RSSAuthor Archive for Kenneth Michek

Kenneth Michek is the Associate Editor for nurse management at HCPro.

Why Do Healthcare Workers Report to Work When Sick?

By John Palmer
This article originally appeared in PSQH.

It’s no secret that that healthcare can be a dirty profession. So why is it that despite the warnings about the dangers of not wearing appropriate protection around hazardous drugs and infectious diseases, workers still choose to put themselves in danger?

It’s an interesting conundrum, and wearing the proper Personal Protective Equipment (PPE) is just as much for the protection of the patient as it is for the worker. In fact, a report published in the November 2017 issue of the American Journal of Infection Control found that as many as 4 out of 10 healthcare professionals show up at work even when they are sick with flu-like illnesses.

The study makes the assertion that illness transmission by healthcare employees represents a grave public health hazard.

Lead researcher Dr. Sophia Chiu called the findings “alarming” and cited an earlier study that showed patients exposed to a medical worker who is sick are five times more likely to get a healthcare-associated infection. “We recommend all healthcare facilities take steps to support and encourage their staff to not work while they are sick,” she added.

The survey of nearly 2,000 health workers during the 2014-2015 flu season interviewed doctors, nurses, nurse practitioners, physician assistants, aides, and others who self-reported flu-like symptoms at work such as fever and cough or sore throat.

“Healthcare personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in healthcare settings,” the report’s authors wrote. “Influenza infections are associated with thousands of deaths in the United States each year. Transmission in healthcare settings, where there is a higher concentration of elderly persons and individuals with immunosuppression or severe chronic disease, is a major concern.”

According to the report’s findings, of the people surveyed 414 (21.6%) of the workers reported flu-like symptoms, and 183 (41.4%) reported working with the symptoms for at least three days at a time. Pharmacists (67.2%) and physicians (63.2%) had the highest frequency of working with symptoms suspected to be the flu.

By work setting, hospital-based workers had the highest frequency of working with flu symptoms—more than 49%. The most common reasons given for working while sick included still being able to perform job duties and not feeling bad enough to miss work. Among workers at long-term care facilities, the most common reason was inability to afford lost pay.

Suggested solutions

So, what does this mean? Well, perhaps most revealing about the study is the prevalence of healthcare workers who think it’s acceptable to show up for work when they aren’t feeling well.

“Training to change social and cultural norms of HCP, such as the expectation to work unless experiencing severe symptoms among clinicians, might address these misconceptions,” the authors wrote. “Different strategies for modifying norms might be needed for different healthcare occupations. For example, physicians develop their sense of professional identity and adopt professional norms and values over a long period of training, which may differ from the experience of nonclinical HCP.”

In addition, the authors of the study came up with several suggestions that healthcare facilities can use to try to fight the problem of workers coming to work sick.

Make workplace policies clear. After listening to the reasons workers gave about why they came to work sick, including the ubiquitous “I could still perform my job duties,” and “I wasn’t feeling bad enough to miss work,” it became clear that individuals may not be the best ones to make the decision about whether they should work. For that reason, the authors stressed that there should be a clear policy and culture that stresses the importance of infection control in the healthcare workplace.

“Employers can convey that the perspective of infection control at the institutional level is important for HCP to consider when deciding whether to work during (an illness),” according to the report. “For example, one academic medical center instituted a triage system requiring HCP with fever or upper respiratory symptoms to undergo evaluation and viral testing. This system provided symptomatic HCP with more information regarding their risk to others. This institution also instituted mandatory absence from work for at least 7 days if testing was positive for influenza.”

Make it easier to take sick time. Many healthcare workers interviewed in the survey said did not take time off from work when they were sick because they were could not afford to lose pay for time off. This may mean that you need to consider a change in policy for sick time. The reports authors suggested institution-level resources to accommodate sick leave, including a “jeopardy system” in which some workers are held in reserve to back up sick colleagues.

This “may help reduce common perceived barriers to taking sick leave when the risk of transmission to others is taken into account,” the report said. “Such barriers include difficulty in finding coverage and desire to not burden colleagues.”

Make the flu shot mandatory, but remember that it isn’t a guarantee. Many facilities encourage their workers to get the flu shot every year, and in fact some make it mandatory. The report’s authors claimed that the fact that a worker received the flu vaccination at any time during the 2014-2015 influenza season may have contributed to the decision to come to work, even with symptoms. In other words, their perception is that there is no way they could have the flu if they’ve gotten the shot, which of course is not the case. Workers should be educated about the flu vaccine, and again, should be encouraged not to come to work if they feel sick.

