FAQS
The following are answers to some of the most common questions that ANA has received about COVID-19, including clinical care, PPE, mental health, and licensure
What nurses need to know
- Clinical Information about COVID-19
- Keep yourself safe (COVID-19 info; PPE, etc)
- Ethical Considerations
- Mental Health and Well-being
- Licensure and Credentialing guidelines (ANCC info)
- Legislative and Regulatory
- Consumers (what to tell consumers/your patients)
Get involved
Clinical Information about COVID-19
Q: What is COVID-19?
A: COVID-19, also referred to as SARS-CoV2, is a novel coronavirus identified in the Hubei Province of Wuhan, China in December 2019. In the naming convention, the CO stands for corona, VI for virus and D for disease. Coronaviruses are not a new family of viruses. In humans, there are multiple strains that can cause mild respiratory symptoms or even the common cold. What is currently understood about COVID-19 is that it spreads person-to-person among close contacts via respiratory droplets produced from coughs or sneezes or droplets exhaled during talking. Transmission through the air (aerosol) can occur in specific settings, particularly in indoor, crowded and inadequately ventilated spaces, where infected person(s) spend long periods of time with others, such as restaurants, choir practices, fitness classes, nightclubs, offices and/or places of worship. It is also possible to spread COVID-19 via touching infected surfaces and then touching your nose, mouth, or eyes. Continued disease tracking and research has confirmed asymptomatic and pre-symptomatic spread of COVID-19 amongst the general population. According to the Center for Disease and Prevention (CDC) and World Health Organization (WHO), COVID-19 has an incubation period that ranges from 1-14 days, with symptoms appearing on average around 5-6 days following exposure. Symptoms associated with COVID-19 include mild to severe respiratory illness with symptoms of fever, cough, and shortness of breath; loss of taste/smell; headache; muscle and joint aches; nausea and vomiting, and diarrhea.
Q: How is COVID-19 transmitted?
A: COVID-19 is primarily transmitted from respiratory droplets sprayed during a cough or sneeze or exhaled when someone talks or breathes. These droplets land in the mouth or nose of those within close contact of an infected individual and can land on surfaces nearby. The size of respiratory droplets can vary from large to small. Larger droplets travel a shorter distance and land within the mouth or nose of a close contact or on a surface nearby. Smaller droplets have the potential to travel further or remain suspended in the air for minutes to hours.
Aerosol transmission can also occur in specific settings, particularly in indoor, crowded and inadequately ventilated spaces, where infected person(s) spend long periods of time with others, such as restaurants, choir practices, fitness classes, nightclubs, offices and/or places of worship. More studies are underway to better understand the conditions in which aerosol transmission is occurring.
There are procedures that can aerosolize the virus resulting in airborne transmission of the virus. These procedures include, but are not limited to positive pressure ventilation, endotracheal intubation or extubation, bronchoscopy, airway suction, ventilator care, tracheostomy care, Chest PT, nebulizer treatment, and sputum induction.
Q: Is there asymptomatic and pre-symptomatic transmission?
A: Asymptomatic and pre-symptomatic transmission of COVID-19 or SARS-CoV2 is confirmed. In fact, individuals can transmit the virus without ever experiencing symptoms or during the pre-symptomatic phase up to 48 hours before showing symptoms. The typical incubation cycle of SARS-CoV2 is 1-14 days with the average onset of symptoms by day 5-6. Most individuals (80%) will experience mild symptoms requiring home management of symptoms. Due to the risk of asymptomatic and pre-symptomatic transmission, the CDC now recommends the general public wear cloth masks in public as a method of source control if you unknowingly have the infection.
Q: Is there a vaccine?
A: On Dec. 18th, 2020 the U.S. Food and Drug Administration issued an emergency use authorization for the second vaccine for the prevention of COVID-19 (SARS-CoV-2). The emergency use authorization allows the Moderna COVID-19 Vaccine to be distributed in the U.S. for use in individuals 18 years of age and older. Find additional information in the Factsheet for Healthcare Providers, and the Factsheet for Patients.
On Dec. 11th, 2020 the U.S. Food and Drug Administration issued the first emergency use authorization (EUA) for a vaccine for the prevention of COVID-19 (SARS-CoV-2) in individuals 16 years of age and older. The emergency use authorization allows the Pfizer-BioNTech COVID-19 Vaccine to be distributed in the U.S. Find additional information in the Factsheet for Healthcare Providers, and the Factsheet for Patients.
Find additional information on the ANA Covid-19 Vaccine Resources webpage, and the CDC Coronavirus Disease 2019 (COVID-19) Vaccines webpage.
Q: Is there a treatment?
A: On November 21, 2020 the FDA issued an emergency use authorization (EUA) for Casirivimab and Imdevimab to be administered together for the treatment of mild to moderate COVID-19 in adults and pediatric patients (12 years of age or older weighing at least 40 kilograms [about 88 pounds]) with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progressing to severe COVID-19. This includes those who are 65 years of age or older or who have certain chronic medical conditions. Additional information can be found in this Fact Sheet for healthcare providers, and for patients, parents and caregivers.
On November 10, 2020 the FDA issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy Bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients. Bamlanivimab is authorized for patients with positive results of direct SARS-CoV-2 viral testing who are 12 years of age and older weighing at least 40 kilograms (about 88 pounds), and who are at high risk for progressing to severe COVID-19 and/or hospitalization. This includes those who are 65 years of age or older, or who have certain chronic medical conditions. Additional information can be found on this Fact Sheet for healthcare providers.
