If pandemic strikes, how much staff will you have?

Project availability, plan for homebound staff

Do you know the main reasons your staff would be reluctant to report to work during a pandemic? Do you know how many of your staff will come to work if a pandemic strikes your community?

No one knows for sure, but a recent survey indicates that conflicting duties (i.e., multiple jobs, family responsibilities) or concern for personal safety could lead to an even lower response than might be anticipated. According to a recent survey, hypothetical response to an epidemic ranged from 80% of health care workers for a mild disease with treatment to 18% for a potentially fatal disease with only experimental treatment.1

To get a better handle on what to expect, Colleen Connelly, RN, BSN, emergency preparedness manager at the University of Utah Hospital in Salt Lake City, surveyed the entire hospital staff. The online survey included questions such as what the respondent's role was; if they felt they were really informed about avian and pandemic influenza; if they'd be willing to come to work in the event a pandemic occurred; and if not, why not. In addition, they were asked what the hospital could do to convince them to come to work if they didn't want to.

"We conducted the survey as part of one of our hospital disaster drills — one of the deliverables," Connelly explains. "The hospital medical director sent it to all department medical directors for distribution, and the pandemic flu panning committee pushed it as well."

What really matters

Connelly's survey indicated 64.5% of employees would report to work during a pandemic. However, her goal was not so much to come up with a number indicating how many of the staff would report, but rather to assess their concerns and address them, in order to secure an optimal number during a pandemic.

"In the initial phase, as we went around and talked to people, we got everything from elder care and child care to pet care, so in the actual survey we asked staff to list their needs from one to 10, with one being the most important," she notes.

The survey, which was distributed July 19, 2006, was left open for two months. The responses were anonymous. "We felt that was important, so staff could answer honestly," says Connelly.

Because of the anonymity, it was not possible to break out numbers for a specific department, such as the ED. However, says, Connelly, based on the responses, changes will be made that should benefit all departments. "The main message we got from the staff was, 'Keep me safe at work, and help me take care of my family,'" says Connelly, "And we have used that to try think of alternative ways to respond to a pandemic."

First, she says, the hospital will set up a little store on-site so that people can visit it after their shift and pick up food and other necessities. "This is modeled after what they did in Toronto following the SARS epidemic," she explains. "It might be hard to find things like this out in the world."

Single parents, whose kids would be at home since schools will be closed, or staff with immunosuppression who are unable to report to work, will be used to help operate the call-in center from home.

Additionally, "We're also spending a lot of resources for personal protective equipment such as Positive Air Pressure Respirators for all those staff taking care of patients," says Connelly.

There also was one message that came out of the survey that should be of particular interest to ED managers, Connelly adds. "The request for education was really significant overall in the hospital, so from the ED perspective, education and updates on the progress of avian flu, when they need to be worried and when they don't, is critical," she says. "It's particularly difficult for ED staff, because every patient who comes in during the winter has flulike symptoms — so that knowledge is critical."

Might an ED manager conduct a similar survey targeted just to ED staff? "I think it's a great planning tool," says Connelly. "Each of our facilities and departments are a little different, and you hate to put all these resources into planning if you are not planning for the right thing."

It's important to ask your staff what they think, she continues. "If you include them in the [planning] process, you will get a lot more buy-in," Connelly advises.

Betsy Hackman, RN, CIC, director of infection control for Emory Healthcare in Atlanta, agrees. Her own models indicated 40% of her staff would not show up during a pandemic, so she has purchased Tamiflu (Hoffman-La Roche; Nutley, NJ) for staff members who are considered appropriate. "The ED is certainly in line for that," says Hackman.

To help offset the staffing shortage, Hackman says she also plans to institute remote triage centers outside the hospital. "In those centers we would have a combination of nurses and doctors from Emory who could do triage to tell the patients whether they should go to our ED or not, depending on how sick they were," she explains. "They will probably be located a little bit way away from the hospital; could be in [Emory] clinics or drive-thrus."


  1. Syrett JI, Benitez JG, Livingston WH III, et al. Will emergency healthcare providers respond to mass casualty incidents? Prehospital Disaster Medicine 2007 (in press).


For more information on using surveys as part of pandemic preparedness, contact:

  • Colleen Connelly, RN, BSN, Emergency Preparedness Manager, University of Utah Hospital, Salt Lake City. Phone: (801) 585-3134. E-mail: colleen.connelly@hsc.utah.edu.
  • Betsy Hackman, RN, CIC, Director of Infection Control, Emory Healthcare, Atlanta, GA. Phone: (404) 686-2358.