Nurses in at least 14 states and the District of Columbia plan strikes and a national day of action to protest for better patient care and Ebola preparedness on November 11 and 12, according to a statement from National Nurses United (NNU), a nursing union with 155,000 members.

At least 18,000 nurses from at least 66 Kaiser Permanente hospitals and clinics in California will strike on both days to protest what they see as a lack of resources to properly care for their patients, as well as to demand better training and protective equipment when caring for patients with Ebola virus infection. They will picket at their hospitals on November 11 and participate in the national day of action on November 12, Katy Roemer, RN, from Kaiser Oakland and a member of the California Nurses Association (CNA) bargaining team.

Both Kaiser Permanente and the American Hospital Association disagree with the nursing union's position.

Patient Care Paramount

"This is really about safe patient care for us, and Ebola is part of that," Roemer said. "We believe that we deserve to have the right equipment to be able to deal with Ebola, and we have made proposals about that, and Kaiser has not responded adequately to those proposals; they have not agreed to give us the optimal equipment that we're requesting.

"We are not going to put up with that; we are going to fight to make sure our patients get what they need," she said. "If we're going to put our lives on the line, we believe that we need the equipment that will allow us to do that as safely as possible, for ourselves and our communities."

Roemer added that they have given Kaiser Permanente more than 10 days' notice so that they can make adequate patient care arrangements in the striking nurses' absence.

Nurses Distressed About Lack of Ebola Preparedness

Another 400 registered nurses will strike at Providence Hospital in Washington, DC, on November 12, and Roemer said she believes nurses from at least one other hospital will be going on strike as well. Nurses at many other hospitals will participate in an informational national day of action for Ebola preparedness on November 12 that will include picketing outside their facilities. These activities are tentatively planned at hospitals in Augusta, Georgia; Bar Harbor, Maine; Chicago; Durham, North Carolina; Houston; Kansas City; Las Vegas; Lansing, Michigan; Massilon, Ohio; Miami; St. Louis; St. Paul, Minnesota; and St. Petersburg, Florida.

"With the refusal of hospitals across the country to take seriously the need to establish the highest safety precautions for when an Ebola patient walks in the door, and the failure of our elected leaders in Washington to compel them to do so, America's nurses say they have to make their voices heard a little louder," RoseAnn DeMoro, NNU executive director, said in the NNU statement.

Nurses Demand Adherence to Precautionary Principle

NNU is demanding that all hospitals in the United States comply with the precautionary principle in Ebola safety measures, which says that the highest level of safeguards must be followed when there is no "scientific consensus that a particular risk is not harmful, especially one that can have catastrophic consequences," the NNU statement reads.

"If we don't know everything about this virus — and I think we don't because it keeps evolving — then give us the very highest level of protection while we're learning about it," Roemer said. "We don't want to look at the [Centers for Disease Control and Prevention (CDC)] and see the CDC with full hazmat suits and then look at the CDC guidelines and see lesser protection for nurses."

Specifically, this means that nurses and other caregivers of patients with Ebola should have the optimal personal protective equipment that includes "full-body hazmat suits that meet the American Society for Testing and Materials F1670 standard for blood penetration, F1671 standard for viral penetration, and that leave no skin exposed or unprotected, and National Institute for Occupational Safety and Health-approved powered air purifying respirators with an assigned protection factor of at least 50," according to the NNU statement.

The nurses also demand that facilities give "continuous rigorous interactive training for RNs and other health workers who might encounter an Ebola patient; that includes practice putting on and taking off the hazmat suits where some of the greatest risk of infection can occur."

American Hospital Association: "Working Hard to Improve Readiness"

"Hospitals are working hard to improve readiness and reassure their communities. Hospitals are using the care of these first few Ebola patients in America as a chance to learn and update the strategies they had put in place. We are taking the real-life experience in a couple of hospitals and using it to strengthen the readiness of all. CDC guidance has evolved as we have learned more about this disease. Hospitals have readily adopted new protocols to better protect patients and healthcare professionals," said Jennifer C. Schleman, senior associate director of media relations with the American Hospital Association."

The association "urges hospitals to continue to conduct frequent drills with all front-line staff, physicians, nurses, and any other staff as appropriate on proper procedures for putting on and taking off personal protective equipment," Schleman added. "Across every region, state, and locality, hospitals have been actively preparing for the possibility of patients with Ebola presenting to their emergency departments and other facilities. Hospitals take this public health threat very seriously and are working tirelessly to improve readiness and reassure their communities on that readiness."

Kaiser Permanente: Claims "Simply Untrue"

CNA, which is part of NNU, has been highly critical of Kaiser Permanente for "repeatedly" dismissing nurses' concerns about not having "proper safety protocols and training with optimal personal protective equipment," NNU said in an October 30 news release.

Gay Westfall, senior vice president of human resources at Kaiser Foundation Hospitals and Health Plan said that's "simply untrue" in a company statement.

"CNA is well aware of Kaiser Permanente's comprehensive and thorough training and preparation for Ebola.... In fact in August, after our South Sacramento Medical Center responded to the first suspected case of Ebola in the state, a CNA representative told local news media: 'Kaiser's pulling out all the stops working with the CDC and the public health department to ensure that our safety is maintained.' "

Westfall added that as national Ebola guidelines have evolved, Kaiser Permanente's protocols and personal protective equipment have "continued to meet and exceed those recommendations. In fact, we recently communicated to CNA our decision to centralize the care and treatment for Ebola patients to two designated Kaiser Permanente medical centers." This will ensure that highly trained intensive care unit–level nurses who have received extensive Ebola training will treat patients with Ebola, she said.