Medical staff treating Ebola victim in West Africa (Photo Credit: Sylvain Cherkaoui)

By Connie Ulrich, PhD, RN and Julie Fairman, PhD, RN, FAAN

The World Health Organization has now estimated that 5,000 to 10,000 new cases of Ebola a week are projected within two months if more is not done to combat this emerging crisis.   Two health care workers have now been diagnosed in the United States, and several other providers have contracted the disease abroad and returned to the US for treatment.

Ebola is described as an “opportunistic infection” due to its ability to degrade existing social structures in chaotic ways.  Indeed, to say that a diagnosis of Ebola is frightening is putting it mildly. With its nightmare-inducing symptoms and high mortality rate, Ebola is a global threat that poses unprecedented implications for health care as a whole.

The public is correct to question our efforts to protect health care workers.  Throughout our history nurses, physicians, and others have put their lives on the line caring for victims of epidemics.  Many of them have lost their lives caring for patients affected during the 1918 flu pandemic where it was estimated that 21.5 million people died. Yellow fever, malaria and tuberculosis in the early 20^th century claimed many more. More recently, Ebola alone has claimed the lives of over 100 health care workers in Africa.

Camp Funston during 1918 Flu Pandemic (photo credit: US Army)

We know how Ebola is spread and we know the precautions health professionals should take to protect themselves against the virus.  But we also know that they can only do this if they have the right resources, the right skills, knowledge, and leadership to ensure that the right equipment and supplies are available at all times.

We owe it to every healthcare provider to make sure that they are equipped with resources that will protect them from harm. If anything can be gleaned from the Dallas incident, it is that nurses and other health care workers were left in a precarious and unacceptable situation.  Indeed, every healthcare institution should have a readiness plan that outlines what needs to be done in case an infected patient arrives on their doorstep.

The Ebola situation also raises significant professional and bioethical questions.  First, we often train nurses and other healthcare providers with a “see one, do one, teach one” mentality during crisis situations.  This just doesn’t work.   We need more substantive thought on developing competent nurse providers who exhibit the skills and confidence to work in extremely stressful and high-pressure situations.  Second, refusal policies must be forthcoming.  When can a nurse refuse to care for an Ebola patient if she fears for her life?  Nurses usually accept any patient care assignment; this is certainly laudable, but nurses also have the right to say “no”.

No nurse should fear reprisal from administration for voicing concerns about inappropriate patient care delivery.  Guidelines, however, are urgently needed.

In the early 20^th century many health professionals’ deaths occurred because there was no clear understanding of the disease and its transmission.   Like Ebola, no treatment existed to cure the infection, and also like Ebola, good and careful nursing care was a critical part of a victim’s fight for survival.   History teaches us many lessons, but it is ultimately up to us to learn from the past.   What will history say about our response to a disease that literally ‘caught us off guard’, and to some degree, is still writing the story?

Additional Resource

Commentary: “In Ebola crisis, time to honor the nurses,” The Christian Science Monitor, August 25, 2014