ResourcesOpen Letter

Health Professionals Groups Urge U.S. Governors to Enact and Enforce Safety Protections for Workers in Health Care Settings

August 10, 2020

Dear Governors,

We, the undersigned medical associations and health and human rights organizations, call on the National Governors Association (NGA) to promote executive action across the 50 states to enhance protections for workers in health care settings during the COVID-19 pandemic. To this end, we urge governors to implement mandatory, enforceable standards for worker protections in health settings that address personal protective equipment, washing and sanitation, and transparency of information, among other issues.

During this pandemic, we continue to stress the necessity for consistent information, direction, support or leadership in working to address this public health crisis. We also underscore the need for supporting public health officials and a science-based approach to combatting the pandemic. Now more than ever, we recognize the critical role that governors across the country must play to safeguard and support health workers and public health data as part of our national response. As organizations and associations representing or supporting workers in all health care settings, we therefore stress the urgent need for new, enforceable emergency standards for worker protections, workplace safety standards, transparency, accurate reporting, and accountability. In this context, we urge the National Governors Association to act to implement clearly defined and universally enforceable workplace safety standards for health care settings.

In health care settings across the country, health workers—including physicians, medical trainees, nurses, technicians, and other health care professionals and caregivers—continue to face dangerous working conditions, alarming shortages of protective equipment (PPE), and little or no enforceable protections. To date, the federal Occupational Safety and Health Administration (OSHA) has only issued voluntary standards for worker protections in health care settings. Thus, these standards are unenforceable, leaving state governments to set and enforce workplace protection standards for health care facilities. To this end, governors across the United States must work to implement and enforce standards to mandate the provision of PPE, clear procedures for social distancing and hygiene practices, and enhance whistleblower protections to safeguard health workers’ ability to raise the alarm about dangerous conditions without fear of discrimination or retribution.

In June, Virginia proposed the country’s first-ever pandemic emergency workplace safety standards, a necessary response to OSHA’s neglect of its own duty to protect health workers. The new state regulations include mandatory guidelines for PPE, sanitation, and other workplace safety guidance, as well as protections from retaliation for health workers who speak out about safety concerns. This is an encouraging development, but whether these new guidelines can help save lives depends largely on the state’s enforcement practices.

Other states, like Maryland and New York, already have various forms of OSHA-approved State Plans that meet or exceed federal OSHA standards. These can be used to protect state and local workers, and in some states these protections extend to cover private and federal workers. In states where there is no State Plan, governors and state legislatures have the authority to institute emergency standards for worker safety and enforcement that go beyond OSHA’s ineffective voluntary standards and enforcement mechanisms and that provide enhanced whistleblower protections.

Whatever a state’s implementing authority, we strongly recommend that state-level health worker protections build on the model of the 2009 California OSHA Aerosol Transmissible Disease Standards to set clear standards for social distancing; face masks; hand sanitizing, washing, and gloves; regular workplace disinfection; increased ventilation; and notification of infections, among other key provisions. These standards must also be accompanied by protection from discrimination, intimidation, or dismissal of health workers for speaking out in the face of dangerous conditions to management, co-workers, the government, or the public. Likewise, health workers should not face retribution for bringing additional personal protection to work when employers are unable to provide adequate PPE.

This pandemic has already claimed the lives of more than 160,000 people in the United States, and infection rates are rising again. We must protect workers in health care facilities caring for patients with COVID across this country. We, the undersigned medical and public health associations and organizations, urge the National Governors Association and governors across the United States to take up urgent, universal, and enforceable protections for workers in health care settings in your states. Now is the time to act.


Physicians for Human Rights

American Nurses Association

American Public Health Association

American Medical Women’s Association

American Muslim Health Professionals

American Medical Students Association

Doctors for America

National Medical Association

National Nurse Alliance, SEIU Healthcare

Society of Behavioral Medicine

Society of General Internal Medicine

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