Nurses Struggle with Duty to Respond

Last night I had a conversation with a friend and former colleague who is concerned about reporting to work. She was told there would be no masks for students and faculty. If that wasn’t enough added stress she also has an elderly parent over 80 years old that lives with her and 3 small children. Her fears are not unfounded and they are the tip of the iceberg.

We have all heard the stories of nurses being told to reuse masks which is a supremely bad idea and risky under the best scenarios and foolish during a pandemic. Too many nurses and physicians in rural hospitals have no N95 masks in the emergency department. Other nurses are making masks out of gowns and we know that there are already many nurses in self-isolation due to work exposure. Fears are well-founded, but we have a duty to report to work.

Duty to Report

Willingness to report to work is largely related to role conflicts: nurse, parent, caregiver for elders, and self-care. Nurses’ willingness to respond has a profound impact on disaster planning, hospital preparedness, patient care, and policy. Chaffee (2009) did an integrative review of the literature on the issue of willingness to respond. As it relates to pandemics she wrote:

Biological outbreaks appear to be a significant barrier to willingness to work. In the Balicer et al study of public health department employees, 53.8% indicated willingness to work in a pandemic influenza outbreak. This is consistent with other reports. Qureshi et alfound 48% of health care workers in New York City indicated they would be willing to work in a severe acute respiratory syndrom outbreak.

In a quick review, I found that between 35% and 65% of nurses say they would not be willing to respond during a pandemic. Many cited fear for children or other family members. Fear under these circumstances is legitimate, but duty should outweigh the fear. I can’t imagine what it must feel like to have small children or frail elders in the home, but I do watch as my 67-year-old husband with asthma and hypertension goes off to the clinic each day. I suppress my desire to ask him to take all the vacation and sick leave he has built up over his workaholic life. I resist because his team and his patients need him. He was surprised as a psychologist that he had a full load of patients today. Rather than his patients canceling it appears that their stress may be increasing visits. Also, when the nurses are busy the other staff (psychologist, social workers, etc.) are helping with the screening of patients at the door to help keep the clinic safer.

I can’t tell you how to examine your conscience and make the decision to report to duty. What I can say is that this time will define how you see yourself for the rest of your life. One day you will look back with pride or regret, but you will look back. Responding to 9/11, anthrax and many other crises profoundly impacted my life. They gave me strength and purpose that I still find hard to explain. As a person of faith, I believe that every nurse is given a gift of healing. Use the gift and bring comfort to the sick, the frightened, and the dying. And know that the nurses and physicians that walk with you through this crisis will be your brothers and sisters for the rest of your life.

Greater love has no one than this, than to lay down one’s life for his friends. –John 15:13

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