THE PIONEER
Written: 4/15 - 4/16

We're always looking to be on the crest of the wave.

That's why if you've been reading the Pioneer since its infancy, you've noticed the initial format has changed to allow us to cover critical and relevant information during the Coronavirus pandemic.

We're always looking for suggestions and feedback... and okay, a little bit of love, too. Email us!

Sincerely,
- Your ANA\California Team
LEGISLATIVE WATCH

When will we be open for business? New federal guidelines aimed at reopening parts of the U.S. were expected to be announced at a 5 p.m. EST briefing today, April 16. We'll have full details in next week's issue.

In similar fashion, Governor Gavin Newsom announced a roadmap to modifying California's stay-at-home order. To do so, Gov. Newsom discussed six indicators and their key questions to help determine if and when modifications can be made.

California Senate President Pro Tem Toni Atkins announced the formation of the Special Committee on Pandemic Emergency Response. The bipartisan committee is comprised of eleven Senators who will undertake a review of the state’s response to the COVID-19 health crisis, identifying where necessary improvements can be made. The committee will also “make findings and recommendations for future preparedness if the Coronavirus returns later in the year, or if the state faces a subsequent pandemic.”

ANA\California signed and supported two letters this week.

The first, urges the U.S. Congress to pass a new relief package with patient protections and health investments. The letter, submitted to the Speaker of the House Nancy Pelosi, Minority Leader Mitch McConnell, and California Senators Diane Finestein and Kamala Harris, focuses on helping Californians best get through the public health and economic crisis caused by the Coronavirus crisis. ANA\California joined 57 organizations supporting this letter.

The proposed package would include a slew of protections, including the following: state fiscal relief, insurance affordability assistance, coverage with no-cost sharing for treatment, immigrant inclusivity, equitable access to testing and treatment, surprise billing, additional protections against medical debt, industry accountability, and do no harm.

The second, expresses our strong and urgent support that schemes to ration scarce health care resources during the COVID-19 pandemic comply with federal nondiscrimination laws. The letter urges the U.S. Department of Health and Human Services and the Office for Civil Rights to issue additional guidance to ensure non-discrimination based on disability and age, that would otherwise deny life-saving treatment to people based on disabilities or age.

If you'd like to read either of the letters, contact us directly .

The Director of the California Department of Consumer Affairs issued two additional waivers, one each for Nurse Practitioners and Certified Nurse Midwives. Both waive provisions which prohibit a physician or surgeon from supervising more than four NPs or CNMs at any one time. Read the full waivers for Nurse Practitioners and Certified Nurse Midwives.
CORONAVIRUS UPDATE

The U.S. has confirmed 639,664 of the 2,078,277 COVID-19 cases reported worldwide this morning, April 16th. Nationwide, 30,985 COVID-19 deaths have been reported, while 138,101 deaths have been reported globally.

Pssst… why are you whispering?* Speaking generates oral fluid droplets that can harbor infections Coronavirus particles. While large droplets fall quickly to the ground, "small droplets can dehydrate and linger as 'droplet nuclei' in the air, where they behave like an aerosol and thereby expand the spatial extent of emitted infectious particles." NEJM reported the results of the laser light-scattering visualization experiment. * It should be noted that data about whispering was not reported on.

While more information is needed, this could mean healthcare workers entering and exiting COVID-19 positive patients' rooms are wafting the virus into hallways. Recent federal data reported by the CDC shows 55% of healthcare professionals who contracted COVID-19, did so from contact within the healthcare setting.

Clinicians around the world are seeing evidence that suggests the virus is impacting more than just a patient's lungs. Reports state the virus may also be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems. Almost half the people hospitalized because of COVID-19 have blood or protein in their urine, indicating early damage to their kidneys, said Dr. Alan Kliger, a Yale University School of Medicine nephrologist.

Without over-promising Dr. Anthony Fauci suggested that a COVID-19 vaccine could be months ahead than previously thought. The original timeline was 12 to 18 months for a vaccine to hit the market but there has been no glitches in the vaccine development process... yet. Watch the interview.

The CDC updated its infection control guidelines for healthcare facilities treating confirmed or suspected COVID-19 patients on April 13th. Three major changes include:
  1. Recommending hospitals require everyone entering the facility to wear a cloth face covering,
  2. Hospitals should screen all patients, staff members and visitors for fever or other COVID-19 symptoms before entering the building,
  3. Instead of performing contact tracing for COVID-19 exposure in healthcare settings, hospitals should screen healthcare providers for fever and symptoms before every shift.


U.S. Coronavirus daily tests analyses have plummeted by more than 30% over the past week. Shortages of swabs used to collect samples and narrow testing criteria are the two biggest reasons commercial and private labs are not operating at full capacity. In response, health providers have been turning away potentially positive patients.

As of April 14, more than 227,600 tests had been conducted in California. At least 214,387 results have been received and another 13,200 are pending. Furthermore, local health departments have reported 2,789 confirmed positive cases in health care workers. This includes on-the-job exposures, and other exposures, such as travel and close family contact.

