Will Nurses Work During a Pandemic?

[cartski]

Re: Will Nurses Work During a Pandemic?

Welcome Gullwing. Excellent post.

Well said. Yes, Gullwing, excellent.

Are not some of your questions addressed by the articles, reports and stories that arose from the hospital experiences in New Orleans and Katrina?

Can we not foresee what will happen, in general terms, during a pandemic from what did happen in New Orleans?

J.

[Blue]

Re: Will Nurses Work During a Pandemic?

Welcome, Gullwing.

I wish that I had a good answer for you but, I do not. I do know that where I am currently living, the biggest hospital has a disaster plan with two teams that staff must belong to. A Team reports first and B team relieves them. Not to report will result in termination. Sounds great on paper but it does not address any of the very real scenarios that you have suggested...

The devil is in the details. Many disaster plans do not mention the details of how we will be able to do this.

[gullwing]

Re: Will Nurses Work During a Pandemic?

Doesn't sound like a winning plan to me. Sort of like a General who threatens to shoot all the soldiers who leave their post. If your position is over run then you lose all of your soldiers. Those that leave will not come back. For a CEO to mandate such a plan they would have to be confident that if everyone held to there positions then the ER could batter such a storm. I am not at all confident. My efforts will be to convince my collegues that there needs to be a safe place to fall back to.

[tropical]

Re: Will Nurses Work During a Pandemic?

Doesn't sound like a winning plan to me.
1.Sort of like a General who threatens to shoot all the soldiers who leave their post.
2.If your position is over run then you lose all of your soldiers.
3.Those that leave will not come back.
4.For a CEO to mandate such a plan they would have to be confident that if everyone held to there positions then the ER could batter such a storm. I am not at all confident.
5.My efforts will be to convince my collegues that there needs to be a safe place to fall back to.

Hi gullwing,
things that seems unbelievable, in certain times, happens.
Obviously the plan would be driven by the circumstances.
If we speak about a reaction to an very serious deadly pandemic, it could be treated like in a war situation - the standard civil procedures can't be fit in such event. Your comparision of a General was quite correct:
1. If a hospital will be infected, I doubt that the staff would be granted to leave it.
2. The staff will not be at lose because they will be bottled in from the outside by armed sanitary line forces (at the begining when the pandemic would not be everywhere).
3. Yes, the lucky ones leaved previous the isolation/quarantine period
4. Well, they must set up some sort of plan, even if it's not realistic to cope on, without much more staff, and "stuff"
5. A safe place to fall back to will be doubtful, a vault under the hospital, etc. What if in that vault sip somebody infected?
The sip measure was individual isolation.

[Sunshine123]

Re: Will Nurses Work During a Pandemic?

I am a nurse of 35 years, i started w/ the gals from Viet Nam as my role-models, most of them had spent time in TB wards of the 50's and 60's.

Gullwing your scenario is well worded and politely stated. I have watched The Morning After, Resident Evil Apocalypse Now, Pearl Harbor, The Stand, 28 Weeks Later and other disaster movies. Lock down of the facility and security should be the first and primary move taken.

I do not intend to participate and will stand back. I cannot change events nor do I feel Called to do so. I can take care of my immediate family and prepare my extended family and friends for three months of self-quarantine. They all get survival presents for gift giving. I have lobbied heavily at work for people to be realistic about their behaviors. For example I throw away Doctors' coffee cups when they make rounds. I am a hall monitor for washing hands etc.

Through the years I have found that isolation and security are closely related. People love to defy the system and when the heat is on, the frequent flyers will be the first to surface. Like rats from a sinking ship, your radar should go up at that point. Many of the ill may not even make it to the hospital. All the historical recounts of the 1918 Flu state that people died while carrying on their daily activities. They got up in the morning, coughed at noon and died before supper.

Sadly, the hospital should begin by closing the doors. You are right no one wants to talk about it. But if the hospital is to survive, that is it's only move. The staff that is left will have to organize under safe conditions, or there will be nothing. The doctor that was left to care for the ones who had little chance for survival in Hurricane Katrina's wake was slandered w/ all sorts of allegations and years of court room time for rendering care. This an excellent example of what to expect.

