Nurses at the San Diego Veterans Health Administration say they are getting mixed messages from supervisors on how to respond to Coronavirus. VA leaders admit there have been inconsistencies.
Around the country, nurses have been protesting about the lack of staff and a shortage of supplies. On Monday, nurses who work for the Veterans Health Administration were protesting in Brooklyn.
The VA nurses in San Diego have some of the same concerns, said Brian Hebert. He works as a primary care nurse at the VA Oceanside Clinic. He spoke about the VA in his role as a member of National Nurses United.
Just prior to the governor asking everyone to cover their faces in public, Herbert said a VA supervisor told two nurses to remove face masks they brought from home.
“Depending on where you are working, it’s kind of a different message given by different managers,” Hebert said. “Our manager is lenient and says you can wear it if you have access. Meanwhile, it seems like some of the managers at the main hospital are following a different protocol.”
Nurses are worried the VA is not always following through on the latest guidance. He describes how the VA has stations set up outside most locations to screen patients for the virus, which follows the guidelines set out by the Centers for Disease Control and Prevention. But that’s not how it works at his clinic in Oceanside.
“They have stations set up for checking patients and isolating them at that point, but that’s not being instituted at all of the locations currently,” Hebert said. “At Oceanside, they’re checking inside the building, not outside where it would be better for all included — the staff and the patients.”
The idea is to direct potentially contaminated patients to a secondary location for further screening before they even enter the building, he said.
A recent report from the VA Inspector General also criticized two other clinics at VA San Diego for not properly screening patients before they actually entered the clinic. Dr. Robert Smith, director of San Diego VA Medical system, acknowledges there have been issues with screening.
“We might screen outside the door. But if weather conditions don’t permit, we might screen right inside the door and again, put people into secondary screening if they have any symptoms or fever or anything else,” he said.
Smith said he has re-emphasized the need to screen everyone before they can mix with the rest of the staff or patients. He also said managers are not supposed to tell staff to take off their own protective masks.
“I can’t speak to what an individual supervisor might have said but that was not policy. We do need to make clear that personally owned gear, whether it’s a mask or a bandana, is not a substitute for formal PPE,” he said.
On the question of hospital-grade personal protective equipment (PPE), officials at the San Diego VA do not want staff to reuse hospital-grade masks, which is another concern raised by nurses on staff. Many of the upper-end masks require being fitted to the individual. Staff has been told to keep the masks that have been fitted for them, maybe in a ziplock bag, so they can be used later, according to Smith.
“Under those circumstances, that’s not a reuse. I know some of the staff were confused that we were suggesting they could reuse that mask when all we were saying is keep the mask and use it as PPE in the first appropriate setting when it’s appropriate to use PPE, not reuse masks after that,” he said.
Asked whether the VA system is able to get out a consistent message as the situation rapidly evolves.
“I think messaging is the single hardest thing to get right for healthcare organizations right now. We have staff that is very concerned. I think the message they get nationally is very concerning. And trying to stay ahead of that has been challenging,” Smith said.
At the moment, the VA is well under capacity. The San Diego VA has had 19 confirmed cases of COVID-19 among patients. Only one is hospitalized at the moment, though the system is still expecting a surge.
