Well-being at work: is your job making you ill?

What nurses told our survey about norovirus, healthcare-related injury and working when sick

What nurses told our survey about norovirus, healthcare-related injuries and feeling the pressure to work when sick

  • Nursing Standard survey finds one in six nurses have taken time off due to an injury or illness related to their work 
  • Many say workplace practices and short-staffing make them reluctant to take time off when ill
  • Tips for how to avoid norovirus and other infections this winter and how to support staff who call in sick
Norovirus, shingles, cld,fluand tonsillitis were among the most common illnesses nurses attributed to work
Picture: iStock

One in every six nurses in the NHS has had to take sick leave in the past year because of an infection or injury picked up at work.

A Nursing Standard survey found that 16% of more than 2,000 respondents had to take time off due to a healthcare-associated bout of poor health.

Coughs, colds and norovirus: why nurses fall ill

Norovirus, cold, flu, shingles, tonsillitis, diarrhoea and vomiting and chest infections were among a long list of infectious illnesses that nurses attributed to work.


of almost 2,240 nurses who took part in our survey (367) have missed work in the past 12 months due to a healthcare-associated illness or injury

Source: Nursing Standard well-being at work survey 2019

As the NHS struggles with a major shortfall of nurses, it can ill afford relatively high rates of work-related sickness absence. The NHS in England alone has 43,000 vacancies, along with workforce gaps in care homes and independent hospitals.

Our survey findings come as a surge in norovirus cases has led to the closure of more than 1,100 hospital beds in England in the first week of December.

Nurses who responded to our survey pointed out how difficult it can be to avoid being exposed to infectious diseases when caring for others. ‘[I got] chicken pox due to caring for a patient with shingles,’ one nurse said. 

Another said they developed diarrhoea and vomiting after a patient ‘projectile vomited on me’. 

One respondent said: ‘Several of our residents have had chest infections and, as they have dementia, it is very difficult to implement any kind of infection control,’ a nurse said. ‘If they want to cough, then they cough. If it is in your face that is your bad luck.’

‘Have had norovirus three years in a row. Gone to work anyway due to feeling guilty as it's short-staffed’

Nursing Standard well-being at work survey respondent

Some nurses said they were exposed to conditions they could do little to alter. ‘Working in the community exposes you to unhygienic environments beyond your control,’ one respondent said.

Others had experienced distressing events that led to illness. 


of nurses have worked at least once in the past 12 months despite feeling too ill to do so

Source: RCN employment survey 2019

A BMJ study suggests that during a mild flu season almost a quarter of healthcare staff in acute hospitals will be infected with the virus. 

Feeling the pressure to work even when unwell

The difficulty of taking sick leave was emphasised by respondents.

Many nurses reported they often didn’t take time off due to concerns about not getting paid, getting into trouble or leaving other staff with too much work.

‘Have had [norovirus] three years in a row,’ one nurse said. ‘Been ill and gone to work anyway due to feeling guilty as it's short-staffed.’

Another said: ‘Although I have been unwell with dreadful cough and stress I have gone to work because we are short-staffed and it puts too much pressure on the rest of the team if I take time off.’

Following infection control procedures such as handwashing reduces risk to staff and other patients
Practice good hand hygiene if in contact with norovirus – and don’t rely on alcohol hand gels
Picture: Neil O'Connor

Tips on avoiding norovirus and other bugs this winter

Always follow local infection prevention control policies, which are designed to protect staff and patients, says Pat Cattini, president of the Infection Prevention Society and lead nurse deputy director of infection prevention and control at the Royal Marsden NHS Foundation Trust.

  • Get your flu jab as soon as possible and encourage others to do the same
  • Carry a small bottle of alcohol hand rub when out and about This is important particularly if travelling on public transport or in situations where you will touch rarely-cleaned surfaces such as escalator handrails or cash points
  • Avoid close contact with people who have obvious coryzal symptoms On a cold day a scarf can double as a face shield if on public transport with people who are coughing or sneezing
  • Clean and disinfect surfaces and ensure good hand hygiene if clearing up vomit from a patient with norovirus – a face mask may also help. Don't just use alcohol hand gels, as they do not kill the virus  
  • If you get norovirus try to maintain your fluids to avoid dehydration and stay off work until at least 48 hours after the symptoms have gone; this acute gastrointestinal illness is usually short-lived. You should also avoid contact with others who are working in a healthcare setting
  • If you get norovirus, use household cleaner to disinfect surfaces or objects that could be contaminated Wash any items of clothing or bedding that could have become contaminated separately at as high a temperature as the fabric will tolerate. Don't share towels or prepare food for others
  • Flush away any infected stool or vomit in the toilet, with the toilet lid down, and clean the surrounding area with a disinfectant such as bleach
  • If your symptoms persist for longer than three days, seek medical advice


‘I don’t dare take time off': why presenteeism is a problem

Presenteeism during illness, when staff come in to work when unwell, was a problem for many. Some staff are simply ‘too afraid’ to call in sick, one survey respondent said.

