Nurses React to New CDC Quarantine Guidelines

 Katie Boston-Leary, PhD, director of nursing programs for the American Nurses Association (ANA), discusses criticisms of the CDC's new policy shortening quarantine periods for positive individuals and shares concerns about its effect on healthcare professionals.

The following is a transcript of her remarks:

The ANA's criticisms of the guidance for healthcare workers and healthcare professionals mainly is regarding the reduced amount of days for quarantining and isolation. We have concerns that there's not enough evidence that supports it, that we're still learning about this new variant. We are also seeing that Delta is still very prevalent in our communities as well. So since we have so many unknowns, we have concerns about the timing of this change. We're not necessarily saying that it's wrong. We just feel that there's a lot more to learn before this change is made, and there has to be full transparency regarding how this change came about, why it came about, and why the timing is now.

The other piece that we're concerned about is the lack of requiring testing for healthcare professionals compared to the general public. In different healthcare institutions, if you're in crisis or contingency status, healthcare professionals are not required to have a negative test before they return to work. In crisis standards, part of the requirements of the guidance is whether you're vaccinated, boosted, or unvaccinated, you can test, and even if you're positive, as long as you're asymptomatic, you can continue to work. And that's really concerning for us because, of course, nurses don't just magically appear at work. They have to interface with the public on their way to work. They have to interface with their families, maybe to drop off a child at daycare, or they use public transportation. And who else may be exposed on the way to work, even if the premise is "While nurses are at work, they're wearing PPE, so they're not exposing anyone"? Yes, the risk of transmission is low in that environment, given the use of PPE, but nurses also need to eat, they need to breathe, they need to use the bathroom, they need to be in break rooms. So what happens in those spaces, right? These are community spaces for other healthcare providers.

And lastly, the issues with testing still remain. There's an impression that just because you work in healthcare, you have access to testing for COVID. This is where we need to make sure everyone knows that that's not necessarily the case. Access and availability are still prevalent issues for this group. And so in some cases, some institutions are requiring nurses to go in the public domain to get tested. In institutions where they do offer testing, a lot of their employee health and occupational programs are overwhelmed. So that's another issue. So testing needs to be in place and more readily available and accessible for this plan to work.

The ANA's preferred quarantine and isolation guidance would look like more of a comprehensive program where it is the CDC locking arms with HHS and working with institutions like ANA, AHA [American Hospital Association], and AMA [American Medical Association] to work on how we can make this a more effective strategy. What is put in place right now is very, very siloed in terms of the approach where you test and can stay, and you now have COVID, what does that mean when I go home?

And you have to think about the emotional toll that has on healthcare professionals. Let us set aside the physical ailments. Because part of this is if you're not symptomatic, you should be fine. You can keep working. But being someone that suffered from a breakthrough infection herself, the emotional toll was heavier for me than the physical toll, which was already pretty overwhelming for me. And you have to think about your family, and what that means not just in your immediate family, but in your community. So we feel that a comprehensive approach to address the staffing issues is important, a plan to address the mental health toll that the pandemic has had on nurses – where PTSD [post-traumatic stress disorder] is real in our nursing population.

Then with all those things, in addition to making sure that there's the science behind the change and making sure the timing is right and making sure there's at least some lead time for a lot of other accommodations we put in place and policies to be put in place, and for there to be more education about this prior to rolling it out.

The climate that nurses have been working under and are working within, it's really at the point of being unbearable. And it's very hard to describe in true terms in capturing what nurses have been dealing with. If you really think about anyone in your personal lives, could you name a crisis that you've endured for close to 2 years nonstop, or when you think it's about over here, it comes again. And this is one of those events that just seems so protracted. And with all the preparation that we've gone through as nurses with emergency preparedness training and disaster planning, this is something that no one ever anticipated, right?

And this is where yes, we've heard the words "burnout" and "frustrated." We have a lot of survey data from nurses and in terms of them feeling stressed and overwhelmed, a lot of the unhealthy behaviors that they've undertaken since this all started, and how this is impacting their ability to practice optimally. Especially in an environment where patients are very sick and care is very complex, you need nurses to be at their best. And right now they're not, because of all the issues that they're facing and all the things that they're struggling with. And right now, which is very concerning, we're seeing that nurses feel that the way to deal with the burnout and a lot of what they're experiencing is to leave the profession or leave where their skills are needed.

This is really concerning because we need our nurses to be there for us for when we need care. And nurses are also healthcare consumers too. And it's not just for COVID, it's for all the other things that we go to healthcare institutions for. So it's unbearable. And it's really the place where we're seeing nurses vote with their feet, which is very concerning, particularly for a profession already struggling with the supply and demand issue: not enough nurses, but high demand for their skill sets and care.

https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/96465