Nurse Sick and FIRED: Exploring Nursing Absenteeism

[allnurses]

Meet Theresa Puckett

If you do a Google search for "nurse fired for being sick" you will be inundated with articles about Theresa Puckett, PhD, RN, CRCP, CNE, a nurse from Northeast Ohio who found herself terminated after a legitimate bout of the Flu during one of the worst Flu seasons our country has seen.

According to an article in Becker's Hospital Review, Theresa worked as a PRN Nurse at University Hospitals, based in Cleveland. She called in sick one day at the end of December 2017 with flu symptoms. Theresa visited a physician and tested positive for the flu virus. She was treated with Tamiflu and ended up missing two days of work. Her physician provided a note excusing her from work for these days. She returned to work a few days later and was instructed by a supervisor to leave early due to continued illness.

The next day, she saw a Nurse Practitioner who diagnosed her with a sinus infection and provided her with another note stating she should not return to work for a few more days. However, returning to work was never an option for Nurse Puckett because she was terminated.

You may be thinking - How does that happen?

According to the University Hospitals statement to Becker's Hospital Review, they allow six unscheduled absences for full and part-time staff within a 12 month period, and nine absences may result in termination. For "as needed" or PRN staff, two occurrences of unscheduled absences within a 60-day period may result in termination. Because Theresa returned to work for one shift in between her two absences, this counted as two occurrences and qualified her for termination.

Presentism versus Absenteeism

If you have ever gone to work sick, raise your hand. As hands of nurses around the world are raised high, let's discuss the reasons we've all done it. To really understand both sides of the issue, you need to understand the difference between absenteeism and presenteeism.

Absenteeism is the practice of staying home from work or school when you are ill. Of course, there are other reasons people call off, but for this article, we are only exploring this issue concerning illness. So, what's the opposite of absenteeism? Presenteeism - the act of going to work when you are ill.

Nurses have high standards for themselves and the care they provide to patients, even when they are ill. A 2000 study by Aronsson, et al. reported that rates of presenteeism were highest among nurses and teachers. But, we know that presenteeism may result in adverse patient outcomes, poor nurse health, and cost consequences. So, why is it so difficult to take a sick day?

Let's consider a few of the most important factors when deciding which side of the issue you support.

The Team Needs You

Your throat is on fire, your head feels like a giant elephant is jumping on it and crawling back into bed sounds like the best possible plan - but, you know your teammates need you. You don't want to let others down. Staffing on many units is kept to a minimum so even one call off could cause your co-workers to take on larger assignments, be in unsafe situations, or be upset with you for calling off.

A February 2018 article by News 5 Cleveland quoted one nurse as saying "Nurses are often commended for coming into work sick, so they don't put their comrades at a disservice for being understaffed." It seems the issues of teamwork, loyalty, and service is a double-edged sword on nursing units.

Patients Need You

Nurses spend more time with patients than any other healthcare professional. You recognize minor changes in assessments and notify physicians. Yes, the doctors diagnose and order new treatments, but it's the nurses who carry out these orders that are often life-saving treatments.

A 2015 study published in JAMA Pediatrics explored the reasons physicians and advanced practice nurses work while ill. While 95% of the respondents believed working while sick put patients at risk, 83% reported working at least one time in the prior year while sick, and 9% reported working while ill at least 5 times. Symptoms reported in this study included fever, diarrhea and acute onset of respiratory symptoms. 92.5% of these clinicians cited not wanting to let patients down as one of the reasons they headed to work with these signs of illness.

So, as you lie in bed contemplating calling in - that's what runs through your mind, right? Without you - who will care for your patients? And, what if you are not the only one with this dreaded illness? So, off to work you go.

Sick Time Policies

Are sick time policies created to protect or punish you? This is a hard question to answer. And, it often leaves nurses faced with difficult decisions that end in absenteeism or presenteeism.

Let's explore a few sick time policy practices.

Forfeiting Pay

Some call-off policies will withhold pay from nurses if you call off at specific times. This might mean that calling off the day before a holiday will result in forfeiture of holiday pay. Or, if you call off on your last scheduled day before a planned vacation or on your first scheduled day after a planned vacation - you forfeit vacation pay.

