The world relies on nurses to care for the sick daily, whether it's an ICU nurse monitoring vital signs or a pediatric nurse administering medications and delivering those lovely ice chips. But what happens when nurses feel a tinge of flu-like symptoms arriving?
The answer is easy -- stay home, said Vicki Allen, MSN, RN, CIC, FAPIC, director of infection control at CaroMont Regional Medical Center in Gastonia, N.C. She also serves on the Association for Professionals in Infection Control and Epidemiology Communications Committee.
"The expectation is, if you are sick, you don't come to work because we don't want you to compromise [the health of] patients and other staff," said Allen.
Hospitals have policies in place to help remind nurses and other staff to stay home when influenza-like illness strikes, Allen said. And it's important to look at those policies regularly to ensure they are working. "We review the policies annually," Allen said. "We typically start looking at this in July or August." Flu activity typically kicks in around October and November, it peaks between December and February and could linger until May, according to the Centers For Disease Control and Prevention. Furthermore, CDC reported flu activity in 2017-18 at its highest in since the 2009 pandemic in the U.S.
Working with flu symptoms -- But why?
Keeping influenza-like illness contained is no easy task, especially when nurses and other healthcare staff bring it into the workplace. Seems like a no-brainer -- stay home when sick. Instead, people tend to muscle through illness at work for various reasons, said Sophia Chiu, MD, MPH, who co-authored the study, "Working with influenza-like illness: Presenteeism among U.S. healthcare personnel during the 2014-2015 influenza season," published November 2017 in the American Journal of Infection Control.
"Hospital-based HCPs had the highest frequency of people working with ILI (49.3%), compared to HCPs at long-term care facilities (28.5%)," the study authors wrote.
More research is needed to understand why the large gap in these numbers exist when comparing both types of facilities, but Chui said it could correlate to the distribution of staff type in hospitals versus long-term care facilities. Based on the study, "Physicians and pharmacists had the highest percentage of going to work with ILI, these are the results by setting," she said. And the most common reason people came to work while sick was they felt capable of performing their job duties, said Chiu. Others reported that they did not feel "that sick." How a person feels is one thing, but Chiu reminds everyone about the importance of being symptom free for 24 hours before returning to work. And that means maintaining normal body temperature for a full 24 hours without fever reducing medications, per CDC guidelines. Otherwise, you could be contagious and put patients at unnecessary risk -- something that poses even greater risk to elderly patients or people with suppressed immune systems, such as a cancer patient, Chiu said. Flu-like symptoms typically last about two days on average, according to the CDC. The grey area is the duration when you can still spread the virus. "Most healthy adults may be able to infect others beginning one day before symptoms develop and up to 5 to 7 days after becoming sick," according to the CDC. Nurses who store up their sick leave could be better positioned to prevent the spread of ILI simply because they can stay home without as many repercussions. Looking at study findings, some respondents cited financial concerns around taking too much time off, a factor that influenced their decision to not call in sick, Chiu said. Also, the concern over lost pay was more prevalent among respondents in long-term care facilities, she added.
Eyes on policy change
Getting back to work after calling in sick can be cumbersome for some nurses, especially if they need an authorized medical check with a clean bill of health upon their return. Administrators at CaroMont Regional Medical Center recognized their health check policy needed some tweaking. After much discussion with key stakeholders, they decided to update their policy that required health checks for employees returning to work after a bout of flu, Allen said.
"We change policies according to the needs of our staff," she said. "We want to make it easy for an employee to call off and also to return to work."
By fall 2017, after many meetings and discussions, they successfully changed the policy that once required health checks associated with ILI. "We come together with a committee which includes physicians, and we edit and revise the policy, it's a multi-collaborative approach," Allen said. "Then we present it to a formal committee that makes the final decision." And there is an important caveat in CaroMont's policy. Health checks are still required when nurses, doctors and other staff have had any other communicable disease. In that case, health checks are mandatory before staff can return to work, Allen said. Freelance writer Elise Oberliesen contributed to the writing and research of this article.
What factors keep you from calling in sick? Share your thoughts in the comments section below.
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