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