A Tale of Two Strep Throats
One of my favorite novels is A Tale of Two Cities by Charles Dickens. You may recall its famous opening line: "It was the best of times, it was the worst of times." One of the reasons I love this book is that it uses dichotomy to illustrate the differences and similarities across classes and systems. This is one reason why I think it's a perfect metaphor for this week's post.
There are a lot of reasons for going to work sick and we've all had to deal with a sick coworker. As a Virgo (and a former microbiologist) I have a lot of thoughts about illness in the workplace.
Going to work sick raises complicated issues - both about our boundaries and those of others, and how policy can help or hinder our wellbeing. In this edition of the Better Boundaries Brief, I'm going to share the Tale of Two Strep Throats and what they tell us about healthy workplace boundaries.
In my first real job after undergrad, I was working as a counselor and teacher at a youth wilderness reform camp. We were required to work 5 days on and 2 days off, being fully onsite for those 5 days. One day, I woke up feeling feverish, with ear pain and difficulty swallowing all morning. As the lunchtime meal approached, I felt I was getting worse. I asked permission to leave to go to urgent care. My employer asked me to wait until the lunch meal was done, which I reluctantly did. That was the first red flag. I was later diagnosed with strep throat and advised to isolate for 72 hours. My employer was not happy! I was even asked to come back early, but I held firm. I mean, anyone who has ever had strep throat can tell you how crappy you feel. I stayed home for those 72 hours, but I never felt the same about my job.
Fast forward many years to when I was managing a team of my own. I had an employee come to work with strep throat. She had not been cleared by a healthcare provider to return to work. Her direct supervisor struggled with what to do because she refused to leave work. I reached out to our HR department because we had a clear policy for these situations. But she still refused to leave and decided to create her own solution by staying masked and in her office with the door closed. Backed by policy, we did not relent, and eventually she did leave and came back when she was cleared for work.
Can't relate to strep throat? Substitute COVID. My brother, who is an emergency department nurse, once realized he had COVID while on shift (loss of smell). He had just been cleared to return to work after surgery to remove thyroid cancer, so he was particularly bothered by his boss's response that if he tested positive, they (the ED) were screwed. There was no consideration or value for him as an employee or person. Or take the case of a friend who worked at a large home improvement chain. She had COVID and went to work anyway, because she couldn't afford not to work, particularly after the death of her husband left her as a sole provider.
What boundaries are at play?
Physical: In the incident of the employee with strep throat who refused to leave, she was violating a physical boundary for both herself and others. By showing up to work sick, she wasn't taking care of her own wellbeing, and she was putting other employees at risk. In general, a physical boundary is crossed when we aren't taking care of our health or are jeopardizing someone else's health, and it's also crossed by our employers who may not provide us the flexibility and resources to stay physically healthy. In the story involving my brother, his employer would have put patients at risk by having a COVID-positive nurse on duty, which seems like a poor tradeoff for having adequate staffing IMO.
Time: Pressure to be at work, to perform, and to meet deadlines implicates a time boundary. If your employer is asking you to work instead of care for your health (like mine did or like my brother's tried to pressure him to do), that is violating a time boundary. We don't just need medical care and rest, we need TIME to get healthy. We get paid sick leave for a reason (although this isn't available to all employees). And it's not just going into a physical work space - I hear countless stories of people who are home sick or to care for a sick family member and who are still taking phone calls and joining Zoom meetings. Just stop! You do not have to be accessible at all times - and never violate your own boundaries around time if you can help it.
What policies are at play?
One of the themes of in A Tale of Two Cities is justice. It is a profile of the institutions that are meant to create justice but are often the arbiters of injustice and oppression, contrasted with attempts by people to seek justice outside of those institutions and create their own solutions. This is still so relevant today. Policies around paid sick leave vary significantly across states and employment sectors, leading to inequities and forcing inadequate solutions and compromises on our health.
Policies that shape boundaries around our physical health include:
Paid sick leave or other paid time off. For certain conditions, you may be required to provide medical clearance before you return to work. Your employer may also have a policy around mental health days or other leaves of absence that will be in your Employee Handbook. The Family Medical Leave Act also provides for unpaid leave, but this is also not accessible to all employees.
Onsite employee health. Employer-sponsored primary health clinics can provide easy access to care, improving employee wellbeing and reducing absenteeism, among other things. You can learn more at the National Association of Worksite Health Centers.
Health insurance. Be familiar with your coverage, including wellness benefits. You can also explore options through the Health Insurance Marketplace and Medicaid in states that have adopted expansion.
Labor Unions and Collective Bargaining Agreements (CBA). Unions are a key factor in better working conditions and better employee health. According to this literature review, unions are "an underappreciated social determinant of health." The CBA in effect at a previous job I held had an article on sick leave that covered health care provider certification and modified work assignments, among other provisions. If you are covered by a CBA, know your rights.
Staffing requirements. My brother's story illustrates the problem of nurse-to-patient ratios across the U.S., which are generally mandated in state law. But staffing issues exist everywhere, from retail and service industry jobs to public defender's offices and more.
Graph from the U.S. Bureau of Labor Statistics
Who is most impacted?
According to this 2019 study by the U.S. Bureau of Labor Statistics, Black and Hispanic workers are less likely to have access to paid sick leave. This report explores other racial and ethnic disparities in access to and use of paid family and medical leave.
According to this pandemic-era article, a higher percentage of essential workers are women, with the highest representation in social work and health care. Women are also 5 to 8 times more likely than men to be affected by caregiving responsibilities, including caring for sick family members.
Low wage workers, who are disproportionately workers of color due to historical policies, like the National Labor Relations Act and the Fair Labor Standards Act in the 1930s, are less likely to have access to both paid and unpaid leave and are more likely to report fear of losing their job due to taking leave.
What can you do with this information?
Take time off before you get sick. Use all vacation, PTO, sick leave, holidays, and personal days. Your life is worthy and precious.
If you value your wellbeing, seek out employers aligned with this value, who offer adequate resources to support your wellbeing, or advocate for these resources if they don't exist.
Paid sick leave is offered in 15 states + DC. If you live in any of the light blue states on this map by KFF, learn more about state-level efforts around paid sick leave legislation and local economic equity efforts.
KFF State Health Facts: State Policies on Paid Family and Sick Leave (Paid Sick Leave displayed)
In "How did this many deaths become normal?", Ed Yong explores how during the pandemic we came to accept both a threshold and gradient of death. This strikes me for what it says about us as a society and the capitalist pressures that force us to de-prioritize our own health and wellbeing and to have less care for others. We need to shift the narrative by advocating for employers and states to give workers what we need to be healthy, and equipping workers with the tools to advocate for better working conditions.
Employer behavior drives the physical and legal infrastructure for our wellbeing. The U.S. is the only country in the developed world without a national framework for paid family and medical leave, which means that employers get to choose what kinds of paid leave policies they offer and to which employees. This is a point of advocacy for a better, national framework for employee health.
I chose this quote from Audre Lorde today because we live in a system that is harsh for many of us, but particularly harsh for employees of color, women, and other marginalized population groups. Taking care of ourselves and prioritizing our health is a way to push back against a system that takes more than it gives, that tells us we must be productive, and tells us that we must do, rather than be. I hope you take today's post and consider how you can prioritize your own health this week.