How Hospitals Punish Nurses for Being Sick

I admit it: I’ve gone to work sick when I should have stayed at home. I’ve gone with hacking coughs, sore throats, Fevers Not Yet Diagnosed, and probable gastroenteritis. I’ve gone in with migraines. Once when I was being treated for an I & D’d abscess, I went in with a saline lok, a kind of intravenous access to give me antibiotics. Should have stayed home, I confess, I know better, but there it is.

So I listened attentively to Brian Goldman’s CBC Radio show White Coat, Black Art this week (you can hear it at the link) on health care professionals coming in to work sick. We do it for reasons perhaps not unique to health care: we don’t want to let down the team, there’s no one to replace us, we’re indispensable. He mentions physicians being expected to show up unless dead or nearly so; nurses, when I was a student at least, were inculcated from our first clinical day that calling in sick was tantamont to being a bad nurse.*

However, the consequences of having sick health care professionals are, of course, unique: we tend to infect patients who are already compromised. As bad, or worse, we compromise our judgement: who can think clearly with a temperature of 39.8C, or while having to run to the toilet every ten minutes? Goldman suggests that a massive culture change in hospitals is necessary to let health care workers take sick days as needed. I agree. But it’s not going to happen any time in the near future: hospital administration itself is the biggest obstacle. There are clear choices in creating a culture that gives permission for nurses in particular to take sick time. I don’t believe hospitals have the will to make that cultural shift.

Let me explain: the problem of sick nurses, other health professionals and ancillary staff coming to work — I’m leaving out physicians, because in Ontario hospitals, they aren’t subject to the same scrutiny as nurses — highlights an internal conflict within hospital administration. In an ideal world, Infection Control in all hospitals would dearly like nurses and the rest to stay home if they’re sick. Patient safety, after all comes first. In the real world, however, hospital Human Resources departments do not consider infection control as a priority. Human Resources views sick time as a controllable cost, and frankly, sick nurses a problem to be managed.

It’s true in general that nurses take higher than average rates of sick time. The reasons for this are complex: we are, after all, exposed to infection on a daily basis, the nature of our work is highly stressful (which in of itself has health consequences), and sick time is an indicator of nursing morale which in many hospitals is quite poor. The job of human resources is to provide strong disincentives to nurses (and others) calling in sick. They d0 this in a couple of ways. In Ontario, hospitals cut sick pay for nurses by up to a third, depending on seniority. If you’re a sole-wage earner living paycheque to paycheque, it’s a substantial amount. Pragmatically speaking, if it’s between feeding your kids, and coming in sick, even if you are a conscientious nurse, guess which will win.

Further, nurses must cope with attendance management programs. In Ontario, and I know this is true in many American hospitals, nurses are subject to punishment if they take as few as three sick days, and made (with union acquiescence) to attend humiliating, disciplinary “attendance-management” meetings. For their part, hospital management and the union — the Ontario Nurses Association — will vehemently deny the attendance management process is disciplinary in nature. Personally, I have never been subject to attendance management. But I have seen nurses leave these meetings distressed to the point of tears, and I know of one nurse who left her position and the hospital because of Human Resource harassment. It’s discipline by other means and it’s a strong deterrent to taking sick leave. I’ve come in sick myself knowing I was close to the threshold of being put on “The Program.”

A conversation I had a few months ago with the Infection Control Nurse illustrates quite nicely this tension between the conflicting goals of Infection Control and Human Resources. The context was a mini-outbreak of gastroenteritis; three nurses were off sick. The Infection Control Nurse got wind of this outbreak, and wanted to ensure the nurses stayed home for 48 hours after the last symptoms, as per hospital policy. She wanted names, which I refused because of confidentiality.  She then wanted me to call the nurses. I refused again. I knew at least one of them was already in some difficulty with the attendance management program, and I was unsure about the rest.

“Well,” she said. “Let me call them.”

No, I said. I explained to her how Human Resources will punish the nurses for following hospital policy.

“Oh,” she said. “That’s a human resources issue, not an infection control issue.”

Actually, I thought, if you have an otherwise diligent, handwashing-fanatical nurse like me resisting infection control directives, human resource policy is an infection control issue.