The public wants to believe that the nurse is there and ever self sacrificing to make sure that an individual needs are taken care of. We have to take care of ourselves first. The Airlines on every flight state that a person has to first breath from the oxygen mask before they can render aid to others. So it is for the nurse, doctors and hospital.

Good Luck.

[Blue]

Re: Will Nurses Work During a Pandemic?

Doesn't sound like a winning plan to me. Sort of like a General who threatens to shoot all the soldiers who leave their post. If your position is over run then you lose all of your soldiers. Those that leave will not come back. For a CEO to mandate such a plan they would have to be confident that if everyone held to there positions then the ER could batter such a storm. I am not at all confident. My efforts will be to convince my collegues that there needs to be a safe place to fall back to.

You are correct about it not being a winning plan. I forgot to mention that this hospital is on an island surrounded by skyscrapers, and in the middle of a very populated city. It's a hugh hospital. I do not know if I would feel comfortable working there. Just to get to it, one must travel thru the city in heavy traffic. I am afraid that a pandemic flu disaster would make this a very unsafe place to be.

I have zero confidence in their plan.

[mixin]

Re: Will Nurses Work During a Pandemic?

http://www.cdc.gov/ncidod/EID/index.htm International conference on Emerging Infectious diseases gsgs
Assessing County Health Department Employees? Willingness to Respond to an Influenza Pandemic

Background: During an influenza pandemic, local health department employees are expected to play a significant role in carrying out response and control protocols. However, little is known about how informed employees are about pandemic response or how willing they are to respond. The Florida Department of Health, in an effort led by the state health office and its 67 county health departments, has been actively planning the response efforts to be undertaken in the event of a pandemic. Here, we determine how knowledgeable local health department employees are about pandemic influenza, how likely they are to respond, and which factors are significantly associated with a willingness to respond to a pandemic.
Methods: We conducted an anonymous, online survey of 4,746 Florida county health department employees randomly selected using a stratified random cluster sample. We gathered information about demographics, knowledge of pandemic response, and the likelihood of reporting to a pandemic given 4 different scenarios that specified the stage of the pandemic (early vs. peak) and the type of duties required (lower risk - no face-to-face contact vs. higher risk - face-to-face contact). Responses were weighted based upon the sampling fraction and the response rates. Multivariate logistic regression was used in the main analysis.
Results: Of the 2,414 (51%) unique responses received, willingness to respond to a pandemic varied by the stage of the pandemic and the type of job duties. 92% were very or somewhat likely to respond early in the pandemic and perform lower risk jobs, 66% early in the pandemic with higher risk jobs, 83% at the peak of the pandemic with lower risk jobs, and 56% at the peak with higher risk jobs. Those who have read either the state or county pandemic flu plan and nurses were significantly more likely to report a willingness to respond. Having attended a pan flu training was not significantly associated with willingness to respond to any scenario.
Conclusions: These results indicate that the majority of Florida county health department employees surveyed are willing to respond to an influenza pandemic, but that their willingness declines during the peak of the pandemic and when face-to-face contact is required. These results highlight underlying issues that must be addressed prior to a pandemic event.

[gullwing]

Re: Will Nurses Work During a Pandemic?

The study you reference asks the question whether county health department employees will come to work. There is a little bit of a problem with this whole question. The health Department Employees are all government employees, they all have medical insurance and workmans comp. They generally staff pre-natal clinics, VD clinics etc. I am sure they do a fine job, a thankless job, they are treating some of the most disenfranchised in our society. That being said they aren't even part of the front lines. These clinics generally are open 9-5 Monday to Saturday. They close on holidays. These people are granted global tort immunity during pandemic no one else is. They are also not required by law to treat all patients that arrive at there facility. In actuality they will be the command and control and will not be the soldiers. In my part of the state we are in a district of 16 counties. In those 16 counties there is one public health MD and 5 public health nurses. I can't imagine how they would or could attempt to impose any law or order upon the Doctors and Nurses that staff the ERs.
On a more personal level during the Katrina evacuation our community set up a Red Cross relief clinic. The public health came in on day 4 and succeeded in alienating all of the staff. I can not begin to describe how much their actions infuriated the actual volunteers, staff, patients and their families. (you don't want to tick off doctor's wifes they don't take it well!)
No one from Public Health has since set foot in our hospital. I go to their planning meetings but not a whole lot of the keystone members of the medical community will have anything to do with them. I am fairly certain that this type of anamosity is not present in most areas but I still can't see any ER staff taking orders from people who have not earned their respect. Getting back to an earlier post I doubt that the CEO will lead by force and intimidation either. Someone will rise to a leadership role but it will be someone with personal charisma and who commands respect. This respect will be earned not by putting the staff in harms way but by considering staff well-being first

