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Beyond the Byline: New COVID-19 guidance tests hospitals' infection control protocol

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Modern Healthcare Senior Hospital Operations Reporter Alex Kacik and Post-Acute Care and Staffing Reporter Ginger Christ talk about workforce shortages and the new federal guidance regarding COVID-19 return-to-work policies.

Alex Kacik: Hello, and welcome to Modern Healthcare's Beyond the Byline where we offer a behind-the-scenes look into our reporting. I'm Alex Kacik, Senior Operations reporter. Our Post-Acute and Staffing reporter, Ginger Christ, is joining me today to talk about workforce shortages and the new federal guidance regarding COVID-19 return-to-work policies. Thanks for coming on Ginger.

Ginger Christ: Thanks for having me Alex.

Alex Kacik: We came out with this story last week about the Centers for Disease Control and Prevention's guidance that came out on December 23rd, gave recommendations for healthcare personnel that test positive for COVID. There are varying levels of protocol. The last two are contingency in crisis, and on that contingency end they recommended that organizations when they're experiencing staff shortages they can bring back folks who tested positive after five days of isolation even if they're symptomatic, with mild symptoms that is, and if they didn't produce a negative test. So we talked to some industry overseers, and some nurses, and frontline staff. What did you hear from healthcare providers in terms of how this is being implemented and how it's affecting their work?

Read more: Nurses worry CDC guidelines will bring more COVID-19 cases, deaths

Ginger Christ: A lot of the healthcare professionals that we spoke to and the associations, they were obviously concerned. They've been raising concerns about conditions in hospitals and healthcare settings throughout the pandemic, just in terms of infection control policies and personal protective equipment, and things like that. So what I heard from nurses and others was just that they're worried about this idea of doing no harm. They're worried about coming into work and potentially exposing a patient or a colleague, and then being responsible for that for one. And then also potentially just spreading COVID more and making staffing situations even worse. Alex, I know you also talked to nurses at different health systems in a few different states and cities. What did they say to you?

Alex Kacik: I talked with a nurse in Colorado who forwarded me an internal memo she wasn't enthused about. It said that, "Staff and providers with symptoms of runny nose, sore throat, body aches, or loss of taste or smell, may continue reporting to work unless symptoms worsen, and you do not have to get a COVID 19 test." So hospitals are using the CDC guidance and these staff shortages as a way to say, "Look, our backs against the wall. We have nothing left to do here. The CDC said it's okay," based on research published in JAMA in August I believe, which found the most contagious stages of the novel coronavirus are just before and after symptoms present.

Alex Kacik: The guidance says that hospitals place recently infected workers in wings without immunocompromised patients, and that they inform patients and workers that they are operating under these contingency or crisis standards and how that will change operations. So it's tough here because CDC isn't typically a policymaking body and these workers are already burnt out. Many of which have left the industry, which is exacerbating these staffing shortfalls. On the disclosure end, Ginger, did you hear what hospitals were saying? If they were informing broadly their workforce and their patients as to what these policies were and how their operations may change?

Ginger Christ: Yeah. The health systems that I reached out to said generically that they were adopting the CDC guidelines. However, when I asked about disclosure none of them answered that piece. They did say that they would try, a lot of systems said they would try to keep COVID-positive workers from working in areas with immunocompromised patients. But none of them actually answered on whether they were going to notify patients or staff if colleagues or staff were coming in while they were COVID-positive. I know that you talked to Stanford Health. What did they say?

Alex Kacik: At first, they sent me a pretty long statement and off the top it said that they're adopting the CDC standards, which says that even if you have symptoms, and they're mild, and you don't have a fever, you can come in. But then a couple sentences later they said, "If you're feeling ill, don't come in." So I asked them about that contradiction and they said, "Thanks for pointing that out," and they amended it saying, "First and foremost, if you are feeling sick, don't come in." So it's hard here because hospitals in many cases want to do the best for their patients and workers, and they're trying to digest this guidance and issue appropriate policies.

Alex Kacik: But one of the nurses said this has illustrated some longstanding issues in healthcare that illustrates how fragile this workforce can be, particularly when it comes to the nurses and respiratory therapists. I know Ginger you've talked a lot about nurses who are leaving. You've written a lot about how nurses are leaving the profession and what's contributing to turnover over the past year or two. What has your reporting shown about why staff, doctors and nurses, are opting for other careers, and what are your takeaways?

