March 20, 2020
Dear CRONA Nurses,
Conditions are changing on a daily basis in patient care, state and public heath agencies, and the CDC. We are all going to do our very best for our patients, for each other, ourselves, and our families. We still have a contract, and CRONA is still to represent CRONA Nurses.
Protecting CRONA Nurses. Recently SHC attempted to retract its policy providing paid administrative leave to any employee instructed by Occupational Health to self-isolate. Thank you to all the CRONA Nurses who communicated your opposition to this change – you were instrumental in assisting CRONA leadership to convince the hospital to again change policy and offer this leave. Some managers may not have heard about this change. If you were directed by Occupational Health to self-isolate and your time off was not coded as administrative leave, please let CRONA know so we can help you.
CRONA’s first priority is to advocate for the health and safety of every CRONA Nurse. We are aware that the 1870+ N95 masks are out of stock; CRONA is pushing to get all nurses who wear those masks re-tested with priority for ED and designated COVID-19 units. We have strongly advocated for Occupational Health expansion and to improve processing of accommodation requests; these improvements are currently in progress. Occupational Health is now open 7 days and planning further increases in operating hours.
Be prepared for changes. Many units are experiencing decreased census due to cancellation of elective procedures and tests. For those who do not want to lose hours there is now a Labor Pool at both hospitals. Participation in the Labor Pool is voluntary at this time. The Labor Pool is considered an out of region float. Your skills should be assessed and an appropriate assignment offered along with any necessary training. Currently, many nurses are working in Occupational Health or taking calls to the Advice Line.
If work is not available on your unit and you have not completed HealthStream, you should be able to complete HealthStream at home. Make sure to verify this with your manager and notify CRONA if you are denied the ability to complete HealthStream at home.
There is a possibility that the hospitals will have to declare a critical staffing shortage. If that happens, nurses may be required to float out of region. This can only happen if the hospitals make this declaration of critical staffing shortage. You still must be given an assignment consistent with your skills. Notify CRONA and submit an ADO if you are given an assignment for which you are not competent.
The contract language on out of region floating and appropriate assignments is from Section 16.3 SHC/Section 15 LPCH:
Except in unforeseeable circumstances of critical patient care needs, the Employer will not float a Nurse outside her/his designated region unless s/he has been crosstrained to the unit, or has volunteered to do so. Such assignment shall be consistent with nursing supervision’s assessment of the individual Nurse’s competence and skills. Nurses who float are expected to fully exercise their knowledge, skills, and abilities in performing the work assigned. The Nurse will not be required to perform without assistance any patient care skills which exceed her/his scope of practice. If the Nurse asserts in good faith that s/he is not qualified to handle the assignment, s/he may request that the assignment be continued only until a qualified Nurse is available and assigned. The Employer will make reasonable efforts to identify a qualified Nurse for the assignment, or to provide guidance, training or modification of the assignment if the Employer determines such assistance is warranted. If a qualified Nurse is available and assigned, the floating Nurse may be excused from the remainder of the assignment and given absent time, PTO or an assignment in another area.
In addition, you may only be involuntarily floated to a work location more than thirty-five miles from your scheduled location if there is a critical staffing shortage. This is not likely to affect nurses at the main campus. For work at offsite locations, CRONA is advocating that nurses from those sites be offered work at their home sites first.
Section 16.4.3 SHC/Section 15.4.3
Except in cases of critical staffing shortages, as determined by the Employer, a Nurse shall not be required to float to a different work location more than one time per shift or to a location more than thirty-five (35) miles from the Nurse’s assigned work location for that shift. In addition, a Nurse who does float to a different work location shall not be required to return to the original location within that shift.
Answering your questions and concerns. CRONA recently held a webinar that was attended by hundreds of nurses. By request, we are including many of the questions and answers in this newsletter.
Supporting Nurses and our families. We know that some areas have sick calls and we anticipate there may be further absences due to staff illness and child care issues following school closures. We are encouraging the hospitals to address these issues proactively.
We know that many demands will be made of CRONA Nurses over the coming days, weeks and months, and we will stand strong together. Communication is key to our success. So let us know what’s happening in your units. Send us your questions and concerns. And look out for one another.
