Healthcare workers may be unable or unwilling to report to work during certain disasters

In a first study of its kind, researchers at the Mailman School of Public Health assessed the ability and willingness of healthcare workers to report to work in the event of disasters involving weapons of mass destruction or virulent infectious disease outbreaks.

Eighty-seven percent of healthcare workers from 47 facilities in and around New York City, indicate that they would be able to report for work in the event of a mass casualty incident and 81% would be able to go to work if there was an environmental disaster. However, only 69% of the workers said that they would be able to reporting for work during a smallpox epidemic.

When it comes to willingness to report for work, only 48% of healthcare workers stated that they would be willing to come to work during a SARS outbreak; 57% during a radiological event; or 61% in the event of a smallpox epidemic. The researchers found that a very large proportion of healthcare workers intended to report to duty if the disaster involved mass causalities (86%) or some type of environmental disaster (84%). In addition, while 80% of workers said they would be willing to come to work during severe weather, such as a major snowstorm, a much lower proportion (less than 50%) felt that they would be able to do so.

Over 6,000 healthcare workers in the greater New York metropolitan area participated in the anonymous survey.

Information on healthcare workers' ability and willingness to respond is invaluable not only to healthcare administrators, but to emergency planners and government agencies, as well. "Ability" refers to being physically being able to report to duty. In New York City, this is especially important since workers rely on public transportation to get to work, and any major disruption in mass transit might prevent large numbers of workers from commuting to work. "Willingness" on the other hand, refers more to the personal decision to report to work and this may be influenced by safety concerns or fear of contagion.

The barriers respondents most often cited as affecting their ability to report to work included transportation problems, child or elder care, or pet obligations. With respect to willingness, healthcare workers' fear for their own safety and that of their family members influenced them the most.

These data suggest that healthcare workers' responsiveness may vary depending on the type of situation involved. According to Kristine Qureshi, RN, DNSc, a researcher in the Department of Epidemiology at the Mailman School and lead author, "Although we might assume that healthcare employees have an obligation to respond to these high impact events, our findings indicate that personal obligations, as well as concerns for their own safety play a pivotal role in workers' willingness to report to work."

Similarly, Robyn Gershon, DrPH, associate professor of Sociomedical Sciences, senior investigator at the Mailman School's National Center for Disaster Preparedness, and co-author of the study points out that "Employers must recognize that their healthcare workers are likely to be as concerned or even more concerned about their safety than the average citizen, because they have a greater understanding of the risks involved." Furthermore, she cautions that their concerns for their family members must also be considered.

These findings are of practical importance, since a catastrophic event would result in the need for a fully-activated healthcare workforce. A less than full contingency of healthcare workers on the job could have far-reaching implications, according to the researchers. In addition to the number of sick already being treated, facilities could find themselves inundated with large numbers of victims of a mass casualty incident or other disaster. If adequate numbers of staff members do not report to work, it could result in a situation where hospitals are unable to meet surge capacity needs.

"These survey results reinforce the idea that workplaces, especially healthcare work settings, should discuss personal emergency planning with their employees. These discussions should take place upon hire and conducted annually," states Dr. Gershon. The researchers point out that these findings provide us with the opportunity to enhance healthcare workers' ability and willingness to respond by addressing those barriers that are amenable to intervention. The healthcare facility can help support both the ability and willingness of their employees though careful planning--for example, arranging for emergency transportation and child and elder care. Adds Dr. Qureshi, "In terms of addressing workers fears, and therefore, their willingness to work, healthcare administrators should talk to their workers about their concerns regarding exposure and contagion, and, importantly, reassure them by describing in detail all of the steps the facility is planning to take to assure their safety."

http://www.mailman.hs.columbia.edu/