In May 2019, all 194 countries that set the agenda of the World Health Organization met at the 72nd World Health Assembly and endorsed the establishment of World Patient Safety Day to be marked annually on 17 September. But this year’s COVID-19 pandemic has unveiled the huge challenges and risks healthcare workers are facing globally including hospital-borne infections, violence, stigma, psychological and emotional disturbances, illness and even death. Furthermore, working in unjust, abusive and stressful environments makes healthcare workers more prone to errors which can lead to patient harm. That is why the theme of 2020 World Patient Safety Day is “Health Worker Safety: A Priority for Patient Safety.”
Safe healthcare workers, safe patients
“Even though there is a laudable move from the Indian government to safeguard healthcare workers from physical attack by patients, relatives or other people, but healthcare workers should also be protected from frequent burnout, psychological distress, exposure to pathogens, long working hours, fatigue, and many such issues that also affects safety of both: workers and the patients” said Jibin TC, National Working Secretary of United Nurses Association (UNA), India. He was speaking on a panel co-organized by Public Services International (PSI).
The ongoing pandemic has placed healthcare workers at an unprecedented occupational risk of morbidity and mortality: lack of or inadequate personal protective equipment (PPE), exposure to infected patients, work overload, and/or poor infection control, makes them extremely vulnerable to occupational coronavirus infection. While some of the problems and challenges that healthcare workers face today are specific to the pandemic, many are pre-existing issues that have been exacerbated by it.
“There are many hospitals where nurses are suffering from paucity of basic amenities like masks, isolation gowns, face shield, testing kits, etc. Also, there is a huge shortage of nurses in both government and private hospitals. Ideally speaking every ventilated patient needs to have one nurse in the intensive care unit (ICU) but many private hospitals are not maintaining the nurse to patient ratio which is also a big threat to patient safety” added Jibin.
Earlier in the pandemic, shortage of PPE was a major issue for safety of healthcare workers. But now the concern has shifted to quality of PPE which is being handed out to the healthcare workers. “Many hospitals are giving extremely poor quality of PPE to nurses and other healthcare professionals. There is no proper standardization of PPE kits. Also, many hospitals are having 12 hours-shifts with PPE kits for nurses even when the government insists on a 6-hours shift. Nurses are often not given adequate support for isolation and quarantine. There are cases when nurses got infected with coronavirus (or their family members tested positive) but the bills were not covered by the hospital management. Only few hospitals are offering free treatment and management for nurses in case they contract an infection” said Jibin.
For example, when a nurse lost her eyesight (in one of the eyes) due to a blast in the humidifier of an oxygen cylinder, not only she had to leave work, but also the organization did not compensate her by any means. “She will not get a job because she lost her eyesight in one eye” shared Jibin.
He demanded that samples must be collected early enough to identify diseases among nurses, as well as immediate isolation, periodic investigation, and free vaccination of nurses for range of vaccine preventable illnesses must be done.
Safety of workers and patients also need strong unions
“A unionised workforce does lead to higher patient safety, as well as better public health and of course better conditions for workers. There is ample evidence internationally that the higher levels of union-density lead to better outcomes for both workers and patients. For example, a recent study in the USA found that COVID-19 related mortality was 30% lower in unionised age-care hospice than non-unionised age-care hospice” said Kate Lappin, Regional Secretary for the Asia Pacific region, Public Services International (PSI).
Concerns of healthcare workers like nurses, can only be addressed effectively (for the safety of workers as well as patients) if they have a strong voice. “…and that can only happen through a collective process of having a union that not only has enough power to be able to raise specific issues but also to bargain for long term changes both at the workplace level as well as in public policy” added Kate.
When healthcare workers are unionised, they have a clear method to raise concerns about either patient or worker safety that would otherwise be ignored. Other methods like helplines are an eyewash and not effective in addressing these concerns of patients and healthcare workers because there is no guaranteed follow-up. Moreover, healthcare workers like nurses need to be involved in the responses to each situation.
In a non-unionised space, if nurses bring concerns to the attention of the management, they risk losing their jobs. “But in a unionised space, these can be addressed. For example, when there are inadequate PPE or noncompliance to the policies set by the government, these issues can be raised and addressed effectively only through a unionised workforce. In a number of countries around the world we can see that the more unionised nurses have been, higher level of respect they receive, better conditions they have (also in terms of pay and working conditions), as well as a higher nurse to patient ratio. This has been a challenge for nurses’ unions and some of them have not only been able to influence the policies but also helped mandated a law. After many years of campaigning nurses in Melbourne gained a law for 3 to 1 patient to nurse ratio in general wards and one to one nurse to patient ratio in ICU. That of course would not have happened without a clear and powerful union – nurses’ union in Melbourne is the largest nurses’ union in Australia and power they have to protect public health more broadly as well as workers’ health has been very clear” shared Kate Lappin.
Bobby Ramakant is part of CNS and Asha Parivar, and a WHO Director General’s WNTD Awardee 2008. Follow him on Twitter @bobbyramakant