Healthcare workers worried about Ebola can do little. They’re asking for better equipment and training, but beyond that, workplace laws offer them few protections

Cyndi Krahne is a nurse. Since the first Ebola patient died in the US, she has not worn her work shoes in the car. When she gets home, she follows a careful ritual in her garage: taking off her scrubs, stepping gingerly out of her shoes. She carefully wraps them in plastic and puts them in an out-of-the-way place where they won’t touch anything. The shoes and the scrubs never make it into the house.

In a week when Dallas is considering declaring itself an Ebola disaster zone, nurses are nervous.



Krahne has five children. “I am concerned. I don’t want them exposed,” she says. She’s seen infectious diseases before in the 10 years she has worked at the Kaiser Permanente Medical Center Santa Rosa, California. She’s been careful – but never this diligent.



Fear is the reason for her conscientiousness. Krahne says she doesn’t feel safe at work. She is still without training or protective equipment. Krahne’s confidence is wavering that her workplace is as dedicated to her safety and well-being as she is.



“We haven’t received any education, nor do we have proper personal protective equipment to care for patients with Ebola,” she says. “Because we pushed the issue, we are beginning to get leaflets and they say there are a couple days of training that’s recommended, it’s not mandatory. Speaking for my facility, I personally have not received any notification of training and neither have my coworkers.”

A lot of workers who have to come into contact with Ebola share her concerns. Their worries about potential exposure continue to grow, especially among those working on the front lines like nurses and airplane cleaners, who worry that they are not being properly equipped to deal with the situation. A leader of National Nurses United revealed that nurses are forced to improvise dangerously at Texas Health Presbyterian Hospital; some used medical tape to secure the openings of their gowns to prevent exposure. Airport employees are, in some cases, walking off the job.



The Nurses Union has previously raised concerns over preparedness of hospitals when it comes to treating potential Ebola patients. Before the Dallas Ebola incidents, the union released a survey of 700 nurses that found that 80% of them had received no communication from their hospital regarding any policy dealing with potential patients infected by Ebola and 87% were provided no education on the disease with the opportunity to ask questions. A third of them said that their hospital did not have sufficient supplies of personal protective equipment like face shields and impermeable gowns.

Four out of five nurses say their hospitals have yet to communicate with them about treating potential Ebola patients. Photograph: National Nurses United

“The employers in these cases assume that individuals will make supreme sacrifices in the course of employment. And they do make significant sacrifices, but if it’s life or flight, many workers choose flight,” says Michael LeRoy, a professor of labor and employment relations at the University of Illinois.

This week, two US nurses were diagnosed with Ebola in Dallas after having been part of the 77-member team that took care of Thomas Eric Duncan, the first person in America to die in the recent Ebola outbreak.



Officially, US leaders including President Barack Obama and Centers for Disease Control and Prevention (CDC) chief Tom Frieden have gone to lengths to reassure the American public that their risk of contracting the disease is low. Obama said he “shook hands with, hugged and kissed” nurses working with Ebola patients at Emory University hospital in Atlanta.



Yet even Frieden appeared to concede the fears about Ebola are not entirely unfounded. “It’s scary and getting it right is really important because the stakes are so high,” Frieden said at a press conference about Nina Pham, the first nurse to contract the disease in the US.

The law is thin on protecting people from workplace hazards having to do with infectious diseases. Workers’ rights are limited outside of demanding more training and better equipment.



Facebook Twitter Pinterest Obama and Health and Human Services secretary Sylvia Burwell, speak to the media about Ebola. Photograph: Jacquelyn Martin/AP

The CDC has issued guidance that tells workers what their protections are, but it’s voluntary and not enforceable.



The Occupational Safety Health Act of 1970 – better known as OSHA – outlines employers’ responsibilities in maintaining a safe and healthy workplace, but Ebola is not something the law’s provisions on blood-borne pathogens could have predicted.



“We think of OSHA standards as the minimum wage of safety and health. Employers can do better if they want,” says Mark Catlin, occupational health and safety director for the Service Employees International Union, or SEIU.



