Risky Business: A Mediated Model of Antecedents and Consequences of Presenteeism in Nursing

Effect of authentic leadership on nurses' stress, burnout, presenteeism during COVID-19

PURPOSE

The COVID-19 pandemic has burdened the health-care system and exposed nurses to immense stress. This study therefore aims to investigate nurses' mental well-being who are working with COVID-19-positive patients. Burnout leads to decreased productivity and manifests as emotional exhaustion, depersonalisation (cynicism) and low personal accomplishment (professional efficacy). Authentic leadership is built on a humanistic value system, which is the core value of nurses and other health-care professionals. This study therefore used authentic leadership as the independent variable.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional quantitative research method was adopted by distributing validated online questionnaires to 1,334 nurses in a private pathology laboratory and 241 questionnaires were analysed with 93.4% female respondents. Multiple linear regression model testing was conducted.

FINDINGS

Multiple regression analyses showed statistically significant negative correlations between authentic leadership and emotional exhaustion, cynicism, job stress and job-stress-related presenteeism, and a positive correlation between authentic leadership and professional efficacy.

PRACTICAL IMPLICATIONS

This study provides empirical data to encourage organisations to focus on developing authentic leaders to decrease nurses' burnout, job stress and presenteeism. The health-care sector should strive to create an environment where nurses are valued and their talent is recognised to increase employee engagement and commitment.

ORIGINALITY/VALUE

There were two contributions in this study: first, to determine whether there is a relationship between authentic leadership job stress and job-stress-related presenteeism. Second, to determine whether there is a relationship between authentic leadership and the three sub-constructs of burnout.

How Do Presenteeism and Family Functioning Affect the Association Between Chinese Nurses' Job Stress and Intention to Stay?

BACKGROUND

Despite a great deal of existing research on nurses' job stress and intention to stay, it is still unclear how the association between Chinese nurses' job stress and intention to stay is affected by presenteeism and family functioning.

AIMS

This study aimed to investigate the correlations of Chinese nurses' job stress, presenteeism, and family functioning with their intention to stay and clarify the mediating effect of presenteeism and the moderating effect of family functioning on the association between their job stress and intention to stay.

METHOD

A cross-sectional study of 1,008 nurses was performed in a major general hospital in Qiqihar City, Heilongjiang Province, China. The participants were invited to engage in a questionnaire survey regarding job stress, presenteeism, family functioning, and intention to stay. A moderated mediation analysis was conducted through multiple linear regression analysis and the PROCESS macro.

RESULTS

Job stress and presenteeism were negatively correlated with intention to stay, whereas family functioning was positively correlated with intention to stay. The effect of job stress on intention to stay was partially mediated by presenteeism (Effect = -0.147, 95% CI = [-0.305, -0.003]). In addition, family functioning moderated the direct effect of job stress on intention to stay (Index = -0.134, 95% CI = [-0.274, -0.001]).

CONCLUSIONS

Presenteeism and family functioning were found to play mediating and moderating roles, respectively, in the relationship between job stress and intention to stay. Relevant interventions or family-friendly programs should be developed to enhance nurses' intention to stay.

The role of the nursing work environment, head nurse leadership and presenteeism in job embeddedness among new nurses: a cross-sectional multicentre study

BACKGROUND

The retention of new nurses has become a major challenge for medical institutions. Job embeddedness has been seen as a valuable lens for examining nurse turnover, but greater details about job embeddedness are rarely disclosed, especially among new nurses. This study aimed to reveal how the nursing work environment, head nurse leadership and presenteeism shape job embeddedness in this population from the perspective of conservation of resources (COR) theory.

METHOD

A cross-sectional multicentre study involving 436 participants from 10 cities and 33 hospitals was conducted over 4 months. Samples were selected using a two-stage convenience sampling method. A sequential multiple mediation model performed with SPSS-PROCESS was used to analyse the relationships among the nursing work environment, head nurse leadership, presenteeism and job embeddedness.

RESULTS

The nursing work environment not only directly affects the job embeddedness of new nurses (β = 0.480, p < 0.001) but also indirectly affects it through the sequential multiple mediating effects of head nurse leadership and presenteeism (R2 = 0.535, F = 82.160, p < 0.001).

CONCLUSIONS

New nurses' job embeddedness needs to be improved. These results suggest that preserving adequate resources for new nurses, such as work environment resources, head nurse leadership resources, and individual productivity resources, is an effective way to shape their job embeddedness. In addition, when a certain resource is insufficient, fully considering the principles of investment and buffering between resources and providing reciprocal, alternative, or buffer resources in a timely manner are necessary to improve new nurses' job embeddedness.

LARGE LANGUAGE MODELS

Large language models (LLMs), such as ChatGPT, were not used during the writing of this article. An expert native English speaker performed language revision.

Nurses' experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities

OBJECTIVES

This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses' experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients.