Another said: ‘My company has very strict sickness policy, I don’t dare to take time off. Three weeks ago I was very ill and I worked through it, because I was worried sickness will go against me.’

Some nurses said this approach exposed them to viruses. ‘I caught a virus from a doctor who came to work ill, which caused me to miss three weeks of work unpaid due to me being in probation as a newly qualified nurse,’ a nurse said.

‘Some organisations are moving away from a punitive approach, to sickness absence schemes that support staff who need time off’

Kim Sunley, RCN national officer for health and safety

The 2019 RCN Employment Survey also highlighted this type of presenteeism as a significant concern.

The survey findings, published in November, show that 84% of nurses have worked at least once in the past 12 months despite feeling too ill to do so, and 18% have done so on more than five occasions.

Many nurses told our survey they do not take time off when sick, due to pressures and short-staffing
Many nurses told our survey they are reluctant to take time off when sick, due to pressures and short-staffing
Picture: iStock

‘Among those nursing staff and students who stated they had worked despite not feeling well enough to do so, 70% said the pressure came from themselves to attend work, and around half (51%) said they felt pressure from their workplace sickness policy,’ the RCN report said. It added ‘the risk to themselves, their colleagues and their services are significant’.

NHS staffing shortages can exacerbate illness and injury, the RCN says

RCN national officer for health and safety Kim Sunley says that poor staffing and gaps in rotas leave nurses more exposed to illness.


of NHS staff sustained musculoskeletal injuries in 2017

Source: NHS staff survey 2018

‘If you are run down, not sleeping well, working long hours and stressed, that affects the immune system, can add to nurses’ vulnerability to illness, and is a concern,’ she says.

‘The workforce crisis can also play a role in physical injuries. For example if it takes 3-4 people to move a patient safely, people may be tempted to take a short cut if there aren’t enough staff around, and leave themselves at greater risk of hurting themselves.’

How NHS managers can help stamp out presenteeism 

Kim Sunley, RCN national officer for health and safety
The RCN’s Kim Sunley: ‘Some organisations
are moving away from a punitive approach’

The RCN urges employers to end punishing approaches to absence that force people to come to work when unwell.

‘Some organisations are moving away from a punitive approach, to sickness absence schemes that are more holistic, realistic and progressive and support staff who need time off,’ Ms Sunley says.

Many nurses told the survey about physical injuries they had sustained through their work. Respondents mentioned knees, hips, shoulders and backs damaged after years of physical work, including moving heavy patients.

About 28% of the almost 500,000 staff who responded to the 2018 NHS Staff Survey said they had sustained musculoskeletal injuries in the course of their work in the previous 12 months. ‘This continues a steadily worsening trend since 2015,’ the report said.

One nurse told the Nursing Standard survey: ‘[Patient] went into cardiac arrest on the floor. Floor was wet so decision was made for us to all lift patient on to bed. Tore my right shoulder tendon.’

Another nurse reported injuring themselves in a fall when using a broken chair, while another was injured when they were strangled by a patient.

One listed a range of physical ailments they had as a result of their job: ‘Back, stress, recurrent infection, anxiety and shoulder pain and neck pain, as forced to stand up for the whole 13 hour [shift] with a computer that has no arm or wrist support.’

What to do when one of your team calls in sick: advice for line managers

According to NHS Employers guidance, how a manager responds when a staff member calls in sick can make a big difference to how they feel about their work.

  1. Preparation is key Familiarise yourself with your organisation’s sickness absence reporting procedure, and keep a note of contact numbers and referral procedures for occupational health and counselling services
  2. Always ask the following questions What’s the reason for the absence? How long do you think you’re likely to be off? Is there any work you’ve been doing that needs to be picked up while you’re off?
  3. Consider any adjustments that may be needed If the illness is infectious, is there a specific period of time that the staff member needs to remain off work once they are symptom free? If the reason for absence is musculoskeletal, could you make a rapid referral (if this is available)? 
  4. Listen and support When you are busy, it can be easy to forget the importance of listening. If this was you ringing in sick, how would you feel and what would you want your manager to say?
  5. Keep in contact If your employee is going to be off for more than one day, discuss how often you will keep in touch and who will contact who. Knowing when you’ll be in touch next will reassure them and enable you to review any support needed, plan cover and discuss dates and options for the staff member’s return to work

Adapted from Everything You Need to Know about Sickness Absence: A Simple Guide for NHS Managers by NHS Employers


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