In many places, it’s still not legal to require flu shots for employees, and if unions get involved it’s a much more complicated issue. Many people still have religious requirements, or moral protests against required flu shots. But the truth is that the flu shot has been proven to be safe and extremely effective.

Therefore, employees who work with patients should be encouraged to get a flu shot each year. In most cases, the flu vaccinations are free, and they really will make things healthier in your facility. Statistics show that those who get the shot stay healthier with very little risk of side effects. That translates to healthier workers who can come to work and not get patients sick. At the very least, there must be a very strict policy in place preventing patient contact when workers are sick, and in all cases, they must wear face masks when working anywhere around patients with compromised immune systems.

During the winter months, you should encourage workers to stay healthy. Your staff cannot help patients when they are not well, so encourage them to keep healthy by living a healthy lifestyle. They should be washing their hands regularly, eating well, and getting plenty of sleep—and staying home when they are sick. They should be getting plenty of exercise, downtime, and time to spend with their families and pursuing hobbies.

Make PPE mandatory, and train more. It should be common sense, and common practice, for anyone who works in healthcare that PPE is part of the job. Yet for some reason, workers still come up with every excuse not to use it.

Over the years, PPE—and standards from OSHA and other regulators—have been developed to help reduce and prevent workers from getting hurt or sick on the job. Yet, every year, we hear more about how healthcare workers have some of the highest workplace injury rates in any industry in the United States. To make things worse, every so often an illness rarely, if ever, seen in the U.S. makes its way into the country’s healthcare facilities (think MERS in 2012 or Ebola in 2014) and changes the way the healthcare community looks at PPE. In addition, training often takes a back seat because of shrinking budgets and lack of time.

“PPE does not remove the hazards; it protects the individual,” says Marjorie Quint-Bouzid, MPA, RN, NEA-BC, who currently serves as vice president of nursing at Parkland Hospital and Health System in Dallas. “Healthcare organizations must continue to attempt to mitigate potential hazardous situations or practices as the first line of defense.”

The trouble doesn’t stop with infection control. Pharmacists who handle hazardous drugs, and the nurses who then administer them, are at high risk of occupational exposure. These exposures can cause acute health effects, from sore throats to hair loss; allergic reactions; cancer; and reproductive toxicity—including an increased risk of miscarriage.

A 2011 National Institute for Occupational Safety and Health (NIOSH) survey reported that the most common reason given for failing to wear gloves was that “skin exposure was minimal”—an opinion at odds with various biological measures of worker exposures.

In 2011, NIOSH surveyed 2,069 healthcare workers—most of them nurses—who had administered one of more than 90 specific antineoplastic drugs in the previous week about their adherence to safe work practices. According to the survey, which was published in the Journal of Occupational and Environmental Hygiene in 2014, workers reported that they had engaged in risky activities or been exposed to hazardous drugs by incidents that included:


  • Failing to wear a nonabsorbent gown with closed front and tight cuffs (42%);
  • Priming intravenous (IV) tubing with the antineoplastic drug (6% had done this themselves; another 12% reported that this was done by the pharmacy);
  • Taking potentially contaminated clothing home (12%);
  • Spills or leaks of antineoplastic drugs during administration (12%);
  • Failing to wear chemotherapy gloves (12%); and
  • Lack of hazard awareness training (4%).

When NIOSH asked healthcare workers why they did not wear their personal protective equipment (PPE), including double gloves and gowns, while compounding or administering hazardous drugs, it found that workers were essentially shrugging off the risk. “Skin exposure is minimal” was the most common answer to the question, followed by “not part of our protocol” and “not provided by employer.” The researchers concluded that “there is a perception among respondents that chemotherapy drugs pose a minimal exposure risk.” In addition, workers reported that employers failed to implement safe work practices and provide PPE in many cases.


The dangers of compassion fatigue

Nurses are the frontline of patient care, making them the most susceptible to compassion fatigue, a state of mental exhaustion caused by caring for patients and their family through times of distress. It’s important that nurse managers are aware of the risks, identify the signs in their staff, and provide guidance to nurses that need it. While the increase in stress and unhappiness caused by compassion fatigue are evident, some of the other consequences are less obvious:

Increased medical risk: Compassion fatigue can lead to an increase in medical errors due to a lack of communication or inability to react. Nurses suffering fatigue can become unsympathetic, self-centered, and preoccupied, to the detriment of a patient’s care. To read more about this connection and how to counter it, check out Reduce Nurse Stress and Reduce Medical Error from HealthLeaders Media.

