While hospitals face staffing challenges because of the severity of the current flu season, the lessons learned from 2009's swine flu epidemic have left them better prepared to handle this year's outbreak.
Officials for hospitals and the Centers for Disease Control and Prevention agree that this year's flu season isn't as severe as in 2009—yet. But the rapidly changing situation still hasn't peaked. Widespread flu activity increased last week by one state to 48 states, according to the CDC, which also reported 29 pediatric deaths attributed to influenza. The total number of pediatric deaths from the full 2009 H1N1 season was 282.
Most hospitals increase staffing during the flu season in anticipation of an influx of patients. They also need additional healthy workers to step in for sick employees, with temporary healthcare staffing agencies often used to fill the breach.
Those groups are so far reporting only a slight uptick in demand from this year's outbreak. Ralph Henderson, president of AMN Healthcare, a temp agency that works with systems from as Kaiser Permanente and New York Presbyterian Healthcare System, said his agency “isn't exactly seeing a windfall” from the increased demand from this flu season, but demand is up. “But it's partially negative—our employees get the flu, too.”
He estimates there is about a 20% increase in demand for temp workers across all departments during flu season compared with the 2011 flu season, including a higher demand for emergency room respiratory technicians. AMN, with offices in Irving, Texas, and San Diego, is seeing a higher demand in pediatric and geriatric-care departments, which mirrors the demand seen in 2009. It also matches the two patient populations most at risk—young children and senior citizens.
The effort to limit hospital-acquired infections reinforces the need to keep sick employees at home. Workers at the Cleveland Clinic's facilities suffering from the swine flu in 2009 could return to work only if a nurse granted them health clearance, said Dr. Paul Terpeluk, the clinic's medical director of employee health services. Cleveland Clinic officials in 2009 used a nurse's hotline to track sick workers. Workers would call the hotline and answer health-related questions before taking sick days. Employees were required to call the hotline again before receiving the go-ahead to return to work.
This season, the clinic isn't using the hotline since fewer employees are calling in sick. Terpeluk noted that the employee vaccination rate in 2009 was 50%. Efforts to promote employee flu shots since then have pushed the vaccination rate to 80% of the system's 41,000 workers. The vaccination is not mandatory. “We just allowed people to do the right thing,” Terpeluk said. “We knew we were doing the right thing, and we felt people would follow that example.”
The Cleveland Clinic's policy matches the Occupational Safety and Health Administration's stance that calls for hospitals to provide vaccinations, but stops short of making it a requirement.
Alternatively, Banner Health instituted a mandate in September requiring vaccination. Officials at Phoenix's 22-hospital system said they already achieved a 100% compliance rate among its 37,000 employees, with 3% opting to wear surgical masks instead of getting the flu shot based on religious grounds or pre-existing conditions, said Dr. Marjorie Bessel, medical director for Banner's eastern Arizona region. No one has been fired at Banner for refusing a flu shot, but there have been a few firings across the country, including the termination this month of a nurse who refused mandatory vaccination at Indiana University Health Goshen.
Service Employees Union International is suing the Rhode Island Department of Health, which implemented its own vaccine mandate in October. Generally, unions and other groups representing workers, such as National Nurses United and American Nurses Association, encourage its members to get vaccinated. But they balk at a requirement—at least one that's not negotiated as part of a labor contract.
“In this union environment, an employee mandate cannot just be put into place as a requirement without being negotiated with the union first,” said David Kurtz, a partner in Edwards Wildman's Labor & Employment group in Boston.
It's too early to gauge the true impact of Banner's mandate, Bessel said, since the flu hasn't hit Arizona and other states closer to the Pacific Ocean as hard as the East Coast. Arizona is among 10 states reporting moderate flu activity, with 30 states reporting high activity, according to the CDC. Banner plans to review its program in the spring.
“We're very pleased that we were able to be organized with really good implementation to help us during what appears to be a very hard flu season,” Bessel said.