LTC nurses are the most likely to be looking for new workplaces.

Employees in long-term care settings stay home while sick more often than their cohorts working in hospitals, but there’s room for improvement across the healthcare industry, a new study finds.

The research, conducted by the Center for Disease Control & Prevention’s National Institute for Occupational Safety and Health, found that, on average, around four in 10 healthcare employees work while experiencing symptoms of an influenza-like illness.

Of the nearly 2,000 nurses, aides, physicians, and non-clinical workers surveyed, around 41% reported working an average of three days during the 2014-2015 flu season with symptoms such as a fever or sore throat. Many said they still felt well enough to do their jobs or not “bad enough” to stay home, while others cited feeling obligated to show up to their jobs or afraid they would lose pay if they didn’t.

Long-term care facilities had the lowest rates of employees working with symptoms, at 28.5%. Those who worked in hospitals had the highest rates of working while sick, at nearly 50%.

Healthcare assistants and aides, who are more likely to be paid per hour, reported the highest rates of working while sick (40.8%), followed by non-clinical positions (40.4%) and nurse practitioners (37.9%).

The overall findings are “alarming,” said lead researcher Sophia Chiu, M.D., MPH, since ill workers can spread their symptoms to patients or elderly residents. Patients or residents exposed to a sick worker are five times more likely to come down with a healthcare-acquired infection.

“We recommend all healthcare facilities take steps to support and encourage their staff to not work while they are sick,” Chiu said.

Providers looking to cut down on the number of their employees who choose to work while sick can update their paid sick leave policies, as well as empower workers to “make healthy choices not only for themselves, but for their coworkers and patients,” researchers said.

Finding appear in the November issue of the American Journal of Infection Control.