In a world where many people live paycheck to paycheck, this policy might result in nurses putting themselves and their patients at risk to keep pay that many would argue is rightfully yours. You can't plan illness, so if you are sick around these specific time points, what are you to do?

Unexcused Absences

Most policies give a number of 'unexcused" absences allowed over a period of time, such as 12 months. Typically after missing this number of days, you will be reprimanded. You may also be given a specific amount of time, such as the remainder of the year or 90 days, in which you must not miss any more work.

Of course, if you end up legitimately ill during this time, you are probably going to go to work or risk disciplinary action.

No Sick Pay

Nurses who work a limited number of hours per week or PRN often have no sick time. This leaves you making financial decisions in the face of illness.

Or, your policy may require you to use vacation time before using sick pay. This may seem counterintuitive given the fact that nurse burnout and fatigue runs rampant on many nursing units and days off are necessary.

Physician Notes

Some sick policies require a physician's note for any unplanned absences. Others might state that no MD note is necessary because all unscheduled absences are unapproved. Or, you may also find policies that require a doctor's note after a certain number of days, which may be due to the Family Medical Leave Act.

No matter what your policy reads in regards to doctors notes, you need to understand it before you need to use it. Be sure to get notes when they are required to remain compliant with your facilities policies.

Termination

Almost all sick policies will lead to termination as an end result. And, when such procedures are executed the same across the board, most nurses find these policies to be acceptable. However, when these policies are not carried out consistently, you may feel that they are being used against you or other staff on your unit to force your hand at finding a new job.

Some of the allnurses team met Theresa at the NursesTakeDC rally earlier this year. Nurse Beth was able to interview Theresa and learn more about her ordeal. Thank you for sharing with us, Theresa.

What are Your Thoughts?

So, where does all of this leave you? Do you stay home when ill or head to work in an attempt to avoid discipline, even when you know it is not best for you or your patients? Now it's time for you to decide.

Tell us your thoughts and experiences with nurse absenteeism, presenteeism, and termination.

[Have Nurse, ADN, RN]

If I am ill, I call in. My colleagues get upset, as they should when someone shows up SICK. Then the whole floor is exposed! I have no patience with idiotic policies that put fear in the heart of nurses who are only trying to do what they were taught. And colleagues have no right to belittle or be angry at one of their own who is genuinely ill. There are policies in some states, many in fact, that allow for FMLA if it's a lengthly illness. The job is protected. Secondly, some facilities absence policies only count an absence as 1, if someone is out for more than one day. If it's more than 3 days consecutively, then a note is required. That seems more fair to me. If it's that critical that the numbers criteria is met then they need to hire more nurses.

[Jedrnurse, BSN, RN]

If I am ill, I call in. My colleagues get upset, as they should when someone shows up SICK. Then the whole floor is exposed! I have no patience with idiotic policies that put fear in the heart of nurses who are only trying to do what they were taught. And colleagues have no right to belittle or be angry at one of their own who is genuinely ill. There are policies in some states, many in fact, that allow for FMLA if it's a lengthly illness. The job is protected. Secondly, some facilities absence policies only count an absence as 1, if someone is out for more than one day. If it's more than 3 days consecutively, then a note is required. That seems more fair to me. If it's that critical that the numbers criteria is met then they need to hire more nurses.

Oh, sure. Play the reasonable card...

[Daisy4RN]

Most hospitals have horrible policies re: sick time. I don't understand why they would want you to come in when you are sick but some nurses do that because of the repercussions of calling off, being written up, fired etc. Of course , they do need rules etc. but fair is fair. If you work prn, and in some states also (even for full time), you are an at will employee so they can just let you go, no questions/answers needed.

[Kitiger, RN]

If I am contagious, I stay home. If my contagion can be contained - using a mask for a residual cough, for example - then I will go in.

If they're going to fire me for refusing to endanger my patients, then so be it.

