Amid Growing Health Threats, Nurses Are Still Fighting for Basic Protections

Five years since the start of the COVID-19 pandemic caught our health care system unawares, nurses and other health care workers say we are no more prepared for the next threat.

“It’s scary,” says Tatiana Mukhtar, a nurse in New Orleans. The exposure during the initial phase of the COVID-19 pandemic “was horrific, for patients and for health care workers” she says, “and having been there and having experienced that, I feel like we have learned nothing because [health care systems] are still not doing what we need to do.”

Although the emergency feeling of spring 2020 may have faded, the need for public health measures to combat the spread of disease remains urgent. COVID is still circulating widely, and studies show that at least 35 million adults have experienced Long COVID, and that COVID increases the risk of heart disease in both children and adults. This has also been the most dangerous flu season in 15 years, with up to 92,000 people dying of the flu between October 1, 2024 and mid-February this year.

The U.S. also faces a resurgence of both tuberculosis (TB) and measles, the latter of which is one of the most contagious viruses on Earth. Meanwhile, with the threat of a bird flu outbreak among humans also looming on the horizon, the Trump administration is eliminating what Mary Bowman, a nursing assistant professor, refers to as our “already meager public health infrastructure.”

“In truth, what was laid bare by the beginning of COVID was how disinterested capitalism is in people caring for themselves when they’re sick, when they could be sick, when they could get other people sick, when their families are sick, when someone dies,” Bowman told Truthout. “There’s just no space for humanity in it.”

Nurses Have Lost Many of the Gains They Fought for Earlier in the Pandemic

Early in the pandemic, nurses fought against dangerous work conditions, and were in many cases successful. Celia Nieto, an ICU nurse in Nevada and member of the National Nurses United (NNU) union, says hospital administrators “tried to force us to recycle our masks to chemically disinfect them and we absolutely refused to.”

“We had to fight for everything, you know, every bit of PPE [personal protective equipment] and precautions,” echoes Nick Shillingford, a nurse and former union steward who is unaffiliated with NNU. “Their starting point was not giving us the protections we needed.” The anomaly, says Shillingford, was the temporary mask mandate that hospitals implemented once public opinion forced them to do so.

Now many of those gains have disappeared. Mukhtar, a member of NNU, told Truthout that despite nurses’ successful fights for access to adequate PPE in 2020, there are no N95 masks available in her unit now. Finding an N95 in the hospital “is like pulling teeth,” she says. Mukhtar’s experiences are echoed by NNU’s national survey from Fall 2024, which shows that almost 20 percent of nurses surveyed are still forced to reuse N95s designed for single use, even now that there is no legitimate excuse for hospitals not to stockpile adequate PPE.

“We were called health care heroes because we worked under horrible conditions, but the moment we start demanding better for ourselves, we are heartless and we want too much.”

In the same survey, only 37.1 percent of registered nurses said that patients are screened for COVID, TB, respiratory syncytial virus or flu when they arrive. Without screening, it’s likely that contagious patients are spending significant time around both workers and other patients without being isolated or asked to mask. Nurses repeatedly mentioned to Truthout that in the places they work, even the insufficient infectious disease protocol is generally not practiced until after a test comes back positive, meaning that workers may have already interacted closely with someone in a room for several days before any precautions are instituted.

Even worse, contact tracing systems, many of which were developed on the fly in 2020, also seem to have disappeared in most facilities. Mukhtar says that “not long ago we had TB exposures and employees were never notified.” By the time workers found out, the patient had been in the hospital for two weeks.

Current approaches to both worker and patient safety leave a lot to be desired even when isolation protocols are followed. Mukhtar said that in her hospital, patients on such protocols, like those with TB and COVID, are allowed to leave their rooms unmasked and move throughout the hospital. And only 36.1 percent of nurses surveyed by the NNU said their facility standard is a respirator (N95 mask) with a confirmed measles case.

Nurses have not forgotten the trauma of the early pandemic, and many health care workers are frustrated at having to continue to fight for basics. “We were called health care heroes because we worked under horrible conditions, but the moment we start demanding better for ourselves, we are heartless and we want too much,” Mukhtar says.

Health Administrators Rely on Outdated Ideas About Infectious Diseases

Why do hospitals and other health care facilities make it so hard for nurses and health care workers to protect themselves and their patients from infectious diseases? Part of the lack of precautions around COVID and other contagious diseases goes back to a decades-old distinction between “droplet” and “airborne” pathogens. This standard, which most working professionals today have been drilled on, holds that most contagious illness is spread via droplets that are too large and heavy to spend much time in the air. The spread of these diseases is prevented by handwashing, cleaning of other surfaces, and surgical masks (which remain abundant in clinical settings).

