Frequently asked questions #
The coronavirus pandemic is unlike anything we’ve seen in our lifetimes and is particularly stressful for health care providers on the frontlines. CDC guidance and hospital protocols continue to change rapidly.
In response to the many questions we are receiving every day, we created a Frequently Asked Questions document to address the most common topics and provide the most up-to-date information on critical issues.
Accurate information is critical during this crisis — both for your own safety and for your ability to treat your patients.
We are tracking, reviewing and responding to the hundreds of messages we are receiving from you, responses to our COVD-19 surveys and staffing concern/ADOs you are sending. We have had three emergency COVID-19 Local Unit Officer meetings with hundreds of nurses attending. This FAQ pulls together answers to some of the most common questions we are receiving with the most up-to-date information we have.
We will continue to update our FAQ as urgently as we can as new information becomes available.
This situation is developing rapidly. We are working around the clock to get you what you need, advocating for you and coordinating with elected leaders at every level, labor partners, public health officials and hospitals.
Please continue to send individual questions to your Nurse Representative. Representatives across the state are helping us determine the most common questions so we can continue to build out our FAQ, and your Nurse Representative is best-positioned to address your concerns in your own workplace.
About: Personal protective equipment (PPE) #
- Should the general public wear facemasks?
- What is the time period that the air inside an examination room (occupied by a patient with confirmed or suspected COVID-19) remains potentially infectious?
- What is the best way to clean my disposable N‑95 mask?
- Do cloth masks offer any protection? Since there are no surgical facemasks available, should I wear a cloth mask?
- Should I wear a homemade mask over my mask (e.g., surgical facemask or N‑95 respirator) to keep it clean?
- When will Washington state get more supplies/what is the status of getting supplies from the National Stockpile?
- There is a severe shortage of personal protective equipment. Organizations are using a variety of strategies to preserve PPE. What are the CDC recommendations?
- Can PAPRs be cleaned without eventually destroying their integrity?
About: Assignments #
- Can an employer force a nurse to work on a designated“COVID-19” floor? Management is denying us masks saying they are not needed when we have to take care of symptomatic patients, what are my rights?
- When can I refuse an assignment based on personal health circumstance (pregnant, auto immune disorder, etc.)?
- What will happen now that my hospital is closing units and stopping elective surgeries?
About: Staffing #
Can my employer require mandatory overtime? Can employer require me to go to work when I’m not scheduled citing“event of an emergency” that is allowed in the CBA or under government declared“State of Emergency”? What happens with the new staffing law? Does the employer have to follow it at all, (e.g., breaks, staffing committees, staffing plans)?
About: Benefits/Low Census #
About: Illness #
Personal protective equipment (PPE) #
Should the general public wear facemasks? #
On April 4, 2020, the CDC set forth a recommendation in support of wearing cloth face coverings in public settings where other social distancing measures are dificult to maintain, (e.g., grocery stores and pharmacies). A special focus is in areas where there is signicant community-based trasmission. CDC advises the use of simple cloth face coverings to slow the spread of the virus and help people who may unknowingly have the virus from tranmistting it to others. Cloth face coverings made from household items at low cost can be used as an additional, voluntary public health measure. See the CDC reference which describes how to make, correctly wear, and clean homemade cloth face coverings. (Reviewed 4/7/2020)
What is the time period that the air inside an examination room (occupied by a patient with confirmed or suspected COVID-19) remains potentially infectious? #
The amount of time that the air inside an examination room remains potentially infectious may depend on a number of factors including the size of the room, the number of air exchanges per hour, how long the patient was in the room, if the patient was coughing or sneezing, and if an aerosol-generating procedure was performed. Facilities will need to consider these factors when deciding when a room can be entered by someone who is not wearing PPE.
For patients who are coughing or underwent an aerosol-generating procedure, the risk period is likely longer. In these scenarios, it is reasonable to apply a similar time period as that used for pathogens spread by the Airborne route and to restrict HCPs without PPE from entering the room until sufficient time has elapsed for enough air exchanges to remove potentially infectious particles.
