Nurses Disciplined, Fired for Wearing Hospital-Issued Scrubs

Sheila Mulrooney Eldred

May 26, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Every day when Cliff Willmeng, RN, got home from a shift in the emergency department (ED), he took off his scrubs in a spot in the garage delineated with red duct tape, a spot his kids knew not to walk through. Then he raced through his house in his underwear, delaying hugs to his kids, heading straight to the shower. He hoped the routine would help keep COVID-19 away from his family.

The policy at his hospital, United Hospital in St. Paul, Minnesota, dictates that emergency department nurses and technicians wear personal scrubs, laundered at home, whereas physicians and physician assistants can wear hospital-issued scrubs that are laundered on site.

One day, Willmeng decided enough was enough. Why should colleagues who worked in the same space for the same 12-hour shifts be subjected to different uniform restrictions? Why should he have to worry about coronavirus-saturated clothes when other employees at the same hospital didn't?

Several years ago, according to Zetella Caauwe, RN, the hospital started requiring ED nurses to wear their own navy blue scrubs. Cauuwe, who has worked at United for 23 years, says they made the change so that patients could distinguish nurses from doctors, who wore seal blue hospital-issued scrubs. But the policies vary from one hospital to the next in the same health system, and even from one department to the next in the same hospital.

Tired of the duality and fearing for his family's health, Willmeng and some of his nursing colleagues started wearing hospital-issued scrubs and changing on site.

"I decided I'm putting these on and not potentially bringing this home to my family anymore," Willmeng said. "I thought, I may or may not survive this job, but I've got to do everything I can to protect my family." The hospital fired Willmeng on May 8.

During a couple of scheduled collective protests, almost all the nurses who worked in the ED wore the hospital scrubs, nurses said. The hospital responded by docking the pay of several nurses by an hour because, according to a May 9 statement from the Minnesota Nurses Association, administrators had spent "an hour yelling at nurses who were asking for scrubs, rather than providing [them]."

After nurses were disciplined, only a few continued to wear the off-limit scrubs, Caauwe said. She was one of them. As of May 22, she had received three written warnings about them. "There are probably at least 30 nurses who would like to, but they are fearful," she said.

The scrubs are just the most conspicuous example of nurses' concern about PPE and safety policies at the hospital, Willmeng and his colleagues said. But scrubs were an issue they could do something about. They realized they could use them to bring attention to other important safety concerns.

"The scrubs are a small measure," Willmeng said. Beyond the scrubs, he said, problems included "poor infection prevention, the general disorganization of the department, and dangerous patient care."

Caauwe, who also works in the ED, said she worries more about exposure to the virus from other hospital protocols than from scrubs. For example, a PPE donning and doffing station is in a hallway that's also used for transporting non–COVID-19 patients. And the doors of an intubation room open into a hallway used by the ambulance crew and are located next to a nurses' station.

Many, Caauwe included, have filed Occupation Safety and Health Administration (OSHA) complaints about those safety lapses with the Minnesota Department of Labor. The state's OSHA office confirmed that the hospital has an open inspection. Nurses allege that the hospital has retaliated and harassed them for speaking up about the safety concerns.

In Willmeng's termination letter, the hospital cited code of conduct and respectful workplace violations arising from the uniform dispute. But uniform disputes weren't the only reason for disciplinary actions. A second nurse, Monica Norberg, RN, was fired on May 18 because she left the hospital to take a required, annual online-education course on her home computer. She had taken the test from home in the past, Norberg said, and requiring staff to take the course on site violated Minnesota's stay-at-home order.

Of all the issues, Willmeng said, the problem concerning the uniform seemed especially ridiculous, because there were plenty of hospital-issued scrubs in the locker-room. With elective surgeries canceled, there was an abundant supply. Plus, he noted, nurses spent more time interacting with COVID-19 patients than the physicians.

"This is crazy," he remembers thinking. "Why am I taking such desperate measures to keep my family from getting sick when there are hospital-issued scrubs right here?"

A lifelong rank-and-file union activist, Willmeng called the hospital's chief nursing officer in late March and asked whether nurses could use the hospital-issued scrubs, given rising concerns about spreading the virus to their families. Her response, which Willmeng recorded on video for his media channel, We Do the Work, was that the hospital's infection prevention specialists didn't consider it necessary.

The director of the ED and two other administrators asked him to take the video down. Willmeng, certain he hadn't violated any policies, refused. He claims the hospital violated labor law by harassing him and his colleagues.

In April, the St. Paul City Council approved a resolution asking Allina Health Care, which owns United and 11 other hospitals in Minnesota and Wisconsin, to reconsider its scrubs policy. The union is urging Minnesota Governor Tim Walz to reinstitute a stay-at-home order, "due to a continued lack of preparedness and shortage of PPE."

The hospital declined to answer questions from Medscape Medical News. It issued a statement that said the hospital does not consider scrubs to be PPE and that "we cannot appropriately retain employees who willfully and repeatedly choose to violate hospital policies designed to protect our patients and staff."

Although scrubs are not the nurses' only — or even their primary — safety concern, they have become a flashpoint. Most experts don't believe there's any infection control problem associated with laundering scrubs at home, said Neysa P. Ernst, RN, MSN, a nurse manager in the Biocontainment Unit at Johns Hopkins School of Nursing. But, she said, "COVID-19 is so novel that ‘psychological safety' is extremely important.... For many frontline providers, changing in and out [of], and wearing, hospital-laundered scrubs reduces concerns about bringing COVID home."

At Johns Hopkins, Ernst said, hospital-laundered scrubs are available to all frontline providers, nurses, clinical technicians, and physicians. But policies vary widely by institution, she said.

"Whenever I am asked about COVID-19, I remind everyone that first and foremost, humans have no immunity to this virus. Protecting yourself protects us all," Ernst added.

Willmeng, who has hired a lawyer, said he hopes to get his job back and change the hospital's policies.

Not 2 weeks after Willmeng was fired, on Wednesday, May 20, the local nurses' union hosted a rally with hundreds of supporters, who marched from the hospital to the Minnesota State Capitol. Picketers used lengths of string to ensure they remained 8 feet apart, and they carried signs that read "Free the Scrubs" and "Bring Back Cliff."

"It was really strengthening and moralizing to see everyone come out" to the protest, Willmeng said.

Sheila Eldred is a freelance health journalist in Minneapolis. Find her on Twitter @MilepostMedia.

Do you have information on how your hospital or health network is responding to PPE shortages, gag orders, or other related issues? Has anyone you know faced disciplinary measures for speaking out? Write to us: news@medscape.net.

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