Despite patient risks, most docs, nurse practitioners go to work when sick

Although they know the risks it poses to patients, most doctors and advanced practice clinicians (APCs) admit they go to work when sick, according to a new survey published in JAMA Pediatrics.

Why? The majority say it's because of staffing concerns, they don't want to let their colleagues or patients down, they fear their colleagues will ostracize them if they do call in sick and they have concerns about continuity of care.

When researchers drilled down further into open response comments, they found that physicians also noted that it's extremely difficult to find coverage and there is a strong culture to come to work unless remarkably ill. Others said it's unclear what constitutes being "too sick to work."

Researchers sent an anonymous survey last year to 459 attending physicians and 470 APCs, including certified registered nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives, who work at a large children's hospital in Philadelphia. They received responses from 280 doctors and 256 APCs.

Ninety-five percent of the healthcare workers said they believed working while sick put patients at risk. However, 83 percent admitted they worked while contagious at least one time in the previous year and 9 percent worked while sick at least five times. Their symptoms included diarrhea, fever and respiratory symptoms.

Their decision to go to work when ill flies in the face of the medical field's guiding principle of first do no harm, write Jeffrey R. Starke, M.D., Department of Pediatrics, Baylor College of Medicine, Houston, and Mary Anne Jackson, M.D., Division of Infectious Diseases, Children's Mercy Hospital, University of Missouri–Kansas City School of Medicine, in an accompanying opinion piece. Clinicians risk spreading infections to patients, especially the most vulnerable ones.

While most of the respondents said they did so because they felt a personal moral obligation to patients and a desire to avoid burdening colleagues, the authors write that the clinicians also noted they felt pressure due a healthcare system that emphasizes productivity. In the past, they said, working while sick was considered a badge of courage and those who stayed home were regarded by colleagues as slackers. But now that clinical productivity is tied to pay and incentives, clinicians feel additional pressure and disincentives to stay home when sick.

It will require a culture change to decrease the stigma associated with healthcare workers' illnesses, Starke and Jackson write. But it's necessary for organizations to create a safer and more equitable system of sick leave that factors in workforce demands and patient safety solutions. Strong administrative and physician leadership and creativity are also necessary to support appropriate sick leave and ensure adequate staffing, they write.

They also advocate for a team-based patient care model to help address the reluctance of ill healthcare workers to take time off from work. "Hospital leadership must ensure that the culture supports a paid sick leave policy that is adequate and nonpunitive," Starke and Jackson conclude.

To learn more:
- read the study findings
- here's the opinion piece

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