As the U.S. continues to reopen, a national survey reveals a majority of nurses are still re-using PPE, are understaffed, and working in unsafe conditions.

National Nurses United (NNU) has released a new survey of more than 21,000 nurses, with 43% saying they are afraid of infecting their families with COVID-⁠19 because their facilities aren’t safe. As states across the U.S. reopen, a dearth of personal protective equipment (PPE) — most nurses continue to reuse what they have — lack of testing among staff and patients, and few dedicated COVID-19 units are still common.

Repeated use of single-use PPE increases exposure of the infection to nurses, patients, and other hospital staff, yet 87% of those surveyed admit to reusing single-⁠use N95 respirators and face shields because they have no choice. Only 9% say they do not have to reuse single-⁠use PPE.

Also, the decontamination of single-⁠use PPE is increasing, with 54% percent of nurses working in hospitals saying that their employer has implemented a program to "clean" single-⁠use N95 respirators between uses, which has not been proven to be safe or effective. The NNU says if a facility reprocesses PPE, the FDA requires notification as part of the authorization for these systems to be used in healthcare settings. Only 12% of hospital nurses were notified by their employer of the risks associated with using so-⁠called decontaminated PPE.

“Healthcare employers' use of unproven ‘decontamination’ systems means they are experimenting on their employees without consent,” the NNU stated.

Meanwhile, only 23% of nurses say they’ve been tested for the disease despite the fact that testing is crucial to reducing its spread.

"Nurses warned about reopening too early, and now this survey shows that nurses are bearing the brunt of premature relaxing of shelter-⁠in-⁠place orders," said NNU executive director Bonnie Castillo, RN, in a news release, adding that more than 165 nurses have died from COVID-19. "One of the only agreed-⁠upon criteria for reopening has been robust, reliable testing,” Castillo added. “Nurses and other healthcare workers must be prioritized for testing. It is a travesty that only a fraction of health care workers have been tested."

The reopening of businesses also means healthcare facilities are treating more patients, with 85% of nurses surveyed saying their workplaces are back to scheduling elective procedures again.

The NNU says healthcare facilities should have designated, separate zones for COVID-⁠19 patients, persons under investigation, and patients for whom COVID-⁠19 has been ruled out. Facilities should be isolating COVID-⁠19 and suspected COVID-⁠19 patients in a negative pressure room. But only 15% of nurses reported that COVID-⁠19 patients were always placed in a negative pressure room, with 18% reporting that sometimes they are.

"This is why we need the Occupational Safety and Health Administration (OSHA) to pass an emergency temporary standard for infectious diseases to mandate that healthcare employers provide protections needed for COVID-⁠19,” said Castillo. “We also need President Trump to use the Defense Production Act (DPA) to order the mass production of PPE now. And, finally, we need the Senate to pass the HEROES Act, which contains language on the DPA and mandates an OSHA standard on infectious diseases."

The NNU had already petitioned OSHA on March 4 for the standard but said they never received a response. That prompted nurses to protest in front of the White House a month later to demand the OSHA standard, as well as mass production of protective equipment for healthcare workers.

“I think you people have been having a hard time,” Trump told a group of healthcare executives gathered at the White House several months ago. “From what I’m understanding, you’re having a hard time and I understand that very well.”

But it wasn’t until earlier this month that the Department of Health and Human Services (HHS) began distributing a second round of financial help — $10 billion in CARES Act Funding — to hospitals, including in hot spots that are dealing with increasing COVID-19 cases.

"At a time when the skills of registered nurses and other healthcare workers are most needed, it is unconscionable that they are being treated as if their lives are worth less than others with this utter disregard for their safety,” said Castillo. “Nurses are willing to be at the bedside caring for COVID-⁠19 patients; their employers should be willing to protect them. Sadly, that's not the case.”

A couple of days ago Senate Republicans released a fourth COVID-⁠19 stimulus package, which includes the HEALS Act (health, economic assistance, liability protection and schools.)

“Chairman Graham is introducing a package of legislation that will incentivize PPE manufacturing here at home,” said U.S. Senate Majority Leader Mitch McConnell (R-KY) in a prepared statement. “It will ensure that our efforts to rebuild our national stockpile of protective gear actually benefit American workers instead of just stimulating China.”

But the NNU says the package still fails to meet the needs of nurses and other healthcare workers on the front lines of COVID-⁠19, particularly the HEALS Act.

“Despite the ongoing dire situation in our nation's hospitals, Senate Republicans have failed to include any provisions in the HEALS Act that would protect nurses and our patients,” Castillo said. “Senate Republicans once again abandoned nurses and our patients."