On October 22, 2020, the FDA approved Remdesivir for adults and pediatric patients (12 years and older and weighing at least 40 kg) for the treatment of COVID-19 requiring hospitalization. Information about using Remdesivir (Veklury) to treat COVID-19 in certain hospitalized pediatric patients under the EUA is available in the fact sheets for health care providers and patients/caregivers.
Read the US Food and Drug Administration’s News Release on the approval of Remdesivir for the treatment of Covid-19 requiring hospitalization, issued on October 22, 2020. Additional information about Remdesivir is found here.
Clinical studies are also underway to understand the role Convalescent Plasma and Immune Globulins play in the treatment of COVID-19. Research of these options continues because of the belief both potential treatments may help suppress the virus and modify the inflammatory response. To learn more about immune-based therapy for COVID-19 visit NIH COVID-19 Treatment Guidelines
To find out what’s new in clinical treatment for Covid-19, access more information from the NIH here.
For the CDC's Ten Clinical Tips on COVID-19 for Healthcare Providers Involved in Patient Care click here.
Q: What are the long-term effects of Covid-19?
A: According to the CDC, persistent symptoms are being reported among COVID-19 survivors, including individuals who initially experienced a mild acute illness. “These persistent symptoms pose new challenges to patients, healthcare providers, and public health practitioners”. “While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness”. The most commonly reported symptoms include:
• Fatigue
• Shortness of breath
• Cough
• Joint pain
• Chest pain
Other reported long-term symptoms include:
• Difficulty with thinking and concentration (sometimes referred to as “brain fog”)
• Depression
• Muscle pain
• Headache
• Intermittent fever
• Fast-beating or pounding heart (also known as heart palpitations)
More serious long-term complications appear to be less common but have been reported.
COVID-19 can also result in prolonged illness even among young adults without underlying chronic medical conditions. Find more detailed information here.
The best way to prevent these long-term complications is to prevent becoming infected with COVID-19.
Q: What is an Emergency Use Authorization (EUA)?
A: During times of public health emergency or infectious disease outbreak when there is no adequate, approved, or an available alternative for the diagnosis, prevention, or treatment for a disease or condition, The US Food and Drug Administration may issue an EUA. An EUA is issued when available scientific evidence suggests reasonable believe that medical products, such as drugs, tests, and medical devices, may be effective in diagnosing or preventing serious or life-threatening diseases or conditions caused by the outbreak and the known and potential benefits of the product outweigh the know and potential risks of the product when utilized.
To learn more information about EUAs and how the FDA utilizes this tool to help make important medical products available during the COVID-19 pandemic watch the video What is an EUA?
Q: When should I return to work after I have been sick with COVID-19?
A: Prior to your return to work, discuss with your nurse manager and infection control / employee health team which process and guidelines to follow. The CDC has outlined and updated the return to work criteria following COVID-19 exposure and recovery These criteria are based upon symptom resolution/recovery, test results, and time of exposure.
Q: I have been infected. Can I get COVID-19 again?
A: Cases of reinfection with Covid-19 have been reported but remain rare. Scientists are working to understand our immune response to COVID-19 and the scientific evidence behind exposure and implications for re-infection. At this time, whether you have had COVID-19 in the past or not, the best way to prevent infection is to take steps to protect yourself.
Q: If a patient tests positive for the flu, should they still be tested for COVID-19?
A: Yes, the flu and COVID-19 are two different viruses. Presence of the flu does not rule out co-occurrence of COVID-19. Some of the symptoms of flu and COVID-19 are similar, making it hard to tell the difference between them based on symptoms alone. Diagnostic testing can help determine if you are sick with flu or COVID-19.
Q: What about immunity? Is there an antibody test?
A: An antibody test or serological test measures the number of antibodies in the blood developed against a virus. These tests are important in identifying who has successfully overcome the virus and developed an immune response, however the immune response, including duration of immunity, is not yet fully understood. There are multiple antibody tests currently approved by the FDA including the first standalone at-home sample collection kit. Learn more here. Given the number of test kits currently available for use, the FDA requires authorization of each kit to remain on the market. For a comprehensive and updated list of current EUAs available for serologic and diagnostic tests, visit the FDA’s EUA page.
Additional studies on serological tests are underway as researchers continue to develop and refine methods to expand the identification of those exposed to COVID-19.
Q: Are children carriers of COVID-19?
A: It is unclear whether children are as susceptible to infection by Covid-19 compared with adults, and whether they can transmit the virus as effectively as adults. Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults and that children can spread the virus effectively in households and camp settings.
Case studies in the US and abroad show that there are fewer cases of pediatric COVID-19 diagnosis than older adults. However, children while not considered vulnerable, can still acquire COVID-19 and must adhere to the same precautions–hand hygiene, social distancing, avoidance of touching the face, nose, mouth, and eyes–to minimize their risk for exposure to COVID-19. Find more information for care of pediatric patients here. As we continue to learn about COVID-19, epidemiological data has revealed a Multisystem Inflammatory Syndrome (MIS-C) in children associated with COVID-19. MIS-C is presenting is previously healthy children and is characterized by a severe inflammatory syndrome with Kawasaki disease-like features. Published May 14, 2020 via the CDC Health Alert Network is a case definition for MIS-C.
Q: Are smokers at greater risk?
