THE PIONEER
Written: 3/25 - 3/26

It's easy to be focused on 'the now' in times like these. But as days turn into weeks, turn into months, it is important for nurse advocates to consider not only the issues at hand but the issues bubbling beneath the surface.

Nurses and other healthcare professionals are subject to more intense working conditions now than ever before and there are little signs of it slowing down.

We urge all those reading this issue of the Pioneer to contact us directly with new initiatives for combating nurse burnout.

Maybe it's time for Jungle Rooms?

- Your ANA\California Team
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LEGISLATIVE WATCH

Nursing students and schools hang in limbo as COVID-19 disrupts the next generation of nurses. In response, nursing organizations in California, like many of our national partners and colleagues, are discussing three key categories:
  1. How to best utilize simulation education,
  2. What can academic institutions do to support nursing students in their academic progression, and
  3. How to assure that we have an adequate nursing workforce moving forward.

Multiple letters have been submitted to Governor Newsom requesting a temporary emergency regulation change to Bureau of Registered Nursing CCR Section 1426 (g)(2) until August 31, 2020. The University of California system, California Association of Colleges of Nursing, California Organization of Associate Degree Nurses, Community College League of California, and the California Student Nurses Association have all sent letters to the governor and/or the BRN describing the impact COVID-19 has had on students across California.

Looking to the BRN for response? Interim Executive Offer, Loretta Melby, responded to CSNA's letter stating, "To date we are still bound by our regulation ( 16 CCR § 1426 -Required Curriculum)... As new information comes out from the Governor, the Centers for Disease Control and Prevention, the California Department of Public Health, or any other entity that may have an effect on clinical rotations we will update the Deans and Directors for each school and they will communicate this information to you.” The waiting game continues.
CORONAVIRUS UPDATE

Third time's the charm. The Senate approves a historic $2 trillion stimulus deal with overwhelming bipartisan support - 96-0 vote. The bill will provide $130 billion in funding to hard-hit hospitals - we'll have more details on this in the next issue of the Pioneer. Next, the bill moves to the House next with Trump already indicating his support.

As of March 25th, 460,611 cases reported worldwide, with 20,842 deaths and 113,798 recoveries. Yet, according to Columbia University researchers the actual number is eleven times (11x) what is currently reported. Their graphs depict drastic differences between severe, some, and no control measures - look at the orange.

New Coronavirus "hotspots" are popping up across the U.S. even as 1 in 5 Americans are on lock down. Florida, Georgia, Louisiana, and Tennessee are beginning to see sharply rising numbers in the second half of March. It remains unclear whether those dates reflect the beginnings of actual outbreaks, or stepped-up testing that revealed those outbreaks.

However, working from home and shutting down schools, bars, and restaurants isn't enough. “The danger right now with the lock downs ... if we don’t put in place the strong public health measures now, when those movement restrictions and lock downs are lifted, the danger is the disease will jump back up,” says WHO emergency-preparedness expert, Mike Ryan. In other words, isolate the sick to save the herd.

Italian doctors are echoing a similar call-to-action by suggesting we return to 'prehistoric' house calls. "Western health care systems have been built around the concept of patient-centered care,” causing hospitals, the very centers of treatment for COVID-19, to be highly contaminated. Instead they call for "community-centered" care. Physicians at Papa Giovanni XXIII Hospital in Bergamo discuss more details in a paper published in NEJM Catalyst.

But even telehealth has its limitations - lack of policies and protocols, dropped calls, and hour-long wait times are just some of the struggles. Learn how hospitals are adapting real-time to handle, in some cases, quadruple (4x) the usage of telemedicine and telehealth services.

Gov. Gavin Newsom released new updates regarding PPE, medical, and testing supplies during his press briefing, March 25th. Here are the latest numbers:

  • 24.2 million N95 masks have been distributed by state of California.
  • 100 million N95 masks were procured by the state today alone
  • 1 million masks plus 150,000 COVID19 testing kits are coming in from Sir Richard Branson from Hong Kong.
  • 1,225 ventilators were developed and delivered by Elon Musk's Tesla manufacturing plants.
  • 8 mobile hospital, supplied by the federal government, are on their way to strategic locations around California. USNS Mercy will be operational by this Friday in the LA area.
  • Seton Medical Center in Daly City is already operational and will increase staffing & capacity in coming weeks.
  • 67,000 COVID-19 tests have been performed as of March 24th, but now face a backlog in getting results. More info below.
  • 4,300 of proposed 51,000 hotel rooms have been procured at this time by the CA government to house homeless population. 


UPDATE: Gov. Newsom responded to Trump yesterday, March 25th, stating California will not be lifting Coronavirus-related restrictions by the President's target date of Easter. "I think April, for California, would be sooner than of any of the experts I've talked to believe is possible," said Gov. Newsom. He also stated the likely timeline for California's stay-at-home order to substantially reduce the rate of infection is 8-12 weeks.

See below for all of Gov. Newsom's directives to date.

An analysis of the facemasks showed "penetration of cloth masks by particles was almost 97% and medical masks at 44%. The study was conducted between March 3-11, 2011 with 1607 participants caring for patients with clinical respiratory illness, influenza-like illness and laboratory-confirmed respiratory virus infection. Participants were randomized to one of 3 arms: medical masks only, cloth masks only and standard practice. Read the full study and share our post to protect frontline nurses.

Approximately 67,000 tests have been conducted in California, including those conducted by all commercial, private and the 22 state and county health labs. At least 18,276 results have been received and another 48,600 are pending. Kaiser also has labs up and running now, and in the process of conducting tests.