Decreased retention: The increased stress and potential trauma associated with compassion fatigue can drive new nurses away from the field. The American Association of Colleges of Nurse reports that 13% of newly licensed RNs work in a different career within a year of receiving their license, and 37% said they were ready to change careers. Many reported that the significant, ongoing emotional stress was a factor in their dissatisfaction.

For more information on combating nurse fatigue, check out the Health and Wellness section of the Strategies for Nurse Managers Reading Room:

Don’t underestimate damage caused by burned out nurses

Preventing nurse fatigue
Beat nursing stress and stay calm and collected

3 tips to resolve staff conflicts

Nurse managers often find themselves in the middle of conflicts, including personal conflicts between staff, nurse-patient conflicts, and interdepartmental conflicts. These issues can be disruptive, and lead to a decrease in productivity and staff morale. This makes the ability to resolve conflicts an essential skill for nurse managers, but nurses rarely receive formal training in conflict resolution. Here are some three tips to manage conflicts in your unit in a stress-free and effective manner.

Active listening: When faced with a conflict, it’s important to listen to what a person has to say and understanding their perspective. This means meeting face-to-face, asking open-ended questions, and listening without interrupting. Observe important nonverbal cues and make sure each side in a conflict understands the other’s perspective.

Keep calm: Emotions can get heated in the midst of a conflict; work to recognize your own emotions, as well as the feelings of those involved. Try to maintain a compassionate understanding for those involved, and acknowledge their feelings when analyzing a problem.

Stay positive: The negativity of some disputes can sometimes seem overwhelming. If you can manage to maintain a positive attitude and a calm demeanor, you’re well on your way to resolving most conflicts.

Source: Minority Nurse

For more about communication and conflict resolution, check out our educational articles from the Strategies for Nurse Managers Reading Room:

Hone your skills as a nurse mediator to manage staff conflict

Improve communication with these teaching strategies for the classroom

Combating racism in healthcare

Nurse managers and their staff often face racism in the work place. In 2013, Minority Nurse reported that almost half of minority nurses said they experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

A Cautionary Tale

Plainfield Healthcare Center was faced with a similar dilemma, when some residents of the facility refused care from nonwhite staff members. The center had a policy of honoring such racial preferences, citing the patient’s right to select their providers.

For Brenda Chaney, a CNA at Plainfield Healthcare Center, this caused issues with both her workplace experience and patient safety. Patients verbalized their preference on a regular basis, causing distress and a hostile work environment for Chaney. Additionally, the policy created safety risks for the patients; Chaney shared one such situation: after finding that a patient fell and couldn’t get up, instead of assisting the patient herself, she had to hunt for nonblack staff members to help the resident return to her bed.

Chaney responded to a call one morning from a resident who was struggling to get out of bed. The patient refused her help, and when she eventually helped another staff member with the patient, the staff member reported that Chaney used profanity when helping the patient. After investigating the complaint, they found no evidence to substantiate the complaint, and the resident’s roommate heard no profanity during the incident. Despite this, Chaney was still terminated.

After her termination, Chaney filed a lawsuit under Title VII of the Civil Rights Act of 1964, where she alleged that Plainfield Healthcare Center’s adherence to resident’s racial bias was illegal and contributed to a hostile work environment. The suit was supported by the Equal Employment Opportunity Commission. After an appeals process, the 7th U.S. Circuit Court of Appeals sided with Chaney and found the practice of allowing patients to refuse care based on race in violation of Title VII. Both parties eventually settled the case, with Chaney receiving $150,000 settlement.

Preventative Measures

The New England Journal of Medicine published an article that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

New Release! Nurse Manager’s Guide to Retention and Recruitment

NMGRRWith the current nursing shortage, recruiting and retaining the best nurses has implications for all levels of practice and all care delivery settings. Nurse Manager’s Guide to Retention and Recruitment is a user-friendly guide for nurse leaders that provides sound theoretical perspectives, evidence-based practices, practical strategies, and tools for achieving the best recruitment, engagement, and retention outcomes for their organization.

In addition, this book includes examples gleaned from the authors’ collective years of experience and expertise in a complex urban healthcare market with large for-profit, not-for-profit, and public (county, state, and federally funded) healthcare organizations and systems.

Click here to order now!

Excerpt: Dealing with the cyberbully

October is National Bullying Prevention Awareness Month, highlighting the dangers of bullying in all settings. The following is an excerpt from Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other by Kathleen Bartholomew, RN, MN that explores the dangers of cyberbullying in the nursing unit.