A: Studies indicate that people who smoke are more likely to have severe symptoms from COVID-19 compared to those who did not smoke. This may be in part due to damage caused by smoking and vaping to the airway and inflammation within the respiratory system that affects the immune system. To help your patients quit smoking, visit our cessation resource page or refer them to 1-800-QUIT-NOW for tips for quitting smoking cigarettes and vaping.
Q: What about the homeless population and self-quarantine and isolation?
A: Lack of housing and shelter increases the risk of poor health outcomes resulting from COVID-19 given the lack of access to health care, facilities for personal hygiene and care, and protection from environmental elements. The CDC has outlined guidelines for state and local health departments to identify and assist individuals without permanent housing, sources for state and local partnerships, and prevention measures for the protection of the homeless.
Q: I’m a psychiatric nurse, how do I continue to provide care?
A: Continuation of psychiatric care and support is vital during these unprecedented times. The American Psychiatric Association has available guidance released by the Department of Health and Human Services, FDA, and at the state level related to COVID-19 to assist with providing mental health and substance use services.
Additional COVID-19 resources can be found through the American Psychiatric Nurses Association
Q: How do I protect my patients in a primary care setting?
A:
- Set up a telehealth service for patients to utilize to minimize in-person office visits. Rotate clinicians through the telemedicine and on-call portal for on-going access during office hours.
- For in-person appointments, designate staff to call ahead of the appointment to screen for exposure and symptoms and for instructions prior to arrival – how to maintain physical distance, provide paper work to complete at home in advance of the visit, request insurance information for prior authorization and verification to minimize time waiting in the office.
- Instruct patients visiting the office to wear a homemade cloth mask.
- Instruct patients to avoid touching the face, eyes, nose, or mouth.
- Encourage physical distancing in common areas by separating chairs and outlining designated areas to stand that are six feet apart.
- Disinfect pens and clipboards after every use.
- Provide hand sanitizer in common areas, at the door upon arrival and exit, in all exam rooms, and post clear signage educating patients on proper cough and sneeze etiquette and hand hygiene.
- Cancel all elective procedures.
- Arrange prescriptions for a 90-day supply to minimize office returns for orders for refills.
Additional information from the CDC can be found here.
Q: How do I set up a telehealth program for my patients?
A: The practice of telehealth will provide a continuation of health services while protecting providers and patients from exposure to COVID-19. To successfully implement a telehealth program, it is essential to understand laws and regulations associated with privacy protection and virtual care. Learn more about starting a telehealth program through the American Association of Nurse Practitioners (AANP) Telehealth Updates.
Other useful resources include The U.S. Department of Health and Human Services FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency and the CDC telephone triage and advice line script for COVID-19.
Q: My patient is positive, but not sick enough to be admitted. What instructions do I provide for home care?
A: If you have a patient with COVID-19 who is returning home, the CDC provides the following guidance to help prevent COVID-19 from spreading between people in homes and communities.
- STAY HOME except to get medical care, do not use public transportation or taxis if sick.
- Call first before visiting your health care provider. Notify them of your symptoms and the need for evaluation for COVID-19. Follow the instructions provided by your health care team.
- Separate yourself from other people in your home, isolate yourself to a single room, utilize a separate bathroom.
- Wear a facemask as instructed if you are sick. Family members providing care should wear a facemask when in the same room.
- Use your elbow to cover your coughs and sneezes or cough and sneeze in a tissue and dispose in a lined trash can. Wash your hands with soap and water afterwards.
- Wash your hands frequently with soap and water for at least 20 seconds.
- Avoid sharing household items such as eating utensils, and clean sheets with hot water and detergent.
- Surfaces within the home must be disinfected frequently.
- Monitor your symptoms, follow instructions for when to seek emergency medical care if warranted.
- Download and print the full list of CDC guidelines to send home with your patients.
Keep yourself safe
Q: How should I protect myself from this virus?
A: Everyday measures to protect yourself from the virus include frequent hand hygiene, physical distancing when in public, wearing a cloth face mask, and most importantly, stay home. If you are at higher risk for severe illness, additional information is found here. If you are health care personnel:
- Adhere to the standards for donning and doffing PPE when caring for COVID-19 patients.
- Avoid touching your N95 respirator, facemask, eye goggles, and face shield if wearing during extended use.
- Wash your hands before donning all PPE. When doffing PPE, wash your hands before doffing your goggles, N95 respirator, and face shield, and again after all PPE is doffed.
- Wash your hands frequently with soap and warm water.
- Doff PPE before breaking for meals and taking trips to the rest room.
- Practice hand hygiene before and after going to the restroom and before eating.
- Eat meals in non-clinical areas.
- Disinfect your cell phone frequently, place your cellphone in a clear sealable bag that serves as a barrier, discard of the bag before going home, disinfect your cell phone before entering your home.
- Change your scrubs and shoes if possible before returning home.
- Find additional CDC infection prevention and control recommendations here.
Q: Is fit testing for an N95 respirator still required?
A: Yes, fit testing ensures the N95 respirator forms a seal around the mouth and nose. If you have not been fit tested for an N95 respirator, your organization or infection control department must provide “just-in-time” fit testing to ensure the N95 respirator is worn properly. Contact your facility’s occupational health department or infection control personnel for your organization’s fit testing requirements.
OSHA is also providing enforcement discretion for annual fit-testing requirements of the Respiratory Protection standard (29 CFR 1910.134) to help reduce the rate at which respirators—specifically disposable models—are used and discarded. Find additional information here.