The CDC provides general guidance on clearance rates under differing ventilation conditions. Consult with the Infection Preventionist and Facilities manager in your building for specific guidelines. (Reviewed 4/2/2020)
What is the best way to clean my disposable N‑95 mask? #
The CDC and NIOSH do not recommend cleaning disposable N‑95 respirators. These respirators are made from a variety of materials and not all respirators have the same construction. Self-cleaning a respirator may result in degrading the quality of the respirator, rendering it less effective or potentially ineffective. Taking a used N‑95 respirator home to attempt cleaning using microwave or oven heat is not recommended. Autoclaving and the use of disinfectant wipes are not recommended as they may alter performance of the filtering facepiece respirator (FFR).
Per the CDC guidelines, FFR (e.g., N‑95) decontamination and reuse may be considered in a crisis to support continued availability. Based on limited research, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat are potential methods of decontamination.
On March 28, 2020, the FDA issued emergency authorization for use of the Battelle decontamination system to decontaminate compatible N‑95 respirators. Of note, only respirator manufacturers can reliably provide guidance on how to decontaminate specific modes of FFRs. The CDC guidelines include a table of decontamination methods that have been evaluated for N‑95 masks. (Reviewed April 2,2020)
Do cloth masks offer any protection? Since there are no surgical facemasks available, should I wear a cloth mask? #
During a crisis, in settings where facemasks are not available, the HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. Homemade masks are not considered PPE, since their capability to protect is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and the sides of the face.
Should I wear a homemade mask over my mask (e.g., surgical facemask or N‑95 respirator) to keep it clean? #
There is no evidence to support using a homemade mask over your surgical facemask or N‑95 respirator. According the CDC, cloth masks are not considered PPE. If you are considering covering your mask, the CDC recommends using a face shield that covers the entire front and sides of the face to cover your mask.
When will Washington state get more supplies/what is the status of getting supplies from the National Stockpile? #
Governor Inslee is working with Vice President Pence to increase our allotment of personal protective equipment from the Strategic National Stockpile. In addition, our congressional delegation has asked Congress for more funding specifically to address the PPE challenges. Washington has received some shipments of PPE, but only enough to cover a fraction of the requests. Governor Inslee is also reaching out directly to PPE manufacturers to negotiate directly for more product to be sent to our state immediately.
WSNA, with our allies, continues to advocate at the federal level for additional supplies for our state, including working with the Governor’s Office and our congressional delegation to direct more supplies to our hard-hit state. WSNA, along with our nursing union and firefighter partners, is calling for businesses and individuals to turn over unopened boxes of masks and other PPE to health care providers — that site is suppliessaveliveswa.org.
There is a severe shortage of personal protective equipment. Organizations are using a variety of strategies to preserve PPE. What are the CDC recommendations? #
Washington State Nurses Association continues to steadfastly advocate for personal protective equipment at the local, state, and national levels to secure the needed supplies to support all personal safety.
(Reviewed 3/17/2020) The CDC offers a series of options to optimize supplies of personal protective equipment where there is a limited supply in an environment of a sudden, unexpected increase in patient volume that challenges or exceeds the present capacity of the facility (surge capacity). Three strata are used to prioritize measures to conserve face mask supplies:
- Conventional capacity: measures consist of providing patient care without any change in daily contemporary practices. This set of measures, consisting of engineering, administrative, and personal protective equipment (PPE) controls should already be implemented in general infection prevention and control plans in healthcare settings.
- Contingency capacity: measures may change daily standard practices but may not have any significant impact on the care delivered to the patient or the safety of healthcare personnel (HCP). These practices may be used temporarily during periods of expected facemask shortages.
- Crisis capacity: strategies that are not commensurate with U.S. standards of care. These measures, or a combination of these measures, may need to be considered during periods of known facemask shortages.
Conventional capacity strategies use masks in accordance with product labeling and local, state, and federal requirements.
Contingency capacity strategies remove facemasks for visitors in public areas and implement extended use of facemasks.
Crisis capacity strategies use facemasks beyond the manufacturer-designated shelf life, implement limited reuse of facemasks and prioritize facemasks for selected activities. Guidance is provided in the event that no facemasks are available.
