Healthcare’s unspoken sick day rules remain unchanged amid pandemic

Nearly 3 years into a global pandemic, doctors and nurses have seen their occupational disease policies change with the waves of COVID-19. They had their temperatures taken, completed screening forms and adapted to the changing availability of personal protective equipment.

But according to those who work at the bedside, attitudes towards coming to work sick have not changed as much. Health care providers said MedPage today that, pandemic or not, the workplace culture built around a sense of duty and urgency means that staying home sick is rare. On the contrary, understaffing in medicine has made people even less likely to take sick leave than before.

As per usual

For some, “no sick time” has always been part of the job description.

“COVID hasn’t changed the nature of most doctors’ desire to go to work. And COVID or not, most doctors go to work even if they don’t feel 100%,” Joel Zivot, MD, anesthetist and intensivist at Emory University in Atlanta told MedPage Today, “whether it’s out of pride, whether it’s not wanting to embarrass your colleagues, whether it’s not wanting to embarrass your patients, whether it’s [medicine] selects that kind of personality of people who like to work hard.”

For others, going to work with certain symptoms is better than relying on someone else – or worse, no one – to step in to do your job.

A travel nurse at a Boston-area psychiatric hospital, who asked not to be named due to workplace policies, recalled what it was like at the small hospital where she was on staff at its peak of the pandemic. “It’s just you and your patients and if you’re not there to help them, then who will be?” she said MedPage today. “I had a small establishment. You don’t really have the luxury of having a sick day.”

A number of doctors and nurses MedPage Today spoke with feelings of guilt when they stayed home due to illness.

“When I’m sick or not feeling well, I’m like, ‘Oh my God, I feel so bad for the other person that I can’t be there,'” said Simone Wildes, MD, infectious disease physician. at South Shore Hospital in Weymouth, Massachusetts. “I know I can’t be there, but it still bothers me that they have all the patient load.”

Disabled by disease

Most providers said the only time they typically miss work due to illness during the pandemic was if they had visible symptoms that would interfere with work or were physically unable to do their job.

Morgan Wolf, RN, wrote in an email to MedPage today that she was more likely to call from the New York-based reproductive health clinic where she worked during the pandemic if she had an illness that “would make you noticeably or visibly sick, like you are when you have fever or a gastrointestinal bug,” but not for someone with “less acute symptoms of an illness, such as a cough, congestion, or more than normal fatigue.”

With the latter, “You’re probably not at your best or most efficient, but you can still do physical work and talk to patients and get through the day. So when I had these symptoms” less treble”, I felt I could call and have a valid reason, but I felt the pressure to agree and go to work,” she explained.

Two of the doctors and a nurse only took time off due to severe COVID-19 early on, before vaccines became available. Wildes said MedPage“When I had COVID, I just physically couldn’t do it. You have to be really sick to not come in. You’re so lethargic or so tired that you can’t do the job.”

When Zivot contracted COVID-19, he was out for 2 weeks. “I think people were like, ‘Well, I wonder if he’s going to die?’ I also thought to myself, ‘So am I going to die now?'” he said. “But I did not do it.”

And although most health care providers MedPage today spoken confirmed what is essentially a mandate to smile and bear it, pandemic or not, not everyone agrees that is a good thing.

The Boston-area nurse said she had COVID-19 so severe early in the pandemic that she needed to seek emergency care. Even so, she recalled, “Every couple of days HR would contact me asking if I was ready to come back. It was quite frustrating not being able to breathe or speak or do anything.”

She also said co-workers started a rumor that she was faking sick to leave work. She said: “It sucks because I’m sitting here going to the ER and they’re like, ‘Oh, she’s just enjoying her time off but pretending to have COVID.'”

Wolf described a similar situation. She described a time when a colleague called in sick with COVID-19 and one of the other nurses, “half-jokingly, said she might have fake COVID.”

“I…didn’t trust that my decision to call would be respected by my managers. I often felt like it was met with suspicion, frustration or a lack of empathy,” she said.

Wildes says she has had to send employees home because they came to work sick and found they were relieved that she made the decision for them.

COVID-19 policies then and now

Healthcare providers described COVID-era policies that made it both hard to call in and easy to come to work sick.

For example, the symptom screening questionnaires most had to complete to get to work or log into electronic health record systems ran on the honor system. The Boston-area nurse described holding a screening tent in the parking lot where all employees had to take their temperature and fill out a symptom questionnaire during the height of the pandemic. She described temperature guns that kept reading 80F because it was so cold outside and people were indicating they had no symptoms while coughing or hoarse audibly.

Two nurses MedPage today spoke with who worked under travel contracts and said no sick days were included. Wildes and Zivot said they were unsure whether or not they allocated sick days.

At least two employers asked staff to report their symptoms if they suspected a COVID-19 infection, but charged them to get their own tests. “We were never tested at work, and we were never given tests to take home and use at our discretion,” Wolf said. “The tests, therefore, had to take place at our own pace and on our own initiative.”

“I would say I felt COVID was being recognized and cared for when appropriate, but protecting patients and staff seemed less important than effective service delivery,” she added.

Temperature checks have been scrapped, but some people MedPage today interviewees are always asked to complete health questionnaires before work. Masking rules have become less stringent for some, but most doctors and nurses said they were still issued masks and required to wear them in clinical or patient care areas.

Staff shortages

One thing has changed: hospitals and clinics have fewer staff for the same amount of work, or more.

HHS reported that in the first few months of 2022, up to 22% of hospitals that chose to report had critical staffing shortages. The Ministry of Labor said the country will need 195,400 more nurses over the next decade to meet health care needs. Hospitals across the country are offering signing bonuses and other incentives to attract new recruits, and traveling nurses are always in high demand.

“A lot of people have left the field, so we don’t have as many people to do the job,” Wildes said. “Healthcare shortages make it even less likely that we’ll be like, ‘Oh, I just want to stay home today and stay in bed.'”

Wolf echoed that sense of obligation: “We were dealing with a significant, and sometimes dangerous, understaffing. I felt guilty calling because I knew it would add pressure to colleagues who were already overworked. of work.”

Doctors and nurses said the added pressure to be a “team player” ultimately contributed to the burnout. “You have to cover other people and you’re exhausted. I think that’s the end result – you’re exhausted,” Wildes said.

Wolf added: “I just wonder if we felt able to call when we felt sick and if we had confidence that our decision would be respected, if that would have alleviated some of the burnout.”