There are an estimated 400,000 patient deaths annually in the United States due to adverse patient events (James, 2013). Globally, nurses are key to providing quality care and promoting patient safety(Aiken et al., 2013). However, a nurses’ ability to provide care can be affected by the work environment and concepts that impact nurse performance, like presenteeism. Presenteeism is when an employee is physically present, but not fully engaged or performing (Rainbow & Steege, 2017). Presenteeism is often studied as due to job-stress or sickness. Globally, occupational health and business scholars have researched presenteeism for decades, and have found that nurses have higher rates of presenteeism than other professions (Garrow, 2016). It is posited that these higher rates are due to multiple antecedents including nurses’ willingness to place patient and coworker needs above their own, poor nurse health and wellbeing, and job-stress. In addition to employee health and productivity consequences, presenteeism in nursing has been linked to negative patient consequences. These include missed patient care and negative health for nurses (Cassie, 2014; Dhaini et al., 2017; Karimi et al., 2015). However, consequences of presenteeism for nurses, patients, and organizations have not been studied in relation to its multiple posited antecedents. Prior studies have used multiple different presenteeism instruments and have focused on either job-stress or sickness presenteeism rather than a more inclusive definition. This has made comparing prevalence rates across studies difficult. As both job-stress and sickness presenteeism are related and prevalent in nursing, we sought to explore the utility of measures of both as well as the relationships of presenteeism to its multiple antecedents and consequences.
The two aims of this study were to: 1) Evaluate the prevalence of presenteeism across five existing reliable and validated self-report measures of presenteeism occurrence and the psychometrics of those measures for use in nursing; and 2) Examine the relationships between nurse presenteeism, and its posited antecedents, and consequences. We hypothesize that presenteeism is a mediator between these antecedents and consequences.
Methods:
A nationwide cross-sectional online survey of 447 RNs providing direct patient care on inpatient hospital units in the United States was conducted between August 2017 and February 2018. Nurses were recruited through hospital organizations, nursing organization listservs, and social media. The survey included five reliable and validated measures of presenteeism, and antecedent and consequence measures. Measures of presenteeism included the Stanford Presenteeism Scale (SPS), Job-Stress-Related Presenteesim Scale (JSRPS), Healthcare Productivity Scale (HPS), Nurses Work Functioning Questionnaire (NWFQ), and Health and Work Questionnaire (HWQ). Measures of presenteeism were evaluated using descriptive, exploratory and confirmatory factor analysis (Aim 1). Antecedent measures included perceived stress, work environment, professional values, health, and work-life balance. Consequence measures included professional quality of life, missed care, and turnover intent. Path modeling was used to examine the proposed relationships (Aim 2).
Results:
Participants came from 40 states, and the majority (44%) worked dayshift, worked with adult and older adult populations (60%), and worked at hospitals with over 400 beds (40%). In the last month, 39% of participants reported working overtime. The majority of participants were Caucasian (92%), female (94%), and had a bachelor’s degree (66%). Mean rates of presenteeism among nurses (SPS=19.50, JSRPS=2.1, HPS = -15.1, NWFQ=17.0 and HWQ=6.7) were higher than previously published and spanned both job-stress and sickness domains of presenteeism. The psychometrics of three of the five instruments differed from published measure information. Significant antecedents of presenteeism included work environment, professional value, perceived stress and work-life balance. Higher perceived stress and lower work-environment, professional value, and work-life balance were all linked with higher presenteeism. Significant negative consequences of presenteeism included lower professional quality of life, higher turnover intention, and more missed patient care. Presenteeism was also a mediator between multiple antecedents and turnover intent, missed patient care and professional quality of life.
Conclusion:
Presenteeism in nursing is prevalent and linked to increased missed patient care, higher turnover intent and lower professional quality of life. In our study, both job-stress and sickness presenteeism were prevalent and should be studied and addressed in the nursing workforce. Nurses should be aware of presenteeism, its antecedents and consequences and seek to address it before negative consequences occur. Healthcare organizations can survey for prevalence and develop policies to prevent sickness presenteeism and interventions to address stress leading to job-stress presenteeism. Both policies and interventions should consider the potential nursing culture barriers to address presenteeism, like the desire to place patients and coworkers above their own health and wellbeing. Researchers should develop measures of presenteeism that are inclusive of both types of presenteeism and are psychometrically sound. Additionally, interventions to address presenteeism should be developed.