Martin, Sharon Dezzani - IUPUI

World Academy of Nursing Science (WANS)
2nd International Nursing Research Conference
Friday, July 15, 2011
Sharon Dezzani Martin, PhD, MSN, RN

Abstract
Aim Explore factors affecting nurses’ ability/willingness to work during pandemic
flu.
Background Studies suggest some nurses may be unable/unwilling to work during
extreme conditions such as PF. Unwillingness is exacerbated by employer
failure to prepare for staff/family safety during emergencies.
Method Questionnaire mailed to random sample of 1,200 Maine nurses during
October - December 2009, second wave of 2009 A/H1N1 flu pandemic.
Results 735 returns. Most (90.1%) reported they would work. Willingness to work
decreased when employers failed to prepare (provide adequate personal
protective equipment (PPE), family/nurse safety, or vaccine/antiviral
medication. Ability to work decreased when nurse was sick, loved one needed
care at home, or with transportation problems.
Conclusion Employer failure to meet ethical duty to prepare impacts nurses
willingness/ability to meet ethical duty to care.
Implications Employers’ duty to prepare precedes and impacts nurses’ duty to care
under extreme conditions.
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Methods
A cross-sectional design with researcher developed and pilot
tested survey.
Population Nurses registered by Maine State Board of
Nursing (MSBON). Stratified, random sample of 1,200.
Data collection During second wave of H1N1 flu pandemic,
October – December 2009, using voluntary, anonymous
survey via U.S. Postal Service.
Instrument 12 variables testing willingness and 14 variables
testing ability to work.
Data analysis Minitab® 15 for Windows (2006), significance
level p

Findings
• Full sample
• Most (90%) initially willing to work
• ↑ risk resulted in ↓ willingness to work
• PPE & family at risk- willingness
• Family or nurse sick - ability
• Coercive & monetary actions ineffective
• Inappropriate work attendance
• Positive vs. negative responders
• PPE
• Family risk
• Negative responders –fearful/mistrustful, resistant to
incentives
• Focus on retaining positive responders
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Ethical Implications
Nurses must engage in dialog and demonstrate leadership in
public and political determinations of “duty to provide care
with obligations to their own health and that of their
families during disasters, pandemics, and extreme
emergencies.” (p.5, Nursing’s Social Policy Statement, 2010)
To date there has been inadequate dialog regarding nurses’
duty to care in emergencies and little or no dialog regarding
employer’s duty to prepare for emergencies.
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Ethical Implications
Though caring for others is central to the practice of nursing,
the nurse must also promote self-care as well as care of
environment and society. (p. 4, Nursing Scope and
Standards of Practice, 2010)
This includes the requirement of adequate safety precautions
during emergencies and the expectation of employer
preparedness even when that involves financial sacrifice for
the employer.
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Ethical Implications
Studies have demonstrated the link between healthy
work environment and effective nursing practice.
Unsafe workplace conditions contribute to ineffective
delivery of care and stress among health professionals.
(p. 5, Nursing Scope and Standards of Practice, 2010)
Unsafe conditions can include the failure to provide
adequate PPE, vaccine, immunizations, education, or
family safety measures during pandemic flu.
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Ethical Implications
The nurse owes the same duties to self as to others, including
the responsibility to preserve integrity and safety…
(Provision 5, Code of Ethics for Nurses, 2010).
This can include a moral objection to resist an employer
pattern of behavior that endangers patient and staff wellbeing,
such as failure to prepare adequately for extreme
emergencies.
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Ethical Implications
The nurse participates in establishing, maintaining, and
improving healthcare environments and conditions of
employment conducive to the provision of quality health
care...(Provision 6, Code of Ethics for Nurses, 2010).
Conflicting obligations for the nurse (employer, family, and
society) are common. Paramount is the employer’s duty to
prepare in order to provide the nurse with a safe workplace
for self and family. This in turn improves the quality of
healthcare for the patient.
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Minimal racial, ethnic, gender diversity among study
population
Potential non-response bias
Study power (76%)
Discrepancy between respondents’ stated intentions -
actual behavior & overestimation of willingness to
behave in socially desirable behavior
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smartin@sjcme.edu
Saint Joseph’s College of Maine
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