaud each and every one of you.”

In another interview discussing her new project, Carolyn said, "I want Nurses to feel elevated and come out of this idea that no one else wants to know what they are doing. The public will never understand it until Nurses tell them what goes on. I hope that some Nurses will rise to the surface and find their voices. They are the best story tellers I’ve ever encountered. That’s what I love about interviewing Nurses – boom, the story is right there.”

In celebration of Emergency Nurses Week, the film will be premiered virtually on October 14, 2020. 

TRAILER In Case of Emergency: Without You, We Don’t Stand A Chance 

Healthcare workers across the country are fighting tirelessly against COVID-19. They're wearing head to toe PPE around the clock. They're hot and frustrated while wearing it, and… they also lose their identity. Patients just see masks, suits, gloves, and goggles. Hospital staff wants this to change.

"Share Your Smile" and the "Button Project" are just 2 examples of a small, but positive movement. To look less intimidating to patients, healthcare heroes are attaching large photos and buttons of their faces, to their PPE.  

The goal of these projects is to eliminate or reduce a level of fear and anxiety for patients, especially children, who find comfort in seeing the smiling faces of healthcare team members.

San Diego respiratory therapist Robertino Rodriguez started the "Share Your Smile" idea. Rodriguez said, “Yesterday I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient. So today I made a giant laminated badge for my PPE so my patients can see a reassuring and comforting smile.”

The movement is catching on amongst health care workers. Peggy Ji, an ER Doctor in Los Angeles, wrote on Instagram, "I was inspired by Robertino Rodriguez who works as a respiratory therapist in this COVID pandemic. I didn’t have a preprinted photo or a color printer so my polaroid will have to do. I wanted to bring a personal touch to caring for patients through my PPE. My hope is that our patients will know there’s a reassuring smile under this mask, and that we’re here for them."

Nurse Derek also posted a photo of himself and fellow coworkers on Instagram saying, "thought it was a beautiful way to bring ease to our patients during this stressful time. Thank you to all the healthcare workers out there for battling on the frontlines."

The Button project holds the same meaning and started at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Adelaide Vienneau, Director of the Children’s Hospital Family Resource Center (FRC) said, “When we were asked to take the lead on this project, I immediately said, ‘yes.' The FRC team likes finding solutions for staff and providing resources to assist patients and families in having the best possible experience during their health care visit. We are delighted with the anecdotal comments on how the photo buttons have been well-received.”

Any time in the hospital as a patient is a scary time for the patient. The personal connection is so important, but difficult to achieve with all of the PPE. What a simple, yet creative way to put patients at ease to feel a more personal connection with the healthcare team.

What is your place of employment doing about this? Please share with our community. Thank you!

Researchers at MIT and Brigham and Women’s Hospital designed a new face mask that is believed to be as effective as N95 masks. 

There has been a dire need for N95 masks in hospitals across the nation. Essential workers were wearing the disposable masks more than once, often weeks at a time. 

Engineers and researchers hope to provide a solution to this shortage by designing a mask that can be safely reused. 

According to CNBC, the new MIT mask is made from silicone, with slots for just two small, disposable disks of the N95 material (which serve as filters). That means the masks themselves can be quickly and easily sterilized and reused.

Adam Wentworth, a Research Engineer at Brigham and Women’s Hospital said, "With this design, the filters can be popped in and then thrown away after use, and you’re throwing away a lot less material than an N95 mask." 

The mask is called iMASC, which stands for Injection Molded Autoclavable, Scalable, Conformable. The iMASC can be sterilized a couple of different ways. You can use a steam sterilize, put it in an oven, or soak them in both bleach and rubbing alcohol. 

In a study researchers had 20 healthcare workers wear the mask and perform a series of movements to see how it stayed in place. High ratings were given for fit and breathability. 

The study also showed the mask successfully filtered out a sugar solution in the air that was used to mimic aerosolized respiratory droplets.

