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As Covid-19 cases grow exponentially, health care workers on the front lines of an already overstretched system are struggling to save lives. For decades the mantra of American hospitals has been “Do more with less!” as budgets are cut back and management pushes employees to limit their “nonproductive” time. But in this moment of crisis, these workers remind us that human life cannot be measured in profits. Zenei Cortez is a nurse at Kaiser Permanente South San Francisco Medical Center and co-president of National Nurses United, which represents 150,000 nurses across the United States. She spoke with The Nation about the crisis she’s witnessing in real time.
—Sarah Jaffe
Sarah Jaffe: I understand you just got done with a shift. How are things where you are?
Zenei Cortez: This morning we had a rally in front of the hospital because nurses are so fed up due to lack of Personal Protective Equipment [PPE]. We have it, but we are being prevented from using it because they don’t want to run out. Nurses from the night shift and the morning shift, we came out because we want the public to know. We need to safely take care of our patients. All we want is to be protected.
Our hospital canceled elective surgery last week. We are doing only emergency surgeries. Because we don’t have that many patients in that department, we are being floated out to the regular floors. The nurses are being given assignments that include both non-Covid-19 patients and Covid-19 patients. They are intermingled. I’m strongly against it, because, even if you are very careful, your risk of cross-contamination is very high.
We want to be able to do our jobs. But we are not using real personal protective equipment like we did for Ebola. We are using a lesser quality of gown because of the shortage. Also, the training—it requires you to do a special technique when you are taking off the contaminated gown. We begged to be trained and the response of our director was, “It is going to be too expensive to train all of you.” We got it, but we had to beg.
They are not reducing the number of patients that you would care for. For regular medical surgical patients, [the ratio] is five patients to one nurse. But the amount of time that you spend donning and doffing [PPE] takes a lot of time. You need to have fewer patients, but that is not what is happening. That is another demand that we have put out there: Give us the proper amount of staff, the right staffing mix so that we can take care of our patients.
The other thing that is apparent is that the managers are nowhere to be found. They are holed up inside their offices, and they make all the decisions. One very important part of PPE is N95 masks—those are locked up inside managers’ offices in their cabinets. If you need one, you have to search for that manager in order for them to give you one, which is absurd. If there is an emergency with a positive Covid-19 patient, you want to jump in and take care of the patient. If the N95 masks are not regularly available, that is a problem.
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It is really frustrating, because we have not peaked with the number of patients. We have been testing a lot of patients now, and the turnaround time for the results is like two to five days. Meanwhile, they have been out there in the community, passing along the virus. That is heartbreaking for me, because if only they could give us those N95 masks, then we would know that we are protecting ourselves and protecting everybody else around us.
SJ: What are you hearing from nurses at other hospitals?
ZC: It is the same story. I have made myself available to a lot of the nurses. They’ve been sending me horror story after horror story. I couldn’t sleep. Why is this happening? We are in America, one of the richest countries in the world and, yet, nurses who have given themselves to the frontlines are being denied something very important to protect ourselves and our patients. I have been a nurse for 40 years, and this is the first time this is happening. I was there when the AIDS epidemic came about. We had SARS. We had H1N1. We had Ebola. Then, this.
We see an uptick of flu during the flu season, but we are allowed to use—according to our professional judgement—whatever we need to protect ourselves. But this time, they are rationing the masks, the N95 masks, which is so important for us to safely do our jobs. Talking to you, I’m crying.
SJ: It still seems like not that many people are getting access to testing.
ZC: It is so unfair because look at the NBA players, they got tested and the results came back quickly. The legislators on Capitol Hill have been tested. Yet we have nurses who have been exhibiting symptoms who are begging to be tested and the employers are denying it. They say, “You don’t meet the criteria.” Come on! An NBA player has met all of your criteria? It breaks my heart.
The other thing that is unfair is that, for them, these people in power, their turnaround time for results is so quick. Yet a lot of our patients are waiting five, six, seven days. There is a lot of disparity. I guess the more money you have, the sooner you get tested.
SJ: Why are they saying it is taking so long?
ZC: They have contracts with the different labs. I guess for the famous people they have a boutique-style lab that they can go to anytime. I didn’t think that it would come to this.
SJ: Nurses have been expected to do more with less for a long time, but this is really showing how bad that has gotten.
ZC: Nurses—I have spoken to a lot of them—we are not afraid to do the job. We have been out in the battlefield, but, if we are going to fight a war, give us the weapons. It is like sending out a firefighter and providing them with a squirt gun.
SJ: What are we learning about the American health care system in this moment?
ZC: Way back in January we got wind of this virus. [National Nurses United] wrote a letter; we demanded that the World Health Organization and the CDC strengthen their guidance on prevention and control of this virus. We were ignored. We said, “You need to be strict on the guidance, because we do not know a whole lot about this virus.” Because of not having guidance, hospitals dismissed it.
SJ: One of the big demands of the union has been for a long time to have safer staffing ratios. As you were just saying, that is even more important now. But instead, it has been going in the opposite direction for years.
ZC: Here in California, we have the nurse-to-patient ratio law, but, because our governor has declared a state of emergency, those ratios do not exist now. That is the only time it can be suspended. The only way we can stop it is to be safe. One of the ways to be safe is to have the proper amount of staff and not overburden the frontline workers. I cannot imagine the nurses from other states that do not have the ratios or nurses from non-union hospitals who could not speak up.
SJ: What are some of the options in a moment like this if you are trying to bring in more staff? Obviously, it takes a while to train more nurses, but what could we do to alleviate some of the pressure?
ZC: Right now, we do have nurses who are looking for jobs. We don’t have a nursing shortage. It is the hospitals who do not want to hire nurses, because it is too expensive—according to them.
SJ: Congress is still fighting about a relief bill right now, but what do you want to see in that, as a nurse and union worker?
ZC: What I want to see is the frontline workers—whether it be a nurse, a patient care technician, anybody who provides care—that we be protected. And hospitals throughout the nation should have the proper staffing: a nurse-to-patient ratio just like what we have here in California. I want very strong language around that ratio. They should also look at the acuity of the patients; if I have a patient who is more acutely ill, then I should get fewer patients.
SJ: We are in the middle of a Democratic primary election where single-payer health care was one of the big issues. We are talking on the 10-year anniversary of the Affordable Care Act, as this crisis proves how broken the system is.
ZC: The only solution to this broken health care system is to have an improved Medicare for All system. If only folks who had the symptoms had early access to care, easy access to care, and no barriers like co-pays or ER visits, then a lot of these problems would have been prevented. We would have prevented a whole lot of this from happening.
SJ: Trump is saying right now that people are going to have to go back to work soon.
ZC: People should follow social distancing. They need to stay home. When they are out in the community, they interact with people. A lot of people do not take it seriously because he was saying it was just like the flu and it will go away. That is what he was saying all along, “It will go away.”
