I Didn't Sign Up For This

First and foremost, I want to thank all the essential workers: healthcare, hospital, and non-healthcare alike. I hope you are safe and do not contract COVID-19 while doing your job.

Now that I've thanked the essential workers let us get to the topic at hand. I cringe every time I hear the words "I/You signed up for this." I have seen these words a lot in nursing forums, in news articles and stories, and from laypeople not associated with healthcare, who enjoy telling people what they should do, but have no real knowledge of healthcare and healthcare workers.

Other healthcare workers (HCWs), and I did not sign up to work without proper personal protective equipment (PPE). In addition to "I/you signed up for this," I've heard many nurses say, "I/we took an oath." No, nurses took a pledge, which is different than an oath. Nowhere in the nurses pledge, does it mention being a sacrificial lamb and dying while providing care. NOWHERE.

In an ACUTE situation like a fire, active shooter, or some other type of accident, instinct kicks in and you try to save as many patients and coworkers as possible, even while putting yourself at risk. Daily work work without proper PPE is not an acute situation, and it is not one HCWs should be encouraged to participate in. 

If an HCW worker feels compelled to work with patients who have COVID-19 with or without the proper PPE, because they feel led to or called to, that is your right and choice. I wish you nothing but good health while you care for those patients. 

When nurses say, "I signed up for this," in my opinion, that statement allows hospitals and other healthcare facilities to continue to provide minimal PPE and to continue to perpetuate the "nurse martyr" rhetoric. I did not subscribe to the "nurse martyr" rhetoric before COVID-19 and certainly do not subscribe to it now. When management says, "You signed up for this," it shows me who they are, and that is not the kind of person I want to work for. Those types of managers tend to be all talk and no action and will find every excuse not to work the floor, even when staff is drowning.

These days you cannot scroll through your social media feed, read a newspaper, watch a tv channel, or news broadcast without seeing some variation of nurses/HCWs/essential workers are heroes. You see things like working on the front line, warzone, battle, etc., when describing essential workers. You see all these war terms, but many HCWs do not have the proper equipment to fight the COVID-19 war.

Police officers, military personnel, firefighters, and paramedics are given the proper equipment to do their job. At times, yes, it may not be the latest equipment, but nonetheless, they are given equipment and protection intended to minimize the risk of injury or death . A police department would not send their officers out onto the street without weapons. A fire department would not send their firefighters out without proper heat-resistant uniforms and masks, nor send their paramedics out without the adequate supplies they needed to save lives. The military would not send their military personnel out to war without the proper gear. No one would ever say to a grieving family of one of the above professions, "Well, you know Johnny/Sue signed up for this life." NEVER. So why is it okay for someone to think it, let alone say to a nurse, "You signed up for this."

Police officers, military personnel, firefighters, and even paramedics know when they join the ranks of their respective fields that they can and will encounter dangerous situations, some that may even result in serious injury or death. Those risks are well known when you sign your onboarding papers. With those onboarding papers, there is life insurance, death benefits, beneficiary designees, etc. There may be unions, benevolent funds, and more to help a decedent's employees, should a worker from the above categories die in the line of duty. I am happy those systems are in place, and they should be in place, as the above put their life on the line every time they step out of the door to report to work.

Now contrast the above to nurses, other HCWs, and essential workers. Those same kinds of systems to make sure the decedent's families are okay after a nurse dies in the line of duty are not in place. At best, you might have a small life insurance policy that the hospital or employer provides as a matter of course that has nothing to do with being killed in the line of duty. It is just a regular life insurance policy. The hospital or employer  may say something at report, send some flowers and a small monetary donation collected from fellow employees, and keep it moving.

You know why people feel like they can say "You signed up for this.", because they, too, have been deceived by the narrative that's been pushed since the beginning of nursing as a profession, that nurses are altruistic, selfless to the point of neglecting their own self-care. While nurses may be altruistic, often to their own detriment, nowhere does it say, nurses should be self-deprecating to the point of being okay working without the proper PPE. As a nurse, you are always taught safety first. It is not safe for you, as the provider to be unsafe, because you endanger your patient's lives.

