Healthcare's Unspoken Sick-Day Rules Unchanged by the Pandemic

Nearly 3 years after the start of a global pandemic, physicians and nurses have seen their workplace sick policies change with the tides of COVID-19. They've had their temperatures taken, filled out screening forms, and adapted to shifting availability of personal protective equipment.

But according to those who work bedside, attitudes toward coming into work sick haven't changed as much. Healthcare providers told MedPage Today that, pandemic or not, the workplace culture built around a sense of duty and urgency keeps it rare to stay home sick. If anything, short-staffing across medicine has made people even less likely to take sick time than before.

Business as Usual

To some, "no sick time" has always been a part of the job description.

"COVID didn't change the nature of the desire for most physicians to go to work. And COVID or not, most physicians go to work even if they're not feeling 100 percent," Joel Zivot, MD, an anesthesiologist and intensivist at Emory University in Atlanta told MedPage Today, "whether it's pride, whether it's wanting not to inconvenience your colleagues, whether it's not wanting to inconvenience your patients, whether [medicine] selects for that sort of personality of people who like to work hard."

To others, going into work with some symptoms is better than relying on someone else -- or worse, no one -- to step in to do your job.

A travel nurse at a Boston-area psychiatric hospital, who asked not to be named due to workplace policies, recalled how it was at the smaller hospital where she was on staff during the height of the pandemic. "It's just you and your patients and if you're not there to help them, then who will be?" she told MedPage Today. "I had a small facility. You don't really have the luxury of having a sick day."

A number of physician and nurses MedPage Today spoke with described feelings of guilt when they had stayed home from work because of illness.

"When I'm sick or not feeling well, I'd be like, 'Oh my goodness, I feel so bad for the other person that I can't be there,'" said Simone Wildes, MD, an infectious disease physician at South Shore Hospital in Weymouth, Massachusetts. "I know I can't be there, but it still bothers me that they will have all the patient load."

Incapacitated by Illness

Most providers said that the only time they generally took time off of work for illness during the pandemic was if they had visible symptoms that would interfere with work or were physically incapable of doing their job.

Morgan Wolf, RN, wrote in an email to MedPage Today that she was more likely to call out from the New York-based reproductive health clinic where she worked through the pandemic if she had an illness that would "make you measurably or visibly ill, like you are when you have a fever or a gastrointestinal bug," but not for one with "less acute symptoms of an illness, like a cough, congestion, or more than normal fatigue."

With the latter, "You probably aren't at your best or most efficient self, but you can still perform physical labor and talk to patients and make it through the day. So, when I had these 'less acute' symptoms, I felt I could call out and have a valid reason, but I felt pressure to suck it up and go to work," she explained.

Two of the physicians and one nurse only took time off because of severe COVID-19 early on, before vaccines were available. Wildes told MedPage, "When I had COVID, I just physically couldn't do it. You have to be really sick to not come in. You're so lethargic or so fatigued that you can't do the work."

When Zivot got COVID-19, he was out for 2 weeks. "I think people wondered, 'Well, I wonder if he's going to die?' I wondered that too, 'So am I now going to die?'" he said. "But I didn't."

And though most healthcare providers MedPage Today talked to confirmed what's essentially a mandate to grin and bear it, pandemic or no, not everyone agrees it's a good thing.

The Boston-area nurse said she had COVID-19 so severe at the start of the pandemic that she had to get emergency care. Even so, she recalled, "Every other day HR was reaching out to me asking if I was ready to come back. It was just pretty frustrating when you can't breathe, or talk, or do anything."

She also said coworkers started a rumor that she was faking illness to get off work. She said, "It sucked because I'm sitting here, going to the ER and they're like, 'Oh, she's just enjoying her time off but pretending to have COVID.'"

Wolf described a similar situation. She described a time when a coworker called out sick with COVID-19 and one of the other nurses, "half joking, said maybe she has fake COVID."

"I ... didn't trust that my decision to call out would be respected by my managers. It often felt like it was met with suspicion or frustration or lack of empathy," she said.

Wildes says she's had to send employees home because they came to work sick and found that they were relieved she had made the decision for them.

COVID-19 Policies Then and Now

Healthcare providers described COVID-era policies that made it both hard to call out and easy to come to work sick.

For example, symptom screening questionnaires that most had to fill out to go to work or log into electronic health records systems worked on the honor system. The Boston-area nurse described manning a screening tent in the parking lot where all employees had to get their temperature taken and fill out a symptom questionnaire during the peak of the pandemic. She described temperature guns that kept reading 80°F because it was so cold outside and people indicating they had no symptoms while audibly coughing or hoarse.

Two nurses MedPage Today spoke with who worked under travel contracts said no sick days were included. Wildes and Zivot said they both didn't know whether or not they had allotted sick days.

At least two employers asked staff to report their symptoms if they suspected COVID-19 infection but made them pay to get their own tests. "We were never tested at work, nor were we ever given tests to take home and use at our discretion," said Wolf. "Testing, as a result, was something that would have to take place on our time and from our own initiative."

"I would say I felt that COVID was acknowledged and attended to when convenient, but protecting patients and staff felt like it was less important than the efficient provision of services," she added.

Temperature checks have gone by the wayside, but some people MedPage Today interviewed are still asked to fill out health questionnaires before work. Masking rules have become less strict for some, but most doctors and nurses reported that they were still provided masks and required to wear them in clinical or patient care areas.

Staff Shortages

One thing that did change: hospitals and clinics have less staff for the same amount of work, or more of it.

HHS reported that in the first few months of 2022, as many as 22% of hospitals that chose to report had critical staffing shortages. The Department of Labor reported that the country will need 195,400 more nurses over the next decade to meet healthcare needs. Hospitals across the country are offering signing bonuses and other incentives to attract new hires, and travel nurses are still in high demand.

"A lot of people have left the field, and so we don't have as many people to do the job," Wildes said. "The shortages in the healthcare field make it even less likely for us to be like, 'Oh, I just want to stay home today and lay in bed.'"

Wolf echoed this sense of obligation: "We were dealing with significant, and at times dangerous, understaffing. I felt guilty calling out because I knew this would add strain on coworkers who were already overworked."

Doctors and nurses said the added pressure to be a "team player" ultimately contributed to burnout. "You have to cover for other people and you get exhausted. I think that's the bottom line -- you do get exhausted," said Wildes.

Wolf added, "I just wonder, if we felt empowered to call out when we did feel ill and trusted our decision would be respected, if it would have eased some of the burnout."

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