ST. PAUL — Alarmed to discover that many of her co-workers had little knowledge of the proper way to put on emergency protective gowns and masks, critical care nurse Melanie Timpano walked the halls of her unit at St. Joseph’s Hospital in downtown St. Paul unbidden, offering instruction and support.

“They weren’t fitted for N-95 masks, and they still aren’t,” Timpano said of her co-workers. “Where are the health care workers in Italy getting their full suits?”

That was last Friday, but Saturday also was bad.

“Over the weekend, the lab technicians were refusing to go into patients’ rooms to draw blood because they didn’t know how to put on the protective equipment,” said registered nurse Emily Allen, a ward supervisor who also volunteered to help train hospital personnel on the fly.

Nearly two weeks after the first confirmed death in Washington state due to the novel coronavirus, nurses and other key medical staff throughout the Twin Cities say supply shortages, training challenges and top-down, bureaucratic communication have left them ill-equipped to meet the threat of a virus-related patient surge head on.

Dr. Rahul Koranne, president and CEO of the Minnesota Hospitals Association, echoed some of those concerns in an interview Wednesday, in response to a question about President Donald Trump invoking the federal Defense Production Act on Wednesday to produce more hospital masks and other materials.

“Consistency of messaging from a federal level is definitely needed,” Koranne said. “At the end of the day, what our frontline caregivers, hospitals and health care systems need is these supplies actually physically appearing in the ICUs and by the beds of these patients. Until that actually happens, these are just words. You hope that some action will follow some words as well.”

Asked for comment about the nurses’ warnings, Allina Health issued the following statement:

“The health and safety of our frontline caregivers is our highest priority at Allina Health,” according to the statement. “We continue to follow the CDC and (Minnesota Department of Health) recommendations for personal protective equipment (PPE) when caring for patients who may, or are known to have COVID-19. We are closely monitoring the PPE supplies we have now and anticipate we will need as this outbreak continues. Following the MDH PPE recommendations and tracking inventory of PPE helps ensure we are able to provide all of our caregivers the PPE they need.”

‘Prepared to do our duty’

Nurses on Wednesday said specialized air filter masks are in short supply, forcing reuse of non-reusable items. Test kits for the highly contagious virus are reserved for the most high-risk patients. Fleeting in-person training is contradicted by new directives and protocols that seem to change almost hourly.

“The emergency preparedness plan was not started until two weeks ago, when it should have been in place two months ago,” said Timpano, one of several nurses from medical centers across the metro who spoke as part of a news conference by the Minnesota Nurses Association on Randolph Avenue in St. Paul.

With tears in her eyes, association president Mary Turner promised that nurses, nurses’ aides and other front-line health care workers would “march into the battle … prepared to do our duty.”

But she begged government and hospital networks to put patients over both profits and public relations and step things up.

“We have younger nurses that hear one thing in nursing school, and now they’re told ‘you will now use this mask until it disintegrates,’ ” Turner said.

Supply chain issues

Turner acknowledged that some of the challenges the medical community is facing have been brewing for years, if not decades, and are not easily fixed. For hospital goods such as FDA-approved filtered masks and other personal protective equipment, disrupted supply chains often originate in China, where the pandemic appears to have originated.

Turner, a nurse at a Level 1 trauma center in Robbinsdale, said her team does disaster drills “all the time,” and there’s less bureaucracy in small hospitals with more face-to-face communication. That’s not necessarily the case at larger health networks such as Allina Health, M Health Fairview and HealthPartners, where new directives from headquarters go out across dozens of hospitals and clinics daily.

Now add tech issues related to hospital mergers, and those communication problems are compounded, according to nurses speaking Wednesday.

At St. Joe’s, Timpano said, nursing staff are repeatedly told to keep abreast of daily emails that many cannot access from home.

The 2017 merger between the hospital’s parent companies — M Health Fairview and HealthEast — continues to complicate communications, she said, and many older computers do not support the software application that would allow nurses to read their lengthy emails, which come loaded with links to dense outside sources such as the Centers for Disease Control and Prevention.

Cliff Willmeng, an emergency room nurse at United Hospital in St. Paul, said he thinks everything is moving too slowly — not just in St. Paul, but nationally — and too many administrators are getting in the way without involving front-line staff in decision-making.

More bed space needed

On Tuesday, following CDC recommendations, M Health Fairview began converting Bethesda Hospital in St. Paul into a COVID-19 specialty care facility in order to meet the specialized needs of an expected influx of patients in the coming weeks. Bed capacity will increase from 50 to 90 beds.

Willmeng called for cities and health care networks to open up even more bed space in U.S. Bank Stadium, the Xcel Energy Center and the vacant Sears department store on Rice Street, near the Minnesota state Capitol.

It may not be needed yet, but reports from Italy, China, Iran and other countries have made it clear that a patient surge is on the horizon.

“We do not have the capacity to do this,” Willmeng said.

Andy Greder contributed to this report.

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