For weeks, the only contact Ana, a nurse in California, had with her 4- and 1-year old children was watching them play outside from her bedroom window.
She contracted COVID-19, the disease caused by the coronavirus, in early April, and had to self-quarantine away from her children and her father for more than a month.
The single mom, a labor and delivery nurse at a hospital with confirmed coronavirus patients, started developing a sore throat and fatigue on April 4. She tested positive for the virus four days later, and immediately told her supervisor she contracted the disease at work. (There were confirmed cases around her unit, and she hadn't gone anywhere other than work prior to testing positive, she told Insider.)
But the hospital administration initially denied that she got sick at work. This kept her from getting workers' compensation, which provides relief for people injured or harmed on the job.
Though California governor Gavin Newsom recently signed an executive order that made it harder for employers to deny workers' compensation for COVID-19 patients, Ana still had to use her remaining personal time off. She didn't get paid for 4 weeks.
Business Insider spoke with nurses across the country who contracted COVID-19, and they echoed Ana's concerns. They've struggled to get workers' compensation or paid time off from their employers, they reported. They also said that hospitals have failed to provide masks and create protocols for treating patients safely.
The nurses featured in this story asked to remain anonymous for fear of backlash from their employers. Business Insider confirmed all identities and job titles of sources before publishing.
So far, 62,000 healthcare workers have tested positive for COVID-19 in the US, and at least 60 registered nurses have died. In a recent survey of nearly 23,000 nurses, one-third of respondents reported being told to use their personal time off if they contract the potentially deadly disease.
But while the conflict between vulnerable nurses and hospital management has reached a breaking point during the coronavirus pandemic, the rift is not new. Nurses have been calling for protections from workplace harassment for years: safer workspaces, better pay, and more staff. Hospital administrators, lobbyists, and private employers, however, have often worked against meeting these demands.
Like Ana, a nurse in New York City took one week of personal paid time off after testing positive for COVID-19.
The nurse worked the night shift, treating two to three patients with COVID-19 at a time in the intensive care unit. She described her job as physically and mentally taxing: she had few breaks during her 12-hour shifts due to staff shortages, and got headaches from wearing ill-fitting N95 masks all night. She struggled with treating her anxious patients, and described tearing up during her shifts.
Another nurse in Los Angeles developed fever and sinus problems on March 16, shortly after treating a confirmed COVID-19 patient. She believes she had the disease, but her hospital refused to test her and, at the time, did not give her additional time off. (On April 18, the hospital adopted 120 hours additional hours that nurses could use to quarantine or help with sick family members.)
Hospital nurses are among the most susceptible to contracting coronavirus from a patient, as studies show they spend more time at bedsides than any other healthcare worker.
"Registered nurses assume many risks on the job, from workplace violence to contracting a deadly disease," said Zenei Triunfo-Cortez, a nurse and president of the National Nurses United union. "It's imperative that their livelihoods are protected when they are not able to work due to an occupational hazard or exposure, such as quarantining or falling ill from COVID-19."
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Victoria, a school nurse, told Business Insider she also contracted COVID-19 on the job. She had been an early proponent of school closings after she noticed students with high fevers and absences in early January. Still, her administration did not close schools until March 13, and she tested positive one week later.
"The school principal and the president didn't reach out personally," Victoria said. "I busted my butt to have Purell in rooms, to pull students out because I didn't want these kids in the hospital. My students have DMing me such nice things, but not a word from the administration. Not one."
Due to a nationwide shortage of masks — caused partly because hospitals slashed inventory before the pandemic — nurses previously told Business Insider they lack enough masks and gloves needed to treat suspected coronavirus patients.
As a result, 72% of nurses nationwide reported having exposed skin or clothing when caring for suspected or confirmed COVID-19 patients, according to the recent survey from the NNU union. Meanwhile, when one nurse tried to share tips about how her floor treated patients on Facebook in lieu of formal protocol, she subsequently got suspended from her HCA Healthcare hospital subsidiary for violating social media policies.
