Editor’s note: This online article has been updated with a statement from CHI Franciscan:
St. Elizabeth Hospital is only one of numerous facilities on the front line of the fight against COVID-19.
But since the beginning of the outbreak, the Enumclaw community has heard little about what’s happening inside their local hospital — questions posed by the Courier-Herald about the number of patients and staff who have tested positive for the novel coronavirus, the facility’s COVID-19 patient capacity, and the availability of personal protective equipment (PPE) for staff have gone unanswered.
Meanwhile, the number of COVID-19 cases and deaths have continued to rise. As of April 20, there have been 64 confirmed cases and 16 deaths reported in the 98022 ZIP code, according to the King County COVID-19 dashboard.
Tired of the silence, three St. Elizabeth nurses — who asked to remain anonymous for fear of losing their jobs — contacted the Courier-Herald to share details of their daily battles with both COVID-19 and hospital administration.
Many of their allegations have been corroborated by a spokesperson for their union, SEIU 119 NW, who said she heard “similar” accounts from other members, though declined to give specifics.
The biggest concerns all three nurses had were interrelated — simply, they felt unsafe working at the hospital without N-95 respirator masks or other PPE necessary to protect them against COVID-19, and that their fear was exacerbated by an administration they see as unwilling to communicate and quick to punish.
In response to questions about PPE usage and other concerns brought up by these nurses, CHI Franciscan’s Vice President for Communications and Government Affairs Cary Evans said “PPE use and protocols are not standard during a pandemic or disaster. CHI Franciscan and our dedicated staff are closely following all CDC and DOH policies to ensure we are doing everything possible to keep employees and patients safe. This includes following all PPE guidelines and appropriate isolation precautions when caring for any patient in isolation.
“CDC and DOH guidelines have evolved significantly since the start of the outbreak in light of a national PPE shortage,”Evans continued. “We currently have sufficient PPE levels under the CDC’s guidelines that provide for the re-use of some supplies that would otherwise be disposable.”
FEW PPE, LESS COMMUNICATION
Hospitals around the county, state and nation are short of personal protective equipment, from the N-95 masks to PAPR and CAPR helmets, which shield the whole skull and have their own air purifying systems to filter out contagions.
St. Elizabeth, run by CHI Franciscan, was no exception. One nurse said duty nurses noticed early on that the N-95 masks were no longer being stored in their regular space, replaced by a sign that said the masks had been “sequestered” as of Feb. 28, roughly a month after the first COVID-19 case was confirmed in Washington.
“We did start out with N-95s and we did start out with the CAPRs,” one nurse said, but “it would literally switch mid-shift — ‘oh, no, you can’t do this now, you have to do that.’ Everything would switch. You’d never know hour by hour what leadership was mandating you to do.”
All three nurses said that until recently, staff were instructed to not wear N-95 masks unless COVID-19 patients were receiving what’s known as an “aerosolized-generating procedure,” which are procedures where the patient is likely to cough, sneeze, or otherwise expel air and moisture. Examples of AGPs include endoscopies, airway suctioning, CPR and stage two labor.
“CAPRs and N-95 masks will only be worn by front line staff caring for COVID positive or rule out patients requiring aerosolizing procedures,” reads a March 18 email from St. Elizabeth Vice President of Operations Renee Yanchura to all hospital staff. “Staff not caring for patients requiring aerosolizing procedures are instructed to wear a simple surgical mask with eye protection.”
According to multiple St. Elizabeth documents, wearing the simple surgical masks and eye gear was known as Special Droplet Contact Precautions.
All three nurses said they understood why they needed to be careful to preserve N-95 masks, which filter out smaller particles than regular surgical masks, but they wanted more communication from upper management as to what sort of situation they were facing.
“I have to give management/leadership people some leeway because we’re all trying to figure this out. Our concern is, we wanted more of a collaborative culture. Not punitive, which is what it’s turned into,” one nurse said. “Everyone knows there’s a shortage of masks… So come to us and say, ‘Houston, we have a problem here… let’s figure this out.’”
Between March 18 and April 8, it appears only indication bottom-level staff received about PPE shortages at their hospital came from the March 18 email from Yanchura.
“The increase in people across Washington with respiratory symptoms needing care is straining our healthcare system’s supply of PPE in many areas,” the email reads, adding that the state Department of Health was working with the Strategic National Stockpile, the Emergency Management Division, and the Department of Enterprise Services to find more PPE. “It is important for our first responders and healthcare system partners to know that even with these efforts, we will not meet the full need in our state. We have received 655 requests from partners and have been able to fill 52 of them.”
Nurses were able to resume wearing N-95 mask when treating most or all COVID-19 patients at the beginning of April.
“In keeping with CDC guidelines, now that PPE is more available all facilities will return to Airborne Respirator Contact Precautions as our first choice,” reads an April 8 COVID 19 Huddle Notes document. Airborne Respirator Contact Precautions are more strict than Special Droplet Contact Precautions, namely because N-95 masks or PAPR/CAPR helmets are required.
