Nursin' USA - 'I was shocked at the level of sickness absence on NHS wards'

11 April, 2010

Our resident American nurse Sarah Morgan on why loyalty to friends and colleagues is a great motivation for reducing staff sickness levels.

Wow - Beyond the Bedpan has certainly hit a nerve.

We all know that the NHS has to become more efficient in the next several years, and we know that sickness absence is one of the areas that keeps being mentioned as a target for improvement. Do nurses get sick? Yes, probably because we are exposed to nations of germs every day. Are we also often tired, dehydrated and therefore more susceptible to illness than the general population? Probably. But we don’t always do ourselves any favours, either.

I know that I have dragged myself into work on a less-than optimal level of sleep because I got talked into seeing the midnight showing of a movie the night before. I have also forgotten to pack a nutritious lunch and have made it through a 12 hour shift subsisting on soda and candy bars. And let’s be honest — I’m not the only nurse in the UK (or the US) that has done this.

But, there are also abuses in the system. There is a tiny minority of nurses (as there is in every profession) that take advantage of the sickness absence policy, calling out sick on a regular basis when they are not really ill. And the process for performance management of sickness absence is so tedious and time-consuming that it is a daunting process even for experienced managers.

I admit, in my first nursing post in the UK, I was shocked at the levels of sickness absence on the wards. It was rare for a shift to go by without at least one person calling out sick. And as we all know, it is very difficult to find bank or agency cover on such short notice, so the shift would be extra busy for those of us who had arrived at work.

Although staffing is fairly similar in the US and the UK, there is one major difference in policy that many hospitals in the US use and I don’t mind saying that in this case, the American way is better. We used an ‘on-call’ system to fill shift vacancies caused by illness.

How does it work? Well, in my emergency room, the nursing rota was written in six week segments. In addition to my normal shifts, I was required to request one ‘on-call’ shift in each six week rota. On that particular day, if one of the regularly scheduled nurses called out because of sickness, I would get a call from the nurse in charge letting me know that I needed to come in to work.

I was paid the bank rate for the hours I worked that day because they were above and beyond my normal shifts. If no one called out sick, I was off the hook and had the day to myself.

OK, there were downsides: you couldn’t make any plans for that day, because you never knew in advance if you would be working or not. And you did have to spend some time anxiously waiting by the phone to see if you got called with the bad news that you did have to come into work. But it was only once every six weeks and if I did get called in, my grumpiness was somewhat soothed by the $300 or so that I would get paid for the shift.

Here’s the interesting thing—the on-call system was an excellent tool for keeping staff honest about their sickness absences. I knew that if I called out sick, someone else was going to have to come in on a day that they should have had off. And since we were a tightly knit team, what it meant in practice was that if I didn’t come in and do my job, one of my friends would have to do it for me. This was a very powerful deterrent to pulling a sickie, just because I woke up on a Monday and didn’t feel like showing up.

You may be wondering if this system encouraged people to come to work even when they were truly sick, just so that they would not impose on their colleagues. I tested this theory during my first year of nursing, when I came down with a terrible cold. I didn’t want to be the weak link and ruin the on-call nurse’s day, so I gamely trudged to work, well-supplied with tissues, paracetamol and throat lozenges.

As soon as I arrived, the nurse in charge took one look at me, realised that I was more infective than a nursery full of three-year-olds with conjunctivitis and sent me back home. Yes, the on-call nurse had to come in, but at least I hadn’t spread my misery and germs to all of my colleagues. And, I happen to know that the nurse who was called in that day didn’t mind covered for my illness. She spent the extra money that she made on a weekend in New York City.

Readers' comments (67)