Q: Can I reuse my N95 respirator?
A: The National Institute for Occupational Safety and Health (NIOSH) has outlined several recommendations for the limited re-use and extended use of N-95 respirators. Visit NIOSH's website for special considerations and recommendations for the implementation of N95 respirator re-use or extended use strategies.
Q: Can the N95 respirator be decontaminated?
A: As of October 20, 2020, the FDA has issued eleven EUAs for decontamination systems for the decontamination of used N95 respirators. The use of decontamination systems is a measure during times of crisis and shortage to extend the current supply of N95 respirators.
The CDC issued recommendations on various decontamination methods for the reuse of filtering facepiece respirators (FFRs). According to the CDC, consideration of decontamination and reuse of FFRs is a ‘crisis capacity strategy’ to ensure continued availability and is not intended for use as a standard of practice. Methods currently used to decontaminate FFRs include:
- Ultraviolet germicidal irradiation – the use of ultraviolet light to kill microorganisms.
- Vaporous hydrogen peroxide – the use of vaporized hydrogen peroxide for decontamination.
- Moist heat – sterilization using steam.
It is important to note that N95 respirators are intended for single use and decontamination might cause change in fit and seal as a result of changes in integrity and/or degradation of the elastic straps and nose bridge materials, filtration efficiency, and breathability of disposable FFRs as a result of changes to the filtering material
The Occupational Safety and Health Administration (OSHA) released the interim Enforcement Guidance for Respiratory Protection and the N95 Shortage Due to the Coronavirus Disease 2019 (COVID-19) Pandemic. This guidance was issued with respect to the extended use and reuse of respirators, as well as the use of respirators that are beyond their manufacturer’s recommended shelf life.
The American Nurses Association continues to advocate aggressively for access to new unused PPE to ensure the ultimate protection of HCP when caring for COVID-19 patients. Read our full statement on the use of decontamination systems here.
Q: What about the use of cloth masks?
A: Within the health care setting ANA maintains that all personnel have access to the highest level of respiratory protection to minimize exposure risk to COVID-19. This includes use of the N95 respirator, face shield, or goggles for eye protection, gown, and gloves. A cloth mask alone when providing care in a medical setting does not provide sufficient respiratory protection from COVID-19.
The CDC recommends that the general public should wear a non-medical mask covering the mouth and nose when in public to minimize transmission and exposure to COVID-19. Use of the non-medical facemask serves as a method of source control for those who carry COVID-19 with the potential of spreading the virus in the absence of symptoms. Use of a cloth mask is to be done in conjunction with other preventative measures including physical/social distancing, frequent hand washing, and staying home.
Q: What should I do to keep my family safe when I go home after my shift?
A: COVID-19 is primarily spread through respiratory droplets from coughs and sneezes and droplets exhaled when talking. Transmission through the air (aerosol) can occur in specific settings, particularly in indoor, crowded and inadequately ventilated spaces, where infected person(s) spend long periods of time with others. The virus is also contracted by touching an infected surface and then touching the face, eyes, nose, or mouth. Therefore, cleaning hands and wiping down frequently touched objects, such as a cell phone or tablet, that are commonly transported between home and work is an important step to take prior to returning home. The U.S. Environmental Protection Agency (EPA) has developed a list of products suitable for use against COVID-19.
Additional tips include:
- Remove scrubs and shoes worn while providing care before entry into the home. If possible, wear hospital provided scrubs or carry a change of clothes to work including shoes.
- Remove shoes before entry into the home.
- Keep scrubs contained in a disposable bag, wash in hot water with detergent separately from other laundry items. Dispose of the bag in a lined trashcan once emptied into the washer.Wash your hands.
- Disinfect your cellphone frequently while on the unit and again just before leaving.Consider storing your cellphone in a clear sealable bag as a barrier.
- Leave high touch objects that are not essential for home on your unit, such as pens and clipboards used during your shift, disinfect frequently during the course of your shift.
- If using a personal stethoscope, leave on the unit in a locker, and disinfect before and after use with every patient.
- Wash hands with soap and water upon leaving the unit and again upon entry into the home.
It's also important that your family members understand what COVID-19 is, the symptoms, and the importance of preventative measures such as hand hygiene and social distancing. This along with the recommendation to limit time away from home to solely work if essential and essential visits to the grocery store, pharmacy, or to your medical provider when scheduled or if you seek emergency medical care. Guidelines have changed during the course of the pandemic. If family members must leave home, emphasize the importance of wearing a cloth face mask along with social distancing which is remaining a distance of 6 feet between yourself and others. Continued frequent hand hygiene is essential. Wash your hands upon returning home with soap and water for at least 20 seconds. When out in public and soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol content. Avoid touching your face, particularly your mouth, nose, and eyes. When you touch surfaces that may be contaminated and then touch your face you can easily infect yourself. Disinfect your cellphone frequently because it is a high touch surface where germs and viruses can live. Consider those around you who are elderly or who fall within the category of a vulnerable population when running errands and offer to pick up items to they can further limit their time away from home.
Q: Can I ask for reassignment if I am within a vulnerable population?
A: Individuals over the age of 65 and with chronic underlying medical conditions are at increased risk of severe morbidity and mortality as a result of COVID-19. If you fall within this category, have a conversation with your employer about redeployment to support telehealth services, transfer to units without COVID-19 patients, or assignment to non-COVID-19 patients needing care. It is also crucial to have access to the appropriate PPE to minimize the risk of exposure.
