'I really had to advocate strongly for myself': Michigan Medicine nurses struggle to access COVID-19 testing

Wednesday, April 1, 2020 - 5:53pm

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Dominick Sokotoff/Daily

Michigan Medicine nurses at high risk of contracting the virus have had different experiences navigating the risk of caring for patients versus returning to work. 

Michigan Medicine began conducting in-house COVID-19 testing for employees and patients on March 19 and has created a COVID-19 hotline for employees and patients as well as curbside screening by referral. 

Meghan Clarke, a nurse at C.S. Mott Children’s on the Regional Infectious Containment Unit, was among the first nurses to volunteer to work in the converted COVID-19 units. She said the level of personal protective equipment and other protections provided was especially high. 

“The RICU where everyone was going at first was really the most protected I’ve heard of in any of the health care systems so far,” Clarke said. “All the rooms have negative pressure, so what that means is the air from that room is being vacuumed back into the room, it’s not being blown out into the hallway. We had either an N95 face mask that we had to be fitted for or a (powered air-purifying respirator). If you had the PAPR, that covered your whole head and face, but if you were wearing an N95, they were giving you eye shields too.”

When Clarke began experiencing symptoms after about a week of working in the COVID-19 unit, she said they were mild and could easily be written off.

“If I hadn’t been very aware of the situation and trying to read up as much as I could, they were symptoms that would have been very easy to ignore or attribute to another cause,” Clarke said. 

Clarke has since tested positive for COVID-19.

She said all Michigan Medicine employees must go through occupational health services. 

“We’re told at Michigan Medicine that if we have any questions, any symptoms, basically direct everything to our occupational health department, so they were the first people that I called,” Clarke said. “They were the people who did the screening with me, going over all my symptoms, and they asked me about more symptoms than just the basic three.”

Clarke said she had to strongly advocate for testing because she did not necessarily meet the typical requirements of fever, dry cough and shortness of breath. 

“A lot of places, because of the limited supply of testing, are only testing people who really meet the criteria, so I made it really clear that one, I work on RICU so I know I’m working with people that are positive and there’s the risk of exposure,” Clarke said. “But two, even though I didn’t have a fever on reading, I had other symptoms of fever-like sweats and chills. I feel like I really had to advocate strongly for myself, I don’t meet the obvious criteria, but I recognize changes in myself that I think are similar.”

Clarke said she had heard about her coworkers experiencing similar symptoms and being denied testing.

“I don’t know if it’s the luck of who you talk to or how strongly you advocate for yourself or if they called a week before I did when those symptoms weren’t being considered, but now they are,” Clarke said. “ … I just know that I really tried to make a strong case for getting myself tested.” 

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Design by Aya Salim

Another registered nurse interviewed for this article has requested to remain anonymous for fear of jeopardizing their job at Michigan Medicine. 

The registered nurse, who works in an Intensive Care Unit at Michigan Medicine’s main hospital, will be referred to as Nurse 1. They said they were exposed to a patient with COVID-19.

“We had a surgical patient that had been on our floor for a couple days, we were trying to figure out why we couldn’t get him extubated and off of the ventilator,” Nurse 1 said. “I was in there working with him without a mask because at that point he was just a typical surgical patient.”

When it was determined that the patient had COVID-19, health care professionals considered to be at risk were notified immediately that they had likely been exposed to the virus. These “exposures” include staff present in the room when certain procedures were performed on COVID-19 patients while not wearing proper equipment, such as adequate masks and eye protection.

“I came back to work two nights later, he had been reintubated, swabbed for corona and was not doing well,” Nurse 1 said. “By Saturday, I woke up after my shift and I had gotten these emails from my boss … missed calls all saying ‘The patient came back positive. Because you were taking care of him on these days when he wasn’t on droplet precautions and he was extubated, it’s considered to be a high-risk exposure.’”

The email from Infection Prevention and Epidemiology, sent out to employees considered to be high risk, notified nurses and other health care professionals that they may have been exposed to the virus. The email detailed exposure criteria and noted that an employee determined to have a high-risk exposure to the virus will be restricted from coming into work for 14 days.

On March 23, two days after Nurse 1 was told to avoid work for two weeks, all Michigan Medicine employees received an email instructing health care professionals that had previously been identified as having had a high-risk exposure to return to work if they do not present any symptoms.

“As a result of widespread community transmission, the state has issued new information today stating that healthcare workers who have been placed off work following travel or an exposure and who are asymptomatic may be asked to return to work,” the email reads. “If you develop symptoms, stay at home. If you develop symptoms at work, do not complete your shift and return home.”

Nurse 1 said when they received this email, they were beginning to experience some respiratory symptoms and attempted to get tested for COVID-19.  

“At that point, I was starting to have some mild upper respiratory symptoms, I was feeling pretty congested, fatigued, getting headaches,” Nurse 1 said. “I called employee health and told them all the symptoms I was having and they were basically like, ‘You don’t meet the criteria for testing at this time because you don’t have a fever and cough, so you’re okay to come back to work and just wear a mask.’”

In early March, University of Michigan employees were given access to extra personal time off for COVID-19 related emergencies. Katie Oppenheim, chair of the University of Michigan Professional Nurses Council, said extra time off was negotiated for health care professionals. 

“The University, March 13, put out this 80-hour special personal time off bank which is to be used for COVID-related things, including childcare,” Oppenheim said. “We negotiated an additional 120 hours for our members because they’re at higher risk, and then immediately the health system provided that to everybody, which is great.”

Nurse 1, having stayed home while sick using the 80-hour bank, said the 120 hours cannot be accessed unless the employee tests positive and that this creates difficulties for people experiencing symptoms who can’t get tested.

“I know a lot of other people on my unit are also experiencing the same symptoms and they’re just making it really difficult for nurses to get tested,” Nurse 1 said. “Not only do I have a confirmed patient exposure and I’m sick, but the University of Michigan won’t let me access that special PTO bank that was bargained for because I’m not getting tested.”

Oppenheim elaborated on the current policy of testing individuals only with strong symptoms, specifically a fever. 

“There’s no special treatment for anybody about testing, health care providers, anybody that works in the institution, everybody is treated the same based on symptoms,” Oppenheim said. “The only time you stay home is if you are symptomatic, so if you were exposed and are completely asymptomatic, then you’re just going to monitor your temperature and continue to work.”

Michigan Medicine spokesperson Mary Masson said she had no information to share with The Daily regarding the criteria that employees must meet to be tested at the moment. 

Nursing junior Rachel Quigley, who also is currently working as an aid at Michigan Medicine, said she has faith in the organization’s ability to protect students and workers. 

“Michigan Medicine is really committed to protecting us, I feel really comfortable and they have an employee hotline and everything,” Quigley said. “They update us numerous times every day, our supervisors have been really excellent at keeping us updated, we’re not really in the dark or anything, and there’s information being sent out all the time.”

Reporter Hannah Mackay can be reached at mackayh@umich.edu.

Correction: This article has been updated to reflect the correct meaning of RICU, which is Regional Infectious Containment Unit.