Healthcare workers are claiming that their employers are firing them, or threatening to, as they debate how to best protect themselves while caring for patients with COVID-19.
The quarrel centers around masks, specifically N95 respirators, as federal safety guidelines shift and supply levels dwindle. Nurses are telling their coworkers that the N95 respirators are safer than the standard face masks that their hospitals are offering, resulting in reprimands from their employers.
Lauri Mazurkiewicz, a nurse at Northwestern Memorial Hospital in Illinois, sued the hospital after she was fired last week for sending an email to colleagues and supervisors conveying that N95s are more effective than the masks distributed by the hospital, according to a complaint filed Monday in Cook County Circuit Court.
Northwestern allegedly mandated that employees wear the standard masks, which Mazurkiewicz declined to wear and instead used her personal N95, which blocks 95% of airborne particles. She claims that the hospital fired her to stifle her speech, and is seeking more than $50,000 for emotional damages and lost wages resulting from the "retaliatory discharge."
Northwestern said in a statement that it is reviewing the complaint.
"As Northwestern Medicine continues to respond to this unprecedented healthcare pandemic, the health and well-being of our patients, our staff and our employees is our highest priority," the company said.
The Center for Disease Control and Prevention recently updated its guidelines, stating that COVID-19 is usually spread via respiratory droplets produced when someone coughs or sneezes. Spreading the virus through typical breathing is "currently uncertain," and airborne transmission from person-to-person over long distances is unlikely, the CDC said.
The agency noted that alternatives to N95s should be used since suppliers have restricted distribution and healthcare facilities have reported shortages. Still, caregivers should use N95s when performing procedures that induce coughing, the CDC said. If reusable masks are used, they must be cleaned and disinfected properly, the agency noted.
Kaiser Permanente, for instance, is now shifting its guidelines to use masks in lieu of N95s, in most cases.
"Continuing to use unnecessary and increasingly scarce equipment, instead of the appropriate gear, will dramatically limit our healthcare system's ability to deliver care to those who need it," the organization said in a statement, adding that it would not be using droplet protection protocols if it were unsafe or put its care teams at greater risk.
Kristine Fry, a nurse at a Kaiser Permanente hospital in Santa Clara, said she was placed on administrative leave after sharing the California Division of Occupational Safety and Health guidelines with her colleagues, which she claims are more stringent than those set by the hospital.
National Nurses United claims that Kaiser told nurses that they could be "fired on the spot" for insubordination if they wore personal N95 masks at work, the union relayed via a flyer sent to its members.
Kaiser Permanente said in a statement that Fry was placed on paid administrative leave because of disruptive behavior—not for matters involving employee safety—and will soon return to work.
"During this difficult time, we remain engaged and continue to work with our staff to ensure work environments that are free from disruption," the company said, adding that the health and safety of its members, patients and staff is its highest priority.
Imports of N95s have dropped significantly and suppliers have limited their distribution, which have caused healthcare organizations to closely monitor their supply.
Around half of 8,200 nurses surveyed reported having access to N95s, according to a recent poll by National Nurses United. Only around a quarter said that their employer has sufficient stock of personal protective equipment if there is a surge of COVID-19 patients; 38% don't know.
More than two-thirds of 179 senior-living facilities polled said they don't have enough PPE, N95 masks being the most pressing need, according to a survey conducted in early March by Premier, a group purchasing and consulting organization.
Use of N95s by emergency medical services agencies is on pace to exceed one million respirators over the next three months, according to data from ESO, a data software company. EMS companies are using nearly 12,000 N95s a day, up from 246 in early March. The data represents all 911 calls, not just those involving COVID-19 patients, ESO noted, adding that the analysis excludes California.
As a result, many healthcare facilities are relying on donations to maintain adequate supply levels. A group of Chicago medical students launched a crowd-sourcing campaign to secure protective equipment for area hospitals, and similar efforts are springing up throughout the country.
Gabe Montoya, an emergency department assistant at Kaiser Downey (Calif.) Medical Center, said that he has to justify requests for masks that are held under lock and key.
"We are running out and running out fast—the number of patients is starting to surge," he said on a press call with reporters Monday.
The anxiety and fear is palpable as he and his peers huddle every morning to discuss the latest safety guidelines, Montoya said.
"Our lives depend on it," he said.