Healthcare workers' perceptions of the duty to work during an influenza pandemic

Abstract

Healthcare workers (HCWs) are often assumed to have a duty to work, even if faced with personal risk. This is particularly so for professionals (doctors and nurses). However, the health service also depends on non-professionals, such as porters, cooks and cleaners. The duty to work is currently under scrutiny because of the ongoing challenge of responding to pandemic influenza, where an effective response depends on most uninfected HCWs continuing to work, despite personal risk. This paper reports findings of a survey of HCWs (n = 1032) conducted across three National Health Service trusts in the West Midlands, UK, to establish whether HCWs' likelihood of working during a pandemic is associated with views about the duty to work. The sense that HCWs felt that they had a duty to work despite personal risk emerged strongly regardless of professional status. Besides a strong sense that everyone should pull together, all kinds of HCWs recognised a duty to work even in difficult circumstances, which correlated strongly with their stated likelihood of working. This suggests that HCWs' decisions about whether or not they are prepared to work during a pandemic are closely linked to their sense of duty. However, respondents' sense of the duty to work may conflict with their sense of duty to family, as well as other factors such as a perceived lack of reciprocity from their employers. Interestingly, nearly 25% of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families.

Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers

“…HCPs were more likely than lay persons to endorse the view that HCPs do not have an absolute obligation to provide care to Ebola patients (29% vs 18%). This echoes the finding of Damery et al 20 that physicians and nurses in the UK were less likely than non-clinician health service employees (eg, ancillary workers) to agree with the statement that ‘doctors and nurses have a duty to the sick even when there are high risks to themselves.’ The tendency of lay people to reject HCPs’ freedom of choice to provide care (more than HCPs) might illustrate the social contract view suggested in ethical discussions 3 4 6. This view holds that society bestows special privileges on HCPs, especially on physicians—including relatively high incomes, medical practice prerogatives and tax support for their training—so that, in return, society can rightfully expect that its members who are ill will receive the care they need.…”

“…They found that 28% agreed that ‘it would be professionally acceptable for healthcare professionals to abandon their workplace during a pandemic in order to protect themselves and their families’, 52% disagreed with this statement and 19% had no opinion. In the  UK, Damery et al 20 examined healthcare workers’ perceptions of the duty to work during an influenza pandemic and found that 37.9% of respondents agreed that ‘healthcare workers should be able to refuse to work with infected patients’ and 59.9% disagreed.…”

An evaluation of knowledge, attitudes, and behaviors of employees of a university hospital in an H1N1 influenza pandemic

“…Nevertheless, they should also protect their health while they are treating patients [7]. For this reason, the training of health professionals is a dynamic process, and continuous in-service training is necessary.…”

What could clinicians do to prevent hospital-based outbreaks of emerging and existing respiratory infectious diseases? Raising awareness is key

“…Barriers to their willingness to work during an influenza pandemic are (1) prioritizing the well-being of their family members, (2) lacking trust in their government's health department, (3) lacking information about the risks during the crisis, (4) fearing litigation during care delivery, and (5) lacking support from employers to address their needs [12] . A survey study conducted by Damery and associates [10] similarly found that healthcare workers feel that they have a duty to work during pandemics despite personal risk. However, their sense of the duty may be compromised by their sense of duty to their families and their perception of a lack of reciprocity from employers.…”