Q: I’ve been re-deployed to new unit and I don't feel comfortable with the assignment. What should I do?
A: As we look at the re-deployment of nurses to meet patient surge in response to the pandemic, staffing to meet demands does not replace the need to give consideration to:
- Assessment of the skill of the nurse prior to assignment. Safety and quality of care remain applicable during times of surge as do the need to match the level of competence with technologies and clinical interventions needed for the assignment; experience with the population served; and overall knowledge, skill and experience of the nurse with respect to the overall complexity of patient needs within an ICU setting.
- If a non-ICU nurse is re-deployed to a specialty area without experience within that area, it is the responsibility of the employer to provide just-in time training before deployment to the newly assigned area is confirmed to ensure the delivery of safe patient care.
- Making assignments that involve implementation of team-based care options that pair the nurse with an interprofessional team or utilization of acute care APRNs as team leads with RNs and ancillary staff is a solution to meet the needs of both the care team and the patient.
Upon re-deployment, request expectations and intervals of evaluating performance post assignment to identify areas needing support nurse and address any patient safety concerns.
If at any point you feel as though the conditions are unsafe, it is okay to speak up and say something. The safety of the nurse and staff AND the safety of the patient are equally important.
According to Provision 4 of ANA’s Code of Ethics for Nurses with Interpretive Statements, “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.” Furthermore, within Provision 4.4 Assignment and Delegation of Nursing Activities or Tasks, “Nurses in management and administration have a particular responsibility to provide a safe environment that supports and facilitates appropriate assignment and delegation. This environment includes orientation and skill development; licensure, certification, continuing education, and competency verification; adequate and flexible staffing; and policies that protect both that patient and the nurse from inappropriate assignment or delegation of nursing responsibilities, activities, or tasks. Nurses in management or administration should facilitate open communication with health care personnel allowing them, without fear or reprisal, to express concerns or even to refuse an assignment for which they do not possess the requisite skill.”
Q: I am pregnant what should I do?
A: The Association of Women's Health Obstetric and Neonatal Nursing (AWHONN) states, "The CDC has identified that pregnant women may be at higher risk for severe illness from COVID-19 when compared to non-pregnant women. Current data demonstrates that pregnant women have an increased risk of needing ICU admission and mechanical ventilation during COVID illness. In addition, there may also be an increased risk of adverse pregnancy outcomes, including but not limited to preterm birth. On May 5, AWHONN released practice guidance on Pregnant Healthcare Personnel that identifies ways for pregnant clinicians to have less exposure to the virus while working in healthcare settings. In order to decrease exposure, pregnant women should continue to practice the recommended safety measures at work, in the community, and in their homes”. Find additional CDC information on pregnancy and Covid-19 here.
Q: I’m a breastfeeding mother and a nurse, am I safe at work?
A: Research on the risk of pregnant women and breastfeeding mothers associated with COVID-19 continues. The following guidelines are outlined by the CDC for breastfeeding mothers for the protection and prevention of spreading COVID-19 to their infants:
- Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.
- You, along with your family and health care providers, should decide whether and how to start or continue breastfeeding.
- In limited studies, COVID-19 has not been detected in breast milk; however, we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk.
- If you are sick and choose to direct breastfeed:
- Wear a facemask and wash your hands before each feeding.
- If you are sick and choose to express breast milk:
- Express breast milk to establish and maintain milk supply.
- A dedicated breast pump should be provided.
- Wash hands before touching any pump or bottle parts and before expressing breast milk.
- Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
- If possible, consider having someone who is well, feed the expressed breast milk to the infant.
For additional resources on breast feeding and pregnancy visit the CDC’s Guidance on Pregnancy and Breastfeeding.
Q: I work in a nursing home. What should I do?
A: Nursing homes have been severely impacted by COVID-19, with outbreaks causing high rates of infection, morbidity, and mortality. The vulnerable nature of the nursing home population combined with the inherent risks of congregate living in a healthcare setting, requires aggressive efforts to limit COVID-19 exposure and to prevent the spread of COVID-19 within nursing homes. The Centers for Medicaid and Medicare Services (CMS) has released guidelines and FAQs in preparation for reopening.
To aid in transparency of care for families and loved ones, effective May 8, 2020, all nursing homes must meet new COVID-19 reporting requirements mandated by CMS via an interim rule. These new guidelines require reporting of COVID-19 cases amongst staff and residents. Data will be gathered and monitored via the National Health and Safety Network. The COVID-19 Module will track:
- Resident Impact and Facility Capacity
- Staff and Personnel Impact
- Supplies and Personal Protective Equipment
- Ventilator Capacity and Supplies
Essential resources for the protection of your staff and residents can be found here:
- Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes, May 2020
- Preparing for COVID-19: Long-term Care Facilities, Nursing Homes
- Association for Professionals in Infection Control and Epidemiology.
- Responding to Coronavirus (COVID-19) in Nursing Homes
- Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19
- Testing Guidelines for preventing SARS-CoV-2 transmission in nursing homes
Watch the CDC’s mini infection control webinar series for frontline LTCF staff: These new webinars are a training tool/resource for frontline long-term care staff members.
Q: I work in home health or provide in home hospice care. What should I do?
A: Connect with your patient or patient’s family in advance by telephone, text monitoring system, or video conference prior to home visits for temperature and symptom monitoring. Document your assessment findings as a nursing note within the medical chart.