In the end, hospitals must choose between trying (and mostly, I think, failing) to control sick time costs and making infection control truly a priority. It’s no good telling nurses to stay home if they are sick, only to turn around and punishing them for fulfilling what is really a professional obligation. Half-measures, like telling nurses to mask for their 12-hour shift, or to be “extra-diligent” in handwashing are impossible to enforce. Maybe some innovation is needed on how we look at sick time. One U.S. hospital I know of recognizes only 2-3% of employees abuse sick time, and assigns twelve days a year for “personal use,” no questions asked, after which HR begins to apply the screws. Nurses who leave part or all the personal days untouched get a payout of three of those days on a pro-rated basis. A change like that would indeed entail a massive culture shift. Present practice does not truly address infection control issues raised by health care professionals working sick, and sends conflicting messages to nurses. Either infection control is a priority for hospitals, or it isn’t. Which is it?

___________

*I’d be interested hearing from new grads whether this is still true.

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  1. #1 by Not Nurse Ratched on Friday 19 November 2010 - 1140

    It was still true 3 years ago in nursing school. I had a temp of 102 after 1 g of Tylenol and my CI made me stay for a 12-hour nursing home clinical. I was terrified I was going to give all these elderly people the flu and thereafter pneumonia. Her reasoning: “We can’t stay home every time we get the sniffles.” This issue has always bothered me—especially when sick nurses have to come to work in critical care areas. If you are immunocompromised or have a fresh surgical wound…do YOU want a sick nurse caring for you, even a careful one? Me neither.

  2. #2 by Diana on Friday 19 November 2010 - 1431

    Call-ins, whatever the reason, are considered during yearly evaluations. Too many (not sure of the exact number) and you don’t get a pay raise. I had to leave work one day this year due to an allergy attack that left me with blurry vision as I couldn’t stop crying. My regular meds were no help. That counted as a call-in and is one strike against me during my next evaluation.

    If you call in on one of your weekend shifts (we work every other weekend), you are automatically put on schedule for the following weekend. No exceptions as you are expected to make up that shift. I know people who have come in a “little under the weather” in order to avoid the make-up policy.

    I’m sure there are other hospital policies that I’m not aware of in order to deter nurses from calling in even when truly sick.

  3. #3 by Maha on Friday 19 November 2010 - 1623

    I had my yearly review a little while ago. I was sick TWO times from last November to this September. It was mentioned as per HR policy. One of the sick calls happened right when I finished a 12 hr night with a fever of 38.7, lots of glorious nausea (I had to get my friend to give me a shot of gravol during break) and a headache that made me feel like my brain was going to explode out of my eyeballs. We work incredibly stressful jobs and pretty much live in a cesspit of disease so now I refuse to feel guilty for calling in sick. HR can suck it.

  4. #4 by Jenn Jilks on Friday 19 November 2010 - 1707

    Excellent post, again.

    If we didn’t feel important to our clients we wouldn’t bother going to work.
    yet absentee management is suposed to fix this.

    Same deal in education. Absence management people phone and help you figure out your issues.

    Management only sees dollars.
    I remember being hired to replace a man who was working as mayor of a small town, while on LTD from his real work for stress. I can understand why higher ups are pissed off. There are reasons for illness. The abusers screw us big time.

  5. #5 by Sean on Friday 19 November 2010 - 1957

    Isn’t it amazing. We do have two separate demons at play here. We have the administration/HR breathing down our necks to never call off, but then we as nurses never known when to say ‘when’ and actually stay home.
    Some how we are the only profession that has this sort of problem??

  6. #6 by Raquel on Friday 19 November 2010 - 2139

    I have been a nurse for almost 6 years. In my first year I got my share of nastiness from the ER and called in sick 3 times. I was told that a letter of censure was being put in my permanent record, basically a warning before termination. Nothing has changed since then. I have heard of some oncology units that are slightly less punitive due to the fact that their patients are so very immunocompromised. I wish that were the case everywhere. Great article with some very good points. Thank you.

  7. #7 by Cartoon Character on Saturday 20 November 2010 - 1059

    I am not a new nurse…..but an old nurse…and I find in hospitals this is the case. Not so much working for the feds in the prison in my experience. My present work….whenever I feel a little bit ill…slight headache, whatever….nothing remotely worth staying home for…..they always ask – “Maybe you should take the rest of the shift off?”…..I am blessed. This is the first time in my 33 plus year career that I am not made to feel guilty…..

