If you’ve followed the "Talk Clean To Me" blog
for a while, you’ll know that sharing others misfortunes for the sake of
getting my point across is not something new.
Take the
#FF – Micro Blog’s Viral Misfortunes
blog from November 2013 as
an example, outlining a Norovirus outbreak within his family. This past week I had the “fortune” or
“misfortune” to have lived through some sort of outbreak that spread through 5
of 6 people at my cottage. The line
listing looks something like this:
Wednesday July 1/15, Male aged 6.5, vomiting
Saturday July 4/15, Female aged 44, vomiting
Sunday July 5/15, Male aged 45, pooping
Monday July 6/15, Female aged 43, pooping
Tuesday July 7/15, Male aged 10, vomiting
Wednesday July 8/15, Female aged 7 strutting around the
cottage bragging that she was the only healthy one (picture to prove it)
As someone in the “know”, perhaps I should have called my
friend and had her postpone her arrival...when I came down sick on
Saturday. But she’s my best friend. I wanted to see her and spend some time with
her and her kids....I was hoping that by disinfecting everything and washing my
hands like crazy I could stem the outbreak, but I knew I was putting my friend
and her kids at risk.....
So why then do doctors, clinicians and nurses routinely
work when sick and put their patients at risk? Well, an editorial in JAMA Pediatrics focused on just that. For
centuries, Primum Non Nocere (first do no harm) has been the guiding principle
for healthcare workers which one would assume also means they should not spread
infections by working while sick. As the
editorial goes to describe, a survey of healthcare workers was conducted looking at the role of
presenteeism and what the key reasons were for going to work while sick (and
infectious).
The top reasons for working while sick included; concern
over who would fill in for them, concern that their patients could not get by
without them and a widespread belief that if they stayed home because of a cold
or flu they would be perceived as being weak or unprofessional. Of the 280 healthcare workers who competed
the survey 83% positively responded to working while sick at least once in the
past year even though 95% stated that working while sick put their patients and
colleagues at risk. That rationale for
working while sick was the belief of an unspoken understanding that you should
be on your deathbed if you are calling in sick.
It was easier and less stressful coming into work than feeling they were
letting their colleagues and patients down.
When asked about what symptoms they would come to work with 55% would
work or have worked with symptoms such as a cough, congestion or sore throat
and 30% said they would work with diarrhea!
The co-authors in reviewing the reasons for showing up
while sick cited that there were systemic, logistic and cultural factors
involved which created a climate where staff felt they had to work when
sick. With streamlining, budget cuts and
the need to balance the books, hospitals have become a place where everyone is
expected to work at peak capacity all the time and with a lean staff this means
less redundancy and less flexibility to find a replacement to cover sick
time. The result being a culture where
those who know they should not work while sick and know that by working sick
they are putting their patients at risk come into work anyways.
Changing a culture of a facility and changing the beliefs
and norms of staff is no small feat.
But in the day and age where hospitals are under scrutiny by the public
for infection prevention rates....perhaps it’s time to invest in developing a
culture where when sick staff know “we’ve got your back”. Stay home and get well because it’s better
for all of us. The alternative of course
could be that the staff member with diarrhea in fact has C. diff....because we
just never know when or how the next outbreak is going to start!
To my friend....sorry that you lost a day of your
vacation being sick!
Bugging Off!
Nicole