If you must visit the home and the patient is suspected or confirmed to have COVID-19, wear the following PPE: Gown, gloves, eye protection (goggles or face shield), N95 filtering facepiece or respirator (or medical facemask if not available). Always perform hand hygiene before donning PPE and after doffing PPE.
Don and doff PPE outside of the home, dispose of PPE outside the home in a lined trash receptacle, do not travel with used PPE.
The Centers for Medicare and Medicaid Services provides guidelines for home healthcare personnel along with detailed guidelines for home hospice care personnel.
The CDC has also provided information for when home health agency personnel are involved in the care of people with confirmed or suspected COVID-19 infection at home.
Q: My employer purchased a supply of KN95 or N95 respirators from another country. What do I need to know?
A: As national officials continue to explore options of securing PPE for the COVID-19 response, the FDA has issued a series of Emergency Use Authorizations (EUA) for the use of N95 respirators to build the rapidly dwindling supply. As a measure to educate infection control staff on how to identify counterfeit respirators, the National Institute for Occupational Safety and health (NIOSH) has released the following tips to assist with making informed decisions to protect the safety of workers. The CDC has also released a series of guidelines and webinar if considering this option.
Read the FDAs EUA released October 15, 2020 here along with the appendix of authorized respirators, FAQs, and respirators no longer approved by NIOSH.
Q: How can I evaluate if the gowns and gloves my facility provides will be adequate to protect me?
A: Information on how to assess the effectiveness of the different types of available gowns and gloves, and recommendations for the types of gowns and gloves to be used under various clinical situations, can be found on the CDC Personal Protective Equipment: Questions and Answers webpage for healthcare workers.
Q: Where can I find updated data and how can I plan for a patient surge?
A: COVID-19Surge - COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic.
COVID-NET - The Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in children (persons younger than 18 years) and adults. Data presented on COVID-19-associated hospitalizations collected through COVID-NET are preliminary and subject to change as additional data are collected. Figures are based on varying denominators as selected variables may require more time to be collected. Data are refreshed and updated weekly. To learn more about the data, please visit: https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington.
The CDC Cases, Data, and Surveillance webpage allows you to track trends in Covid-19 testing, cases and deaths by County and State.
Ethical Considerations
Q: What is my obligation to care for patients versus keeping myself safe?
A: The Code of Ethics for Nurses states “the nurse’s primary commitment is to the patient”, and yet the nurse owes the same duty to self as to others. These equal obligations can conflict during pandemics when nurses must continually care for critically ill infectious patients, often under extreme circumstances including insufficient or inadequate resources and uncontained contagion. During pandemics, nurses and their colleagues must decide how much care they can provide to others while also taking care of themselves. Find out what nurses should consider when making these decisions. Find out what nurses should consider when making these decisions.
Q: I am concerned about the standard of care during the pandemic.
A: Professional nurses have a duty to care during crises like pandemics. Changes in the standard of care can occur in circumstances when available resources are limited or when a clinician is practicing in an unusual setting or with unfamiliar patient care needs. In a pandemic, nurses can find themselves operating in crisis standards of care environments. See ANA’s guidance for nurses in Crisis Standards of Care.
Q: We don’t have enough ventilators. What should I do?
A: An ethically sound framework should be used for health care organizations during public health emergencies for the fair allocation of resources, including ventilators and other lifesaving equipment. The Hastings Center has drafted guidelines to assist health care organizations when making these ethical decisions. The Hastings Center has drafted guidelines to assist health care organizations when making these ethical decisions.
Q: I am concerned about being retaliated against when I speak up about safety and other patient care issues.
A: ANA is disturbed about reports of employers retaliating against nurses and other health care workers for raising legitimate concerns about their personal safety while caring for patients with COVID-19. Reports of intimidation, firing, ostracizing, and more are unacceptable. Nurses who are experiencing acts of retaliation from their employer are urged to file a whistleblower complaint online with Occupational Safety and Health Administration (OSHA) or call 1-800-321-OSHA (6742). For more information please see ANA’s news release on this issue.
Mental Health and Well-being
Q: I am completely overwhelmed. What can I do to help myself?
A: Coping mentally and emotionally with the COVID-19 pandemic is difficult for everyone, but even more so for nurses. Please know that you are not alone-you are providing care to a grateful nation, and the American Nurses Association honors your service.
Below, you will find two categories of resources to assist nurses and other health care providers with mental health resources. The first category is for dealing with stress, fear, and anxiety associated with the COVID-19 Pandemic. You may also want to check with your employer, university, state, specialty nurse association, or your state board of nursing about their resources including any employee assistance program (EAP) or peer assistance/counseling programs. The second category contains national lifelines and helplines.
If your stress, anxiety, or fear causes you to think about suicide or be in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK.