  8. #8 by Julie on Wednesday 24 November 2010 - 1613

    Fortunately, my employer doesn’t punish for sick time unless abused. If we call in sick 2 days in a row, during the same week, it is counted as only 1 call-in occurence, not 2. After the 3rd day in a row we are required to have a physician’s notice to return to work. Patient safety and infection control SHOULD be the priority!

    I think most nurses push themselves to work sick because of low staffing issues. We feel guilty leaving our co-workers struggling when staffing is already short.

  9. #9 by Anonymous on Wednesday 24 August 2011 - 0910

    I work weekend option in an L&D unit at a hospital. We are allowed 1 (yes, ONE) sick DAY (not occurrence) in a 365 day rolling calendar. The 2nd sick day, you are subject to termination. So we all come to work feverish, hacking, puking, and with all sorts of other nasty little bugs. I’d say that risking your newborn to the care of an infectious hospital nurse is an excellent argument for home birth….

  10. #10 by margaret duncan on Monday 04 February 2013 - 0125

    I am a casual employee, at a tertiary care hospital, I worked two 12hr days back to back, and was healthy prior to working.

    At work , I experienced other co-workers, sick, coughing, sneezing , and obviously unfit to work, so why were they there?? because their managers, do not allow them to have sick time, even although the official policy is ” do not come into work sick”, I have seen some younger members of staff, even after miscarriage adviced that ” they have had enough time off, get back to work” wtf. It is time nurses stood up to the bulling tactics of managment, and said “fuck off I am sick and I will not be back until I am better”…

    I have just done this, and taken a week off to recover from infection I recieved from co-workers, too scared to take time off. I am casual, which means , I am not paid for sick leave, or indeed have to let people down if I take time off. As a casual, it means I get shifts when people are SICK or on holiday…

    So come on someone out there, you all have your Masters in Administration, how about you take some heart felt emotions, and get over your budgets, your, numbers on a chart, and look after your staff. ??

    Until you care about your staff as humans, instead of numbers on a duty sheet, you are doomed to loose, so many young wonderful new grads, and your senior staff cannot sustain the work style shortages that present… get with the program managers,

    I know you have a very hard and un -recognised difficult job, I have done it myself, in other countries, but you know what, I never lost track of my employees , what makes them tick, who they and their families are, and that is what you are doing wrong.. You are treating budgets, and numbers instead of people.

    I do not wish to use my name , or my place of employment, as indeed , I will have some form of come back to me which will not be pleasant, got to love the health care system where they do not care for their own…

    I dreamt of being a nurse since I was a little girl . I am now nearly 55yrs old. I have been in the profession since I was 17yrs old. I love nursing, I love looking after families, I love my co-workers, I hate how they are having to work under suck unhuman conditions.

    I hate what has happened to our managment system.

    We have so, so, many levels, so far removed from patient care , they no longer no what it is like to CARE…

    and care that is what most RN’s do every day, every shift. WE CARE ABOUT YOU AND YOUR FAMILY….. so you know what , please care about us???

  11. #11 by K. on Monday 11 March 2013 - 1915

    Hospitals still do it they pay lip service to not coming in sick but will counsel you quickly for to many absences excused or otherwise.

  12. #12 by E. on Wednesday 15 May 2013 - 2036

    Great post! I stumbled across your site when seeking information on how to deal with my fellow employees who abuse their sick time. I’m really getting burnt out, running a busy unit short staffed, when I know darn well that the person who called in sick, the same one that calls in every other week, is malingering. We have a pocket of nurses who ARE abusing the system, and while we have a powerful union in Alberta, nothing stops them. No HR meetings, no discipline, no letters on files, nothing. (at least not in my facility) It’s funny how they are the same ones who are available for overtime when they are “feeling better”. I am one of those nurses who shows up rain or shine, I have two kids who yes, get their fair share of illnesses, and I still manage to show up on time. I have maxed my sick bank and when some of my colleagues found out, they called me crazy for not using my sick days as I was “entitled”. I think what drives me crazy is the abusers who wreck what should be an honorable system for the rest of us, who leave us working short, and who have this bizarre sense of “entitlement” when they should have some sense of loyalty, some sense of work ethic. It IS a management issue, in that they should have contingency plans for when people call in sick, (or my favourite, self cancel pick up shifts on a regular basis), however there is only so much a manager can do when we all ready run on an overstaffing model. Theoretically we should always have an extra staff member for vacation or sick time. People look ahead on the schedule, see that we are overstaffed, and call in sick that day. Trouble is when more than one person has the same idea, those of us who show up end up holding the bag.

