Many nurses are still facing problems accessing Covid-19 tests, being quickly notified of coronavirus exposure, and receiving optimal personal protective equipment (PPE), according to a new survey conducted by National Nurses United (NNU)—suggesting providers may need to do more to become fully ETS-compliant.

Covid-19 risks for nurses

The Occupational Safety and Health Administration's (OSHA) emergency temporary standard (ETS) imposed various pandemic-related requirements on hospitals in order to protect health care workers from Covid-19. However, the survey—which includes data from more than 5,000 RNs in all 50 states, Washington D.C., and Puerto Rico between June 1 and July 21—shows some nurses are still experiencing problems.

The survey found that more than three-quarters of respondents said they are not being notified by their employers in a timely manner when they are exposed to the coronavirus. In a March edition of NNU's survey, 31.6% of respondents said they received timely notification of exposure to the coronavirus, but just 23% reported the same in the most recent survey.

Access to Covid-19 tests also remains a significant problem for nurses, the survey found. Around 41% of respondents said that any staff asking for a Covid-19 test has access to one, while almost 20% said testing access is limited at their facility and 7% said testing is unavailable. Notably, more than half of respondents said only those who are experiencing Covid-19 symptoms can receive a test.

In addition, not all health care facilities are screening every patient for Covid-19. Just two-thirds of respondents said all patients are screened for signs and symptoms of Covid-19 before they arrive or when they arrive to the facility, and less than a third of respondents said every patient is tested for Covid-19 before or upon arrival.

At hospitals specifically, 53% of RNs said every visitor is screened for signs and symptoms of Covid-19 before or upon arrival, and just 4% said every visitor is tested for the disease before or when they arrive.

Nurses are also still struggling to access PPE, the survey found. Around 61% of hospital RNs said they wear a respirator for every encounter with a Covid-19 patient, down from almost 75% in the March edition of the survey.

And just 40% of hospital RNs said they wear respirators when caring for patients suspected to have Covid-19 or whose test results are pending. Meanwhile, 62% of respondents said they wear surgical masks when caring for patients suspected of having Covid-19 or awaiting test results.

"We are more than 18 months into the pandemic, yet hospitals are still not doing enough to ensure the safety of nurses, patients, and other health care workers," Bonnie Castillo, executive director of NNU, said. "Covid cases are surging to their highest levels yet in some areas of the country, and some ICUs are over capacity. Nurses need optimal personal protective equipment. Health care employers must notify nurses as soon as possible when they are exposed and make it easier for RNs and other health care workers to get tested."

Staff shortages, poor mental health, and workplace violence

Nurses are also being affected by staff shortages, according to the survey. Over 57% of RNs said staffing has gotten slightly or much worse, up from 47% in the March edition of the survey. And almost half of hospital RNs said their facility is using excessive overtime to keep units staffed.

The survey also found that Covid-19 is still having a significant impact on the mental health of nurses. Almost 42% of hospital RNs said they're afraid they'll contract Covid-19 and just over half said they're afraid they'll infect a family member.

Meanwhile, 35.1% said they're having more difficulty sleeping, 53.5% said they feel stressed more often than they did before the pandemic, around 42% said they feel sad or depressed more often than they did before the pandemic, and over a third feel traumatized by their experiences caring for patients.

Reports of workplace violence have also increased, the survey found. Around 31% of hospital RNs said they've seen a small or significant increase in workplace violence, up from 22% in the March edition of the survey. The RNs attributed these increases to low staffing levels, changes in patient population, and fewer restrictions for visitors. (National Nurses United release, 9/27)