Resources
- American Nurses Foundation Well-Being Initiative
- ANA Nurse Suicide Prevention/Resilience webpage
- ANA Healthy Nurse, Healthy Nation
- ANA Healthy Nurse Healthy Nation blog: Mental Health Help for Nurses
- American Psychiatric Nurses Association Managing Stress & Self Care during COVID-19: Information for Nurses
- Six Tips for Nurses Coping with the COVID-19 Pandemic A blog by Dr. Bernadette Melnyk and ANA’s Healthy Nurse, Healthy Nation™
- Substance Abuse and Mental Health Services Administration (SAMHSA) Suicide Prevention Resource Center (SPRC) Resources to Support Mental Health and Coping with the Coronavirus (COVID-19)
- Coronavirus and Mental Health: Taking Care of Ourselves during Infectious Disease Outbreaks A blog from the American Psychiatric Association, includes printable hand out
- Uniformed Services University’s Center for the Study of Traumatic Stress’ Sustaining the Well-being of Healthcare Personnel during Coronavirus and Other Infectious Outbreaks
- American Holistic Nurses Association’s Holistic Stress Management website
- National Alliance on Mental Illness (NAMI) Navigating a Mental Health Crisis
- NAMI’s Navigating a Mental Health Crisis Infographic
- US Department of Veterans Affairs (VA) National Center for PTSD’s Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak
- SAMHSA Suicide Prevention Resource Center website
National Life-and Helplines
- National Suicide Prevention Lifeline 1-800-273-TALK (8255)
- SAMHSA National Helpline 1-800-662 HELP (4357)
- SAMHSA Disaster Distress Helpline 1-800-985-5990
Licensure and Credentialing guidelines
Q: What does the emergency declaration mean with regard to my nursing license?
A: This varies greatly by state and is evolving. Some general themes include granting an extension for license renewal, the ability for nurses to cross state borders to practice, waiving of restrictions imposed on advanced practice registered nurses (APRNs) and exemptions for inactive/retired nurses.
A comprehensive source to determine how you may be impacted can be found on The National Council of State Boards of Nursing’s (NCSBN) website. The site is updated daily, Monday through Friday.
Additional information on licensure and credentialing can be found on the ANA Covid-19 Licensure and Credentialing Guidelines webpage, and in these ANCC Covid-19 Policy Frequently Asked Questions.
Legislative and Regulatory
Q: An emergency declaration has been declared in my state. What does this mean?
A: When the Governor declares a state of emergency, the state government can impose policies and perform actions that would not normally be permitted. Limits on gatherings and stay at home orders are examples of directives during the current pandemic.
For state specific information on emergency declarations go to the Association of State and Territorial Health Officials (ASTHO).
Q: How do I set up a telehealth program for my patients?
A: The practice of telehealth will provide a continuation of health services while protecting providers and patients from exposure to COVID-19. To successfully implement a telehealth program, it is essential to understand laws and regulations associated with privacy protection and virtual care. Learn more about starting a telehealth program through the American Association of Nurse Practitioners (AANP) Telehealth Updates.
Other useful resources include The U.S. Department of Health and Human Services FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency and the CDC telephone triage and advice line script for COVID-19.
Q: What is ANA doing to get more PPE to the frontlines?
A: ANA is engaged in ongoing advocacy efforts to support all health care personnel responding to the COVID-19 pandemic. We continue aggressively pushing Congress and the Administration to take action to ramp up the production of PPE. Through our RN Action campaign, nurses and the general public can write a letter that is submitted to Congress asking for more PPE on the frontlines. We have remained present throughout media outlets such as CNN, MSNBC, and NPR, and on social media through Twitter Chats, polls, and posts working to keep this issue at the forefront. Below is a list of letters written to date advocating for PPE, medical equipment, increase in testing capacity along with our statement condoning retaliation against nurses within the workplace.
- April 9, 2020 - ANA Disturbed by Reports of Retaliation Against Nurses for Raising Concerns About COVID-19 Safety
- April 8, 2020 - ANA Letter to President Trump
- April 2, 2020 - ANA Letter to HHS Secy Azar Regarding Special Enrollment for Federal Health Insurance Exchange
- March 24, 2020 - Joint AHA/AMA/ANA Letter to the American Public Regarding Coronavirus
- March 21, 2020 - Joint AHA/AMA/ANA Letter to the President Requesting Immediate Use of the Defense Production Act
- March 19, 2020 - Joint AHA/AMA/ANA Letter to Capitol Hill seeking $100 billion for frontline health care workers
- March 18, 2020 Joint Industry Letter to Administration & Capitol HIll recommending actions to address COVID-19
- March 16, 2020 Joint AHA/AMA/ANA Letter to Capitol Hill seeking $1B for comprehensive strategy in response to COVID-19
- March 12, 2020 ANA Mask Transparency Letter to Leadership
- March 12, 2020 Joint AHA/AMA/ANA Letter to Vice President Michael Pence
- March 11, 2020 ANA Letter to Honorable Michael Pence in response to the work of the Administration and the Coronavirus Task Force
Q: I am concerned about being retaliated against when I speak up about safety and other patient care issues.
A: ANA is disturbed about reports of employers retaliating against nurses and other health care workers for raising legitimate concerns about their personal safety while caring for patients with COVID-19. Reports of intimidation, firing, ostracizing, and more are unacceptable. Nurses who are experiencing acts of retaliation from their employer are urged to file a whistleblower complaint online with Occupational Safety and Health Administration (OSHA) or call 1-800-321-OSHA (6742). For more information please see ANA’s news release on this issue.
Consumers (what to tell consumers/your patients)
Q: How should I protect myself from this virus?
A: Everyday measures to protect yourself from the virus include frequent hand hygiene, physical distancing when in public, wearing a cloth face mask, and most importantly, staying home. If you are at higher risk for severe illness, additional information is found here. Other protective actions are:
- Wash your hands frequently with soap and warm water.
- Practice hand hygiene before and after going to the restroom and before eating.
- Disinfect your cell phone frequently.
Q: I am COVID-19 positive, but not sick enough to be admitted to the hospital. What should I do to take care of myself at home ?