California represents approximately 30% of reported infected healthcare workers. Federal data released this week showed that healthcare professionals account for 9,282 of the 315,531 COVID-19 cases nationwide. National median age is 42, and 73% of them are female.
NURSING HOME SPOTLIGHT

Much of media recently has focused on nurses and healthcare workers inside of hospitals, but this week we turn our focus on Skilled Nursing Facilities (SNFs), Long-Term Care Facilities (LTCs) and nursing homes. Let's start with a status report...

3,600 deaths nationwide have been linked to Coronavirus outbreaks in nursing homes and LTCs, an alarming rise in just the past two weeks. On April 3rd, reported deaths were only 450.

However, experts believe the true death toll in SNFs are much higher, about 10% higher. Most states counts don't include those who died without ever being tested for COVID-19... or anonymous tips, like this one, which led police to 17 bodies stacked in a nursing home morgue.

And this is true globally as well. More than 2,000 nursing homes in Britain, about 13 percent of the country’s total, have had Coronavirus cases. Care England, a charity representing independent care agencies, has estimated that nearly 1,000 Covid-19 deaths in nursing homes have gone uncounted.

Experts suggest that the high rate of infection in these facilities is a result of several factors:

Social Determinants of Health
  • Caregiving staff often work at several organizations because their wages are too low for them to survive on a single job. This allows transfer of disease between organizations if the infected individuals are asymptomatic for a prolonged period.

Resource shortage
  • Personal protective equipment (PPE) distribution has been focused on hospital shortages, but LTCs, until recently, has been overlooked. This has led to reports of caregiving staff using materials like garbage bags for protective gowns and gloves.
  • Even when PPE is available, staff do not receive training in properly donning and doffing to avoid contamination.
  • Facilities do not have the number of staff to adhere to CDC recommendations that staff should COVID-19 positive patients receive dedicated staff members.

Special population
  • Elderly individuals require more personal contact than other patients and may also exhibit different symptoms than the general population to COVID-19.

Reduced oversight
  • At the start of this pandemic, California Department of Public Health eased infection control monitoring practices for facilities and relaxed staff-patient ratio guidelines.
  • Current guidelines do not require individuals being transferred from hospitals to be tested for COVID-19 prior to transfer.
  • Facilities with prior infection control issues have seen the largest outbreaks, while oversight of these facilities has been reduced.


Special thanks to Chris Cinkownski RN BSN CCRN for helping compile this information.

In the U.S., this is putting many nurses operating in SNFs in ethical dilemmas - forcing a decision between their job(s) and their well-being. Extreme working conditions and the lack of PPE and other medical supplies are causing nurses to harbor emotional fears about spreading the virus throughout the facilities and bringing it home to their families.

Liz Stokes JD MA RN, the Director of the ANA Center for Ethics and Human Rights, joined MSBNC to discuss the ethics of these dilemmas. Watch the interview.

While hospitals begin to receive emergency funding, many leaders associated with SNFs are wondering if they will receive funding as well. In California, Gov. Newsom stated combatting the virus in nursing homes is a "top priority" and is promising relief for beleaguered nurses and nursing assistants. However, funding wasn't mentioned at this time.

There are 1,224 skilled nursing facilities in California and new statewide numbers show 1,266 people - who are either patients or work in 191 of those nursing homes - have the virus. In response, Gov. Newsom said, "SWAT teams of infectious disease specialists would be sent to the homes where the virus is present." Specific numbers were not stated.

In addition, California has sent 200,000 sets of gloves and 200,000 sets of N-95 masks to nursing homes, among other provisions , including: nursing home workers would be eligible for $500 stipends to supplement their pay, and the administration was working to pay for hotel rooms where they could spend their off-hours and avoid the potential of exposing family members to the deadly virus.

We'd love to hear stories from nurses on the frontlines and in SNFs and nursing homes. Email us directly.
NURSE BURNOUT

Nurse burnout is the next pandemic. But these organizational initiatives may help. The Clinical Well-Being Knowledge Hub has made initiatives available that have demonstrated success in supporting well-being and reducing burnout among practicing clinicians, trainees, and students.

Ensuring success of these initiatives within your own organizations will require you to measure and re-measure the effects. The National Academy of Medicine provides these 7 survey instruments to measure burnout, well-being, and other work-related dimensions.

"If you do nothing else in the next week, at least do this." 65 hospital and health system leaders shared the most critical actions for their colleagues to take in the next week. Hint: communication, communication, communication.

Question: What are your best leadership tips for motivating your nursing teams? 5 nurse leaders share their best advice for leading and motivating a nursing team through the COVID-19 pandemic.

The COVID-19 pandemic is testing all of us, but nurses are on the frontlines. This WikiWisdom Forum was created specifically for frontline nurses fighting the pandemic so they can share their experiences with each other. Key ideas will help shape the organization's "Never Again" report.
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?

As the legislative cycle heats up, advocating for important issues can come down to the minute. ANA\California is using Phone 2 Action, a mobile texting and advocacy platform, to help you contact your legislators with curated messages in seconds... seriously... seconds. Click this link to opt-in and receive text messages from ANA\California when your fellow nurses need you most!

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-- Your ANA\California Team