Several academic laboratories and medical companies in the U.S. are rushing to produce cost-effective blood tests for Coronavirus immunity. The hope is to quickly identify disease-fighting antibodies in people who already have been infected but may have had mild symptoms or none at all. Their idea? Find those who can return to work without quarantine, especially nurses, physicians, and other first responders. Read the full story.

Per the CA Dept. of Public Health, “in order to better focus public health resources on the changing needs of California communities, on March 18, the state is no longer collecting information about California travelers returning from countries that have confirmed COVID-19 outbreaks. Community transmission of COVID-19 has been identified in California since late February, and since early March, most of the confirmed cases in the state were not related to travel outside of the United States.” Read their latest posted information.

Retired health workers are urged to return as U.S. Coronavirus cases set to spike. In New York 1,000 responded in one day, with many of the current health workforce expected to fall ill amid the pandemic. Read the story.

The American Association of Critical-Care Nurses wants to support you and other nurses who need to cross train to care for patients with COVID-19. This eLearning course is available for all nurses, at no charge, to provide vital resources during this challenging time. Take a the course.

TIPS

Last week we connected with ANA\California member, Thao Tran MSN APRN-CNP FNP-BC RN-BC PHN CHIPS, to answer common questions regarding COVID-19. We return this week her colleague Dr. Elizabeth Beam PhD RN , also an infectious disease expert. Answers have been lightly edited for clarity.

Do you have any tips on not bringing COVID-19 home with us post-work? Change clothes? Bleach wipe shoes?
EB: It seems very reasonable to bring your uniform to work and change into it there. Then you can leave your work clothes at work and wear your personal clothes home. Bringing your work clothes home to wash should be fine, but you may want to wash them separately with a warmer setting for wash and drying to ensure a good disinfection. Bleach or disinfectant wiping your shoes is good practice, and if they can be left at work, all the better. This limits exposure to your car, your home, and your community.

We are being told to use makeshift masks? How do we know if these work?
EB: These decisions will be based on supplies available to you, and I know that in California there are difficult situations. Something is better than nothing. Remember that covering the source is a critical component, so if we can get a mask on the patient, that helps to limit spread.  

How long is an N95 mask good for?
EB: Quite a while. Truly they were designed for very dusty environments and the healthcare setting is typically very clean. Moisture is probably the biggest issue that would impact the filtration, or contamination of internal aspects of the respirator...if you are reusing them.

Any advice for pregnant working nurses in hospitals or those providing direct patient care?
EB: Work with your administrators to identify a low risk area to work in. There are several key response activities that would limit exposure to aerosol generating procedures. Beyond this a lighter load is safer for mom and baby. 

Special thanks to Trusted Health for fielding this issues questions, and to both Thoa Tran and Dr. Elizabeth Beam for their amazing help. Thank you!
TAKE ACTION

Increased work hours. Surges of patients. Concerns of exposure. Potential carrier to family and friends. The Coronavirus is increasing the stresses on our already burned out nursing workforce. Each day we get messages from nurses across California and the United States telling us of the conditions they face daily. We hear you! And we support you!

We are nurse advocates. And you, the one reading this newsletter, you can be a nurse advocate, too. Help your fellow nurses by taking action - click and send the messages below:

Registered Nurses have been experiencing severe shortages in personal protective equipment (PPE) as they work on the frontlines to provide vital care to COVID-19 patients.

The COVID-19 pandemic has rapidly and substantially impeded UC, state, and community nursing schools’ ability to provide clinical placements.

FOR YOUR FAMILIES AND FRIENDS

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. But while schools are out, keeping children healthy is important. Head, shoulders, knees, and toes, of course - but don't forget about their toys.

Over 100 million U.S. unemployment claims have been submitted since March 13th, according to Gov. Newsom's press briefing March 25th. For family members whose job has been impacted by COVID-19, visit the Employment Development Department's (EDD) website for guidance.

Cabin fever yet? Here's more free resources for you, your family, and friends:

  • 300,000 Books for free download from NYPL.
  • Free Audible books.
  • Free education & interactive lectures from TED Ed.
  • The Ultimate Guide to Virtual Museum Resources, E-Learning, and Online Collections via MCN. Over 200 free offers.
  • Disney and the Kennedy Space Center are offering free online activities for kids during school closures.
  • Students from Harvard, MIT, UC Berkeley are giving free tutoring to K-12 students.
  • Open-access to 6,000 accessible ebooks and over 150 journals via JSTOR.
GOV. NEWSOM'S DIRECTIVES TO DATE

Special thanks to ANA\California's Lobbyist, Roxanne Gould for compiling this information.

 
 
 
 
 
 
March 19, 2020 Executive Order -  Stay at Home Order
 
 
 
 
March 18, 2020 Executive Order –  Waiving Statewide Testing for CA Students
 
March 18, 2020 Executive Order -  Safety Net Services
 
 
March 17, 2020 Executive Order -  Guidance for K-12 Schools  &  CDE Guidance
 
March 17, 2020 - $1.1 billion in emergency funding  can now be used to increase hospital capacity, clean schools and protect those most vulnerable to the disease.
 
March 17, 2020 - California Requests  Federal Government Waiver  to Cover Medi-Cal Recipients and Expand TeleHealth Options
 
March 16, 2020 Isolation -  A dults with Elevated Risk
 
March 16, 2020 Executive Order -  Protect Renters and Homeowners
 
 
Hello. We're ANA\California.

We enhance the health and well-being of Californians and advance the profession of nursing by advocating for legislation, regulation, and policies. We focus on improving quality care, quality experiences, quality nurses, and the quality of our profession. We're the ANA\California Team and we're here for you. How can we help?

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-- Your ANA\California Team