    I’m not perfect, I do call in 2 or 3 times a year, and I have taken the odd personal day for sick kids or whatever. To me, this is not excessive. I’m referring to the people who take every weekend off, the ones who you can predict won’t show up according to the weather forecast. It sounds like HR departments in Ontario are much more hard core than they are here.

    Quite honestly, I think we could use some “attendance management” at my workplace. I have worked with people who have 14 years in and have “0” hours of sick time banked. No chronic illness, no surgery, just zero accountability.

    I try not to be judgmental, but I’m tired of it, I’m stressed out and its starting to show. Perhaps I need to take a few “mental health” days myself.

    I’m waiting for the day that someone will give me some sort of bonus for having a full sick bank ( I can’t accumulate any more time) but my guess is that the union would never allow it. After all that would be discriminatory to those with empty sick banks…

    • #13 by Anonymous on Wednesday 19 June 2013 - 1810

      I too work in Alberta and feel blessed to have decent sick time. I have never abused it either, usually 2 or 3 days a year only. What makes me equally as angry as staff who abuse their sick time are the martyrs who come in sick and infect the rest of us. There has to be a balance. As nurses we know better.

  13. #14 by joanne on Friday 14 June 2013 - 0841

    I am a community nurse – exposure to cancer patients, dialysis and immuno compromised. let’s not forget the number of elderly, fragile people I see. I am waiting for my HR phone call. As a single mum, I have no else to watch my daughter if she’s sick, also – if she is vomitting – I am very possibly a carrier. so if not feeling well, I have asked staffing not to give me any picc dressings or compromised persons. We do not get paid sick time. When i worked at the hospital – hated when people came in hacking and complaining. we have a very difficult job. Our jobs are lifestyles. there are people who do abuse sick time, others who should. we work with a high level of stress and are usually tired. we are compromised. our priority should be to take care of ourselves so we can take better care of you. when is this going to be understood. why is nursing now a business??

  14. #15 by Joann on Friday 14 June 2013 - 2011

    This is so true, you get in trouble for calling in sick and trouble for coming in sick, so what are we to do? I have even gone in with severe abdominal pain. If we are sick we really don’t want to be there, we don’t want to make our patients ill, we have seen what happens when family come in sick and have that spread like wildfire. We are caught in the middle, HR is aggressively harassing and if you can’t do anything about it as then that gets worse…………Nurses need some help here!

  15. #16 by tina on Friday 14 June 2013 - 2238

    2013.. IN ATTENDENCE STAGE 3 AND TOLD COULD BE FIRED EVEN WITH A UNION, AND DOCTORS NOTES.. TO BE OKAY SICK TIME. CANCER, DEATH OF SPOUSE OR CHILD, SURGERY, FRACTURE, AND MAYBE A COUPLE OTHER DIESEASES.
    Nurse TMM

  16. #17 by Erika on Saturday 15 June 2013 - 1219

    Interesting that sick time should be used as a measure of morale. Shouldn’t it be a measure of… sick time? I think when we say its a reflection of morale, we are negating ourselves as nurses. Meaning we are taking leave for moral reasons, not illness reasons. I’m not saying show up when you’re kid is sick or other emergencies…. but how do you tell management sick time isn’t being abused when you have a high sick call rate, and then say it’s a reflection of morale? A good article, shedding light to a side of health care the public doesn’t see.

  17. #18 by D on Saturday 15 June 2013 - 2349

    It’s simply money driven. People with black hearts and dollar-sign pupils control the hospital market and you can see that in sick time, in supply stock, in parking fees (oh don’t get me started on the parking fees).

    New grads might be able to introduce some insight, but that would be minimal. This isn’t a thought issue or a method issue; It’s a money issue. Culture change is needed but it needs to start with the ones controlling the money. Beneficence? More like benefits and cents.

