Frustration with a lack of personal protective equipment, concerns for the safety of their colleagues and loved ones, and being afraid to speak out to employers for fear of retaliation—these are just a few of the issues reported by 1,200 of America's healthcare workers in a survey by George Washington University researchers.
The anonymous online survey asked 1,200 healthcare workers from all 50 states and the District of Columbia to assess their working conditions and safety concerns beginning on May 4, 2020. Researchers also collected data on the amount of PPE received, restrictions on PPE, COVID-19 exposure, and staff demographics.
"This survey gives a voice to U.S. healthcare workers who have been on the front lines of COVID-19," said David Michaels, a professor of environmental and occupational health at the George Washington University and former administrator of the Occupational Safety and Health Administration.
Over 18 million healthcare workers served on the front lines of the COVID-19 pandemic. Many faced a heightened risk of exposure and serious illness as a result of their jobs, leading to a number of adverse physical and mental health consequences. Lapses in the medical supply chain and preexisting wealth and racial disparities made matters worse, with hospitals and government agencies failing to prioritize worker safety, respondents said.
Half of those surveyed reported receiving an inadequate amount of PPE from employers and 1 in 4 said the type of PPE provided was not sufficient to protect them from COVID-19 exposure.
"My coworkers are terrified. Many nurses are taking unpaid leave rather than be exposed. Many doctors do not go bedside to assess COVID patients, all care is performed by nursing staff," said a registered nurse in Washington, D.C.
Gloves, gowns and surgical masks were the most common PPE reported by healthcare workers, with face covers and air respirators among the least common. In fact, under 10% said they had received those supplies.
"My N95 is a month old, the straps broke and I was told to staple (them) back together and wear it. It no longer fits my face," one Ohio respondent said.
About 2% of healthcare workers reported receiving no PPE at all.
Over 15% of healthcare workers surveyed said their employer provided no training on the use of PPE to limit COVID-19 exposure. Without proper training and fit, PPE is not considered effective at protecting against airborne hazards.
The supply shortage left many concerned for the safety of their families. Many blamed improper occupational safety measures for allowing COVID infection to spread to loved ones. However, those who spoke out against unsafe working conditions reportedly experienced retaliation from employers.
One anesthesiologist from Massachusetts said he received "punitive assignments," which further exposed him to COVID, after "requesting appropriate PPE for intubations."
Another respondent said employers "marginalized emergency department leadership who have advocated for reasonable measures for protection for all (not just ED) employees."
Others said employers denied them COVID testing or proper equipment. Many condemned employers for restricting PPE as supplies depleted and showing greater consideration to their "financial bottom line" than the safety of their staff.
Additional reports show worker experiences during the pandemic contributed to growing distrust of employers and government agencies. Regulatory agencies, such as OSHA, were criticized for failing to enforce safety standards during the crisis. A registered nurse surveyed in the GWU survey suggested the government "forces hospitals to provide adequate PPE. Fine them if they refuse to do so. OSHA needs to do their job and protect employees."
In 2015 OSHA released a report on workplace safety standards for healthcare facilities.
If Rep. Joe Courtney's (D-Conn.) workplace safety bill passes after being brought to the Senate floor, OSHA will be tasked with mandating certain guidelines for employers, such as the creation of training programs, investigation procedures and tracking violent incidents against workers, with more specific regulations coming through OSHA rulemaking over the next three years. The bill has received bipartisan support but a vote has yet to be announced.
Healthcare workers surveyed said that enforceable workplace safety standards based on scientific evidence would improve working conditions. Other recommendations include increasing the strategic national stockpile of emergency supplies, such as PPE, and improving the coordination between federal agencies to better distribute materials.
"The lack of trust with research foundations has diminished almost completely in regards to how they treat front-line workers. The inadequacy is appalling and free food or being called heroes doesn't remedy the situation. Give us the proper PPE and don't lie to us," said a Maryland nurse who participated in the survey.
The majority of respondents were female (81%), white (82%), nurses working in Ohio (32%) and in hospitals (62%).
Less than 10% reporting were Black, Asian, Native American or Hispanic. Around 20% of respondents were working or had worked in more than one facility and almost 12% were under age 30. Few physicians, surgeons, or nurse practitioners were working in nonhospital facilities were surveyed (less than 10%).
In April 2020, 1 in 5 COVID cases were healthcare personnel, but by July it was 10 times that amount. In May 2021, 500,000 COVID cases and 1,582 deaths were attributed to healthcare personnel, according to the Centers for Disease Control and Prevention. Over two-thirds of those who died in the first year of the pandemic were healthcare workers of color and 50% were nurses.