Why nurses were able to resume wearing N-95 masks was explained in an April 9 email from Yanchura to all St. Elizabeth staff, which also revealed how the local hospital and the entire CHI Franciscan system came close to running out of protective gear.
“Current SYSTEM PPE resources have increased due to CommonSpirit Health resources available now, and donations from many entities,” the email reads. “We are in better shape in regard to PPE than the month of March, when we had a 3-day supply as a system.”
The email also stated that CHI Franciscan now had a 95-day supply of N-95 masks, and emphasized that its previous Special Droplet Contact Precautions were consistent with CDC and Department of Health mandates.
But those three weeks of radio silence from administration took its toll on St. Elizabeth staff when rumors began to fly and staff were being reprimanded.
All three nurses, plus their union representative, either heard of or saw nurses from other hospitals who came to temporarily work at St. Elizabeth complained about the lack of N-95 masks and CAPR helmets when treating COVID-19 patients, saying they were allowed to use the PPE at their regular places of work. The nurses added that administration then allowed them to use the PPE when regular staff could not.
At one point, a nurse was fired mid-shift for donning a CAPR or N-95 when entering a COVID-19 patient’s room after being specifically instructed not to do so. The Courier-Herald confirmed the firing, but the nurse declined to comment, citing ongoing negotiations with the hospital.
“There’s a huge amount of fear,” one nurse said. “We’re not breaking any laws. We’re just trying to make sure we’re protected so we can take care of patients.”
Although it was announced early on in April that PPE supplies were more abundant, one nurse said that as late as Friday, April 17, that they still haven’t seen additional N-95 masks come their way.
NO HOMEMADE MASKS
Since the beginning of the COVID-19 pandemic, there have been countless feel-good news stories about community members sewing cloth masks for their local healthcare workers, including in Enumclaw.
But it appears St. Elizabeth nurses were not allowed to wear homemade masks, even when CHI’s systemwide supply of N-95 masks dropped to just three days worth.
“We are investigating the use of donated cloth masks,” a March 23 COVID-19 Huddle Notes document reads. “Stay tuned for the pattern, directions, material type and specifics regarding the donated cloth mask this week.”
However, an April 1 Huddle Notes document stated: “At this time, personal masks (those not provided by CHI Franciscan) may not be worn by employees in the hospitals/clinics.”
Some nurses have clearly disregarded that order.
“The only ones we’ve been able to keep for ourselves have been back-channel things, like people bring them over to somebody’s house, or they bring them in the hospital and give them to a specific nurse when management isn’t around,” one nurse said. “We hide them away so that management doesn’t know we have them, because if they see them, they’re like, ‘Oh no, you have to turn those in.’”
At some point, at least one St. Elizabeth nurse went to social media to either ask for donations of cloth masks and tell their followers about the PPE situation at the hospital, which earned them stern warnings from their superiors.
“Nurses are also getting reprimanded by management saying, ‘You have to stop saying that on Facebook. You have to stop telling the community that we don’t have these PPEs because it’s making it look like we’re not supporting you,’” one nurse said.
“As a reminder, social media is considered actual media and staff are not permitted to represent CHI Franciscan without prior approval,” a March 28 COVID-19 Huddle Notes document reads. “Sharing information intended for staff only is a policy violation, and may cause unnecessary risk to the organization if misinterpreted by others outside our organization.”
As of April 8, CHI appeared ready to distribute homemade or cloth masks to St. Elizabeth and other hospital staff, according to another COVID-19 Huddle Notes document.
“In the next 7 to 10 days, CHI Franciscan employees will be given a set of cloth masks… that must be worn as part of their work attire,” the document reads. “Cloth masks will work in place of simple masks.”
An April 13 email from CHI confirmed that when homemade mask donations were arriving in hospitals, the masks were sent to Tacoma for cleaning and counting before being then sent “throughout the system” based on need.
Still, one nurse was adamant that local donations should have come back to St. Elizabeth.
“If my community is donating to my hospital, then it needs to stay here,” she said, adding that she had no issue with sharing masks, but would have wanted better communication regarding them. “[Administration is] not treating nurses like we’re actually in a fight here, and trying to help people. I do want to say I’m very thankful for the help the community has given us, and they’ve given us a lot more help than our management has.”
UNKNOWN CASE NUMBERS
As with the status of PPE and homemade masks, the three St. Elizabeth nurses say administration has not been forthcoming about how many positive cases have come through the hospital, or even how many patients have died from the virus.
“We can only do tallies in our head of what we know from working there,” one said.
“It’s hard to track the number of positives and negatives because we had to re-test people a couple times… you’d have to do some digging to get that number,” another said. “At the end of the day, they might have it, when all this is said and done and the dust has settled, but when you have people negative and they turn positive… there was a lot of variables in that.”
March and April Huddle Notes documents did not give any indication of how many positive cases or deaths have gone through St. Elizabeth. The Courier-Herald has made multiple requests for those numbers, and CHI has responded with only system-wide statistics.