  18. #19 by Kelly on Sunday 16 June 2013 - 1927

    I love this article. I want to go and give it to our HR department. “The program”
    Is so ridiculous! It’s awful- we get punished for coming to work sick (and sent home) and we get punished for calling in sick. I think HR doesn’t realize that we work with sick people so are therefore going to get sick more. There really does need to be changes made because patients are going to die because we are scared to call in sick and take care of ourselves.

  19. #20 by JR on Sunday 16 June 2013 - 2113

    I have been a nurse for 30 yrs. I have always called in sick when I was sick. The problem is that many nurses are calling in sick when they are not sick.( and that has made a culture of distrust)
    I am now a leader and deal with sick calls and scheduling. With shift work, there are times that you are trying to get time off but are unable to. ( sometimes this is even for important reasons, like birthdays or weddings) obviously you need to be off so you call in sick.
    I think the culture shift is needed in scheduling and not so much the sick time. if nurses are more liberty to change shift when they want; have days off that where not planned “before the schedule was posted” ; take vacation when they want it not when they are allowed it; stay home with sick children or family and get paid, I think there would be less sick time thus increasing the trust between managers and staff.
    AND PLEASE stay home when you are really sick ( and yes you might have to prove it with a doctors note until the trust is established)

  20. #21 by Anonymous on Monday 17 June 2013 - 0021

    The punitive process begins at 5 sick days in cheo…they say that management is reviewing and will improve it…we can only hope.

    I have never called sick if I could work at all…yes I have worked ill…wore a mask and gloves plus frequent handwashing. Im afraid of the program.

  21. #22 by geojg on Monday 17 June 2013 - 1253

    I’ve been a nurse for 30 years now. Times have changed. I think it took a turn for the worse when they didn’t deal with the individual offenders or abusers of sick time. They put in effect policies that, in the end, punish everyone for being sick. For the first 24 hours of being out sick, you must use your vacation time. Then you begin to draw from your sick time. Nothing like having an illness completely thwart a long-planned family vacation because you are now short on vacation time. We are given a $10 voucher for each quarter of perfect attendance. But it is only good in the hospital gift shop or for a small variety of clothing items with the hospital name & logo on them. I have at least 20 of them I’ve never used. It is a huge joke to most of us. Personally I will call only for puking or a fever of >101. And right now I’ve been off for almost 2 months from a back injury, not directly work-related, for which I’ve depleted all my benefits and have no income. I’m a hair away from losing my position I’ve occupied for the last 14 years. My manager has been fair about it all but the HR lady, geez, she asked me what I’ve been doing while I’ve been off. Like I’ve been working another job or who knows. I’ll just say that corporate couldn’t care less.

  22. #23 by Lita on Monday 17 June 2013 - 1821

    Unfortunately…recently my department has gone to the attendance extreme. It used to be that no one was really held accountable. Now EACH absence is an occurrence even if they are back to back. We had an employee with appendicitis who had each day of absence counted toward her performance review for attendance. I have never been one to abuse my sick time and it is frustrating when the person next to you calls in repeatedly and still has a job. However, there are limits to enforcement. People with a doctors note and those who are admitted/surgical should not have those counted as an occurrence, in my opinion.

  23. #24 by Gina Macdonald on Monday 17 June 2013 - 2341

    I had surgery a few years ago and wound up with complications and a second surgery resulting in my being off for 15 weeks.At year end,I was put on The Program with no consideration given to the circumstances of my absence.When I returned to work,I had no sick time for over a year AND worked almost one overtime shift per pay period whenever they were short and needed someone.Not so much as a thank-you or recognition from management but my co-workers were very grateful.

  24. #25 by fedupnurse on Tuesday 18 June 2013 - 1307

    The attendance management programs punish the wrong people. Nurses at my hospital in Ontario are put in the program after a set number of absences, regardless of the reason. This includes nurses who’ve been off work to have surgery, family emergencies, etc. Sick pay is also reduced significantly, depending on seniority. I took a 6-month UNPAID leave of absence, with a doctor’s note, to look after my mother as she deteriorated and succumbed to lung cancer. After she died, the hospital didn’t send a sympathy card, but they did manage to send me a letter informing me I was now in the Attendance Management Program. I’ve been an employee there for 21 years.

