Predictor's of nurses' ability and willingness to work during the 2009 A/H1N1 pandemic

Background: Studies of health care worker unwillingness or inability to work during emergencies have been reported but none has focused on nurses during a flu pandemic. Objective: This study reports variables affecting nurses' ability and willingness to work during the 2009 A/H1N1 flu pandemic. Methods: A survey was mailed to a random sample of 1,200 Maine nurses during the second wave of the A/H1N1 flu pandemic, October through November 2009. Initial willingness to work was measured then tracked as situational variables were presented. Results: Of the 735 (61.3%) returns most (90.1%) initially reported intention to work (positive responders). Thereafter, only personal protective equipment (PPE) increased willingness to work and many variables decreased ability or willingness to work. Positive responders were more likely to work with gown, gloves and N-95 mask (P < .001) or with gloves and N-95 mask but no gown (P = .022) but less likely with inadequate PPE (no gloves, N-95 mask, or no PPE at all). Those indicating initial intention not to work (negative responders) were less likely when assigned flu patients for care (P < .001), colleagues were quarantined (P = .036) or had died of flu (P = .009), they feared family might die of flu (P = .037), they were sick for any reason (P = .033), children or elders needed care at home (P = .008), antiviral medication and vaccine were provided for nurse and family (P = .034), double pay was offered (P < .001) or free room and board was provided to avoid bringing the virus home (P = .004). No variables increased the likelihood of negative responders to work. Conclusions: To retain the nursing workforce employers should focus on positive responders providing adequate PPE and decreasing risk to families. Negative responders are unlikely to work even with incentives.