[Laidback Al]

Re: Will Nurses Work During a Pandemic?

In my part of the state we are in a district of 16 counties. In those 16 counties there is one public health MD and 5 public health nurses. I can't imagine how they would or could attempt to impose any law or order upon the Doctors and Nurses that staff the ERs....
but I still can't see any ER staff taking orders from people who have not earned their respect.

As the population ages in the U.S., there will soon be mass retirements of experienced and knowledgeable Public Health Workers. See this link about the coming problem in Utah:

http://www.flutrackers.com/forum/showthread.php?t=60027

[mixin]

Re: Will Nurses Work During a Pandemic?

Gullwing,
It appears from your post there is a lot of animosity which would have to be dealt with during a pandemic.

Even though the public heath dept is not on the frontlines, we will still continue to need pre-natal, venereal disease clinics operating.
Only 58% of those workers will come to work at high risk jobs during peak pandemic. That figure may well go down once they see what a real AI pandemic looks like.

The fact that only half the questionnaires were returned left me curious. I wonder if that is a typical amount.

[tropical]

Re: Will Nurses Work During a Pandemic?

Folks, look at the SARS episode in China, and Canada.
Somebody remained into the story to do the job.

The ones who will be at duty where the contagion happens, will be the ones who will cary it on, in isolation. The rest of the staff have a chance to change the job, escape, or got a forced duty.

[Sunshine123]

Re: Will Nurses Work During a Pandemic?

RE: Gullwing

I would like to know if anyone in any medical community has a fall back position where the staff can rally and rebuild?

It seems as though you have a closer experience to a disaster than most. As someone said before "You never know who will be the one to rise to the occasion." My point is to avoid as little destruction to the existing structure and staff by surviving the initial impact of the masses. I'd put the public health crew at the top of the list to work the masses and triage outside the closed door.

[gullwing]

Re: Will Nurses Work During a Pandemic?

Sunshine what I envision as the only hope for success is for those health care providers who are of the belief that there is futility in attempting to "treat the masses" to fall back away from any "hot zone". You will need a facility that is clandestined and you will treat only those persons with a chance for survival. How do you determine the later? It would be essentially only those who have food water and PPE. The way I figure it only the ones that build the ark will know where it is and will be invited on board. It sounds pretty harsh but all have been invited on board. If you choose not to "sign up" until its too late then you are free to persue your previous plan (or lack there of). I think there are enough medical personell in my clique that will fall back quickly and with equiptment to make this work. Most are unwilling to commit openly for fear of reprisals. Thes are interesting times we live in.

[Sunshine123]

Re: Will Nurses Work During a Pandemic?

Here is some ark building material if you would like. http://www.flutrackers.com/forum/showthread.php?t=58748

[CBloom]

Re: Will Nurses Work During a Pandemic?

So many nurses already feel that they are undervalued and exploited. Add to that the memory of the fight to get hospitals to move to safer injectables. Cost was more important than safety for far too long. We may end up reaping what we have sown - nurses and other health care workers who refuse to be taken advantage of any more.

Peggy, You have no idea how glad I am to see your post. I want to discuss with some colleagues a unique plan to get safer injectables in use and not just on a back shelf of a hidden room where nurses can't even find them and become familiar with them on their own. Please contact me at safenurse at live dot com.

There are too many innocent victims: the family members of exposed nurses and the generations of nurses still being taught unsafe practices.

Be safe