  25. #26 by dblwhammy on Wednesday 19 June 2013 - 0903

    I, like a lot of you, have worked in the health care field. I am not a nurse but have worked around them, with them and for them for many years and I have met quite a few whiners. You would think they are the only ones that have contact with patients and susceptible to all the germs that are floating around in hospitals, nursing homes etc. In fact they are only one branch of a facility that keeps it running. All depts of hospitals face the same rigid sick day “rules” but it is always only nurses that we read about and complain. You would think they were unique and germs only fell on them! I have always wondered too why a person would get into a profession that requires shift work meaning days, nights, weekends, afternoons and then all they do is complain about them.and try and get doctor’s notes to excuse them from working some shifts. I have also worked with nurses that are awesome and in the right profession. You, nurses, are not unique to work hazards, hardships, working dbl shifts, short handed or subject to abuse but sometimes you think you are and it gets really old after awhile. A lot of you mention do you want someone sick looking after YOU, well do you want someone sick driving your bus, policing, teaching, housekeeping….hope you get the point. You are no different than everyone else so stop crying about a well paid job!!!

    • #27 by Anonymous on Wednesday 19 June 2013 - 2021

      The difference between a bus driver, police officer , teacher and a housekeeper ;which I assume is what your role is, is that those professions do not deal with immunocomprimised people directly and constantly such as febrile neutrapenics where a common cold to you and I could kill them. If your loved one was my patient and in this condition and I came in coughing and sneezing what would your reaction be?

    • #28 by Nursiejay on Wednesday 19 June 2013 - 2028

      @dblwhammy

      The difference between a police officer, bus driver, teacher and a housekeeper (which is what I assume your role to be) is that those professions do not come into constant direct contact with immuno-compromised patients such as febrile neutrapenics where a common cold to you or I could simply kill them. If your loved one was in this type of condition and I as their nurse was taking care of them while coughing, sniffling and sneezing what would your reaction be? I am sure a lot more different than if you heard your bus driver sneeze.

  26. #29 by ky on Wednesday 19 June 2013 - 1112

    Hospitals don’t treat nurses properly. Nurses look after sick patients at hospital but when we get sick, hospitals only care whether you exceeded the maximum time a nurse can call in sick in a year ( where I work I think is only 7-8 shifts 12 hr rotation).

    By working day and night rotations, how many nurses have chronic health issues just to name fews diabete, hypertension, high cholesterol, mood disorder, etc

    But bottom line is nothing will be changed because the hospital only pay attention to the patients and hospital afraid of any cases when patients sue to hospitals and of courses the media too.

  27. #30 by Lauri on Wednesday 19 June 2013 - 1420

    Our hospital rewards perfect attendance. If you have zero sick days you get entered in a draw to win gift cards. I have worked with nurses battling serious illnesses such as cancer, diabetes, heart disease who are continually bullied by HR and management to be at work. Off sick with hypoglycemia no prize for you… ER with chest pain, sorry better luck next time…. Better yet, you came to work with influenza on your cancer ward with immunocompromised patients, Here’s a $500 gift card! Patient welfare and staff health loses to the almighty budget.

  28. #31 by Kimmer on Wednesday 19 June 2013 - 1437

    I graduated 3 yrs ago from a Canadian university. We were told that if we called in sick for clinical, we had to make it up in the simulation lab. As you can imagine, this was EXTREMELY difficult to do since you had to arrange the time AND have an instructor there with you to show the “skills” you were demonstrating that week. Basically, calling in sick was tantamount to risking a “FAIL” in clinical.

    Currently, I work in an NICU in a major Canadian city. For us, infection control is no laughing matter and taken extremely seriously. If you have a sniffle, tickle, fever, ANYTHING that you think you might pass on to coworker or worse, sick and/or premature baby, you stay home. No ifs ands or buts… No questions asked. I came in for a shift one day thinking i felt “ok” and my charge nurse sent me home. I know not all units have this type of acceptance of sick days but it really is life or death on our unit. Babies that contract a common cold will become sick enough to die.

  29. #32 by Anonymous on Sunday 23 June 2013 - 2040

    now when you call in sick they phone you back an tell you to come to work or they will fire you.

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