A: If you are COVID-19 positive and returning home, the CDC provides the following guidance to help prevent COVID-19 from spreading between people in homes and communities.
- STAY HOME except to get medical care, do not use public transportation or taxis if sick.
- Call first before visiting your health care provider. Notify them of your symptoms and the need for evaluation for COVID-19. Follow the instructions provided by your health care team.
- Separate yourself from other people in your home, isolate yourself to a single room, utilize a separate bathroom.
- Wear a facemask as instructed if you are sick. Family members providing care should wear a facemask when in the same room.
- Use your elbow to cover your coughs and sneezes or cough and sneeze in a tissue and dispose in a lined trash can. Wash your hands with soap and water afterwards.
- Wash your hands frequently with soap and water for at least 20 seconds.
- Avoid sharing household items such as eating utensils, and clean sheets with hot water and detergent.
- Surfaces within the home must be disinfected frequently.
- Monitor your symptoms, follow instructions for when to seek emergency medical care if warranted.
Download and print the full list of CDC guidelines to send home with your patients.
Q: Information for the general public about the use of cloth masks?
A: Data supports the use of a cloth mask to control the spread of Covid-19. When wearing cloth masks, it is critical that you continue to practice social distancing, continue to perform frequent hand washing, and continue to refrain from touching your face, nose, mouth, and eyes with unclean hands. Use of a cloth mask is different than use of a medical mask or an N-95 respirator. It is not recommended that the general public use a medical mask or N95 respirator.
The CDC issued the following direction for the public for the use of cloth masks:
Cover your mouth and nose with a cloth face cover when around others.
- You could spread COVID-19 to others even if you do not feel sick.
- Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.
- Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
- The cloth face cover is meant to protect other people in case you are infected.
- Do NOT use a facemask meant for a health care worker.
- Continue to keep about 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.
- Additional guidance on the "Use of Cloth Face Coverings to Help Slow the Spread of COVID-19", can be found on the CDC’s website.
Give to the Coronavirus Response Fund for Nurses (CRFN)
Q: I want to donate. Where should I go?
A: The Coronavirus Response Fund for Nurses supported by the American Nurses Foundation Nurses is another way to help support nurses on the frontlines of the COVID-19 response. We have created a Coronavirus Response Fund for Nurses to enable the public to support and thank nurses. The national fund will address the identified, emerging needs of nurses and will focus on:
- Providing direct assistance to nurses
- Supporting the mental health of nurses – today and in the future
- Ensuring nurses everywhere have access to the latest science-based information to protect themselves, prevent infection, and care for those in nee
- Driving the national advocacy focused on nurses and patients
To share your thanks and support for nurses on the frontlines you can make an online donation to the American Nurses Foundation Coronavirus Response Fund for Nurses.
You can also Text THANKS to 20222 to make a $10 donation. The $10 donation will be added to your mobile phone bill and remitted to the American Nurses Foundation Coronavirus Response Fund for Nurses.
Q: I want to learn about the good work that the Response Fund has done so far. Where can I learn more about that?
A: Based on the needs of American Nurses, the American Nurses Foundation developed the Coronavirus Response Fund for Nurses with 4 distinct programmatic pillars in mind. Foundation staff have developed the following pages as our work advances and the pillars take shape. Please use the following links to learn more about the work being done by the Response Fund:
- Mental Health & The Well-Being Initiative
- Advocating for Nurses and Those They Serve
- The Latest Science-based Information
- Direct Financial Assistance
Q: I want to learn about the Response Fund donors, who they are and what they have done to raise money for American Nurses. Where can I learn more about that?
A: Support for the Response Fund comes from a broad range of both individuals and corporations. We wanted to honor their generosity and fundraising resourcefulness/creativity by creating a dedicated space to highlight their work. Learn more about the donors and their fundraising methods on the following pages:
Volunteer
Q: I am a retired nurse. How can I help?
A: First, you need to determine if your state or the state in which you are planning to work has provisions specific to retired nurse’s ability to re-enter the workforce and if those have been relaxed during the emergency response. It is also critical to self-assess your current competence based on anticipated contributions and identify if there is support for filling any gaps. You can find additional volunteer information here.
Q: I want to volunteer. What should I know?
A:
- If you are nurse or medical personnel seeking to volunteer in response to the COVID-19 pandemic, here is a list of resources where you can volunteer your time and service:
- Medical Reserve Corps
- Locate your state’s public health emergency coordinator
- American Red Cross
- NCSBN Stands Ready to Support States in Verifying Licenses for Nurses Responding to COVID-19
- Policy Brief: U.S. Nursing Leadership Supports Practice/Academic Partnerships to Assist the Nursing Workforce during the COVID-19 Crisis
- Designated Health
- Follow your local and/or state directives on sheltering in place and maintaining social distance. It is important that we do everything to slow and stop the spread of COVID-19 to reduce the current and future strain on the health care system.
- Reach out to the volunteer service department or chaplain at your local hospital and ask what type of assistance is needed.
- Don’t forget about reaching out to the local emergency response agencies. They too are feeling the pressure of this pandemic.
- If you are well, consider making an appointment to donate blood at a Red Cross or other blood services donation center.
- Check your local media services websites. They often post information on ways to help.
- If you are interested in donating items or services reach out to the state or local public and/or emergency response coordinators.
Information on State Emergency Declarations and licensure.
It is also important to consider other factors that may affect your ability to volunteer. For additional guidance on volunteering: What can you do to help? Guidance for Nurses Who Want to Volunteer.