Will HCWs come to work during a disaster?

Barriers differ with SARS, snow storm

If a major disaster struck your community, how many of your employees would show up for work?

A snow storm would likely draw in just about anyone who could make it to the hospital, but in an infectious disease outbreak such as SARS, about half of your employees might be unwilling to work, according to a study published in the Journal of Urban Health.1

"Different crises present the responder with different challenges and obstacles," and emergency plans need to address that reality, says lead author Kristine Qureshi, RN, DNSc, assistant professor of community health nursing at Adelphi University in Garden City, NY.

Some emergencies will tax employees’ ability to report for work, due to childcare or eldercare responsibilities or transportation difficulties, Qureshi notes. In other disasters, some health care workers may simply be unwilling to work due to the perceived risk to themselves or their families, she says.

Qureshi and her colleagues at the Mailman School of Public Health of Columbia University in New York City surveyed 6,428 workers from 47 health care facilities in the greater New York City area. The survey encompassed a variety of acute care hospitals — both teaching and nonteaching facilities, ranging in size from fewer than 200 beds to more than 600 beds. It also included long-term care facilities and community clinics. The findings were consistent for all types and sizes of facilities, the researchers reported.

About half (48.9%) of employees said they would be able to report during a snowstorm, while most expected to be able to report for a mass casualty event (82.5%) or environmental disaster (80.6%). Barriers to reporting for work included transportation (33.4%), childcare (29.1%), eldercare (10.7%) and pet care (7.8%). Many also had health care problems (14.9%) that could affect their ability to report. That might include the need for treatment, such as dialysis, or for medications.

Hospitals should stress the need for personal emergency planning, including backup caregivers and emergency contacts that are updated annually, says co-author Robyn Gershon, DrPH, associate professor at the Mailman School of Public Health.

They also should have emergency plans for providing care for employees’ family members, she says. For example, a temporary childcare center could be set up, and elderly relatives may be able to help with the care of the children. Hospitals should also consider employees’ needs for pet care, she adds.

"People don’t want to be separated in a time of disaster. They want to know where their family is," Gershon says.

Willingness to report to work involves different barriers. Less than half of those surveyed said they were willing to work during a SARS outbreak (48.4%). They also were less likely to be willing to work during radiation (57.3%), smallpox (61.1%), or chemical (67.7%) events.

The reason: concern for their family or themselves.

For those events where employees perceive they are at higher risk of injury to themselves or their family, they are less likely to be willing to report," says Qureshi.

Health care workers must believe that they are going to be safe at work, she says. "In the United States, we normally do not tell people when they’re hired in health care that you have an obligation to respond, even if it’s going to hurt or kill you."

Health care workers might be worried about being stigmatized during an infectious disease outbreak. During the SARS outbreak in Toronto, some health care workers reported that their children were ostracized as their friends’ parents worried they might carry the virus, Gershon says. Nurses also were quarantined during the outbreak, allowed only to go home or to the hospital. They even wore respiratory protection at home when they were around their family.

The survey was conducted shortly after the SARS outbreak.

In some cases, the perception of risk may not reflect the true level of risk, Gershon reports. Hospitals may address perceptions of risk through education, she says. They also can improve trust by providing for adequate personal protective equipment and other worker safety provisions in emergency planning, she says.

Health care workers also were very willing to help out another facility during an emergency (79%), but that willingness depended in part on proximity. For example, only 17.5% said they would be willing to work in another state.

The recent Katrina disaster demonstrated the willingness of health care workers throughout the country to pitch in. Some volunteered for medical support teams that traveled to the Gulf Coast. And in many communities, nurses and other health care workers volunteered to provide medical care and assessments to evacuees.

"Every person that I talk to within the system wants to help," says Sharon Marsden, RN, employee health nurse at Seton Medical Center in Austin, TX, where nurses, social workers, and pastoral care staff were able to take time from work to care for evacuees at the Austin convention center.


1. Qureshi K, Gershon RRM, Sherman MF, et al. Health care workers’ ability and willingness to report to duty during catastrophic disasters (Advance Access published on July 6, 2005). J Urban Health 2005; 82:378-388.