Certification Pay Deadline is March 31, 2020. Remember to upload your proof of certification to your HealthStream profile in order to qualify for the $2000 certification bonus. If you had a scheduled certification testing date through March 31st that was cancelled due to COVID-19, you will be given an extension to test. Details went out to LPCH in employee email Thursday and will go out to SHC via employee email on Monday. You will be asked to provide proof of scheduled exam and show that your test was cancelled.
Other issues to be addressed. As we move forward, this crisis is likely to affect many ordinary activities. Many educational conferences and classes have been cancelled. Activities nurses use for PNDP points are also being affected. Use of PTO may affect pre-approved vacations. CRONA will be discussing these issues with the hospitals and we will let you know about any changes.
A word of caution. HIPAA laws are still applicable; you may not look up the chart of a patient you are no longer caring for, or a coworker, to check their COVID-19 status. You may only wear a mask at work: as specified by isolation guidelines while providing patient care, if you declined the flu shot, or if directed to do so by Occupational Health. Practice good hygiene. There are alcohol gel dispensers at entrances; you should use them when entering and exiting the building.
We can help each other. If there is a nurse on your unit asking to not take an assignment because of a co-morbidity or pregnancy, and you are able and willing to help, consider offering to help. Helping each other is a part of what makes CRONA Nurses strong and united. What other ways can we band together to support one another and keep our spirits up?
Q & A
Questions and answers from this week’s CRONA webinar. If one nurse has a question, changes are at least 10 other nurses have the same question.
Q: Are we at risk of running out of PPE and if so will we be forced to take care of patients without proper PPE?
A: We have sufficient PPE except for the 1870+ N95 masks. Staff who were FIT-tested for that mask have an alternate mask they can wear, but fit of that mask must be confirmed via FIT testing. Occupational Health is preparing to re-test those employees. This is why we should not be wearing PPE when not necessary, such as wearing masks for “peace of mind”, and bundling tasks in isolation rooms to the extent possible.
Q: What about rotating the assignments instead of repeatedly getting the same patient set?
A: There is no specific policy regarding rotation of patient assignments. It makes sense to distribute assignments so the unpopular assignment is not given to the same people every time, as long as all nurses have the competencies necessary for the patient care required. Staff who wear the 1870+ N95 mask and would need to wear an N95 mask may not be assigned to patients requiring an N95 mask until they have been re-tested for a different mask.
Q: If you have had a known exposure to COVID-19, what is the policy on working if you have no symptoms?
A: Current policy is to wear a mask and self-monitor, but you must be evaluated by Occupational Health. Being in the vicinity of a COVID+ patient while wearing proper PPE is not considered an exposure.
Q: Hi, I went to Occ health today with my accommodation letter from my doctor. When there they referred me to TRTW (Transitional Return To Work). I opened a case and now waiting for an answer.
A: LPCH process to request an accommodation is to send an email with your request and doctor’s note to IDM@stanfordchildrens.org. SHC process is currently to contact Occupational Health, however as of today (3/20/2020) the process is being changed to make it more streamlined.
Q: Are we going to have temp checks? Is the hospital going to test us to make sure we are not asymptomatic carriers?
A: Universal testing of healthcare workers has not been enacted. There are not sufficient tests and lab processing capacity for that at this time. We do not know when this will change.
Q: Why are the clinics open in the Cancer Center?
A: Some patients are being seen virtually where possible. Many non-urgent testing, such as screening mammograms, is on hold for now. Patients with cancer are not having their treatment suspended.
Q: I helped a patient Tuesday and Wednesday and they were not on isolation. When I returned on Saturday, they were on isolation for a rule-out… I now have a sore throat and called Occupational Health. Was told not to go in and I will need a test tomorrow for COVID. They said I cannot go back to work until my result is back. I was told to call staffing and I was told I had to use my PTO. Is this correct? Especially if that patient actually ends up being positive?
