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The vast majority of doctors and other trained medical professionals at a hospital went to work while sick within the past year, even though they realized the risk that decision places on patients, according to a recent study.
In fact, almost 1 in 10 hospital clinicians worked while sick at least five times in the past year, primarily because of staffing concerns or not wanting to let colleagues down, reported Julia Szymczak, Ph.D., and her associates at the Children’s Hospital of Philadelphia (JAMA Pediatr. 2015 July 6 [doi: 10.1001/jamapediatrics.2015.0684]).
“A combination of closed- and open-ended questions illustrated that the decision to work while sick was shaped by systems-level and sociocultural factors that interacted to cause our respondents to work while symptomatic, despite recognizing that this choice may put patients and colleagues at risk,” the authors wrote.
Of 929 surveys sent out, 538 clinicians completed them, which included 280 of 459 physicians (61%) and 256 of 470 advanced-practice clinicians (54.5%). The advanced-practice clinicians included registered nurses, physician assistants, clinical nurse specialists, registered nurse anesthetists, and certified nurse midwives. Of those who responded, 15.7% worked in intensive care, 13.1% in surgery, 12.5% in general pediatrics, and 44.8% in another pediatric subspecialty.
Although 95.3% of respondents believed working while sick put patients at risk, 83.1% reported having done so at least once in the past year. Further, that proportion included 52% of all respondents who reported coming to work sick twice in the past year and 9.3% who worked while ill at least five times in the past year.
Nearly a third of respondents said they would work even if they had diarrhea (30%), while 16% said they would work with a fever, and 55.6% would work with acute respiratory symptoms, including cough, congestion, rhinorrhea, and sore throat.
But doctors were more likely than other professionals to say they would go to work with these symptoms: 38.9% of doctors would work despite diarrhea, compared with 19.9% of advanced-practice clinicians. Doctors and advanced-practice clinicians would also work with acute respiratory symptoms (60% vs. 50.8%, respectively), a fever only (21.8% vs. 9.8%), and fever and chills with body aches (18.6% vs. 10.9%, all P < .03).
Nearly every respondent (98.7%) said they worked despite being sick because they did not want to let their colleagues down, just as almost all of them worried the hospital would not have enough staff (94.9%) or that they would let their patients down (92.5%).
Smaller majorities of respondents also worked because others also work while sick (65%), worried their colleagues would ostracize them (64%) if they didn’t work, were concerned about their patients’ continuity of care (63.8%), had unsupportive leadership (56.2%), or believed they could not be easily replaced (52.6%).
Among the 316 respondents who filled in additional reasons, 64.9% said they had a very hard time finding someone to cover their shift, 61.1% described a strong cultural norm to work unless extremely sick, and 57% expressed uncertainty about what is considered “too sick to work.”
The Centers for Disease Control and Prevention funded the research. The authors reported no disclosures.
For centuries, a guiding principle for health care workers has been primum non nocere, or first do no harm. However, health care workers do exactly that when they work with patients while ill themselves with contagious infections. Even common but untreatable infectious like enterovirus and respiratory syncytial virus can prove deadly to immunocompromised patients.
The propensity to work while ill is influenced by cultural trends. In past years, many ill physicians worked even to the point of receiving intravenous fluids while on the job; working while sick was regarded as a badge of courage. Dr. Szymczak and colleagues identified as an issue the absence of an effective sick relief system that has sufficient flexibility to “staff up” during high rates of health care worker illness. Sick relief systems and policies need to be clear regarding when health care workers should stay away from work, how patient coverage will be ensured, and the availability of and access to paid sick leave.
Determining what constitutes being too sick to work is complicated and lacks a sufficient evidence base. Using a system that bases work restrictions on the presence of key symptoms may add clarity and enable health care workers to recognize when they need to stay home.
Creating a safer and more equitable system of sick leave for health care workers requires a culture change in many institutions to decrease the stigma – internal and external – associated with health care worker illness. Identifying solutions to prioritize patient safety must factor in workforce demands and variability in patient census and emphasize flexibility. Strong administrative and physician leadership and creativity are essential to support appropriate sick leave and ensure adequate staffing. Hospital leadership must ensure that the culture supports a paid sick leave policy that is adequate and nonpunitive.
These comments are selected from an accompanying editorial (JAMA Pediatr. 2015 July 6 [doi:10.1001/jamapediatrics.2015.0994]), written by Dr. Jeffrey R. Starke of the department of pediatrics at Baylor College of Medicine in Houston, and Dr. Mary Anne Jackson of the division of infectious diseases at Children’s Mercy Hospital, University of Missouri–Kansas City. Dr. Starke and Dr. Jackson reported no disclosures.
For centuries, a guiding principle for health care workers has been primum non nocere, or first do no harm. However, health care workers do exactly that when they work with patients while ill themselves with contagious infections. Even common but untreatable infectious like enterovirus and respiratory syncytial virus can prove deadly to immunocompromised patients.
