Half of nurses may not report during pandemic

Strategies include providing vaccine, family, pet care

Nurses were more likely to report to work in the aftermath of a terrorist attack involving smallpox or a radiological release than face down pandemic influenza, researchers found.

More than half the nurses surveyed in a San Francisco hospital said they would not report for work if a influenza pandemic hit, according to a study presented recently in San Jose at the annual conference of the Association for Professionals in Infection Control and Epidemiology.1 Health care facilities must develop strategies to deal with potential staffing shortages in an effort to prepare for disasters. The objective of the study was to consider potential staffing shortages at an urban, tertiary care, teaching hospital by assessing both the ability and the willingness of nurses to report to work in the event of a local biological or nonbiological disaster, the authors report.

Survey of high-risk units

Descriptive information was obtained through a survey distributed to a nonrandomized sample of nurses working on high-risk units. High-risk units were identified as those most likely to be heavily affected during a disaster. The survey described local disaster situations such as an explosion at a sports arena, an earthquake, and pandemic avian flu. The participants were asked to first indicate if they would be able, and then to indicate if they would be willing to report to work during each disaster scenario.

Ninety-three surveys were completed and returned. The potential of "suffering from a personal health problem" was found to be a significant barrier to the perceived ability to report to work as well as perceived willingness to report to work during a disaster. Out of all the disaster scenarios, nurses were least willing to report to work during an avian flu pandemic (51%; n = 47). Correlations between willingness to report to work during a crisis and significant concern/fear for self or family were found.

In other results, 48% of respondents said they would not report for work following a denotation of a radioactive bomb and 41% said they would not go in during a smallpox attack. "For those three events, the willingness dropped quite a bit," says Karen Anderson, CLS, CIC, one of the lead researchers and an infection control professional at California Pacific Medical Center. "They may have the ability to come but they don't have the willingness anymore. Those were the three where we noticed the shift, and the most was pandemic flu."

On the other hand, nurses were much more willing to work during an earthquake, suggesting that hazards already associated with a region may be more acceptable to workers.

"An earthquake could definitely happen in this area," Anderson says. "It seemed like if it was something physical like that the nurses were much willing to come to work. Some said they may not have the ability to get here if public transportation was disrupted, but they certainly had the willingness to come to work."

They findings suggest that some presumptions about willingness to report to work may be made based on the expected hazards in a given geographic area. Going beyond the San Francisco earthquake example, Anderson notes, "People in Kansas are used to tornados and have already thought some things out."

General factors that could potentially affect willingness to come to work include offers to provide vaccine or treatment to workers and families, elder and child care, and provisions to shelter pets, she noted. "In true disasters, people are going to have to start thinking differently," she says. "Those were things that also entered into nurses' willingness to work during [Hurricane] Katrina. A hospital in New Orleans was able to provide pet care and they were able to keep their staff working. The actually had an area where the pets were kept in crates, and that was very effective. You also have to think up ways of having child care on site."

With regard to pandemic flu, the ability to provide vaccine for staff and their families could be critical in getting workers through the doors of the hospital.

"We didn't ask the question if a vaccine was available for you and your family would you come in?" Anderson says, though adding that in a follow-up survey may address the issue. "Our take-home message is that we need to plan accordingly for those kind of [issues] — to think outside the box and think about giving the influenza vaccine to families so the nurses will remain at work.


  1. Anderson K, Dahl C, DeBaun B. Are all disasters created equal? A survey of nurse's ability and willingness to work during a health care crisis. Abstract 3-37. Presented at the Association for Professionals in Infection Control and Epidemiology. San Jose, CA; June 24-28, 2007.