A: This is not correct. The hospital changed its guidance to provide paid administrative leave to anyone directed by Occupational Health to self-isolate and not come in to work. You must be cleared by Occupational Health to return to work. Other forms of applicable pay, such as workers compensation, will also be pursued where applicable. If you have been coded for PTO in this situation, please notify your manager and ask that your time be converted to paid administrative leave. If this does not happen by the end of the pay period, please contact CRONA via email.
Q: How many positive cases have we had at LPCH and Stanford?
A: This has varied as patients have been admitted and been well enough to discharge to home. Overall numbers are still low as of 3/20/2020.
Q: Are they going to take our temp on entry and exit from hospital?
A: That is possible as CDC and Public Health guidelines are updated frequently.
Q: There are concerns that nurses from the Float Team on Packard side are being deployed to other clinics to swab, will they be allowed back to work on the immunocompromised units on 500?
A: You will wear PPE to swab so you are not considered exposed. You should be able to return to PCU 500.
Q: I just started at Stanford in January and have minimal PTO, what if I have to go into quarantine for a known exposure, what happens if I run out of my PTO/ATO/ESL etc?
A: If directed by Occupational Health to self-isolate, you will receive paid administrative leave and will not have to use your PTO.
Q: Does the use of ESL up to 80 hours also apply to self-isolating while I’m symptomatic/awaiting results of COVID-19 testing?
A: No, you receive paid administrative leave. You may use up to 80 hours of ESL/ATO/PTO/unpaid time to care for your children if childcare is not available because of day care or school closures; this also applies if your elder day care is closed. You must notify your manager which type of time you would like to use and you must provide a copy of the notice of closure.
Q: Are Nurses who are pregnant or immunosuppressed exempt for taking care of COVID-19 patients
A: No one is currently automatically exempted. You must request accommodation from the hospital with a note from your doctor.
Q: I work in the Main Operating Room. Because our census is low, I have volunteered to take an A-Day. When do you expect Adays to be given due to the “float pool trial?”
A: No A-days were given for the first days of the Labor Pool at LPCH to allow time to get everyone assessed and HealthStream completed.
Q: Will Stanford/LPCH extend the deadline for bonus certification pay since the testing sites are closed?
A: Yes, if you already had a scheduled test date before the deadline that was cancelled. You will be required to provide proof of scheduled test date and cancellation.
Q: Will testing be available for any staff if just having sniffles?
A: We doubt it. If you are seen in Occupational Health, the staff there make the determination if you need to be tested. Sniffles are not generally considered symptomatic of COVID-19 so you may be directed to return to work.
Q: I have had inquiries as to whether the hospital is required to tell us if any staff have been tested for the virus. I work in ICU where we have COVID+ patients.
A: You should be informed. This has already happened with both patients and staff who tested positive. You do not have the right to know the identity of the person who tested positive; that is HIPAA-protected.
Q: I have an underlying chronic illness on the CDC list but Occupational Health says that I am not exempt from direct patient care. Who makes these criteria and has it changed at all?
A: This is determined by the hospital but must be in alignment with regulation and law. You must request an accommodation with documentation from your doctor. If your request for accommodation is denied you may explore taking a leave of absence.
Q: I was cleared by Occ. Health that I can return to work if I wear a mask, but was still told to go home by my manager. Is that allowed?
A: What hospital/unit? This is not right and we need to follow up. Please email email@example.com
Q: What is the PPE needed at this time?
A: Current CDC guidelines are on the hospital intranet under the COVID-19 page. CRONA is not publishing that information because it is changing frequently and we do not want nurses looking at outdated information. Currently CAPR and M95 masks are to be used for the most high-risk procedures such as intubation and bronchoscopy. Check out the hospital intranet COVID-19 or the CDC’s guidelines on their site.
Q: How about rotating nurses for patients who test positive? Even within a single shift?
A: This is something you can ask about on your own units. Working together you can accomplish that. That type of thing has already happened for other reasons in the past.
Q: I have been reading different things online. Is the appropriate PPE for COVID 19 a regular surgical mask or N95? In other words, is it airborne or droplet?