DESIGN

An explorative qualitative study.

SETTING

The study was conducted at three out-of-hours primary care facilities in southwest Norway.

PARTICIPANTS

A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study.

RESULTS

The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses' health; nurses' awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism.

CONCLUSION

Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.

Work limitations and associated factors in rheumatoid arthritis, axial spondyloarthritis, osteoarthritis and fibromyalgia

INTRODUCTION

Rheumatic and musculoskeletal diseases (RMD) impact on work participation. The aims of this study were to: examine work limitations of working people with: rheumatoid arthritis, axial spondyloarthritis (axSpA), osteoarthritis, or fibromyalgia using the Workplace Activity Limitations Scale (WALS, a measure of presenteeism); and identify personal, functioning and disability, and work contextual factors associated with presenteeism.

METHODS

Secondary analysis was conducted of a cross-sectional survey including work outcome measures (WORK-PROM study). A literature review identified variables (coded to ICF) to include in multivariable regressions examining factors associated with presenteeism.

RESULTS

Moderate to high WALS scores were identified in: 93.60% with FM; 69.90% OA; 65.20% RA; and 46.80% axSpA (n = 822). Similarities in work limitations were noted across conditions, although some more problematic in specific RMD. Participants received help with about a quarter of activities (27%RA; 25%FM; 23%OA; 17%axSpA) and work adaptations for less than a fifth causing difficulty (18%FM; 14%RA; 14%OA; 9%axSpA). Literature review identified 33 variables in the WORK-PROM dataset to include in multivariable regressions. Factors associated with higher WALS scores were worse: functional limitations, job strain, pain, difficulties with mental-interpersonal job demands, perceived health status, work-life balance, greater need for work accommodations and lack of perceived work support.

DISCUSSION

This study extends understanding of work limitations of working people with these four RMD, the extent of help and adaptations received, need for more work accommodation support, and focus on work support, work rehabilitation, and healthy workplace practices to help keep people working.

Health-Related Factors Influencing Nurse Turnover by Clinical Career: A Secondary Data Analysis of Clinical Nurses in South Korea

The increase in clinical nurse turnover is an important issue in human resource management worldwide. Factors influencing it include health-related risk factors such as sleep quality and presenteeism, which need further exploration. We examined differences in job survival time of clinical nurses in relation to nurses' sleep quality and presenteeism. Participants were 857 Korean clinical nurses with more than three months' experience providing direct patient care. Data were analyzed using a time-independent Cox proportional hazard regression analysis of factors affecting actual turnover of clinical nurses. Average job survival times of competent, proficient, and expert nurses were 33, 64, and 143 months, respectively. Sleep quality and presentism significantly affected turnover risk. For clinical nurses with less than three years of experience, sleep quality significantly influenced the risk of turnover. For clinical nurses with more than six years of experience, presenteeism significantly affected the risk of turnover. The findings of this study offer a clinical career-based approach to reduce the turnover rate of clinical nurses. A differentiated approach based on work experience is necessary to establish a turnover management strategy for clinical nurses.

'Powering through': A qualitative descriptive study of nurses working while in pain

AIMS AND OBJECTIVES

To describe the experience of nurses working while in pain and the potential impact on work performance. Pain is described more broadly and inclusive of musculoskeletal injuries, psychological and emotional pain.

BACKGROUND

Nurse have been recognised as developing pain and injuries; however, the experience of nurses working while in pain and its impact is not well-described.

DESIGN

A qualitative descriptive analysis of interviews from an explanatory mixed methods study.

METHODS

Twenty direct care nurses who experienced pain in the past week participated in the semi-structured interviews. Transcripts were analysed using content analysis. Guidelines for reporting following the COREQ checklist.

RESULTS

Categories identified: (1) pain provocation, quality of pain, refers, severity, and time (PQRST); (2) Avoiding pain at work; (3) Hiding pain's impact; (4) Tools at Work; (5) Pain recovery at home; (6) Career consequences; and (7) 'Supernurse' culture; (8) Stigma and its impact on pain management; and (9) Dream work environment.

CONCLUSIONS

Pain was described as part of nursing and impacted nurses' career plans and performance. Nurses described minimising the direct impact on their patient care but admitted that there was an impact on teamwork and thinking which have been linked to negative patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Clinical practice was an aggravating factor for all nurses in the study and impacted their performance and career trajectory. Workplace tools to decrease nurse injury and pain exist; however, tools were not used often due to lack of resources and training. The culture of nursing that accepts pain as part of the job needs to be addressed.