According to FastCompany, researchers are beginning talks with the FDA about emergency use authorization, both for healthcare workers and the general public. The team is currently running both an environmental impact study and a cost-effectiveness study, and has estimated that its mask could cost just $15 and be used up to 100 times, making the cost per use likely less than a quarter, with the filter inserts less than a dollar.

There is no timeline yet as to when these masks will be available. 

One positive thing to come out of the COVID-19 pandemic is the renewed appreciation for healthcare workers, particularly Nurses. This appreciation is leading to an increase in Nursing school applications.

Donna Havens, PhD, RN, FAAN, Dean of Nursing at Villanova University M. Louise Fitzpatrick College said, “For the first time in my career, which has been a long one, folks truly get what Nurses do and they see how important and rewarding a career it is. Some would say Nurses are the glue, especially in hospitals and healthcare organizations." 

Havens believes another reason for the uptick in applications is from the record unemployment that has resulted from the pandemic. People in struggling occupations may look to Nursing as a rewarding and stable profession. 

Widener University spokeswoman Emily A Barrett said, "Historically speaking, economic downturns translate to an increase in Nursing programs due to industry stability and growth, which is projected to rise 15 percent by 2026 according to the U.S. Bureau of Labor Statistics."

Sandra Russo, Chair and Director of the Nursing program at Touro College in New York said, "This year, I have 20 students on a waiting list to get into my program, so the demand is much higher."

Kevin Finn, Dean of Colby-Sawyer School of Nursing and Public Health said, the one thing he sees in common on the applications is a desire to help. 

The incoming Nursing class is 34% larger than last fall's. The college will have 90 students enrolled in its Nursing program in September, an increase from 62 students last year.

The University of Kansas School of Nursing said it’s currently at capacity on applications. In fact, they’ve increased their Salina branch because of so many people who now want to be a Nurse.

Nurses are in demand. Getting into Nursing school was already extremely competitive before the pandemic. Nursing schools may become even more selective with the increase in applications. Future Nurses should focus on boosting their credentials. 

COVID-19 has shone a light on how systemic racism plays a role in health disparities among Black people. 

According to Scientific American, the overall death rate from COVID-19 is 2.4 times greater for African Americans than it is for white people. 

Camara Phyllis Jones, an Epidemiologist who recently served as president of the American Public Health Association said, “People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism.”

Hypertension, obesity, diabetes and other risk factors for severe coronavirus complications, are more prevalent in minority populations.

According to an article from STAT, Black people in the U.S. are more likely than white people to live in food deserts, meaning they have limited access to fresh fruit or vegetables. They are also less likely to be able to access green spaces, and more likely to live in areas without clean water or air.

Household spread is the most common form of virus transmission. Many people of color live in overcrowded homes and communities so it's difficult to social distance. It is also difficult to find an outdoor place to social distance as there are fewer publicly provided resources, such as parks and bike lanes, for minority-dense neighborhoods.

The best advice to fighting the virus is to stay at home but, unfortunately essential workers don't have this option. Not only are fewer Black and Latino adults able to work from home, but they're also overrepresented in essential jobs.

These health disparities are further worsened by an unequal healthcare system. People of color often have unequal access to care, and when they do receive care it is often poorer quality.

The National Academy of Medicine (NAM) released a report that found “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

In order for things to change, the entire health care field, from medical schools to hospitals and even medical device manufacturers, need to work to unravel and address racism within the healthcare system.

Progress will take time and efforts must occur on every societal level. This involves a wide range of actions, like improving wages and closing pay gaps, improving access to health insurance, providing better access to fresh foods and green spaces, and ensuring more diversity in the health care system so healthcare workers can provide culturally competent care.

The National (CLAS) Standards is a great strategy intended to advance health equity, improve quality, and help eliminate healthcare disparities, by providing a set of 15 action steps for healthcare organizations to implement.

