The nurse without a nurse: the antecedents of presenteeism in nursing

Patient Safety Culture Among Nurses in Hospital Settings Worldwide: A Systematic Review and Meta-Analysis

BACKGROUND

Assessment of patient safety culture (PSC) is critical for health care organizations worldwide to recognize areas that require urgent attention, promote patient safety, and improve quality of care. The aim of this systematic review was to determine the overall PSC score among nurses worldwide and identify the dimensions of PSC that score the highest and the lowest, as well as any geographical differentiations.

METHODS

Literature research was conducted in PubMed and Scopus search engines and the Agency for Healthcare Research and Quality (AHRQ) Research Reference List to identify studies published in English between January 2004 and May 2023 that used the Hospital Survey on Patient Safety Culture, version 1, to measure hospital nurses' assessment of PSC. This review followed the PRISMA 2020 guidelines and was registered in PROSPERO.

RESULTS

From 1,507 records, 21 studies were included with 10,951 participants. The overall PSC score was 3.341 (95% confidence interval [CI] 3.221-3.460). The dimension scored highest was Teamwork Within Units, with a mean score of 3.719 (95% CI 3.594-3.844). Staffing, with a mean score of 3.096 (95% CI 2.980-3.212) was scored lowest. Statistically significant differences related to geographical distribution were found for overall PSC score and five of the PSC dimensions.

CONCLUSION

Nurses throughout the world rated the PSC at their organizations moderate to good. Certain dimensions of PSC were reported to need reinforcement to create a strong overall safety culture in health care. Participants rated European hospitals as having a stronger PSC than South American or Middle Eastern hospitals. Differentiations need to be further studied and analyzed for effective and targeted global interventions.

Presenteeism among nurses: An integrative review

Background

Presenteeism, a phenomenon in which employees attend work despite physical or mental limitations, is prevalent among nurses and has negative implications for patients, healthcare organizations, and nurses themselves.

Objective

We aimed to present the current state of knowledge on presenteeism in nursing, focusing on prevalence rates, reasons, influencing factors, and consequences.

Design

We performed an integrative review.

Methods

We searched databases for studies on presenteeism in the nursing workforce published between 2018 and 2024. This review included 44 studies that met the inclusion criteria, specifically 38 quantitative studies, 4 qualitative studies, and 2 reviews.

Results

The results indicated that the prevalence of nurses exhibiting symptoms of presenteeism varies between 32 % and 94 %. The influencing factors include workload, team culture, age, childcare responsibilities, job insecurity, and leadership practices. Presenteeism can lead to significant individual and organizational consequences such as increased health issues among nurses, decreased quality of patient care, and higher healthcare costs. Most studies were focused on nurses who work in hospitals, with only one study addressing nurses who work in nursing homes.

Conclusion

This review highlights the high prevalence of presenteeism among nurses and its multifaceted causes and effects. This underscores the need for increased awareness and training of both nurses and management teams regarding the importance of addressing presenteeism. Further research is needed in settings such as nursing homes and outpatient care to understand the unique challenges and impacts in these environments. Efforts should focus on improving working conditions, fostering supportive organizational cultures, and implementing effective leadership practices to mitigate the negative effects of presenteeism.

Relationship between job burnout and presenteeism in anesthesia nurses: mediating effect of psychological capital

BACKGROUND

Psychological capital can effectively alleviate job burnout and improve career autonomy and job satisfaction. However, there is a lack of research on the mediating role of psychological capital between job burnout and preseneeism in Chinese anesthesia nurses.

AIMS

The mediating role of psychological capital between job burnout and presenteeism based on constructing structural equation models in anesthesia nurses.

METHODS

This study was a cross-sectional study design. From June to July 2024, convenience sampling was used to conduct a questionnaire survey of 568 anesthesia registered nurses in different levels of hospitals in Sichuan Province. The self-designed general information questionnaire, Chinese version of Stanford Invisible Absence Scale (SPS-6), Psychological Capital Scale-Chinese Revised (PCQ) and Maslach Burnout Inventory-General Survey (MBI) were used to investigate the status through the form of questionnaire star. Pearson correlation analysis was used to explore the interaction among psychological capital, job burnout and presenteeism. AMOS 26.0 software was used to further verify the mediating effect of psychological capital between job burnout and preseneeism, and to construct the corresponding path relationship model.

RESULTS

The scores of psychological capital, job burnout and preseneeism were 93.31 ± 14.33, 56.35 ± 17.67 and 18.96 ± 4.97, respectively. Job burnout of anesthesia nurses was significantly negatively correlated with psychological capital (r=-0.558, P < 0.01), and was significantly positively correlated with presences (r = 0.465, P < 0.01). Psychological capital was significantly negatively correlated with presences (r=-0.495, P < 0.01). In addition, psychological capital was identified as a partial mediating effect between job burnout and preseneeism in the mediation model, and the mediating effect was 0.279, accounting for 48.18% of the total effect.

CONCLUSION

The job burnout of anesthesia nurses has reached a moderate level, and job burnout can positively predict preseneeism. Psychological capital partially mediates the positive effect of job burnout on preseneeism, and the improvement of its level has a positive effect on reducing job burnout and preseneeism of anesthesia nurses. Therefore, enhancing psychological capital has become an important way to relieve the occupational stress and improve work efficiency of anesthesia nurses.

Examining presenteeism and productivity losses among nursing workers: a cross-sectional study

Objective

To characterize presenteeism and productivity losses among nursing professionals in public and private health services.

Method

A cross-sectional study was conducted with 123 participants from a public hospital and 159 from a private hospital in Manaus, Brazil. The Sociodemographic Health Questionnaire was utilized to assess presenteeism, while the Work Limitations Questionnaire measured productivity losses. Data were analyzed using non-parametric methods.

Results

Health-related work loss and presenteeism were reported by 50.41% of public sector professionals and 39.62% of private sector professionals. Despite this, presenteeism was more prevalent in the private sector (93.65%) compared to the public sector. Common health issues included musculoskeletal (26.49%), mental/behavioral (19.21%), respiratory (17.22%), neurological (16.56%), and gastrointestinal (5.96%) conditions. