Nurse Sick and FIRED: Exploring Nursing Absenteeism

You work long hours, rotating shifts, and holidays. The schedule alone is enough to leave you feeling run down, tired, and needing a day off. But, what happens when you are in fact sick? Does your facility’s call-off policy protect you from discipline or termination? Nurses General Nursing Video Interview

Updated:   Published

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.

Specializes in Critical care.
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.

That's fabulous and has me jealous. I had to be able to return to full duty before I was allowed to return to work after an accident. I had short term disability coverage that reduced as my recovery stretched out over months, but thankfully I also had my own coverage for wages through my auto insurance (I was hit by another driver). I would have loved if I was able to return to work earlier and do chart audits or something else not related to patient care. I didn't want to return any sooner than was safe for patients and myself, but I was chomping at the bit to get back to work. It was very hard for to sit at home for months and have nothing to do other than go to physical therapy.

Its time to unionize folks. Nurses have the most vitriolic mean spirited reputation toward one another. Don't you think management likes it that way? Stop attacking weaker nurses. Stop mistreating those that need mentoring. Stick together. Protect each other. Have my back! We are failing one another.

Specializes in Orthopedics, Med-Surg.

I kept a sheet posted on my fridge that listed how many days and when I was last out sick. The sheet really was a list as I kept the information as it filled in until the sheet was full. I used it to make sure I hadn't called in within 60 days of that day and that I hadn't called in too many times in the last year, also of that day. That made go/don't go decisions really easy. I would scratch off the call ins that were more than a year from today back.

Their number of incidents policy worked against them. As a weekender, if I was out one day, I wasn't coming back for a week (my weekends were Saturday and Sunday only). So if I missed a Saturday, I definitely wasn't coming back in on Sunday. Two consecutive days counted as one incident.

You might be able to tell the bloom was off the rose for me and I no longer wanted to work any more than the bare minimum. Every shift at work was just that much more exposure to getting in trouble, so I avoided what I could. My unit fired 14 nurses during a one year period, all older, more experienced nurses and I figured the writing was on the wall for me. (I ended up retiring without a write-up in my last seven years; but it was just a matter of time before something would happen.)

Anyway, I took a pre-emptive attitude and avoided the place as much as I could. Not all of my sick days were because I was sick. At least half of them were because I was "sick of". But I would definitely call in rather than bring disease to work if it was possible. Those supervisors we had to call were a cold lot, too. Some of them required an excuse from your mortician before they'd accept your absence. I was legitimately ill one time when they just wouldn't take "no" for an answer, so I went in. They ended up sending me home when I passed out and knocked over a central supply cart on my way to the floor. Made a spectacular mess that was difficult even for them to pretend they didn't see.

This shouldn't be an issue but it puts us all in a very tough spot. A culture and specific issue I have strong feelings about. The institution creates an infrastructure where this is an issue because it limits staffing to bare minimum for profit. Nursing lives and patient lives are treated as expendable because it makes money. Ultimately it is our fault because we have needs and are human, not machine. Despite what hospital administrators say, they don't care about burnout or patient safety as much as they care about CEO bonuses.

I so agree. Without appropriate policy infrastructure and autonomous power that unions can provide, nurses will keep operating on the 'bucket of crabs' behavior of pulling anyone back down that they see as potentially having it better off than themselves because of resource insecurity-whether people call off, get an education, get a better raise, etc.

Specializes in primary care, holistic health, integrated medicine.

I have not been sick once, in the past five years, since I started taking Vitamin D3, 5000 units daily. Prior, I definitely was a practitioner of presentism. Now, I take wellness days. ;)

In the hospital where I used to work, we had a nurse who called in sick. The manager said he did not believe her and she needed to come in and threatened her job. During her shift, she fainted and fell. She ended up being admitted in the same hospital for head trauma and laceration. I am told the she and her husband settled out of court.

I told my staff last year I wasn't counting flu absences. We had several cases of positive flu in staff and I didn't want to spread the wealth. I doubled up on agency, worked shifts myself & offered seasonal bonuses to cover shifts. Sick nurses just create more Sick nurses- & potentially kill a pt. However I do count other absences if you call in and we have to scramble to get agency- we all have each other's numbers and staff should text each other to try and cover their shift. And everyone should pick up occasionally so their coworkers don't have to work short. Our rule is if you get a staff member to cover for you, the absence doesn't accrue any points.

Does anyone have a policy where if you call in for a weekend shift you must make it up the next weekend? We do.

As someone who has both been sick often and worked in a healthcare facility, if you are sick, stay home! It sucks, policies need to change for healthcare providers who are sick, but you could legitimately be putting a patient's life in danger and many of you know this. Just because you can muscle through work while sick does not mean the patient you are seeing will react the same way. A cold can lead to pneumonia in a person like me with my immune system. The flu can lead to death in the elderly. Before you go into work, think about it. Is it worth someone's life? At the end of the day we think, it won't be a big de. I won't hurt anyone, but the truth is you don't know. This isn't like risking going to any other office job. You are literally around the sickest of the sick. I would hate when people would come to work sick, because I knew if I caught it, it wasn't going to be a day of rest for me or something I could push through. My immune system would not be so kind. I would be down for days! That's pay I'm losing all because you couldn't stay home. Now, if you have a common cold then by all means if you feel up to it come to work, but be prepared to take precautions even when you're not with patients. That way, your coworkers are also protected.

I feel for people in this situation though. I, too, have experienced being fired for being sick. 2 years ago I got whooping cough. It was awful. I worked at clinic that treated adults only, but many would bring their newborns in. Many would ask for me to hold them so they could go to the restroom or get things or whatever other reason. Many times I would decline, but still I knew I was going to be around newborns. I did not risk their life by coming into work. I lost my job even with a doctor's note. My boss should know better. They knew how bad that could be for babies. They didn't care. Shame on them. But I can rest easy knowing I didn't risk exposure to an unvaccinated baby. That's not to say things weren't hard for me. It wasn't by no means a luxury. I ended up losing my house, having to move, struggling to find a new job before ultimately deciding on going to school to become a nurse. Even now I'm struggling to pay for school from this one event several years ago. Would I change my decision though? Heck no. No amount of money is worth another person's life. Period.

Specializes in Cardiology, Research, Family Practice.
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.

An extremely generous policy. One wonders how this is financially sustainable.

Specializes in Education, Informatics, Patient Safety.

I have never called in sick, but I am not proud of it. Exposing patients and coworkers to whatever is running around in my system is completely uncool. That being said, I have always felt too guilty, and worried about letting my coworkers down. You can be fired for any reason in North Carolina - they don't have to even tell you why. I was fired two years ago - it's complicated - not for being sick though. It's an incredibly painful experience and my heart goes out to this nurse. Thank you for writing the article and bringing up this topic. It just provides more supporting evidence for my assertion that nurses MUST speak up and band together or we will never have the respect and rights we deserve. Please consider joining the ANA and getting involved in policy making through the ANA PAC - donate $1 - it makes all the difference in getting our voice heard.

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