Stan Wilson Quoted in the WALL STREET JOURNAL
As appearing in the WALL STREET JOURNAL
When Ebola Is a Workplace Issue: Health-Care Workers Worry About Risks, and Hospitals Focus on Training, Communication
Oct. 14, 2014 7:13 p.m. ET
Only a few hospitals in the U.S. are currently treating Ebola patients, but health-care workers around the country are on edge.
A Dallas nurse was diagnosed with the virus Sunday, ratcheting up stress and worry among hospital employees, health-care leaders say. Now, in addition to crafting technical protocol and decoding the latest infectious-disease guidelines, hospitals must figure out how to properly train and motivate workers who may be in harm’s way—and deal with those who may refuse to treat potential Ebola patients.
Issues around communication, training and pay are cropping up as leaders try to quell fears while making sure they will be adequately staffed if infected patients come to their facilities.
New York’s Mount Sinai Health System is trying to combat “a rising sense of anxiety” among staff with town hall meetings hosted by the organization’s president and an infectious-disease expert, according to Marc Napp, its deputy chief medical officer and senior vice president for medical affairs. Middle managers are also being trained to take the emotional temperature of their employees with brief huddles during shift changes—and then to report back to higher-ups, who are supplying the managers with talking points.
Dr. Napp said the biggest logistical challenge thus far has been training workers in the proper use of the protective equipment intended to shield workers from the virus.
Mount Sinai staff started Ebola preparations in late July or early August, Dr. Napp said, believing they were unlikely to actually get a case. Four days later, he said, a patient with a 103-degree fever who had just returned from a trip to Sierra Leone, one of the West African countries with an outbreak, showed up. The patient turned out not to have the disease, but it was a wake-up call.
“Not one staff member balked at being involved in caring for that patient,” Dr. Napp said. “That may change.”
Right now, staff care for the patients they are assigned to but he said the health system is trying to figure out how to respond if a worker refuses.
Tom Frieden, director of the Centers for Disease Control and Prevention, said Tuesday he had been hearing “loud and clear” from concerned health-care workers who felt they were unprepared to treat the virus, which has so far caused more than 4,400 deaths, most of them in Africa.
Daisy Sanchez, a technician who administers dialysis to patients at four hospitals in Connecticut, said she would “just say no” if assigned to an Ebola patient. She said she hasn’t received sufficient education or guidance about the disease from the hospitals she works at or DaVita HealthCare Partners Inc., the dialysis company that employs her. Until recently she wasn’t sure if the virus was airborne or not. (The CDC says the virus is spread by blood or bodily fluids.)
“So many people are dying,” she said. “I need more information about it.”
Levi Njord, an infectious-disease epidemiologist for DaVita, said the company has been emailing some workers with guidelines and information, but has been careful not to “barrage” employees. “We didn’t want to scare teammates,” he said.
He said the company wouldn’t force employees to do anything they felt was unsafe. Dialysis can be a risky procedure for workers to perform on an infected patient.
A survey of 3,000 nurses conducted this past weekend by allnurses.com, an online community for nurses and nursing students, found that 74% don’t feel safe with the situation or prepared to deal with an outbreak or patient. Nurses’ unions have called for more protective gear for caregivers, and a nurses’ organization in Montana—home to one of four institutions with special biocontainment units in the U.S.—said members have requested information on short-term life insurance and extra pay if they were to care for an Ebola patient.
“Any of us would be crazy not to be nervous, not to be scared,” said Karen Higgins, an intensive-care-unit nurse at Boston Medical Center and one of the co-presidents of the nation’s largest nurses’ union, National Nurses United.
Mount Sinai and several other hospitals said they don’t plan to give extra pay to those caring for Ebola patients. Stanford Wilson, an employment lawyer based in Atlanta, advised against so-called hazard pay, saying it could create problems for employers.
Giving bonuses afterward isn’t a bad idea, he said, though employers should be aware that this can cause morale issues, too, with other workers potentially seeking bonuses for other challenging, hazardous situations they have dealt with.
His firm, Elarbee, Thompson, Sapp and Wilson LLP, has had inquiries from a few health-care providers, including at least one hospital, making preparations for potentially treating Ebola patients. Mr. Wilson says hospitals could face lawsuits or federal complaints if they try to force employees to work and they refuse.
At UCLA Health System, leaders say they will make Ebola-related work voluntary. After hearing from workers concerned about putting their families at risk, the health system decided to create a dedicated Ebola response team, according to Zachary Rubin, the health system’s medical director of clinical epidemiology and infection prevention. He is aiming for about 50 volunteers—nurses, doctors and techs—who will receive extra training for treating potential Ebola cases.
Dr. Rubin said he worries about getting enough volunteers but that it hasn’t been a problem yet.
“We understand this is not a situation for everybody,” he said. “We want to let people be able to sleep at night, feeling like they’re good with this decision and they’re not being forced to do something they don’t feel comfortable with.”
Still, Jim O’Brian, the vice president of quality and patient safety at OhioHealth Riverside Methodist Hospital in Columbus, points out that it is hard to relegate Ebola work to a certain subset of employees—a case could come in through an urgent-care clinic, for example. And Mark Fleming, a professor of safety culture at St. Mary’s University in Halifax, Nova Scotia, said volunteerism sometimes isn’t the best approach as it can actually encourage risk-taking behavior. “People feel they’re going to be heroes in that situation and get the job done and get some status,” he said.
Hospitals might find some lessons for navigating the Ebola threat in hazardous industries like mining and construction. But in those industries, a risky situation is often avoided by simply stopping the task at hand and going home for the day.
“The difference between [health care] and other industries is there’s no off switch,” Mr. Fleming said.