Several health care workers who spoke with Truthout expressed frustration that their workplaces enforced “handwashing audits” that monitored how consistently staff washed their hands before and after contact with patients while simultaneously not enforcing any kind of masking standard. Such audits are part of the industry’s out-of-date focus on “droplet rules,” says Jane Thomason, the lead industrial hygienist for NNU.

In reality, there is no such clear binary between “droplet spread” and “aerosols.” Pathogens are better thought of as on a continuum between the two, Thomason says, with many more viruses than previously thought spreading via small particles in the air rather than in droplets. This means that pathogens can travel much further — hundreds of feet — and can linger in the air for hours.

Getting hospital administrators to implement policies based on this shift in understanding, however, has been difficult. Whereas a droplet protocol puts more pressure on individuals to stop the spread of infectious disease, an understanding of inhalation transmission requires more systemic adjustments — like changes to air filtration, universal masking, regular fit testing to make sure that respirators are airtight, and negative pressure rooms to isolate patients.

Beyond the old thinking about droplets, it’s also easy in the current political context for hospital administrators to hide behind the excuse that workers don’t want better precautions. Masking is unpopular across the U.S., with only 4 percent of people masking regularly and many people expressing “pandemic fatigue.” Health care workers who do mask all the time at work have disclosed some frustration with their colleagues’ indifference regarding the need for universal respirator usage.

Letting workers argue with each other about masks rather than implementing a policy, though, is part of a tried-and-true tactic of employers everywhere, says Thomason: Let bad conditions drive stress and conflict between workers in ways that divide them so it’s harder for workers to collectively organize against management.

“Care workers are already balancing on the blade of a knife in terms of wanting to be there and having what they need to do their jobs well,” Bowman says. “So asking them to do one more thing while still not providing the actual resources or staffing that they need to do their job well and prevent infection would be a problem.”

Nurses Are Fighting for Safer Conditions for All of Us

NNU has long been fighting for health care facilities to adopt the precautionary principle in their approaches to infection control. In other words, the health care system should not assume new diseases or new strains are not very contagious or only spread in large droplets until proven otherwise, but rather the opposite: Until more is known, the highest level of precautions should be taken.

Several nurses that spoke to Truthout described being told not to wear masks in March 2020 as COVID ripped through the United States because masks would supposedly “scare the patients.” Still, many nurses are continuing to wear high-quality masks and doing their best to protect themselves and their patients even as they describe a near total lack of COVID or airborne infection protocols where they work. These workers continue to advocate for more robust masking and control of infectious diseases, including COVID.

Alex, a nurse in a community clinic in Ohio, did not want to share his last name for fear of repercussions. Alex wears a respirator at work every day and keeps extra masks to share with patients or colleagues. Measures beyond that, he says, are “just such a hard push and pull, you know, like what battles to fight.”

Bowman works in a collectively run clinic that has retained a mask requirement for patients and clinicians. In fact, the clinic is currently trying to figure out how to increase precautions by providing KN95 or higher masks to patients. “Masking is about so much more than infection prevention. It’s about solidarity. It’s about signaling to other people … I care about you. And I’m willing to be inconvenienced or made slightly physically uncomfortable,” Bowman says.

Some nurses and health care workers are focusing on the slow, steady work of public health education and agitation to improve community protections against infectious disease, like the People’s Health Education Program. Others are focused on labor organizing that includes minimum standards for safer conditions for patients and workers.

Mukhtar is organizing with other nurses at her New Orleans hospital for their first collective bargaining contract. Alongside safe staffing, she hopes for easy access to N95 masks on her unit and stronger isolation protocols. Mukhtar says they’re fighting for protection: “Protection for us, infection control, holding [administrators] accountable. … We are trying to have a seat at the table so that way we can make the best decisions possible for us and for our patients.”

In California, nurses won a statewide regulation that requires employers to have a three-month stockpile of PPE on hand. Nationally, NNU has been pushing for a permanent OSHA standard to improve infectious disease controls, as well as fighting back against the Trump administration’s cuts to public health agencies and withdrawal from the World Health Organization.

Nurses won a temporary OSHA standard in 2021, after what Thomason calls “tireless advocacy.” While it was in place, she says, “We saw improvements in facilities across the country. We saw fit testing, saw access to respirators, things that actually saved people’s lives.” Thomason says that standard was supposed to be a temporary fix while a permanent one was developed, but it was allowed to expire while work on the permanent standard dragged on. Now, under the Trump administration, that work has stopped entirely and it is unclear when or if it will begin again.

Nurses say they wish their bosses would just “do the right thing,” but they know from experience that only organizing will result in enforceable standards and better conditions. The health care system is where many people end up in some of their most vulnerable moments — meaning that whatever nurses and other health care workers do to increase their own safety at work is a win for everyone.