No Sick Time Allowed! Doctors and Nurses Work While Sick.
Do doctors and nurses work while sick? Yes, we work while we are sick. Why? We’re not allowed to take sick time. We take care of sick people, but are not permitted to be out sick ourselves. This isn’t written in any policy, but it is the understood law of the land.
Recent findings published this week in JAMA Pediatrics confirm what I already know – doctors, nurses and other medical professionals work while sick. Here is a summary of the survey:
The purpose of this study was to understand how frequently and why attending physicians and advanced practice clinicians work while sick.
Ninety-four percent of respondents believed that working while sick puts patients at risk.
Despite recognizing the risk, 446 respondents (83.1%) worked sick at least once in the past year, with 50 (9.3%) reporting having worked sick more than 5 times in the past year.
Primary reasons why respondents work sick included not wanting to let colleagues and patients down, extreme logistic challenges in finding coverage, a strong cultural norm to work through sickness, and ambiguity about what constitutes too sick to work.
Over the last thirty years, I’ve worked at several hospitals and out-patient settings. The pressure to work while sick was the same. It is not specific to one employer. While “sick time” is included in benefits packages, healthcare workers are discouraged from using it. It is the cultural norm.
What constitutes too sick to work? If you can’t stand up, you can’t work. But we’ll do everything we can to keep you standing. If you can stand on one leg (as in a recent case of a healthcare worker with a broken foot) and use a scooter for the other, you can work.
Fever? Dehydration? Nausea? Vomiting? Diarrhea? Headache? Cough? No problem. Doctors and nurses help each other to keep going. Just start an IV line, run in some fluids for the fever and dehydration, push an anti-emetic for the nausea, then take a few Imodium to stop the runs. Swallow Robitussin. Add IV Tylenol or a couple of tablets and we’re cured (or at least covered up the symptoms). Cap off the IV and leave it in for use later in the day when the medications wear off. Cover with a sleeve long enough to hide the IV site. We don’t want the patients to know we are sick.
Why don’t we take sick time off? We can’t. Doctors have obligations. Patients don’t want to hear their surgery is cancelled or a physician they don’t know will perform it instead. Patients don’t want to have their long awaited appointment cancelled because the provider doesn’t feel good. Resident physicians have to put in a minimum amount of hours to graduate. Taking sick time eats into the few weeks of vacation they can take. And getting somebody to cover a long shift is problematic. Nurses generally work thirteen hour shifts, many times short on staff already. Somebody has to cover those thirteen hours – that is if you can find a nurse who isn’t already burned out or sick, too. We also feel the obligations to our coworkers and patients.
Working while sick is our cultural norm. We don’t want to let down our patients or our coworkers. We’ll keep each other going, because calling out up is not an option.
Is it right? Not really. We shouldn’t put our patients at risk by working sick. We’re not at our best when sick, but we are obliged to function perfectly for patient safety, and it is exhausting to do so in the face of illness. We shouldn’t expose our patients to potential contagions, either, such as the flu (you did get your flu shot, didn’t you?).
But our patients come first, and we’ll put ourselves at risk to care for them. Because somebody has to do it, and we’re it.
Source: JAMA Pediatr. Published online July 06, 2015. doi:10.1001/jamapediatrics.2015.0684