A recent survey by the Alabama Nursing Association shows that nurses on the frontlines of the COVID-19 battle have been concerned about a lack of personal protection equipment, their own health, taking the virus home to their families and having the needed time to spend with patients isolated from their loved ones.

Others, furloughed by public health orders that stopped elective surgeries and procedures, worried about paying their bills and even their own health insurance.

There are more than 100,000 licensed nurses in Alabama, but only a few facilities in the state have been able to provide leave at normal wage levels during the crises, association President Dr. Sarah Wilkinson-Buchmann said in a letter last month to Alabama’s congressional delegation.

“Approximately one-third of our workforce has served tirelessly and courageously during COVID-19 while approximately one half of our nurses have been sent home,” she wrote in the letter seeking financial assistance for nurses.

The survey of about 1,600 ASNA members in mid-April asked about their experiences, needs and fears. A lack of personal protection equipment was mentioned in many responses.

“Not enough PPE, we are wearing the same stuff for at least 12 hours, some more than 12 hours!,” one respondent wrote about concerns. “Not testing everyone with symptoms bothers me because we discharge them not knowing if they have COVID or not.”

The survey responses were scrubbed of identifiable information and shared with Alabama Daily News. According to their responses, the nurses work or worked in a variety of settings, including hospitals, medical offices, home-care services, government-run facilities and nursing homes.

The survey showed:

• 65% didn’t think previous training for possible pandemics helped prepare staffs for the COVID-19 pandemic
• 64% said supplies of PPE, test kits and ventilators were not adequate in the first weeks of the pandemic to protect staff and treat patients
• 46% said their perception is that their facilities have a shortage of nurses.

Since mid-March, more than 470,000 Alabamians have applied for unemployment benefits. About 38,000 of them had been employed in the health care and social services sector, according to data from the Alabama Department of Labor.

“I am appealing to our federal elected officials to include nurses in the financial assistance plans designed to help workers affected by the COVID-19 crisis remain solvent until providers reopen affected units,” Wilkinson-Buchmann wrote.

“As hospitals geared up for the onslaught of the crisis, they suspended such things as elective surgeries, which resulted in funding shortfalls and ultimately the layoff of many nurses. At the very time that we need all hands on deck, we are pushing the very people we need the most out the door. We simply don’t know what the impact of a surge will create in any given hospital, so it is crucial that we maintain the existing staff.”

‘Nowhere Near Being Over It’

Elective surgeries were allowed to resume earlier this month, but Wilkinson-Buchmann on Thursday told Alabama Daily News that many nurses went weeks without pay or with reduced pay. And those on the frontlines are still seeing COVID-19 patients.

“We’re nowhere near being over it,” she said. “In some areas, we’ve got hotspots jumping up, including Montgomery County.

“We know, as health care professionals, it’s because people are not abiding by the guidelines that have been put out there,” she said. “And as businesses are trying to reopen, and people are assuming that businesses, that’s everything’s back to normal, and it’s far from being normal when we continue to have an uptick in the number of cases.”

As of Friday morning, there have been more than 11,000 confirmed COVID-19 cases in the state, nearly 3,000 of them confirmed in the past 14 days, according to the Alabama Department of Public Health.

Dr. Don Williamson, president of the Alabama Hospital Association and former state health officer, said Thursday the number of COVID-19 cases in hospitals remains steady.

“As of Tuesday, there’s nothing I’m seeing that makes me think confirmed COVID patients are going down,” Williamson told Alabama Daily News. “We’re still seeing 400 and 500 confirmed COVID-19 patients in hospitals and it’s actually gone up since the end of April. We got down below 400 by the end of April and now it’s consistently over 400 since then.”

Meanwhile, obtaining PPE is still a daily issue for hospitals.

“For most, their supplies are probably measured in days, maybe a few hospitals in weeks,” Williamson said.

Hospitals are beginning to bring back furloughed staff. Williamson said his association is working on collecting information on the lost revenue COVID-19 has cost Alabama hospitals, including from the elective surgeries that were stopped in March and April.

As of late April, Alabama had been awarded nearly $450 million in federal funding for provider relief funds for increased health care-related expenses or lost revenue attributable to the coronavirus.

Gov. Kay Ivey on Thursday sent lawmakers a proposal for spending about $1.8 billion in federal money sent to Alabama. She suggested $250 million for health care services related to the pandemic.

Vote in Washington

The Democrat-led U.S. House is expected to vote today on a fifth COVID-19 relief package, called the Heroes Act, that would provide nearly $1 trillion to help financially struggling state and local governments, extend unemployment benefits and direct payments to individuals and bolster spending for health care programs and essential workers, The Associated Press reported. Republicans have said the package won’t pass the Senate.

Alabama Democratic Rep. Terri Sewell was to meet with Alabama nurses Friday.

“It is impossible to overstate the bravery and heroism of our nurses, who day after day have put their own safety and security on the line to protect our collective public safety,” Sewell said in a statement to Alabama Daily News. “It is essential that we support th­ese brave women and men by ensuring that they have the resources they need. This includes PPE and other medical equipment; but it also means ensuring that our nurses are compensated commensurate to the danger and necessity of their work. I have been proud to cosponsor legislation that would provide hazard pay for nurses, and I will continue to fight for hazard pay for nurses in any future legislation. Our nurses are essential and they deserve to be treated as such.”

Of the state’s more than 11,000 confirmed COVID-19 cases since mid-March, more than 1,500 have been in health care workers, according to the ADPH. As of Friday morning, Alabama had had a total of 473 COVID-19 related deaths.

One portion of the ASNA survey asked nurses to share their toughest experience. Hundreds of responses were given, including:

• “Not being able to come home and hold my two young children. Telling them that mommy can’t cuddle them before bed or hold them and read a book or watch a movie. My daughters have both told me they wouldn’t care if they got sick as long as they can hug their mom.”
• “Filing for unemployment for the first time in my life.”
• “Watching patients die alone, without family contact for days, surrounded by strangers too overwhelmed to even hold a hand.”
• “Switching from days to nights since my kids are 10. I had to homeschool during the day and work night shift. I’ve had no sleep. I’m tired and stressed out.”