Some nurses, including John Pearson at Highland Hospital in Oakland, said their hospitals hadn't established protocol for prepare for treating suspected COVID-19 before the outbreak. Pearson has been vocal about the hospital on his Twitter account, and had previously posted photos about the hospital's lack of PPE for nurses.
"The scariest thing for us who work at the bedside is to end up making a choice between who lives and who dies because we don't have enough staffing and equipment," Pearson told Business Insider. (Business Insider reached out to Highland Hospital for comment.)
Though the coronavirus pandemic highlighted some challenges within the nursing industry, the friction between nurses and hospital management has been building for years.
As baby boomers age, US demand for healthcare staff has increased; the workforce has among the highest projected job growth in the next decade. Yet the job has become increasingly taxing for those working in it: the industry has a higher than average rate of suicide, and a 17.2% turnover rate for bedside nurses.
One point of tension between nurses and hospitals is patient ratios. Linda Aiken, a longtime researcher and professor at the University of Pennsylvania, has found that when nurses don't have more than four patients at a time, it can save lives and lead to less readmission. Just 18% of respondents believed their nurse-to-patient ratios were safe, according to a 2019 survey of Illinois nurses.
Still, only one US state limits how many patients a nurse can care for during their shift. Hospitals have reduced staff to cut costs, and nurses in California, Michigan, and Massachusetts have protested staff reductions in the last few years.
In 2016, nurses in Massachusetts tried to pass a ballot initiative that would decrease patient ratios, but voters ultimately decided against the proposal. Linda Aiken told Modern Healthcare that the hospital lobbying group outspent nurses by $5 million to campaign against the nurse-led reform.
In 2019, nurses in Michigan attempted to form a union in order to fight against budget cuts and other staffing issues; over the past few years, thousands of unionized nurses authorized strikes in California, Illinois, and Vermont.
Now, nurses are fighting back once again by protesting working conditions amid a worldwide pandemic.
Nurses at 15 HCA hospitals in six states will stage a mass protest this week, according to a press release from the NNU. HCA, the largest health system in the country, introduced pay cuts for senior leeadership on May 12 and cut hours for nurses due what it says is a reduction in the volume of elective procedures. HCA spokesperson Harlow Sumerford told Business Insider the company has not laid off any caregivers as a result of COVID-19.
"We call on all health facilities to immediately agree that any nurse exposed to COVID-19 be fully compensated while off work, without having to use PTO or lose pay or benefits," union president Triunfo-Cortez said in a statement to Business Insider.
Karly, an LPN in Southwest Oklahoma, lives paycheck to paycheck to support her husband and son. She and her husband contracted coronavirus in early April; the hospital gave her a one-week grace period, but told her she couldn't return to work until she tested negative twice.
Karly quarantined with her husband for a month before receiving two negative tests. She missed two paychecks while already struggling to support her family.
"I'm not really sure exactly what's going to happen because we live paycheck to paycheck," Karly said. "My husband does still have a job, but I make more money than he does."
But the coronavirus has left the most vulnerable nurses without many options, exacerbating inequities that already existed.
Women make up more than 90% of the registered nurse population, according to the Journal of Nursing Regulation. One in every 5 registered nurses identified as a minority, and almost 30% of licensed practical nurses, the lowest paying of any nursing role, are people of color. Since black and Latina women already make among the lowest average salaries in the US, lack of paid leave during the coronavirus can upend family finances.
Many nurses have decided to leave their jobs altogether for fear of contracting the illness. A nurse from Illinois with cancer was told by her doctor going into work could threaten her life. But her employer told her that she cannot get paid time off or work from home, and that she should either come into work or quit her job.
The hospital presented the nurse with an impossible decision: risk her life doing her job or quit. The nurse ultimately decided to leave her job altogether, leaving her without health insurance to cover her ten thousand dollar cancer medication.
"I feel like I'm leaving my career not the way I wanted, but I feel like I have to," the nurse told Business Insider. "Nobody really cares about my safety."