The price of speaking out: Protecting health workers amid COVID-19

Frustrated and scared, health care workers have taken risks to speak out about the dangerous lack of personal protective equipment (PPE) and other safety provisions to care for patients during the COVID-19 pandemic. Many are being silenced, threatened, suspended, or dismissed from their jobs instead of being commended for their commitment to safety as they risk their lives to carry out their professional duties.

Anesthesiologists at a major teaching hospital received verbal and then written warnings last month when they sought to wear their own N95 masks while preparing COVID-19-positive patients for surgery. In late April, a nurse in Texas was summarily fired after raising concerns that the nursing facility where she worked was not adequately protecting staff or residents. These are two of several stories told to Physicians for Human Rights. The anesthesiologists chose to stay anonymous for fear of losing their job. The nurse is seeking legal recourse.

The current risks of inadequate protection in health care settings could not be more serious. According to some figures, more than 30,000 health care workers in the United States were reported to have contracted coronavirus (the CDC’s figure from April is 9,000).

Amidst severe shortages of PPE, health care facilities have issued strict regulations for their use based on the rationing of supplies. Even as supplies increase, many of these fall far short of providing adequate protection from infection. A new Washington Post-IPSOS poll of 8,000 individuals working in U.S. health care settings reported serious gaps in PPE and a survey of 400 nurses in Massachusetts revealed that almost half of the respondents felt inadequately protected on the job and 60 percent felt fearsome or all of the time of contracting the virus at work. A number indicated that they could not raise safety concerns for fear of losing their job. 

Virtually every major U.S. medical and nursing association has condemned retaliation by employers against health care workers who have spoken out about these deficiencies or worn their own protective equipment.

Physicians for Human Rights (PHR) convened 10 leading professional groups that together stated strong support for the rights and ethical duties of health care workers to speak out. The standoffs in these fraught contexts have raised many questions about the occupational rights of health care workers and the official channels that exist for voicing concerns and seeking protection or redress. 

A new guidance document offers advice to health care workers about their risks and protections when speaking out or providing their own protective gear and the available channels for complaints. Unfortunately, there are no simple solutions. They must assess their risks based on employment agreements and non-disparagement clauses. In some cases, they should obtain legal counsel. The guidance also outlines how to file OSHA, whistleblower, or National Labor Relations Board complaints. It offers suggestions about other official channels for issuing complaints, documenting grievances and ideas for effectively organizing in response to silencing or intolerable restrictions on self-protection in the face of continued shortages. The recommendations are anchored in the requirement that patient confidentiality must be protected throughout.

Health care workers who are besieged amid the pandemic should not be expected to take action alone. Political leaders at every level should be rushing to their defense. OSHA failed at the federal level to enact a temporary emergency standard to protect health care workers and others in high-risk jobs. In the absence of such a national standard to protect health and safety associated with COVID-19 in the workplace, states and localities must act.

Governors can use their emergency public health powers to issue executive orders to implement worker protection standards where federal authorities have fallen short. Governors should call for all health care employers to issue a uniform policy that recognizes the importance and obligation of frontline workers to speak out about shortages and safety, and to refrain from any punitive actions against them. State and local legislatures can pass laws enhancing protections for whistleblowers who speak up about a lack of safety in health care settings.

The growing tensions within health facilities facing ongoing shortages have created immense stress, low morale, and mistrust as some health professionals conclude that their institutions appear to care more about their brand or image than their critical personnel. Health care executives harm their own institutions and public trust when they muzzle doctors and nurses and initiate punitive measures against those who speak out. Nurse unions have begun filing lawsuits against hospitals and state health departments for failure to provide adequate protective equipment, citing not only shortages but also lack of transparency regarding policies that are well known to have been unscientific and unsafe. 

Instead of exacerbating standoffs, we suggest that health systems use this unprecedented crisis to strengthen collaborative relationships with their workforce. If health care workers are expected to be the first line of defense against this virus, then medical institutions can show them that hospital leadership is their biggest ally.

Time and effort should not be spent punishing doctors and nurses advocating for the safety of themselves and their patients during a pandemic that has already taken more than 330,000 lives worldwide. Health care institutions can and must do better.

Susannah Sirkin is the director of Policy at Physicians for Human Rights. Elizabeth Kaselitz, MSW, is Senior Project Manager at the University of Michigan. Ranit Mishori is a senior medical advisor at Physicians for Human Rights and Professor of Family Medicine, Georgetown University School of Medicine.