A: The recommendation to change from N95 to a surgical mask (except for intubation and similar procedures with high risk for aerosol) is based on lack of supplies available and reserving N95 for the riskiest procedures. When supplies are restored it will go back to previous practice. No, this is not ideal. It is a move made in extreme circumstances, the likes of which we have not experienced before.
Q: What if we were exposed by another employee?
A: That is still an exposure that occurred at work, not community exposure.
Q: Any possibility to use ESL hours if you are sent home? And can we do online classes and use education hours if we are sent home? And lastly can we work on our health stream during this time either at work or from home?
A: If there is no work available on your unit and you do not wish to accept an assignment from the Labor Pool, you may be sent home. As you will have declined other work, this would be a voluntary A-day. You may not use ESL for A-days. You should be able to do HealthStream from home, verify this with your manager and notify CRONA if you are denied. Many units already allow this. Check with your manager about doing Education at home. This might be a great time to take some infectious disease home study CEUs.
Q: I work in the OR. Our volume has drastically changed. There was mention by management about possibly floating to other units that are short staffed. I do not have any skills or training to work on another unit. Can they force us to float or make us go home? What options do we have?
A: The Labor Pool is a volunteer opportunity to have work instead of being cancelled. Hi, there are many tasks that can be done by anyone. Nurses are being used to screen patients and visitors at entrances, and as PPE runners. Other areas need people to make phone calls. This type of work should be within any nurse’s skill set. You should not be given an assignment for which you are not competent. If that happens, submit an ADO and notify firstname.lastname@example.org immediately, and ask for a different assignment. Right now, floating is voluntary. The ORs on the main campus have told CRONA that there are many projects and they are using nurses on projects.
Q: What code do we use for API for ESL to take care of our kids?
A: The new updated FAQ from the hospital states that you may use ESL, ATO, or PTO. ESL or ATO up to 80 hours to care for your child or elder whose school or day care has closed. Only managers currently have the ability to enter the code for ESL. You need to email your manager and request that your time be coded as ESL. You will be asked to provide a copy of the school closure notice in whatever form you received it.
Q: When nurses have been out of units will they be trained?
A: You should only be given an assignment for which you are already qualified or provided necessary training. If asked to take an assignment that you feel is not within your skills/competencies, you should object to the assignment, ask for a different assignment, notify email@example.com, and submit an ADO.
Q: Is the Labor Pool mandatory?
A: Not at this time. We have contract language and a Floating Guidelines policy about when out of region floats can happen. Those conditions do not currently exist. As this situation evolves that may happen and CRONA will put that out via membership eblast.
Q: I am immunosuppressive and my MD says to wear a mask. I want to work but Packard says I can’t wear a mask and was sent home. I have a note from my MD, can they keep me from working? If not do I have to use my PTO?
A: You must request an accommodation in order to be allowed to wear a mask a work. Email the Integrated Disability Management (IDM) team at firstname.lastname@example.org with your request and include the letter from your doctor.
Q: Didn’t we go to no visitors?
A: No. Limited visitors. See the hospital intranet for the most up-to-date visitor policy.
Q: I am currently in quarantine since last Monday because I was having symptoms. I went through Occupational Health and got tested. My test came back negative. Two days later I started having mild symptoms again. I called Occupational Health Monday morning and they told me to stay home. I notified my supervisor and Occupational Health had not notified her. Since I’m not getting paid now because of no PTO, will I be able to get paid for my time missed?
A: Yes, you should be on paid administrative leave since you were directed by Occupational Health to stay home. Send your manager an email about it and copy CRONA on the email. Let us know if you have issues getting paid.
Q: You can also use no pay if desired during school closures?
A: Yes, that is your choice.
Q: Do you need to call out every shift for childcare during school closure?
A: That can be arranged with your manager. They can remove you from the schedule as they have documentation from you. Make sure you have closed loop communication with your manager about this.
Q: Is volunteering for labor pool day by day? Or if you volunteer to be in labor pool once, you are expected to be in labor pool indefinitely?
A: Labor Pool assignment is based on the floating policy and mandatory cancelling policy. If you work one day you are not obligated to continue. This will be true for as long as no critical staffing shortage is declared and floating out of region continues to be voluntary.