The National CLAS Standards are as follows:

Principal Standard

1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

Governance, Leadership and Workforce

2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

Communication and Language Assistance

5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

Engagement, Continuous Improvement, and Accountability

9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

Bonnie Castillo, is the Executive Director of National Nurses United (NNU) and a former Intensive Care Nurse. 

Back in January, Castillo was concerned by news reports about a virus that was devastating Wuhan, China. So she called for a meeting with the NNU's Director of health and safety and its industrial hygienist to go through scientific reports.

After learning more about the coronavirus, she directed her staff to investigate how prepared U.S. hospitals were for an outbreak.

According to the New York Times, Bonnie said, “As a Nurse, there are just times when it’s very intuitive. You just sense that something catastrophic is going to happen.”

The NNU contacted hundreds of hospitals asking for detailed information about how much personal protective equipment (PPE) they had. The union also surveyed thousands of Nurses asking how they felt about their health facilities’ readiness.

While the survey is ongoing, here are highlights as of March 3, 2020 tallying responses from more than 6,500 Nurses in 48 states, including the District of Columbia and the Virgin Islands.

Some highlights from the survey include:

• Only 44% report that their employer has provided them information about novel coronavirus and how to recognize and respond to possible cases.
• Only 29% report that there is a plan in place to isolate a patient with a possible novel coronavirus infection. 23% report they don't know if there is a plan.
• Only 63% of nurses report having access to N95 respirators on their units. 27% have access to PAPRs. 
• Only 30% report that their employer has sufficient PPE stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections. 38% don't know.
• Only 65% report having been trained on safely donning and doffing PPE in the previous year.

At the beginning of March, Castillo’s team sent a letter to Vice President Mike Pence and the coronavirus task force coordinator Dr. Deborah Birx, warning that “the majority of U.S. health care facilities are completely unprepared to safely contain Covid-19.”

Then they asked the Occupational Safety and Health Administration (OSHA) to issue an “emergency temporary standard” for infectious diseases which would prompt employers to implement safety standards such as providing more effective N95 masks to Nurses working with coronavirus patients, instead of basic surgical masks. But OSHA didn't take Bonnie's advice.

The Centers for Disease Control and Prevention (CDC) then acknowledged that hospitals did lack sufficient PPE. So the CDC decided to loosen restrictions and required hospitals to provide their staff with only surgical masks, not N95 masks in many situations.

Castillo and her team were rightfully upset and decided to push publicly for more PPE. They held more than 350 socially distanced protests and 2 vigils in front of the White House for Nurses who died from COVID-19. 

"Nurses are not afraid to care for our patients if we have the right protections," Bonnie told NPR. "But we're not martyrs sacrificing our lives because our government and our employers didn't do their jobs."

After protests, some officials began allowing the N95 masks for all Nurses working with Covid-19 patients.

In May, House Democrats passed a stimulus bill that included some of the Nurses’ demands, including mass production of PPE through the Defense Production Act and an emergency temporary standard for infectious diseases.

Bonnie is still fighting for adequate PPE for Healthcare workers as the coronavirus rages on and concerns grow about a second wave of infections in the fall. She is an advocate and a cheerleader for all Nurses. It is imperative Nurses and all Healthcare workers get the PPE they need to protect themselves and their families, so they can provide care for their patients.

Black Lives Matter protests are happening all across America and as people take to the streets to protest, medical workers are doing their part in supporting protesters.

After working tirelessly for long hours and risking their own lives on the front lines caring for coronavirus (COVID-19) patients, Nurses are leaving their shifts and going straight to protests to help those who've been injured.

Martha Dawson, DNP, RN, a professor and the president of the National Black Nurses Association, said Nurses and frontline healthcare workers of color were deeply saddened after the killing of George Floyd, an unarmed Black man who was killed in Minneapolis, Minnesota, at 46 after a white policeman pushed his knee into Floyd’s neck for more than eight minutes.