For detailed information on personal protective equipment (reviewed 3/17/2020) please see https://www.cdc.gov/coronavirus/2019— ncov/hcp/ppe— strategy/index.html.
Can PAPRs be cleaned without eventually destroying their integrity? #
PAPRs must be worn and cleaned according to manufacturer’s recommendations. The respirator is no longer effective if the seal around the face becomes loose or is no longer intact.
Can an employer force a nurse to work on a designated “COVID-19” floor? Management is denying us masks saying they are not needed when we have to take care of symptomatic patients, what are my rights?
You may have to make a decision about accepting an assignment involving abnormally dangerous conditions that pose an imminent risk to your safety and health and could potentially cause serious injury or death. If you have already accepted the assignment your professional license may be at risk if you fail to continue that assignment, unless you have handed off the assignment and been relieved of responsibility for the patient. If you decide to refuse the assignment, you should remain at the workplace and offer to perform other work that does not pose an imminent risk to your safety and health (e.g., an assignment for which you are provided proper safety equipment and training). A decision to refuse an assignment could result in disciplinary action taken against you by the employer. Under the collective bargaining agreement between the employer and WSNA, there must be “just cause” for any discipline. WSNA would defend you if you are subjected to unjust discipline, but resolution of any such discipline would likely be delayed and the outcome may be uncertain as a result of the current national and state emergency declarations.
When can I refuse an assignment based on personal health circumstance (pregnant, auto immune disorder, etc.)? #
If you have a health condition that you believe requires some accommodation in the workplace, you should consult with your health care provider and talk to your employer about your need for reasonable accommodation.
It is imperative that nurses who are at high risk be accommodated — especially in the situation we now face of inadequate supplies of PPE and crisis guidelines for their use. WSNA is working to address this issue at the state level and individual Local Unit level. We have called on employers to bargain with the union over an MOU that addresses multiple issues related to COVID-19. CHI Franciscan is the first hospital system to agree to and sign a MOU with WSNA and other unions. The MOU includes a section on this issue:
“A nurse or healthcare worker who is unable to work due to being part of the CDC’s at-risk group (older than 60 or with an underlying medical condition) may request an accommodation. If a workplace accommodation cannot be granted, the employee will be granted a leave of absence and have access to accrued time off benefits. If the employee’s paid time off accruals exhaust during the leave, Employer will work on a case by case basis with the employee to ensure appropriate continuation of medical benefits until the employee is deemed eligible to return to work by the Employer.”
Read the full MOU with CHI Franciscan here: https://www.wsna.org/union/st-clare-hospital/update/health-care-unions-and-chi-franciscan-reach-agreement-on-worker-safety-and-compensation
What will happen now that my hospital is closing units and stopping elective surgeries? #
It is difficult to predict what will happen, though it is anticipated that there will be some reassignment of personnel to areas where there is a critical need for staffing and for emergency facilities like field hospitals. As work continues to meet the challenges posed by COVID-19, it is reasonable to be concerned about accepting an assignment in an unfamiliar area and with an unfamiliar patient population.
If the situation exceeds your scope, skills or knowledge required to care for patients, work collaboratively to develop a plan to provide care/assistance while alleviating elements of an unsafe patient assignment.
WSNA and other unions representing health care workers are actively working on agreements that address the issue of floating to ensure that nurses are protected and supported if asked to float to another unit or facility.
We’re also advocating for compensation and benefits to address low census, furloughs, paid administrative leave if you are exposed and more. We have already shared info on state benefits available to you (https://www.wsna.org/news/2020/state-resources-for-workers-missing-work-due-to-covid-19) and will continue to update you with additional resources and nformation as we move through this crisis.
Can my employer require mandatory overtime? Can employer require me to go to work when I’m not scheduled citing “event of an emergency” that is allowed in the CBA or under government declared “State of Emergency”? What happens with the new staffing law? Does the employer have to follow it at all, (e.g., breaks, staffing committees, staffing plans)?
Nurses can be required to work overtime during an emergency. On February 29, 2020, Governor Jay Inslee issued a declaration of emergency covering all counties in Washington state in response to the coronavirus COVID-19 outbreak. Therefore, the statutory prohibition on mandatory overtime for health care workers is suspended for the duration of the emergency.
