# 3188
Over the past several years we’ve seen a number of polls of HCW’s (Health Care Workers) that have suggested anywhere from 33% to 50% of HCWs might elect not to work during a pandemic.
Government estimates, however, have routinely listed an absenteeism rate of `up to 40%’, mostly due to actual illness of HCW’s, or due to HCW’s staying home to take care of ill family members.
Very little public mention is being made about HCW’s who would be reluctant or unwilling to work during a pandemic, particularly when vaccines, effective antivirals, and adequate protective gear (masks, gloves, gowns) may be in short supply (or non-existent).
Today, we’ve a new poll, this time conducted in the West Midlands of the UK, that suggests that as many as 85% of HCWs in the UK might elect to stay home during a pandemic.
First excerpts from the abstract, then some discussion.
Will the NHS continue to function in an influenza pandemic? A survey of healthcare workers in the West Midlands, UK
Sarah Damery , Sue Wilson , Heather Draper , Christine Gratus , Sheila Greenfield , Jonathan Ives , Jayne Parry , Judith Petts and Tom Sorell
BMC Public Health 2009, 9:142doi:10.1186/1471-2458-9-142
Background
If UK healthcare services are to respond effectively to pandemic influenza, levels of absenteeism amongst healthcare workers (HCWs) must be minimised. Current estimates of the likelihood that HCWs will continue to attend work during a pandemic are subject to scientific and predictive uncertainty, yet an informed evidence base is needed if contingency plans addressing the issues of HCW absenteeism are to be prepared.
Results
The survey response rate was 34.4% (n=1032). Results suggest absenteeism may be as high as 85% at any point during a pandemic, with potential absence particularly concentrated amongst nursing and ancillary workers (OR 0.3; 95% CI 0.1 to 0.7 and 0.5; 95% CI 0.2 to 0.9 respectively).
Conclusions
Levels of absenteeism amongst HCWs may be considerably higher than official estimates, with potential absence concentrated amongst certain groups of employees.
Although interventions designed to minimise absenteeism should target HCWs with a low stated likelihood of working, members of these groups may also be the least receptive to such interventions.
Changes to working conditions which reduce barriers to the ability to work may not address barriers linked to willingness to work, and may fail to overcome HCWs' reluctance to work in the face of what may still be deemed unacceptable risk to self and/or family.
It should be noted that this survey was conducted prior to the outbreak of the novel A/H1N1 virus, and many of the responses may be predicated upon a pandemic caused by the H5N1 virus – which has thus far produced a staggering 60% fatality rate.
Employee attitudes regarding working may soften somewhat in a less severe event.
But even a mild to moderate pandemic can produce serious morbidity and mortality, and many HCWs believe that their workplaces aren’t doing enough to protect their employees and their families.
Nearly a year ago the HHS recommended that hospitals here in the United States acquire sufficient antivirals to protect their staff during a pandemic wave.
That would require prophylactic doses for each HCW for up to 12 weeks.
And OSHA released these estimates for mask use (N95) by HCW’s during a pandemic wave.
Many hospitals don’t appear to have made much progress in stockpiling sufficient quantities of either of these needed supplies.
And just last month a multi-union study was conducted on HCW concerns over their workplace’s ability to protect them during a pandemic.
Healthcare Workers In Peril:
Preparing To Protect Worker Health And Safety During Pandemic InfluenzaA Union Survey Report
April 16, 2009
From the Executive Summary:
More than one third of the respondents believe their workplace is either not ready or only slightly ready to address the health and safety needs necessary to protect healthcare workers during a pandemic.
Given this lack of readiness, 43 percent of respondents believe that most or some of their fellow workers will stay home.
One-third of the facilities have yet to develop a written plan for responding to pandemic flu and only 54 percent of the facilities have identified healthcare workers who will be at some risk of occupational exposure to the pandemic flu virus.
Less than half the facilities surveyed (43 percent) have provided pandemic flu training to their workers, one of the fundamental elements of protecting workers from occupational hazards.
In another study, this time conducted in the United States, researchers looked at two very different concepts: A Health Care Worker’s Ability To Work, and their Willingness To Work.
Willingness of Health Care Workers to Report to Work During a Pandemic
Research indicates a distinct difference between the concepts of ability to work and willingness to work, with the first referring to a worker's capability and the latter referring to a worker's attitudes and intentions regarding reporting to work.19
Surveys indicate that a significant number of health care workers may be unwilling to report to work during an infectious disease-related emergency.
N = 6,428 health care workers in 47 facilities.
Source: Qureshi K, Gershon RRM, Sherman MF, Straub T, Gebbie E, McCollum M, Erwin MJ, Morse SS. Health care workers� ability and willingness to report to duty during catastrophic disasters. Journal of Urban Health. 2005;82(3):378�388.
Another poll which has been running for more than a year on the Allnurses.com forum is entitled: Nurses, would you go to work during a Pandemic?
Nearly 28% said they definitely wouldn’t work. Another 19% weren’t sure. The numbers willing to work have jumped sharply in this poll over the past couple of weeks, perhaps reflecting attitudes that might exist in a milder pandemic.
I strongly urge all hospital administrators and nursing supervisors to read the 440+ comments that accompany this poll. It makes for illuminating reading.
Additionally, non-medical hospital staff are almost never asked whether they will work during a pandemic, and yet their absence would have a direct and serious effect on the ability of any facility to deliver patient care.
Housekeeping, food service, laundry, security, lab, and even clerical are all critical areas, without which few facilities could operate for very long.
Health Care Facilities need to do a lot more to prepare for a pandemic, and they need to include their staff in the creation of these pandemic plans.
Otherwise, they may well find that their most valuable resource will come up missing during the next pandemic crisis.
