Duty to Care Vs. Duty to Prepare: Ethics of Nurses' Ability and Willingness to Work During Pandemic Flu

Friday, July 15, 2011: 10:30 AM

Sharon D. Martin, PhD, RN
Nursing, Saint Joseph's College, Standish, ME

Learning Objective 1: Describe predictors of nurses' ability and willingness to work during pandemic flu.

Learning Objective 2: Discuss the ethical conflicts between the nurse's duty to care and the employer's duty to prepare.

Objective: Health care worker unwillingness or inability to work during emergencies has been reported but no research has focused on nurses during an actual pandemic. This study reports variables affecting nurses’ ability and willingness to work during the 2009 A/H1N1 flu pandemic and discusses the duty to care vs. the duty to prepare.

Method: A research-based, piloted questionnaire was mailed to a random sample of 1,200 Maine nurses during October – December 2009, the second wave of the A/H1N1 flu pandemic.

Results: Of 735 (61.3%) returns most (90.1%) initially reported intention to work. Thereafter the proportion willing or able to work dropped based upon situational variables. Greater flu threat perception resulted in decreased willingness to work. Major variables affecting willingness to work were decreased personal protective equipment (PPE), family or nurse perceived to be at risk, and vaccine or antiviral medication not provided to both nurse and family. Major factors affecting ability to work included nurse sickened, a loved one needed care at home, or transportation problems existed.

Conclusions: The duty to care was well represented by high intention to work. However, many variables resulted in decreased willingness or ability to work. Although it is impossible to control all variables that can impact a workforce during a pandemic some actions by the employer can increase the likelihood of work attendance. The most important actions are providing adequate PPE, antiviral medication and vaccines to both the nurse and family. These actions demonstrate the employer’s duty to prepare, sometimes referred to as the principle of reciprocity which argues that if employers expect staff to work in high risk situations they, in turn, have the duty to protect staff. The important ethical issue is to what extent nurses have a duty to care when the employer has not demonstrated the duty to prepare.