[VivaLasViejas, ASN, RN]

There were only two ways I would call in: if I couldn't get my head OFF the pillow, or OUT of the toilet bowl. Anything short of that, and I went to work. Every place I ever worked had penalties for calling in and I didn't want to get written up, or worse. It's a horrible position employers put us nurses in...we can't win no matter what we do.

[caliotter3]

There were only two ways I would call in: if I couldn't get my head OFF the pillow, or OUT of the toilet bowl. Anything short of that, and I went to work. Every place I ever worked had penalties for calling in and I didn't want to get written up, or worse. It's a horrible position employers put us nurses in...we can't win no matter what we do.

Pretty much my take on the matter, also including not being able to get my butt off the toilet seat in conjunction with head out of the toilet bowl. Head, butt. Head, butt. Head, butt. Prefer my own toilet instead of the ones at work.

[GoodNP]

Way more often than not I've gone to work sick.

Illness is just not black and white. Most commonly when we refer to work absences due to illness we are refering to URIs - overwhelmingly viral, and most contagious before symptom onset and while febrile. So if I'm asymptomatic, I'm unwittingly exposing people, but if I'm febrile I try to go home. Otherwise, I'm typically going to work sick.

The reason I go to work sick is the very punitive work culture. As an FNP, if I call in sick there's no floater to come see my pts for me, they all end up getting rescheduled. This means unhappy patients who have to rearrange their busy schedules and an even more unhappy practice owner losing revenue. Besides, I've learned that many patients would rather see a provider who has runny nose and cough than to be cancelled. I have had my MA call all pts and inform them that I have a URI and offer to reschedule. The patients will nearly always come in anyway. I'll sometimes wear a face mask, but for that lingering post viral cough/asthma exacerbation I just can't.

Interestingly I rarely have nurses come in for sick visits/work excuses compared to other professions. I'm just saying...

[NurseCard, ADN]

I'm like others; I have to be pretty bad off to call in sick. I generally have

to have a fever and/or puking my guts out.

[GrumpyRN, NP]

"If you have ever gone to work sick, raise your hand. As hands of nurses around the world are raised high, let's discuss the reasons we've all done it."

Sorry, but not all around the world. In UK for example policy is for 1 week to be self certified and if over that then a fit to work line from a doctor has to be obtained. (Fit to work is in fact a sick line that states you are not fit to work).

In NHS (certainly my bit of it) you can be off sick for 6 months on full pay then a further 6 months on half pay. Your manager will keep in touch during that time and agree to this length of time and also to see if you can be supported back to work. As an example i required back surgery a few years ago and as it was elective surgery my manager knew when I was going to be off but I still had to go in to talk to them so that they could help me return to work. In my case no heavy lifting and they put me through a course of Pilates to help with the pain and in hospital time.

There is a disciplinary procedure if you are continually taking odd days off here and there without good reason.

I don't want a nurse standing beside me coughing and spluttering and infecting me and the patients with her germs. She should be tucked up at home recovering fully.

It scares me that experienced, knowledgeable staff are afraid to take time off when needed in case the get fired.

[Nascar nurse, ASN, RN]

I'm like others; I have to be pretty bad off to call in sick. I generally have

to have a fever and/or puking my guts out.

Especially when my kids were younger - I had to suck it up and work if AT ALL able to do it because down the road those kids were going to need me to call off to stay home when they're sick.

And side note: I am managment. I understand it from both sides. I can hire 1 extra nurse - I can hire 20 extra nurses...chances are not a single one will be available the day someone needs to call off (or they get tired of not getting enough hours and quit). It's an on-going struggle to balance.

[missmollie, ADN, BSN, RN]

I've called off sick and taken FMLA when appropriate (child's hospitalization). The thing that absolutely kills me is that if my child is sick, well, I better go to work because I only have 6 absences before I can be fired. I, as a mother first and a nurse second, am the most appropriate person to take care of my child when he is sick. Instead, I must leave it to my husband. My husband is a great father, but there is no substitute for a mother. My son does not understand sick days. He understands that I don't have time for him when I am needed.

In a field dominated by females, we need to have more lenient policies for illness within the family. Because of this, I often go in when I am contagious because if not, when my son is sick he may feel that he is not as important as my patients or job. This is not right.