Anonymous | 11-Apr-2010 9:21 am
All I can say is, lucky you, getting a higher rate of pay for your banking hours. It is a bog standered rate in the hospital I work in, so there is no incentive to work over your contracted hours.
I do think that the 'on call' system you work sounds interesting.
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Anonymous | 11-Apr-2010 9:50 am
I agree that the on call system sounds interesting. Perhaps it should be trialled to see if sickness levels improve and whether costs can be saved.
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Anonymous | 11-Apr-2010 10:05 am
I think it sounds like a good idea. I would rather have a day when I knew I had a chance of being called in, and make plans accordingly, than being phoned frequently on my days off and when I am on holiday to ask if I would cover a shift, and then feeling bad when I say no because I want my holiday.
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tinkerbell | 11-Apr-2010 10:31 am
I agree, there is a large amount of sickness amongst nhs staff. Of course, there are those who are genuinely off sick, but there are those who are regularly off sick from one month to the next, year in, year out. Its always the same old names on the off duty who leave the rest of the staff on the ward to struggle on. Everybody knows who they are and it lowers the morale of the team spirit. Not only do they take substantial amounts of time off work regularly, they then ask that they have their annual leave reimbursed or carried over to the following year, thus leaving the ward understaffed yet again. I think its called 'screwing the system' and some nurses seem to have taken a degree course in how to do it. There's no need to feel guilty if you are off with a genuine illness or a heavy cold, that can't be helped, but i think it is high time that the regular sick merchants got called to account. When I worked in the private sector we were allowed 5 sick days a year, if you had more than that you had to claim SSP. I didn't agree with that because sometimes staff went in to work even though unwell. It goes from one extreme to another but the NHS certainly needs to deal with the issue of the regular sick merchants who are using the nhs as a gravy train. It probably wouldn't make any difference using an on call system to those who have no moral conscience about phoning in sick at the drop of a hat but its worth a try just to get the message home because of the impact it has to those who keep holding for the fort for those who have no loyalty towards their work colleagues or patients.
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mike | 11-Apr-2010 11:20 am
First of all I would like to say that I come from an Army background with a culture of 'loyalty to your mates' and just getting on with it. After all if you weren't there to do your job your mates would pick up the slack. The difference was, you knew in the military that while you were backing your mates up, they would back you up to the hilt too.

It just does not work that way in the NHS. I too have noticed that a lot of people 'take the piss' when it comes to taking time off. At first it really annoyed me, for example I had 100% attendance throughout my training and took great pride in that, whilst other students were off every other week and some missed vast chunks of placements, yet still qualified. All they had to do at the end was write a few essays to make the time up! That really annoyed me! And this carried on into my work.

But do you know what? I can't really blame them anymore!

Nursing is already a highly stressful job with low pay for the level of work we do, we are already working at full capacity with too few staf, it gives you no thanks or reward for working your backside off, for doing countless hours of unpaid overtime, for leaving you stressed, burned out and demoralised, for missing precious family time, Christmas's and celebrations, ward managers are like vampires, happy to suck the life blood out of you untill you are a bitter and twisted wreck on the floor.

So can I blame people for saying sod this, I want a better work life balance! No, I can't.

I say if the NHS managers want to solve the issue of people starting to look after themselves for a change and taking extra time off work, then they need to adress the issues of poor working conditions. It is easy enough to do.

1. Give us better pay for the level of work that we do.

2. Pay us properly for any overtime that we do, and count those extra hours that we always give at the end of a shift for handover or to cover a patient emergency. (I would be happy to swap overtime pay for time off in lieu).

3. Staff the wards correctly with a decent Nurse/patient ratio so that we are all not burned out at the end of every shift.

4. Have a bit of common sense with the off duty to take into account work/life balance (no split days off for one), family time and holidays such as Christmas (those of you with Children don't have the monopoly on taking holidays off you know) and let us actually take our holiday leave WHEN WE WANT IT so we can plan our holidays!!! Not a few days here and a few days there because you are too incompetent to hire enough staff and get cover.

Etc etc etc.