The propensity to work while ill is influenced by cultural trends. In past years, many ill physicians worked even to the point of receiving intravenous fluids while on the job; working while sick was regarded as a badge of courage. Dr. Szymczak and colleagues identified as an issue the absence of an effective sick relief system that has sufficient flexibility to “staff up” during high rates of health care worker illness. Sick relief systems and policies need to be clear regarding when health care workers should stay away from work, how patient coverage will be ensured, and the availability of and access to paid sick leave.
Determining what constitutes being too sick to work is complicated and lacks a sufficient evidence base. Using a system that bases work restrictions on the presence of key symptoms may add clarity and enable health care workers to recognize when they need to stay home.
Creating a safer and more equitable system of sick leave for health care workers requires a culture change in many institutions to decrease the stigma – internal and external – associated with health care worker illness. Identifying solutions to prioritize patient safety must factor in workforce demands and variability in patient census and emphasize flexibility. Strong administrative and physician leadership and creativity are essential to support appropriate sick leave and ensure adequate staffing. Hospital leadership must ensure that the culture supports a paid sick leave policy that is adequate and nonpunitive.
These comments are selected from an accompanying editorial (JAMA Pediatr. 2015 July 6 [doi:10.1001/jamapediatrics.2015.0994]), written by Dr. Jeffrey R. Starke of the department of pediatrics at Baylor College of Medicine in Houston, and Dr. Mary Anne Jackson of the division of infectious diseases at Children’s Mercy Hospital, University of Missouri–Kansas City. Dr. Starke and Dr. Jackson reported no disclosures.
For centuries, a guiding principle for health care workers has been primum non nocere, or first do no harm. However, health care workers do exactly that when they work with patients while ill themselves with contagious infections. Even common but untreatable infectious like enterovirus and respiratory syncytial virus can prove deadly to immunocompromised patients.
The propensity to work while ill is influenced by cultural trends. In past years, many ill physicians worked even to the point of receiving intravenous fluids while on the job; working while sick was regarded as a badge of courage. Dr. Szymczak and colleagues identified as an issue the absence of an effective sick relief system that has sufficient flexibility to “staff up” during high rates of health care worker illness. Sick relief systems and policies need to be clear regarding when health care workers should stay away from work, how patient coverage will be ensured, and the availability of and access to paid sick leave.
Determining what constitutes being too sick to work is complicated and lacks a sufficient evidence base. Using a system that bases work restrictions on the presence of key symptoms may add clarity and enable health care workers to recognize when they need to stay home.
Creating a safer and more equitable system of sick leave for health care workers requires a culture change in many institutions to decrease the stigma – internal and external – associated with health care worker illness. Identifying solutions to prioritize patient safety must factor in workforce demands and variability in patient census and emphasize flexibility. Strong administrative and physician leadership and creativity are essential to support appropriate sick leave and ensure adequate staffing. Hospital leadership must ensure that the culture supports a paid sick leave policy that is adequate and nonpunitive.
These comments are selected from an accompanying editorial (JAMA Pediatr. 2015 July 6 [doi:10.1001/jamapediatrics.2015.0994]), written by Dr. Jeffrey R. Starke of the department of pediatrics at Baylor College of Medicine in Houston, and Dr. Mary Anne Jackson of the division of infectious diseases at Children’s Mercy Hospital, University of Missouri–Kansas City. Dr. Starke and Dr. Jackson reported no disclosures.
The vast majority of doctors and other trained medical professionals at a hospital went to work while sick within the past year, even though they realized the risk that decision places on patients, according to a recent study.
In fact, almost 1 in 10 hospital clinicians worked while sick at least five times in the past year, primarily because of staffing concerns or not wanting to let colleagues down, reported Julia Szymczak, Ph.D., and her associates at the Children’s Hospital of Philadelphia (JAMA Pediatr. 2015 July 6 [doi: 10.1001/jamapediatrics.2015.0684]).
“A combination of closed- and open-ended questions illustrated that the decision to work while sick was shaped by systems-level and sociocultural factors that interacted to cause our respondents to work while symptomatic, despite recognizing that this choice may put patients and colleagues at risk,” the authors wrote.
Of 929 surveys sent out, 538 clinicians completed them, which included 280 of 459 physicians (61%) and 256 of 470 advanced-practice clinicians (54.5%). The advanced-practice clinicians included registered nurses, physician assistants, clinical nurse specialists, registered nurse anesthetists, and certified nurse midwives. Of those who responded, 15.7% worked in intensive care, 13.1% in surgery, 12.5% in general pediatrics, and 44.8% in another pediatric subspecialty.
Although 95.3% of respondents believed working while sick put patients at risk, 83.1% reported having done so at least once in the past year. Further, that proportion included 52% of all respondents who reported coming to work sick twice in the past year and 9.3% who worked while ill at least five times in the past year.
