A health care worker practices donning anti-Ebola protective gear at a Denver hospital.
Photograph by Cyrus McCrimmon — Denver Post

The largest union of registered nurses is calling for mandatory Ebola training at hospitals.

By Claire Zillman
October 22, 2014

This week, registered nurses will gather in cities across the country—from Bangor, Maine, to St. Louis to Sacramento—to call on the Obama administration and Congress to institute standards for protecting front-line healthcare workers from Ebola.

The rallies, which have been organized by National Nurses United, the nation’s largest union for registered nurses, are the latest in a series of actions the group has taken to protect nurses from the virus since—as NNU co-president Deborah Burger puts it—“our worst fears were realized.”

Burger is referring to the disclosure last week that two nurses who had treated U.S. Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Hospital in Dallas had themselves contracted the disease.

In that wake of that news, the 185,000-member NNU staged a nationwide conference call to discuss hospitals’ readiness to respond to Ebola—11,500 nurses dialed in—and sent a letter to President Barack Obama, calling for him to order all hospitals to meet the highest “uniform, national standards and protocols.”

The NNU’s campaign is an extension of that demand and is aimed at collecting signatures for a petition that asks President Obama and Congress to mandate uniform protocols for treating Ebola patients.

Mandate is the key word here.

The Centers for Disease Control and Prevention on Monday issued updated guidelines on how hospital staff should protect themselves from Ebola. The new rules call for healthcare workers to wear double sets of gloves, disposable hoods with full face shields, and special masks. Earlier protocol required goggles and one set of gloves. The latest guidelines also call for “rigorous and repeated training” for medical personnel. (The NNU wants the CDC to tighten its guidelines even further, specifically the current rule that hospitals can select which protective equipment to use “based on availability.”)

But for all the news the CDC’s rules have generated, they are just recommendations.

“What it comes down to is this: the CDC guidelines are merely suggestions. [Hospitals] don’t have to implement them in their facilities,” Burger says. “[The CDC] is a scientific body. It provides guidance and education and makes recommendations, but unfortunately it has no regulatory authority at all.”

In a NNU survey of 3,000 nurses, 84% of respondents said their hospital had not provided education on Ebola that offered nurses the chance to ask questions.

Burger speculates that hospitals in the U.S. are ill-prepared because they “bought into the fallacy that Ebola wouldn’t come to our country or, if it did, we would be able to stop it in its tracks.” There’s also the cost of training and equipment to consider, which would cut into profits, she says.

The American Hospital Association, which represents nearly 5,000 health care providers, said in a statement to Fortune that, starting in July, it “shared updated news and guidance with all hospitals as it became available,” and that it has raised hospital concerns and communicated the need for “additional guidance and answers to key questions” with the CDC, the White House, and other government entities.

There is a government agency responsible for enforcing workplace safety that’s applicable to this situation: the Occupational Safety and Health Administration. And the agency does have blood-borne pathogen and respiratory protection standards in the event of worker exposure to the Ebola virus.

The problem, according to NNU’s national political policy director Michael Lighty, is that those guidelines gives employers a great deal of latitude, and in exercising that discretion, they turn to the CDC standards, which are more specific but not mandatory. Lauren North, a spokesperson for OSHA, said that the organization is working closely with the CDC to ensure that workers are protected, though she couldn’t immediately provide a comment on what power the agency had to enforce the CDC’s Ebola protocol.

President Obama, Lighty says, “could tell the CDC, ‘this is what I want.’ He could do this with an executive order tomorrow.” Hospitals’ compliance with those standards could be enforced through OSHA or by pulling Medicare funding levers, Lighty says.

Similar action could be taken on the state level. Representatives from the NNU met with California Governor Jerry Brown on Tuesday. During the meeting, Brown called on the state’s Department of Industrial Relations and its Occupational Safety and Health Administration to address hospital protocol for Ebola (though his administration did not issue any mandates). “That is what should happen at the federal level,” Lighty says.

NNU was founded in 2009 through a merger of three nurses unions. The threat of Ebola has recently catapulted the organization to the national stage, but NNU and its predecessor groups have an established reputation for being just as outspoken on other issues. In 2011, NNU members gathered outside the U.S. Chamber of Commerce and on Capitol Hill to demand increased tax revenue from corporations as an alternative to Medicare and Medicaid cuts. The organization has protested the Keystone XL pipeline and has advocated for a single-payer health system.

NNU’s Burger says that the union’s efforts to protect nurses from Ebola are in no way an attempt to gain new members.

Though that doesn’t detract from the good publicity the NNU is generating by taking center stage in a controversial and concerning epidemic of global scale and speaking out on behalf of its most likely victims.

“They’re strutting their stuff,” says Gary Chaison, a professor of industrial relations at Clark University’s graduate school of management. “They’re showing what nursing associations can do that individual nurses cannot.”

In fact, last week, nurses from Texas Health Presbyterian, who are not unionized, released a statement anonymously through NNU on how the hospital cared for Duncan, the U.S. Ebola patient, which highlighted issues of poor training and equipment.

“Nurses have a great deal of power as a group, and they’re just beginning to exercise it,” Chaison says. They constitute one of hospitals’ biggest operating costs—a position that puts them at the center of ongoing cost-cutting debates but also generates clout. “Just the mere thought of unionizing would turn the head of any administrator,” he says. And their status as caregivers provides them with what might be their greatest asset—public support. “People like nurses,” Chaison says, “no one ever gets out of the hospital and says, ‘They have such wonderful administrators there.’”

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