The result: unions like the SEIU are stepping in to let workers who may be exposed to Ebola know their rights.



The California Nurse’s Association has held press conferences. The SEIU held a training session at a Clarion Hotel across the road from LaGuardia airport in New York.

“[The training] wasn’t meant to replace the training that those employers of those airport workers need to do,” explains Catlin, SEIU’s occupational health and safety director. “It was done because we heard that the workers weren’t getting training or having knowledge about what was expected and what was in the CDC guidance that applied to their work and to them.”

Facebook Twitter Pinterest A protester holds up a sign during a one-day strike by airline cabin cleaners demanding more protection in the fight against Ebola. Photograph: Carlo Allegri/Reuters

Power in Numbers

If conditions are bad enough, or the equipment inadequate enough, nurses could walk off the job – a tactic highly discouraged by unions but which remains within the realm of possibility.

Workers who are members of the SEIU or the National Nurses Association can recruit these organizations to lobby with their employers on their behalf. What’s more, if workers walk off the job as a united front, instead of doing it as an individual act of protest, there is less likelihood of disciplinary action from their employers.

“Workers in this country have a limited right to refuse dangerous work under federal OSHA. In certain circumstances, they aren’t supposed to outright refuse to work, they refuse to do the specific task that they deem to be dangerous,” explains Catlin.



“It’s not a very strong right. We urge workers to work through their union because a lot of time workers who refuse the dangerous work can lose their jobs and not get them back. “

There are ways to get around this, says LeRoy, the Illinois University law professor. Rather than show up for work, employees who are afraid to come to work could call in sick and start using up their sick days.

“It’s always an individual’s prerogative whether they are going to go to work,” says Katharine Parker, partner at the law firm Proskauer, adding that some workers might be risking disciplinary action if they don’t show up or don’t give enough notices.

“If the employer is not following what the CDC is saying, then the employee should raise that as a concern. Most employers will want to engage in a dialogue to address those concerns. Employers want to have a safe workplace, and so do employees.”

Calling in sick to avoid work could also result in disciplinary action, or even termination. In some states, if a manager has a reasonable suspicion that the employee is not actually sick, they can ask him or her to produce a doctor’s note, says Parker.

While nurses are fearful for their personal safety, they are also concerned with the safety of their communities and their patients, says Krahne.

“There may be some nurses who don’t want to come to work, but overall – nurses, we take care of people,” she insists. “We go into situations where other people would never go and so the majority of us are going to be there for our patients.”



Bentley, the one-year-old King Charles Spaniel belonging to Nina Pham, the nurse who contracted Ebola. Photograph: AP

The fear factor

Yet first responders also have families and fear for their safety. “The fear factor is the number-one employment-related matter that first responders don’t pay attention to,” says LeRoy.

LeRoy points to simulation of a three-day smallpox attack in Oklahoma City just before 9/11 that found that 20% of of healthcare workers would fail to report to work due to a fear of contamination.



By discounting the fear factor in circumstances such as these, those in charge of planning often underestimate absenteeism that might occur if there is a wider outbreak.

“Employers who have employees reasonably anticipated to come into contact with blood or pathogens have to document that they have solicited input from frontline workers in identifying, evaluating and implementing appropriate work practice controls,” says Parker.

It is this dialogue between executives and workers that many workers say has been missing in the current handling of the situation.

“Managers and supervisors need to listen better to front line responders. The front line responder is a subject matter expert and even if their science isn’t as good as the planners’, the fact of the matter is if they don’t feel comfortable doing their job, they are simply going to refuse doing their job,” says LeRoy. “It’s critical and it’s simple: there has to be bottom up listening instead of top down direction. It has to be a two way communication flow.”

Specifically, the hospitals and employers should focus on the most elementary things like more masks, more training, more education and more upfront talking about work refusal.

“Those hard talks never took place in those simulations and planners learned from that,” LeRoy says, adding quickly, “Or they claimed to. Whether that’s been put in practice or not, I don’t know.”