Ginger Christ: Yeah. As you said, there have been some long-standing issues between staff and employers. I think a lot of those kind of came to a head during the pandemic, some issues that people were willing to just ... Like workplace issues that were a problem, but weren't necessarily as life or death maybe as they are now. There's been a lot of turnover because a lot of nurses and others are burnt out. You know, they've been dealing with the pandemic since early 2020, and they're dealing with staffing issues, feeling like they're doing more and more and not being rewarded for that.

Ginger Christ: And you know we started the pandemic with healthcare professionals being regarded as heroes, but now you see a lot of animosity toward healthcare professionals too. So that takes a toll, and there's that mental piece. But at the same time healthcare workers are going into these dangerous positions, into these dangerous settings every day and doing the same thing over and over again and it definitely takes a toll on them. So yeah. I know that you spoke with an ICU charge nurse that said something kind of similar I think.

Alex Kacik: Yeah. This is a charge nurse and she's also head of the Massachusetts Nursing Association. We didn't include this in the story, but she's at Brigham and Women's. She said they've been criticizing hospital administrators for years for not hiring enough nurses and for nurses high caseloads. I covered Massachusetts ballot measure I believe it was in 2019. They tried to become the second state behind California to pass mandated nurse-to-patient staffing ratios, but that was voted down. She said if that had passed they'd be probably in a better situation now. As of now they're closing beds. I don't think that's led to folks being turned away, but that's just because they don't have enough staff to care for those beds.

Alex Kacik: A lot of the capacity's there just from an infrastructure standpoint, but when it comes to staffing that's where the real bottleneck is. So one of the things we got into were the legal ramifications here. And at least the lawyers I talked with were saying that the CDC guidance was kind of crafted and designed to protect or insulate some of these health systems from potential lawsuits if some workers are going to say they're exposed because of these policies. I don't know if what you heard from your sources too on that end about whether it was disclosure or other workplace issue lawsuits. Did you hear anything there?

Ginger Christ: Yeah. It sounds like there could be some protection for workers just because this was a CDC recommendation. So there could be some protection there. However, when it comes to like individual workers, that could be something that could vary by state just based on their different rules in terms of that. Another issue that's brought up just in terms of disclosure is just this idea of ethics. Like it could be legal to do this, but ethically what should you be doing, and how should you be notifying patients or workers about some of these potential exposures to COVID-19?

Alex Kacik: As of now we're hearing more hospitals going into that crisis mode, which is beyond that contingency protocol saying after five days isolation you can return to work. This is essentially like no restrictions. I know AP had a story earlier, I think it was yesterday, showing that some health systems are bringing in COVID-positive workers. So it's really the worry of some of these providers that we've talked with that there's just not enough being done to protect the workers or patients under the recommendations here as listed by the CDC.

Alex Kacik: But I imagine this will take some time to suss out. We've heard some preliminary reports just about folks who are contracting COVID after they got to the hospital. Not necessarily from the hospital themselves or when they're in that setting. It's just they weren't admitted for that primary diagnosis of COVID and they later are shown to have it. So this is going to be an ongoing issue it seems. Ginger, did you hear from anything in terms of your sources when it comes to long-term changes to workplace conditions that could stem from some of this?

Ginger Christ: Yeah. I mean there's been a lot of labor activity and union actions throughout the pandemic, and we've seen a lot of places unionizing that hadn't before. There's been a lot of strikes and just things like that where healthcare workers are just standing up and demanding different conditions. Some of those things it looks like from some of the contracts that we've seen already, and some of the strikes, we've seen workers really having a stronger voice than they have in the past.

Ginger Christ: Because they're really showing what some of their concerns mean and what those look like so we're seeing different ... With some of the Kaiser contracts out in California and some of the other Western states, we saw that they're having certain staffing ratios and different things like that where healthcare workers are feeling like they're in a safer position. Different infection control things, different rules about pay, and making sure that people are being rewarded for the sacrifices that they're making.

Read more:
36K Kaiser workers plan one-day sympathy strike
Kaiser Permanente strikes averted with tentative deal

Alex Kacik: Great Ginger. Thank you so much for sharing with us and sharing your reporting and expertise. I appreciate it.

Ginger Christ: Thank you so much for having me.

Alex Kacik: All right. And thank you all for listening. If you'd like to subscribe and support our work, there's a link in the show notes. You could subscribe to Beyond the Byline on Spotify or wherever you listen to your podcasts. You can stay connected with our work by following Ginger and I and Modern Healthcare on Twitter and LinkedIn. We appreciate your support.

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