HR policies can affect ill HCW decisions
Leave may sway HCWs to work when sick
The surge of novel H1N1 also is a surge of ill employees and absenteeism. Do you have human resources policies that will help you cope?
First and foremost, you need to make sure that you can continue essential services, such as the emergency department. How you will fill the gaps must be thought out before staffing shortages reach a crisis, says Robert Dunne, MD, vice chief of emergency medicine at St. John Hospital and associate professor at Wayne State University in Detroit. Dunne was scheduled to speak at the September conference, "Keeping the World Working During the H1N1 Pandemic: Protecting Employee Health, Critical Operations and Customer Relations," sponsored by the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis.
For example, if you're going to move employees from other units, you need to consider cross-training and whether employees are comfortable in their new, temporary roles, he says.
"Health care has gotten more specialized. Taking people out of their environment is not necessarily going to help out in another part of the hospital," he says. "Taking the endoscopy nurse and putting her on a med-surg unit might be a bit of a challenge."
Agency nurses are in demand by all hospitals in a region hit by novel H1N1. So where else can you turn for personnel? States have credentialing programs for retired workers who are willing to return to duty during a crisis, and they may have pre-credentialed volunteers that you can tap, Dunne suggests.
Meanwhile, hospitals also are wrestling with sick leave policies. You don't want to inadvertently create incentives for employees to come to work sick - thus potentially exposing their co-workers and patients. Yet at the same time, you don't want to encourage unnecessary absenteeism, either.
"Hospitals are going to have to take a close look at their sick leave policies - what's fair to employees and what will protect them," advises Gina Pugliese, RN, MS, vice president of the Premier Safety Institute, part of the Charlotte, NC-based Premier Inc. health care alliance.
If you have a bank of "paid time off" that includes sick leave, then employees are more likely to come to work sick so they can save their time for vacation, notes Dunne. You may want to counter that tendency with symptom screens and require employees with respiratory symptoms to wear a mask during their shift, he says.
Yet if you provide sick days that can only be used for illness and do not carry over from year to year, your employees may feel entitled to take them. "We have significant issues with call-ins, particularly on the weekends, and those are not people who are sick," says Dunne. "If you have five sick days guaranteed and they don't carry over, people will use those. They're perceived as a benefit."
Other advice about handling the risk of hospital-based exposures to novel H1N1:
Notify staff promptly of exposures. If employees had an unprotected exposure to a patient later identified as having novel H1N1, they will need to report that information promptly in order to consider post-exposure prophylaxis with antiviral medications. The CDC advises that antiviral medications are most effective when given within 48 hours of symptom onset.
Employees should be advised to stay home if they develop flu-like symptoms after an exposure. Those at higher risk for complications who have flu-like symptoms should receive antiviral medications, CDC advises. "The very young and very old, people with chronic medical conditions, and pregnant women, in general, ought to be treated with antivirals when they have an influenza-like illness," Anne Schuchat, MD, CDC's director of the National Center for Immunization and Respiratory Diseases, said at a press briefing.
Educate staff about novel H1N1. You want employees to take appropriate precautions but not to overreact to novel H1N1 exposures, says William Buchta, MD, MPH, medical director of the Employee Occupational Health Service at the Mayo Clinic in Rochester, MN. "Keep people apprised of the situation. Make it very clear that this is influenza by a different name," he advises.
Don't put too much reliance on the novel H1N1 vaccine. Buchta notes that it is just one "leg" of an infection control program, which includes hand hygiene, cough/respiratory etiquette, and protective equipment. Influenza vaccines are not 100% effective and the actual effectiveness of the novel H1N1 vaccine won't be known until the outbreaks have subsided, he notes. "You can't just ... assume the vaccine's going to do it all. It's not up to the task," he says.
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