Showing posts with label COVID19. Show all posts
Showing posts with label COVID19. Show all posts

Monday, February 14, 2022

Managing and terminating staff who refuse to comply with COVID19 safety recommendations

Most medical practices are taking steps to protect their employees and patients from the risk of contracting COVID. I have worked with many practices over the past several months to create thorough policies and training programs to assure compliance with state and federal recommendations.

While most employees/contractors are fully compliant with practice policies while at work, outside the practice many are less vigilant. Some staff may travel to known hotspots or refuse to wear masks outside the practice office. Others regularly socialize with large groups (also without masks) and flout compliance with safety recommendations through comments and photos posted on social media. For practices that are trying to create a safe environment for patients and employees, such employee activities can pose a challenge.

Unfortunately, an employer generally cannot dictate an employee’s conduct on their own time if such conduct is not illegal (i.e. drug use). Efforts to talk with employees and asking them to comply with COVID safety recommendations to help protect patients and co-workers may work, but not always. While many practices would rather turn a blind eye to their staff’s outside activities, this approach may not work if the employee becomes infected with COVID, or when other employees see social media postings and threaten to leave the practice due to safety concerns.



If your practice is facing similar issues, here are some recommendations:

1. The practice should continue to educate staff on the latest data regarding COVID so that all staff is well-informed on travel hotspots to avoid, transmission risks, and best practices. Ongoing training and the constant reminder that practice employees need to care and look out for each other (and patients) can foster some sense of community among employees.



2. Employees that do not have written contracts are generally considered “at will” employees, depending on the state. I have worked with practices that simply decide to terminate those employees they feel are non-compliant with moral or behavioral expectations or who show a disregard for others’ health and safety. It’s important that if the practice elects to terminate an employee who is at will, that no reason be given for the termination (and none is required). It is also important that employees all be treated the same and that there is no discrimination in any termination choices. Be aware that terminating an at-will employee “for no reason” may lead to an unemployment claim.



3. Employees with written contracts are more difficult for a practice to terminate. I have worked with several practices to terminate employees “without cause” where appropriate, by simply providing notice and either paying out the notice period or allowing the employee to work during the notice period. Such terminations also will lead to unemployment claims, but minimize other types of employment claims by the terminated employee


Very few employment contracts have “termination” for cause provisions that apply to an employee’s legal activities outside work (and that would not be legally challenged). One practice I work with used a provision tied to the employee’s conduct “negatively affecting the practice’s reputation.” In this instance, several patients called to complain about an employee’s photo appearing on social media at a large, crowded indoor event with no masks being worn. Even worse, the employee was quoted as saying she did not believe in masks and thought that COVID was a hoax. The practice’s patients threatened not to return to the practice if their employees were not being careful to avoid COVID and taking the risks seriously.

While some practices may have “for cause” provisions that will work to allow an employee to be terminated for such conduct, most practices will want to review their written contracts to see what changes are needed in the termination provision. Alternatively, instead of adding “for cause” termination provisions, shortening a “without cause” provision is always an option.


As the pandemic continues and everyone tires of compliance with masks and other restrictions, employee non-compliance may increase. Employers should continue to enforce all recommended COVID precautions within the practice and remain vigilant of changes in state and federal laws. While conduct a practice views as improper can adversely affect the practice’s reputation and put employees and patients at risk, employers need to be careful (and talk to counsel) before any decision is made to terminate an employee.


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Friday, January 22, 2021

A clinician’s thoughts on the future of COVID-19

The world has been battling the COVID-19 pandemic for nearly a year. As the numbers of infections and deaths continue to surge across the United States, we have finally received hopeful news: vaccines are on the horizon. Vaccines may certainly help protect patients and alleviate the hardship of COVID-19 on healthcare systems, but they will not eliminate the virus or its often tragic repercussions. Even if every person who can safely receive the vaccine takes it when it is widely available, we will still be dealing with the impact of the pandemic for quite a while. And with cold and flu season already in full swing, the question remains: are we prepared for COVID-19 surges this winter?



In September of 2020, LocumTenens.com surveyed physicians and advanced practitioners about their thoughts on the pandemic and the country’s preparedness for future waves as part of its 2020 Physician and Advanced Practice Salary Report. In addition to salary information and employment trends, the company sought a better understanding of clinicians’ perceptions of the pandemic and where they believe us to be in terms of preparedness. The results are not incredibly reassuring. At the time the survey was fielded, 61% of the 2,080 clinician respondents were either unsure or do not think we are better prepared for future waves of COVID-19.

Those who do think we will be prepared believe we have come a long way in our understanding of the virus. Although its long-term effects are still not well known, we have a better idea of best practices for prevention and treatment. These respondents partially credit their belief to enhanced safety measures and equipment, but clinicians generally remain torn about whether they think they will have enough PPE if cases continue to increase at the rate they have been. Forty-two (42%) percent of respondents do believe they will have access to enough PPE, but 58% are either unsure or do not think they will. One family practice physician assistant from the Southwest explains, “I think the hospitals will be more prepared from a standpoint of understanding treatment options better but not from a PPE or facility space standpoint, and the general public will likely not take the precautions as seriously.”



A psychiatrist from the Southwest provides an alternative viewpoint: “Patients and the general public are already educated about how to reduce risks. We have supplies or access is more manageable for PPE.” Throughout the pandemic, the burden of education about the virus has largely fallen to clinicians, many of whom have found themselves playing the role of a teacher to their patients more so than ever before.

When asked whether patients are taking the pandemic seriously and whether misinformation about the virus is an issue, the word “education” was among the most frequently used. “I am concerned with certain patients. I believe most have adequate information, but I disagree with the conclusions they draw from it. The issue is to try to convince them of the serious consequences even if they aren't very likely,” shares a general surgeon from the Midwest. Despite clinicians’ best efforts, education will never be enough if the knowledge shared is not put into practice.

Lack of federal leadership and consistency of healthcare guidelines, as well as the complacency of the public were among the top reasons some respondents do not think we will be prepared to handle COVID-19 surges this winter, but there is also the issue of healthcare insurance. When LocumTenens.com surveyed the public to better understand current healthcare trends in September of 2020, 12% of respondents reported losing healthcare insurance due to being laid off at some point during the pandemic. “[Fewer] people have insurance, so the emergency care system and hospitals will be overwhelmed,” worries an orthopedic surgeon from the Southeast. With emergency rooms across the country already reporting that they do not have enough beds to meet patient demand, the situation is looking especially grim, particularly in some rural areas.


“Until everyone accepts that there is no going back to normal until we have a viable vaccine,” explains an emergency medicine physician from the Southwest, “we are doomed to see a cyclical regression back and forth between excess disease burden and improved patient numbers.” Although it might be easy to believe best practices for prevention are second nature to the public at this point, it is imperative clinicians continue to both educate and reiterate to their patients the importance of doing everything they can to stop the spread of the virus, if not for their own health, but for the health of emergency departments across the country.


About the Author

Diana Adler is SVP of Hospital Medicine at LocumTenens.com. LocumTenens.com is a member of NALTO®, the only professional association of temporary physician staffing firms committed to a code of ethics and to maintaining the highest industry standards.


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