Most nurses do not mind caring for patients who have COVID-19, provided they have the right PPE. It is when nurses do not have PPE, improper PPE, or single-use PPE becomes multi-use PPE, that nurses draw the line. Why is it okay for a nurse to sacrifice themselves because they do not have the proper PPE? I will tell you for this nurse, and countless more, it is not okay.

When hospitals and healthcare facilities say they have the proper PPE to the media, the next question should be, "What does having the proper PPE mean?" Having PPE, while telling your staff that they have to wear the same surgical mask for a week, is not proper PPE. Having your staff use the same gloves between patients is not proper PPE. Having staff save their masks N95 or surgical masks in a paper bag is not proper PPE. Giving your staff a mask made of fabric so thin, you could see through it when the sun shined on it, is not proper PPE. Telling staff to spray their disposable gowns down with disinfectant is not the proper PPE. All of the above examples are statements I have seen in various nursing groups.

Yes, the Centers for Disease Control and Prevention has made some infection control changes due to the lack of PPE, including some recommendations on conserving PPE and reuse, prolonged use, etc. That said, I think some hospitals and healthcare facilities are taking advantage of that and twisting the guidelines and recommendations to suit their needs and their pockets if we are honest. No facility should aspire to have the bare minimum when it comes to infection prevention. If a facility gets to a point where conservation guidelines must be implemented, the facility should use those conservation guidelines while still furiously looking for new PPE.

If one looks at the flip side of the situation from a patient or patient's families' perspective, how do you think that patient or their family would feel if they found out staff was doing the bare minimum to prevent infection? It would not make them feel good, and it would have them questioning the care they or their family received.

Many facilities lack the proper PPE, and many of the HCWs working without proper PPE contracted COVID-10, and worse, some have died. To be fair, some people will get COVID-19 even with the proper PPE. Regardless of how a HCW contracted COVID-19, you have lost people on the frontline, temporarily while they recover or permanently. Per this NPR article, over 9,000 HCWs contracted COVID, and 27 have died. Would you say to the loved ones of those who got ill or died from COVID "It's okay, they signed up for this." Most people would NEVER do that, but in the abstract, some people think it is okay to say that, as if by being a nurse or HCW, they forgo all rights to protect themselves and their families.

Do you think all of these employers are showing their employees grace and telling them to stay home and recover from COVID-19? You would be wrong. I have seen and heard far too many times, of healthcare facilities harassing their employees to come off of quarantine early, questioning their illness, threatening staff with disciplinary action for not coming in. When you force staff or make them feel bad (a common occurrence, only worsened by COVID-19) for not coming in when they are sick, especially in skilled nursing facilities, rehabilitation hospitals, and long-term care facilities, it is the patients who suffer the most.  There are numerous outbreaks with many associated deaths in the facilities mentioned above. Many of the HCW coming in sick may not have the PTO necessary to stay home, and for those that do have PTO, are made to feel bad or facilities try to twist the CDC guidelines to their advantage.

If the general public at large, media, etc., want to make HCWs heroes, then provide HCWs with the things they need to do, to be that hero: PPE.  PPE is what most nurses and HCWs want.  HCWs want to be able to do their job with the proper protection. Free food, first responder parades, etc. are all well and good, but unfortunately, that is not enough to soothe the incredible wounds that have opened up during this pandemic.

The American Nurses Association and the World Health Organization declared 2020 as "The Year of the Nurse." I do not think this is the year they envisioned. Nurses are upset and tired of being martyred, and a revolution is rising. This revolution WILL BE televised.

If not subscribing to "I signed up for this." is wrong, then I do not want to be right. To my fellow nurses, HCWs, and essential workers, please be safe and keep fighting the good fight.

P.S. I recently left direct patient care as a psychiatric nurse and work in infection prevention now.  I am passionate about nurse's rights. One does not have to give direct patient care to patients with COVID-19 to fight for those who are giving direct care to patients with COVID-19.  All nurses and HCWs, in some way, play a role in the COVID-19 response.