Nearly a third of respondents said they would work even if they had diarrhea (30%), while 16% said they would work with a fever, and 55.6% would work with acute respiratory symptoms, including cough, congestion, rhinorrhea, and sore throat.
But doctors were more likely than other professionals to say they would go to work with these symptoms: 38.9% of doctors would work despite diarrhea, compared with 19.9% of advanced-practice clinicians. Doctors and advanced-practice clinicians would also work with acute respiratory symptoms (60% vs. 50.8%, respectively), a fever only (21.8% vs. 9.8%), and fever and chills with body aches (18.6% vs. 10.9%, all P < .03).
Nearly every respondent (98.7%) said they worked despite being sick because they did not want to let their colleagues down, just as almost all of them worried the hospital would not have enough staff (94.9%) or that they would let their patients down (92.5%).
Smaller majorities of respondents also worked because others also work while sick (65%), worried their colleagues would ostracize them (64%) if they didn’t work, were concerned about their patients’ continuity of care (63.8%), had unsupportive leadership (56.2%), or believed they could not be easily replaced (52.6%).
Among the 316 respondents who filled in additional reasons, 64.9% said they had a very hard time finding someone to cover their shift, 61.1% described a strong cultural norm to work unless extremely sick, and 57% expressed uncertainty about what is considered “too sick to work.”
The Centers for Disease Control and Prevention funded the research. The authors reported no disclosures.
The vast majority of doctors and other trained medical professionals at a hospital went to work while sick within the past year, even though they realized the risk that decision places on patients, according to a recent study.
In fact, almost 1 in 10 hospital clinicians worked while sick at least five times in the past year, primarily because of staffing concerns or not wanting to let colleagues down, reported Julia Szymczak, Ph.D., and her associates at the Children’s Hospital of Philadelphia (JAMA Pediatr. 2015 July 6 [doi: 10.1001/jamapediatrics.2015.0684]).
“A combination of closed- and open-ended questions illustrated that the decision to work while sick was shaped by systems-level and sociocultural factors that interacted to cause our respondents to work while symptomatic, despite recognizing that this choice may put patients and colleagues at risk,” the authors wrote.
Of 929 surveys sent out, 538 clinicians completed them, which included 280 of 459 physicians (61%) and 256 of 470 advanced-practice clinicians (54.5%). The advanced-practice clinicians included registered nurses, physician assistants, clinical nurse specialists, registered nurse anesthetists, and certified nurse midwives. Of those who responded, 15.7% worked in intensive care, 13.1% in surgery, 12.5% in general pediatrics, and 44.8% in another pediatric subspecialty.
Although 95.3% of respondents believed working while sick put patients at risk, 83.1% reported having done so at least once in the past year. Further, that proportion included 52% of all respondents who reported coming to work sick twice in the past year and 9.3% who worked while ill at least five times in the past year.
Nearly a third of respondents said they would work even if they had diarrhea (30%), while 16% said they would work with a fever, and 55.6% would work with acute respiratory symptoms, including cough, congestion, rhinorrhea, and sore throat.
But doctors were more likely than other professionals to say they would go to work with these symptoms: 38.9% of doctors would work despite diarrhea, compared with 19.9% of advanced-practice clinicians. Doctors and advanced-practice clinicians would also work with acute respiratory symptoms (60% vs. 50.8%, respectively), a fever only (21.8% vs. 9.8%), and fever and chills with body aches (18.6% vs. 10.9%, all P < .03).
Nearly every respondent (98.7%) said they worked despite being sick because they did not want to let their colleagues down, just as almost all of them worried the hospital would not have enough staff (94.9%) or that they would let their patients down (92.5%).
Smaller majorities of respondents also worked because others also work while sick (65%), worried their colleagues would ostracize them (64%) if they didn’t work, were concerned about their patients’ continuity of care (63.8%), had unsupportive leadership (56.2%), or believed they could not be easily replaced (52.6%).
Among the 316 respondents who filled in additional reasons, 64.9% said they had a very hard time finding someone to cover their shift, 61.1% described a strong cultural norm to work unless extremely sick, and 57% expressed uncertainty about what is considered “too sick to work.”
The Centers for Disease Control and Prevention funded the research. The authors reported no disclosures.
FROM PEDIATRICS
Key clinical point: A majority of hospital doctors and other clinicians work while sick.
Major finding: 83.1% of doctors and advanced-practice clinicians worked while ill at least once in the past year; 95.3% recognized the risk to patients and colleagues.
Data source: The findings are based on a cross-sectional, anonymous survey of 280 attending physicians and 256 advanced-practice clinicians at the Children’s Hospital of Philadelphia from January 2014 to March 2014.
Disclosures: The research was funded by the Centers for Disease Control and Prevention. The authors reported no disclosures.