Q: Several of us have pre-approved vacations upcoming this month and we asked our management with no response as of yet if we can cancel our vacations without losing that vacation week in order to save our PTO for these days of uncertain work conditions.
A: You may ask to be put back on the schedule. Your manager may elect to do this. You will be considered “over commitment” and would be cancelled ahead of a nurse, even a more senior nurse, who is working her/his regularly scheduled shift that are not “over commitment”. If you are put back on the schedule you may ask for a vacation week later in the year, and the time is available, it is CRONA’s position that you may make this request.
Q: If I’m taken off schedule for childcare closure am I still required to do call shifts?
A: You should not be. You need to communicate the need to be taken off your on-call shifts as well as your regularly scheduled shifts. This may not be necessary for every employee so be specific about your child care issues. Contact email@example.com if you are required to work on call shifts when you do not have child care.
Q: Are they going to take our temps on entry and exit?
A: That is not currently being done. Practices are changing frequently based on guidance from the CDC and Department of Public Health.
Q: My husband is immunocompromised and I’m also taking care of my elderly mom. Would I be exempted from taking care of Covid-19 pts?
A: You need to file a doctor’s note and ask for an accommodation. The hospital can decide to grant your request, or not. If not, you may consider applying for a leave of absence.
Q: If I work night shift and I have a child that normally goes to school but is now at home, can I still use the school closure exception? It’s difficult to come off a shift and have to stay awake to care for my child, when I normally come home when she is at school.
A: Yes, you can. You must provide notice of school closure and may use up to 80 hours of ESL/ATO, then use PTO.
Q: I heard the COVID-19 rule-out patients at Stanford are now 1:3, is this true?
A: Staffing of these patients are based on acuity. Yes, the ratio on the AAU for these patients could be 1:3, but it could be less considering the individual patient. You must consider time spent to don/doff PPE when determining acuity for these patients.
Q: I have 2 valid reasons for accommodation to exempt me from taking covid-19 patients. Until I get the letters from 2 different doctors, can I ask to be exempted for now until I get the notes?
A: You may, but your request is unlikely to be granted. You may ask if there is a less patient-facing assignment available, or take PTS.
Q: I have young kids that were being watching by my elderly parents. They can’t watch them anymore. Does this qualify for calling out?
A: It is not in the FAQ, but needing to care for your children due to school closure also applies to loss of day care. You will need to provide documentation. You are also able to explore using Bright Horizons for back-up care. The information for that is on the hospital intranet and was sent to employees via email.
Q: I was scheduled to take my CPN test on March 24 in order to meet the deadline by March 31. But now my test center is being closed and my test rescheduled after the deadline. Will the certification deadline be extended because of the situation?
A: Yes. You will be asked to submit proof of scheduled test and cancellation. Email went out to LPCH nurses from the hospital on 3/19 and will go out to SHC nurses on 3/23.
Q: If/when I am exposed to COVID19, I’m worried that I may pass this on to my parents I live with, who are older than 60. Will the hospital offer certain lodging discount/accommodations for nurses who will need to self-isolate? There have been travel nurses whose housing contracts have been canceled because landlords are worried about being exposed to COVID19.
A: CRONA has not been informed of such a program. It sounds like a good idea. This is a question we can start asking of the hospital.
Q: We have a few nurses that live out state and fly in for their shifts. Other nurses are concerned about them exposing everyone. They have asked if the hospitals have any say in their ability to fly back and forth during this time.
A: You are supposed to be in charge of getting yourself to work. You may ask the hospital if there is a plan to assist with housing for out of state workers so you do not have to go back and forth, but there is no guarantee it will be provided.
Q: When will I hear from the Labor Pool at Stanford? I had volunteered to help yesterday. How long will I continue to be cancelled and am I to use my PTO/ATO/no pay for these cancellations?
A: You should not be cancelled at all. Call the Labor Pool back and ask about coming in. Let CRONA know if you are not contacted.
Q: I heard that managers are not allowing some nurses to wear surgical masks prophylactically. Have you heard of this?