Until working conditions are sorted out, you can't blame people for looking after themselves. I know that sounds selfish, but you know what, this career has FORCED me to start thinking that way!
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Anonymous | 11-Apr-2010 11:25 am
It's time the NHS took a good hard long look at the Agenda for Change trash that we have to put up with. You get paid all your enhanced rates even ig you are off sick and a lot of nurses just milk it to the extreme and are off at the drop of a hat, leaving everyone else to pick up their work. As a manger, I then have to pay twice to cover the same shift...no wonder the NHS is going down the pan. Sickness management policies are total pants and OH depts are way way too soft!!!
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Anonymous | 11-Apr-2010 11:29 am
It is an excellent idea (it would be better were overtime paid, but as had already been said, flat rate seems to be the norm over here), but if we truly want to fix the excessive sickness seen in the NHS we should be doing this AND stop paying people when they don't work. Or if this is too draconian for those who believe NHS workers deserve to be paid to stay at home, then sick pay (limited to a few days a year) should not be paid at all for the first 37.5 hours of sickness. Go off for a day or two and you get nothing. Go off for two weeks and you only get one week's pay, go off for longer than that and you should have to claim SSP like the rest of the country.
And, and here's a thought, rather than paying serial offenders, those who are off for long periods time and again or for two or three days a month every month, and we all know who they are, instead of interviews with management which let's face it are no deterrent at all, then give out the prerequisite amount of verbal and written warnings, and then give them the sack and replace them with people who want to work instead. It's a penalty the rest of the country, and the world, face every day. We should not be treated any differently.
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Sue Bacon | 11-Apr-2010 11:30 am
I think that this seems a good idea - everyone knows where they are.
I note the comment about pay - 'only the standard rate' - however, you mustremember that if you work over and above full time hours then you are entitled to overtime pay. Ifg you only work part time you will get your normal pay up until you go over full time (37.5). It may be that you are asked to take time owing - this may be the case in some hospitla but remember - if you do not get the time back then you are also entitled to get paid.
I feel very passionate about the NHS getting free hours from dedicated nurses who feel that they 'owe' some duty of care to work without pay. Each ward should have a recognised system for recording time owing and ensure that staff get the time back or get paid - if this does no happen in your hospital then it is important to speak to your union rep.
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Anonymous | 11-Apr-2010 11:32 am
If professionalism(MANNERS, ETC,) interpersonal skills(REFLECTION,etc), and ways to keep healthy(EXERCISE AND DIET) were incorporated into mandatory training every year, sick time taken would decrease. Nurses need continued training and yes sick time as education must be included in this training to make them more aware of the decisions they make. The most important thing, is to teach people how to be morally conscious of the decisions they make and management needs to care more about the humans they employee rather than the budget and its components, the chances for a ward to work as a team increases, to care for each other , which results in staff working cohesively rather than being short staffed, etc. As a nurse(presumably a manager knows how to care, I am sure they care for someone), inclusive of our roles, is to care for each other. If all these factors were mandatory before commencing employment and with continuous yearly training, we might just have a chance to run a ward smoothly with people who care about their patients, and each other(this is really common sense stuff), ask any psychologist.
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Anonymous | 11-Apr-2010 12:53 pm
I too get very annoyed at the same nurses always calling in 'sick'.
It has not helped that the trust now will record a nurses compassiate problem as a sickness rather than allow a small amount of flexibility eg a shift swop so this leads to an increase in sickness.
Also many a time have I went into work and coughed and sneezed over my patients and colleagues but the nurse in charge never asks if I am ok let alone send me home!
I think we should publish every depts sickness level monthly.
If we didn't get paid for the first 2 days of sickness the level would soon drop. Harsh I know but I always seem to have to work twice as hard as I can almost guarantee if a nurse has called in sick there won't be anyone else coming in to cover the shift.
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Anonymous | 11-Apr-2010 1:13 pm
Does anyone know the legal standpoint regarding working "overtime" as bank/NHS professionals? I know a Trust which has banned overtime only to fill the gap by nurses working bank on their own wards. Surely if they work in their own employment this should be paid as overtime, not bank rate? And just because you sign on with the bank to work elsewhere does not mean you can't be paid overtime on your own ward?
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Anonymous | 11-Apr-2010 1:19 pm
There is no perfect system but this one seems like a very good idea to be tried and tested in the NHS. I would have liked this system better than the one I worked on when one could be called at very short notice during leave 24 hours a day. One was always politely asked but if you refused you were told there was no one else availabe and made to feel extremely guilty if you made a fuss. However, being expected to drop arrangements at short notice was not always easy or agreeable and colleagues who worked 100% always bore the brunt. Nurses with children and those who worked part time and lived further from the hospital were more priviledged and for some reason were allowed to say which days they were unavailable for work even during the normal duty rota. This made it impossible for those working full time to attend courses on a regular basis as they had to work or be available on the days the others did not wish to work!
There is only one problem with the above suggestion and that is that the NHS seem to be totally resistant to any suggestions from nurses who come from outside and who have the experience of exellent systems which really worked well.
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Anonymous | 11-Apr-2010 1:21 pm
Out of interest, I asked my manager how often they submit their statistics for sickness. Her response shocked me. Apparently in 2009 managers in the London area ( not sure about other areas) we required to submit the number of nurses not on duty eachday -- this ranged from those that were having their day off, on annual leave or maternity leave and those who were 'off sick'. Interestingly though all these categories were reported as absence due to sickness. I checked with another manager and I found this to be true. This error may have been corrected by now but one wonders whether the high statistics that were produced were a result of this error. I am one of the nurses who rarely go offsick and at one point last year I went to work against my doctors' advice (& I dont reccomend this to anyone) and everything turned out to be fine. I wonder how such an error(if true) could have happened ....cuts?...cuts?...cuts? ... SOMETHING STINKS ABOUT THE WHOLE ISSUE!
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Jaqueline Turner | 11-Apr-2010 2:02 pm
I worked in Oz and they also have an 'on call' system-ie one day every 6 weeks,it worked extremely well as every day each shift was covered if another nurse off sick.there certainly didn't seem to be the high levels of sick days as in NHS.they also have a system of a payment every year over and above salary which can be used for courses,training days,conferences-even abroad.Overall a much much superior work system than here-think I will return!
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Anonymous | 11-Apr-2010 2:28 pm
Hi, have just been reading these comments and my blood is boiling. I am 53 years old and have nursed from I left school. I have worked numerous hours of unpaid overtime, without question. However, I am now on long term sick leave, faced with the prospect of losing my job, and why? I tore the cartilidge in my rt. knee 3 years ago. knee locking continuously, was seen by locum gp(sports specialist), was referred to orthapedic I Cats in April 2008. Was seen by them in August 2008, referred tp knee surg.-s/b him November 2008. MRI ordered, review in 5 months. August 2009, after limping for months, left knee ?went while coming down stairs. Went to A?E.-told it was a wee cyst at back of knee, would be better in a week. Was already on weeks holidays so used them instead of sick leave,as you do.However, on review by surg, (10 monhs later, instead of 5) Sept. 2009, was diagnosed with torn cartilidge. Was put on 16 weekwaiting list for surgery. Went limping back to work (clerical). Had surgery 22nd Dec.2009, left knee. Coming out of pool in Jan. 2010, knee went again, have now been diagnosed with 2 herniated discs , trapping nerves, awaiting another orthopedic app,. Was sent to surgeon who specialises in knees, he referred me to spinal team who, 61/2 weeks later, have not received any communication. Their waiting list is 26weeks. Meanwhile I am waiting, waiting, waiting for someone to see me . totally fustrated. Is this any way to treat dedicated nursing staff. i detest being off work, it is through no fault of my own, especially, when i hour of surgery(artheroscopy) in 2008 would have sorted the original problem, saved me suffering, the health service moneyand sick time and one less sick stastistic. Care of staff should be paramount.
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veronica farrow | 11-Apr-2010 6:03 pm
this sounds like a good idea being on call, but i like the rest of NHS staff work extra hours for the bank at the rate as i am paid now. i work with a very good team who have a loyalty to each other. And if life is so wonderful in the States...? instead of slagging off this overwork and underappreciated body that Sarah has seen fit to grace with her presence and opinions
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Anonymous | 11-Apr-2010 6:07 pm
I would be nice to know that if I walked into work not well that someone would tell me to go home. What usually happens is that they don't notice or if they do they don't care.
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Anonymous | 11-Apr-2010 6:26 pm
The way NHS staff are treated seems to be like an epidemic that has spread throughout the country. Here was I thinking it was only a local problem!