Note that the declared emergency suspends the normal requirement that an employer must make “reasonable efforts to obtain staffing” before resorting to mandatory overtime, so an employer is not required to make reasonable efforts to obtain alternative staffing before requiring a nurse to work overtime. Similarly, the declared emergency suspends the statutory rest between shifts requirement that a nurse who accepts overtime and works more than twelve consecutive hours must be provided the option to have at least eight consecutive hours of uninterrupted time off from work following the time worked, since the declared emergency has the effect of suspending the entire mandatory overtime statute.
ADDITIONAL NOTE: While the mandatory overtime statute is suspended by the declared state of emergency, any overtime restrictions and rest between shifts provisions contained in your collective bargaining agreement may still remain in effect, depending on the specific language of the contract. You should consult with your WSNA nurse representative about the specific situation at your facility.
Benefits/Low Census #
What will happen now that my hospital is closing units and stopping elective surgeries? Can I get unemployment? #
We expect most nurses to be redeployed; however, if you have been laid off your job, you should generally be eligible for unemployment compensation benefits. Unemployment benefits are intended to assist workers who are out of work due to no fault of their own, by partially replacing the income you would earn if you were still working. Unemployment benefits are not based on financial need. The fastest way to apply for unemployment compensation benefits is on-line at esd.wa.gov/unemployment.
Do not delay applying for unemployment benefits. As of March 18, 2020, Governor Inslee waived the one-week waiting period to allow for faster access to unemployment benefits during the COVID-19 emergency.
The Washington State Employment Security Department (ESD) is adopting new emergency rules concerning eligibility for unemployment compensation benefits as a result of the coronavirus crisis. Eligibility decisions are made on a case-by-case basis, so it is difficult to give definitive answers as to whether nurses will be eligible under any particular scenario.
There are several categories of unemployment compensation benefits that may apply to nurses whose work hours are reduced as a result of the coronavirus crisis. There is a useful list of questions and answers at https://esd.wa.gov/newsroom/covid-19.
Employers that continue operating on a less-than-full-time basis can request “Partial” status for their employees, under which eligible workers who were hired for full-time work continue to work a reduced work schedule (at least 16 hours per week) while receiving partial unemployment compensation benefits. Workers are not required to engage in an active job search while collecting unemployment benefits under this status.
There is also “Furlough” status, a form of temporary lay-off which may consist of a complete stoppage of work or reduced work hours for a period of time.
The only certain way to determine whether you are eligible for unemployment compensation benefits is to apply.
If I am sick with a high fever and my employer tells me I have to go into work, what should I do? #
According to CDC guidelines, a health care provider with even mild symptoms consistent with COVID-19 must cease patient care activities and leave work. These include fever ≥ 100.0oF and respiratory symptoms consistent with COVID-19 – cough, shortness of breath, and sore throat.
A health care provider in any of the risk exposure categories who develops signs or symptoms compatible with COVID-19 must contact their established point of contract (e.g., public health authorities or their facility’s occupational health program) for medical evaluation prior to returning to work. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
Health care workers with confirmed COVID-19 should not return to work sooner than 7 days after illness onset, or 72 hours after recovery, defined as resolution of measured fever without the use of antipyretic medication and improvement in symptoms, whichever is longer. https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/HealthCareworkerReturn2Work.pdf
WSNA is actively advocating for:
- Notification of nurses that have been exposed to COVID-19 positive patients.
- Clarification/consistency regarding quarantine.
- Access to testing.
Other questions #
If I have a COVID related complaint, how do I go about having my voice heard? #
Communication of concerns requires a multi-pronged approach.
- Communicate the issue following the established chain of command at your hospital or health care facility.
- Complete an incident report at your facility for any event or issue outside the usual operations of the hospital or health care entity.
- Complete an ADO form and contact your union representative.
Again, please continue to share your questions and concerns. WSNA is committed to providing you with the most accurate, up-to-date information and advocating at every level to ensure you have what you need to continue your dedicated work to caring for patients through this crisis.