Dawson told Refinery29, “For Nurses of color working on the frontlines, it’s disheartening to still realize that you’re living in a country where you’re under-appreciated and judged, first, on the color of your skin, rather than the content of your character. And you have to recognize that the concern with the death in Minnesota is just now emerging as one stressor on top of the many stressors of the pandemic.” 

Nurses want their voices heard at rallies but they also want to help protesters who have been shot with rubber bullets, sprayed with tear gas, or have been otherwise physically injured. 

Not all protests have become violent. But when they have, healthcare workers have also found themselves in the line of fire while treating injured protesters.

According to an article from Shape.com, a Minneapolis Nurse said police stormed a medical tent and opened fire with rubber bullets while she was working to treat a man bleeding badly from a rubber bullet wound.

"I was trying to look at the wound and they were shooting at us." The wounded man tried to protect her, she said, but eventually, she decided to leave. "I told him I wouldn't leave him, but I did. I feel so bad. They were shooting. I was scared," she recounted through tears.

Nurses are using social media to share tips on how to stay safe from coronavirus while protesting and where to find free medical help for those injured during protests.

One Nurse tweeted, "I am a licensed Nurse with an organized group of frontline medics. We are all healthcare workers (doctors, nurses, EMTs) and we provide safe spaces of first aid care for anyone who might have minor injuries related to police protest. We prioritize care for Black, Indigenous, and People of Color (BIPOC) folks."

Another person tweeted health safety tips for protesting during a pandemic.

Nursing schools all over the country are switching from traditional clinical studies to virtual simulations. Colleges are offering online clinicals in several different ways.  

There is no national governing body recommending what each program does since Nursing education programs are approved by each state’s governing board.

The Society for Simulation in Healthcare (SSH) and the International Nursing Association of Clinical Simulation and Learning (INACSL) encouraged that, “regulatory bodies and policymakers demonstrate flexibility by allowing the replacement of clinical hours usually completed in a healthcare setting with that of virtually simulated experiences.”

Some students interact with avatars while others use unfolding case studies in which actors play out different scenarios, said Patty Gagliano, Indian River State College Assistant Dean of Nursing.  

Angela Ramos, second-year Nursing student at Indian River, is completing this semester's clinicals by passing medications to her patients through an online simulation platform, v-STEM. 

Most states in the United States allow up to 25% of clinical hours to be simulation-based and some states permit over 50%.

In Florida, the state has relaxed limits on the percentage of clinical hours that can be done through simulations, with programs now able to go up to 50% or more, said Cynthia Cummings, associate professor at the University of North Florida.

Georgia Gwinnett College is using two simulator programs that allows students to work together in online scenarios mirroring what they’d be doing in person, once they are Registered Nurses.

“Once you start, it’s just like going to the hospital,” said Desi Kennedy, a Nursing student set to graduate this month. “We have to give reports on four different patients. We break off into groups and decide what our priorities should be and how we should delegate certain tasks. We have huddle sessions about our patients. Those situations are really realistic, things can change really fast.”

Not all institutions are following the virtual trend. Kirkwood Community College in Cedar Rapids, Iowa have continued with in-person clinicals.

College officials opted instead to reduce the number of clinical hours students in the final semester would complete, said Kathryn J. Dolter, Dean of Nursing at the college. 

While there's "definitely a place for simulations" and what most schools are doing now is helpful, the simulations don't take the place of being with patients, Nurses and Doctors, said Cindy Dawson, Chief Nurse Executive and Associate Director at University of Iowa Hospitals and Clinics.

Donna Meyer, Chief executive of the Organization for Associate Degree Nursing said, "Simulations can be helpful to the education process and even stimulate a student’s critical thinking. Plus, virtual simulations are very structured. Faculty want their students to have strong outcomes, so the simulations are still very stringent.”

A virtual connection for Nursing students is crucial for continuing education and skill development during a pandemic.