Working straight shifts with no breaks, including lunch breaks. Working extra hours outside of my contracted hours...for free. Extra work being gradually added on to my workload outside of my job description. Not to mention being expected to be psychic the communication betwen management and staff is appauling. The way we are expected to work is more like a juggling game, trying to do all the tasks that is piled upon you, it's more like being on a conveyor belt getting one job out of the way and starting on another just to get the boxes ticked.

It's hardly any wonder you get patients complaining, and mistakes being made. Patients needs attention from nursing staff but the nursing staff are too busy concentration on the non human work getting the boxes ticked. Paper work in triplicate that is more important than patient care. It's expected of you to work extra hours without pay, and you have no choice but to do this.

I have had one day off sick this year which started the day before my leave and 2 days compassionate leave that doesn't really count because I took annual leave. Around me I see staff going sick one after the other, and often think I am the mug. high levels of sickness in any company indicates there is something very wrong within the organisation. How can you expect loyalty when there is none given from the employer.

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Anonymous | 11-Apr-2010 6:59 pm
I've been reading all the comment and agree with them all. Like one nurse, I'm also 53 been nursing for 36+ years and am ready to quit. Can't wait for retirement! Our unit works overtime nearly every day; the time is written in a diary - not that you get it - we don't get paid anymore 'cos it's too expensive. It not unusual to be 15 - 30 min late off duty each night - but woe betide you if you're 1 minute late coming on duty! Sound familiar?

The American and Ozzie system of on-call sounds good. It would be goo to to know your off duty 6 weeks in advance - we're lucky if we know what we're doing in 2 weeks.

I'm starting to moan now so I'll end here. Just to finish, despite all the inadequacies of the NHS, the long hours and hard work; I know it's worth it because most days my patients tell me I do a good job and that makes it all worthwhile.

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Anonymous | 11-Apr-2010 8:25 pm
Here's novel idea- Stop paying sick pay!! Then those lazy sods (We all know one or two) will come into work.
When I worked in the US my bank holiday, vacation and 12 sick days were all thrown into my time off pool. Once I used my time off- whether sick or vacation, that was it, no pay. Guess what motivated me to get into work, when I really wanted to stay in bed- that's right, I could not afford not to work-so I went and was paid for it.
Most private organisations have an limit of 8-12 days per year. And they monitor your time off, and counsel accordingly.
In the US too, they treat their staff well if they suffer an injury at work, and try their hardest to get you the treatment you need in a timely fashion, so that you can get back to work swiftly- until the NHS.
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