The Effect of Emotional Labor on Presenteeism of Chinese Nurses in Tertiary-Level Hospitals: The Mediating Role of Job Burnout

Background: Employees who are physically present but work insufficiently because of illness are deemed as having presenteeism. In the health care setting, the issue has taken on greater importance because of the impairment of the physical and mental health of nurses and the nursing safety of the patients. According to the Job Demand-Resource Model, burnout may link emotional labor with presenteeism. Thus, this study analyzed the role of burnout as a mediating factor between the three types of emotional labor strategies and presenteeism among nurses in tertiary-level hospitals. Methods: A cross-sectional study of 1,038 nurses from six Chinese hospitals was conducted. The questionnaires, including the 14-item emotional labor strategies scale, 22-item Maslach Burnout Inventory scale, 6-item Stanford Presenteeism Scale, and items about demographic characteristics and work-related factors, were used to collect data. A multivariable linear regression was used to predict work-related factors and investigate the correlation of emotional labor, burnout, and presenteeism. The structural equation model was implemented to test the mediating effects of job burnout. Results: The results of the study showed that the average presenteeism score of the participants was 14.18 (4.33), which is higher than in Spanish, Portuguese, and Brazilian nurses. Presenteeism was explained by 22.8% of the variance in the final model in multivariable linear regression (P < 0.01). Presenteeism was found to be positively correlated with surface acting, emotionally expressed demands, deep acting, emotional exhaustion, depersonalization, and low personal accomplishment (P < 0.01). Notably, presenteeism was negatively correlated with deep acting (P < 0.01). In addition, burnout partially mediated the correlation between emotionally expressed demands, deep acting, and presenteeism with a mediatory effect of 24 and 63.31% of the total effect. Burnout completely mediated the association between surface acting and presenteeism, a mediating effect of 86.44% of the total effect. Conclusions: The results of this study suggested that different emotional labor strategies affect presenteeism, either directly or indirectly. Nursing managers should intervene to reduce presenteeism by improving the ability of the nurses to manage emotions, thereby alleviating burnout.

Why Are Spanish Nurses Going to Work Sick? Questionnaire for the Measurement of Presenteeism in Nurses

Presenteeism is defined as the presence of the worker at their workplace despite not being in optimal physical or mental conditions. Presenteeism is a phenomenon that has been poorly studied in the context of healthcare. Despite the many negative consequences associated with presenteeism, to date, no studies have investigated this issue in nurses in Spain. The objective was to develop and validate a questionnaire on presenteeism to be used by nursing staff in Spain.

METHODS

A psychometric study for the development and validation of a questionnaire. The PRESENCA^® questionnaire on presenteeism was created by a panel of experts, based on a survey comprised of 31 Likert-type items.

RESULTS

In total, 355 nurses completed the questionnaire. The factorial analysis revealed the existence of 3 factors and confirmed appropriate levels of validity and reliability (alpha = 0.729).

CONCLUSIONS

The PRESENCA^® questionnaire is the first tool developed and validated in Spanish for the assessment of presenteeism in nursing. Our findings demonstrate that this scale has appropriate psychometric properties and its use may facilitate the detection of presenteeism among professionals. As a result, use of this questionnaire may contribute towards the improvement of clinical safety.

Compassion fatigue, presenteeism, Adverse Childhood Experiences (ACES), and resiliency levels of Doctor of Nursing Practice (DNP) students

BACKGROUND

Doctor of Nursing Practice (DNP) students often experience challenges that can cause poor academic performance and attrition. Known threats to nurses' professional quality of life and patient care include compassion fatigue and presenteeism; it is not known how these phenomena carry over from prior nursing experience to DNP students' academic experiences and subsequent NP practice. Adverse Childhood Experiences (ACEs) can also threaten nursing students' coping ability and overall wellbeing. Building resilience can combat the negative effects related to professional quality of life and traumatic experiences and promote nursing student success.

OBJECTIVES

Measure compassion fatigue, presenteeism, ACEs, and resiliency in DNP students.

DESIGN

A cross-sectional survey was conducted with three cohorts of DNP students.

SETTING

A DNP program at a large public American University.

PARTICIPANTS

DNP students (n = 118) from four NP specialty tracks: Family, Pediatric, Psychiatric Mental Health, and Adult-Gerontology Acute Care.

METHODS

Online surveys were sent to three cohorts of DNP students: one group before beginning the program and two groups, one year apart, before starting clinical rotations in the program. Surveys included measures for compassion fatigue, presenteeism, ACEs, and resiliency.

RESULTS

The demographics of this study sample was similar to other published DNP student samples. The students reported moderate levels of compassion fatigue, presenteeism, and resiliency. ACE scores ranged from 0 to 8 out of 10, and 50% reported at least one ACE.

CONCLUSIONS

Survey results from three DNP student cohorts indicate that many are pursuing advanced practice nursing education with a history of traumatic childhood events, demands of balancing work and school, and moderate resiliency levels. Many have symptoms of negative professional quality of life and presenteeism that could inhibit their job satisfaction and quality of care as an NP. Promoting DNP students' resiliency may improve their ability to thrive amidst academic and professional challenges.