A: Yes. Nurses and other staff are absolutely not allowed to wear masks prophylactically. You wear a mask if you declined the flu shot or if directed to do so by Occupational Health.
Q: If any of our patients had symptoms but were not tested can we still be tested just in case?
A: Not unless directed to do so by Occupational Health.
Q: I’m at home with my children while they are out of school. I can use my ESL? What code do I use?
A: Yes, you may use up to 80 hours of ESL, ATO, PTO, or no pay. This policy is in effect until March 28 and will likely be reconsidered based on current conditions at that time.
Q: Are we being screened as we enter work?
A: You are supposed to be screened at the start of your shift, after you clock in.
Q: L&D was told today that we will be in the Labor Pool if we are not needed as staff on our own unit. We are designated as a non-float unit, except for Antepartum. Where could we be floated to? Many of our staff have only worked L&D, so they are concerned about skill set, etc.
A: The Labor Pool is currently voluntary. If a critical staffing shortage is declared then it may become mandatory.
Q: What will happen to OR and Periop nurses if elective surgeries are canceled and the census is low resulting in mandatory A days?
A: If there are not projects available on your unit, you may volunteer for the Labor Pool.
Q: Are all parents/visitors entering LPCH being screened?
A: Yes, they are screened upon entry.
Q: Stanford is having travelers float to B1 and care for rule out or confirmed COVID-19 patients and on the same day float to other units that house immune compromised transplant patients. How is that ok and not preventing in the potential spread of disease for vulnerable patients?
A: If you are wearing proper PPE you are not considered “exposed”.
Q: Does the cancellation of CEPD/CPEI classes apply to ACLS and BLS type classes as well? Will they extend that? Due in April.
What about PALS and BLS testing recertifications? Will there be extensions for this as well?
A: Please see the email sent to all employees earlier this week. Your ACLS/BLS/PALS certification is extended automatically, but in order to renew you must complete the online skills/test portion during the month that your certification expires.
Q: Sounds like if we were planning to make the appointment but hadn’t when this started two weeks ago, we are out of luck?
A: Yes, you are out of luck, sorry. Get certified when you can and you will still be eligible for the ongoing bonus of $1500/year, paid in quarterly installments of $375 per quarter.
Q: Is there a way for CRONA to let us know what the numbers are at the hospital? I feel like there is so much gossip….
A: CRONA requested that this information be made available to staff. We will continue to request it. UCSF has a very nice summary they send out and we want the same thing.
Q: How about if we as a nurse have a residual cough from a previous illness? If we do not have a fever but still have a cough. Since we are telling visitors to leave, but how strict are we with ourselves?
A: If you answer “yes” to the screening questions you should be sent to Occupational Health. You will be evaluated there and they will determine your disposition.
Q: I traveled recently before the travel restrictions changed. I reported to occupational health and was told to wear a surgical mask for 14 days from the day I arrived back even though I am asymptomatic and without known exposure. People have been questioning me for wearing a mask, just want to clarify is this the standard for people who have traveled?
A: If directed by Occupational Health to wear a mask, wear a mask.
Q: If I have a residual cough from a previous illness but I am no longer febrile, I can’t wear a mask to and from work?
A: Not unless directed to do so by Occupational Health.
Q: How many hours are you allow to use for HealthStream?
A: The number of hours required to complete. Everyone is an individual learner and may require more of less time. If your manager imposes time limits, please let CRONA know.
Q: So to clarify, for elder care, I can use 80 hours of ESL first, then PTO?
A: Yes, or ATO or unpaid time. Your choice, but you need to let your manager know, preferably in writing via email so there is a record.
Q: Would an email from the school stating they are closed… would that suffice? Or someone from the office had to write a specific note?
A: You should submit a copy of the notice you received. If your manager asks you for additional documentation, please notify CRONA.
Q: Continuing education courses/conferences are being cancelled and moving to fall. Can I apply or carry over my book time and book money from my April class that was moved to September?
A: There is no agreement between CRONA and the hospitals for this sort of non-contractual accommodation. We are currently covering the most urgent issues with the hospital, then will progress to other issues. We do not know what the final outcome will be.