Facebook boasts more than 1.86 billion monthly users worldwide, with more than 40% of Americans logging in every single day. In 2007, Twitter reported 5,000 tweets a day; and in only six years, tweets jumped to more than 400 million. Ten years later in 2017, we tweet 6000 tweets per second. (Zephoria) Without a doubt, we have entered the digital world:

  • Fifteen nurses received letters of warning from their State Board of Nursing after they were reported by their nurse executive for “liking” a derogatory comment that one nurse posted about a husband who was uncaring and unsupportive during childbirth. They did not heed the first warning.
  • A nursing student was dismissed from the program after taking a picture of herself holding an unidentified placenta and proudly commenting how thrilled she was to assist at her first birth.
  • A group of nurses who were friends started a conversation on Facebook which included several disparaging comments about a nurse they didn’t like, as well as remarks on the safety of the organization’s staffing levels.

We talk to each other on online chat rooms in casual conversations that feel so real we forget that no discussion in this virtual world is ever private. Every one of the nurses in the above situations had no idea that they were violating professional ethical guidelines by breaching confidence.

As social networking becomes more integrated into our daily lives, the boundaries between social conduct and professional misconduct are becoming increasingly difficult to navigate.

—Rose Sherman, EdD

While it is generally accepted that we cannot speak about our patients, even anonymously, many nurses do not realize that it is also not professional to speak about a coworker. According to the National Council for the State Board of Nursing policy on Social Media, any online comments posted about a coworker may constitute lateral violence; even if the post is from home during non-work hours. Communication modes for cyberbullying include: instant messaging, email, text messaging, bash boards, social networking sites, chat rooms, blogs, and even Internet gaming.

Nurses often fail to realize that deleting a comment does not erase it. Talking about coworkers is unprofessional and contrary to the standards of honesty and good morals (moral turpitude). Depending on the laws of a jurisdiction, a Board of Nursing may investigate reports of inappropriate disclosures on social media by a nurse on the grounds of:

  • Unprofessional conduct
  • Unethical conduct
  • Moral turpitude
  • Mismanagement of patient records
  • Revealing a privileged communication
  • Breach of confidentiality

Guidelines for nurses victimized by cyberbullying

  • Save all evidence. Copy messages or use the “print screen” function. Use the “save” button on instant messages.
  • First offense: Ask to speak to the person in private and bring a copy of the evidence. Use the D-E-S-C communication model.
    • Describe: “I was on Facebook yesterday and my friend sent me this post because it was about me.”
    • Explain the impact: “I was really surprised because I had no idea that you didn’t like working with me, or that that was the reason you switched weekends.”
    • State what you need: “No one is perfect. Next time could you come to me privately and let me know if you are having any issues so that we can work together to resolve them?”
    • Conclusion: “I am willing to learn how we can be more mutually supportive of each other for the sake of our relationship, our team, and our patients.”
  • Document the conversation and the outcome.
  • Second serious offense: Report to manager (if not serious, try a mediated conversation).
  • Third serious offense: Report to the chief nursing officer.

Manager guidelines

  • Verbalize that no bullying or hostility of any kind will be tolerated, including online.
  • Set the expectation that all staff are responsible for monitoring their virtual world. Don’t assume the parental or vigilante friend role.
  • Educate staff on standards and policies, and provide examples.
    • National Council of State Board of Nursing Guidelines
    • Hospital/organizational policy (including use of hospital computers, cell phones, etc.)
    • Review common myths. Use case studies from NCSBN YouTube.
  • Be supportive of online targets and take derogatory online comments seriously.


Source: National Council for the State Board of Nursing:

The 2017 Nursing Salary Report

HCPro recently conducted a survey among 291 nursing professionals in the healthcare industry regarding their work experience, environment, salary, and benefits. The results show that while careers in nursing careers are more varied and higher paid than ever, nurses are working later in their career and the age gap is growing.

A majority of the respondents were over 50 years old with over 10 years of experience. Respondents had a wide variety of education background, job titles, and salaries. While salaries overall are higher than ever, most respondents say that wages have not increased in the past year, and that benefits for many positions are lacking.

Click here to download!


Subscribe to Nurse Leader Insider!

Get expert advice, tips, and best practice strategies on nursing burnout, recruitment and retention, communication, leadership, and much more!

Subscribe to the Nurse Leader Insider for FREE now!

