Nurses vs. hospitals: How much Ebola training is enough?

UCLA nurses Lucia Brandt, left, and Fong Chu, right, at the demonstration at the Ronald Reagan UCLA Medical Center.
UCLA nurses Lucia Brandt, left, and Fong Chu, right, at the demonstration at the Ronald Reagan UCLA Medical Center.
Elizabeth Aguilera/KPCC
UCLA nurses Lucia Brandt, left, and Fong Chu, right, at the demonstration at the Ronald Reagan UCLA Medical Center.
UCLA surgical pre-op nurse Beatriz Quintanilla-Cardenas.
Elizabeth Aguilera/KPCC

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Some nurses are loudly criticizing California hospitals for not providing Ebola training to their entire staffs, but hospital officials say their priority is preparing those health care workers most likely to be directly involved in the treatment of any cases that might arise.

The National Nurses United union has organized many of the protests about training, including one Wednesday at Ronald Reagan UCLA Medical Center in Westwood. The state has designated the five UC medical centers as priority facilities to treat any Ebola cases that might arise.

Some of the protestors wore "I am Nina Pham" and "I am Amber Vinson" stickers, referring to the Dallas nurses who contracted Ebola after treating an infected patient.

"All hospitals need to have the appropriate protective equipment and the training that goes with it," said Beatriz Quintanilla-Cardenas, a nurse in the surgical pre-op unit at UCLA. "In my unit I have not had any training, I have not seen the protective equipment that we have."

UCLA medical center officials declined to be interviewed. They issued a statement that said training has been focused on a small group of nurses, doctors and staff who would be treating any potential Ebola patients.

That’s not enough, said Fong Chu, an operating room nurse at UCLA.

"I think everybody should be trained because there is always a potential that we will take care of the patient," said Chu.

Besides what they see as a lack of training, the nurses say there’s confusion over the guidelines regarding protective equipment. 

"What we want is a national standard for everyone so that different hospitals in different states don’t have a choice to provide different kinds of equipment and so that they don’t get to decide who gets trained and who can't," said Lucia Brandt, a nurse at UCLA.

National Nurses United says the equipment and training issue extends beyond the UC medical centers, noting that nurses and healthcare workers in county and private facilities have expressed similar concerns.

Kaiser Permanente Los Angeles critical care nurse Teresita Costales  said she feels unprepared.

"What they are doing right now, they are sending us flyers and directing us to the website," she said, adding that the site "has no clear description on what we are supposed to do. What we want is interactive training."

Like their counterparts at UCLA, officials at Kaiser said they’re focusing training first on the staff who are most likely to deal with a potential Ebola patient.

That includes everyone working in the ER, urgent care and ICU’s, said Kalvin Yu, Kaiser's Southern California chief of infectious diseases.

"We have a tiered level of training and we are cascading outward where you train and educate the highest risk for mortality areas first…and we hope to over time to include all of the healthcare workers," said Yu.

Staff who wouldn’t come in direct contact with Ebola patients might receive less intensive training, he added.

National Nurses United has asked for supplemental Ebola-related life insurance in its negotiations for a new contract with Kaiser

At Los Angeles County-USC Medical Center, the Ebola training system is a little bit different.

Chief Medical Officer Brad Spellberg said the hospital’s Ebola response team includes staff who volunteered for that duty, "so only the volunteers and the people in the emergency department who may have to make the decision or the initial contact to determine if it’s an Ebola suspect are going to receive the intensive training," he said.

That includes training on how to put on and take off protective gear.  

Training for those who don’t work in the emergency department or the ICU has included emails, bulletins, posters and town hall meetings, said Spellberg.

One of the struggles for both sides in this debate is that the guidelines for training and equipment continue to change. Just this week, the Centers for Disease Control and Prevention updated its guidelines on protective gear, saying hospitals should use equipment that leaves no skin exposed, and that includes a respirator.

Spellberg said he is already planning training on the new suits.

"We are, as everyone else, adopting to changing requirements and recommendations," he said. "We are adapting to more comprehensive suits but we have to get them."

Spellberg said he understands that the frequent changes in guidelines have fed anxiety among some health workers. But he stressed that nurses and other providers need to remember that Ebola only spreads through direct contact with a victim’s bodily fluids..

"People have to put Ebola into perspective," he said. "There are very few case in the U.S,  there have been no cases in  California. Everybody  just needs to take a breath. Fear is the enemy here."

UCLA nurse Lucia Brandt said the remedy for the fear is training.

"The more prepared you have people the less panic you have, the less fear you have and the more capable people are of rallying together to do the work that needs to be done, and that is what training is about," she said.

You can find answers to your questions about Ebola here.