Guidelines for the critique of nursing research articles

The overall goal of a research critique is to evaluate a study’s merits and its applicability to clinical practice. A research critique goes beyond a review or summary of a study, and it carefully appraises a study’s strengths and limitations. By evaluating a study’s component parts, the critique should assess objectively a study’s validity and significance.
Several guidelines for the appraisal of evidence—in the form of meta-analyses, systematic reviews, and clinical practice guidelines—have been published in print and online. In addition to nursing research textbooks, several published guidelines for how to review single research studies can help nurses in their journal club endeavors. The following resources specifically target the critical appraisal of research studies:

  • Critical appraisal tools developed by the Critical Appraisal Skills Program, (suitable for all types of studies) NHS Trust-Public Health Resource Unit. (
  • Critical appraisal worksheets in the EBM Toolbox, Center for Evidence-Based Medicine at Oxford (
  • Users’ Guide to Evidence-Based Practice. Site maintained by the Canadian Centre for Health Evidence ( (Originally published in the Journal of the American Medical Asociation.)

The level of discussion at the initial journal club meetings will depend on the facilitator’s knowledge base. Nurses who have completed graduate-level research courses will be able to guide the group so that all questions can be answered and discussed. It may not be possible, however, to have a registered nurse with a master’s degree serve as a facilitator for every journal club. If this is the case in your organization, consider limiting how many journal clubs meet to ensure adequate mentorship. Another choice is to have baccalaureate-prepared nurses serve as facilitators and understand that, in the beginning, certain questions may pose a challenge to the group. In that case, the group should agree to discuss as many of the questions as possible and to skip over questions they find difficult. The facilitator can then follow up with someone who can clarify the difficult areas of the critique. With experience, educational sessions, and mentoring, nurses’ knowledge and confidence levels will continue to increase. Evidence-based practice, like any new skill, takes practice. Journal clubs are a great way to learn the skills necessary to evaluate the evidence and to decide whether it’s applicable to specific practice areas.

Source: Evidence-Based Practice Made Simple

Time management and preceptorship

This is an excerpt from The Preceptor Program Builder

The three primary tasks affecting time management in healthcare include organization, prioritization, and delegation. It is especially challenging for preceptors to manage their time when given the added responsibilities of working with preceptees. Only by developing their skills in these three tasks can preceptors gain perspective and control over their time in any effective way when working with preceptees.

The following tips should help you to manage your time more effectively:

  • For example, schedule interruptions. Do not chart every event as it occurs. Set aside time once or twice during your duty hours to stop what you are doing and update your reports:
  • Keep your work and practice settings clear and ready for action. Papers, tools and supplies, and items waiting for attention should not clutter the desk or work area but rather should be organized and easily accessible.
  • Do one thing at a time. Studies suggest that multitasking is not effective and can lead to increased errors. Complete one task before moving on to the next.
  • Determine what must be done versus what you would like to do. They are not always the same. Say “no” if you have too many duties to handle responsibly or safely. Preceptees try very hard to please preceptors, coworkers, managers, and educators. They may take on too many tasks or responsibilities if they do not know how—or when—to say “no” occasionally.
  • Avoid time wasters: the activities, things, people, habits, or attitudes that divert us from our primary objectives. They reduce our effectiveness and interfere or prevent us from completing our tasks or achieving our goals. Time wasters result from ineffective or a lack of planning, ineffective or a lack of priority setting, over commitment, clutter, interruptions, failure to delegate, unnecessary telephone calls or emails, paperwork, perfectionism, procrastination, conflict, ineffective problem-solving skills, daydreaming or escape activities, and hurrying (haste makes waste).
  • Increase time savers: the activities, things, people, attitudes, or habits that direct us to meet our primary objectives or goals. They increase effectiveness and efficiency and enhance completion of tasks. They include planning and controlling time, making lists, setting priorities, creating agendas for meetings (Do we really need to meet? How much can be done by email, for example?), handling paper only once, not procrastinating (do it now), and delegate, delegate, delegate. Preceptors and preceptees need to know how to:
  • Manage interruptions, emergencies, and crises with tact, diplomacy, and courtesy
  • Become better at solving problems and resolving conflict (use tried and true models)
  • Be assertive (say “no”)
  • Control the controllable and accept the uncontrollable
  • Keep interruptions short—be ruthless with time, generous and kind to people
  • Occasionally become invisible and not so completely available
  • Avoid getting angry or hurt if possible—these waste time and energy
  • Maintain a sense of humor
  • Remember to plan and make personal time for fun and recreational activities
  • Delegate routine tasks or projects. Set deadlines when you delegate. Ask for help from coworkers and specialists (e.g., educators) instead of trying to do everything alone. Delegate a task to your preceptees that you thought only you could do. Encourage preceptees to delegate tasks to coworkers when appropriate.

We all are given 168 hours per week, no more and no less. How we spend those hours affects our outcomes, professional and work goals, and job satisfaction. Preceptors can increase efficiency and induce wiser use of time through planning, thereby increasing productivity and decreasing stress.

Preceptors should determine the best use of time and help their preceptees do the same.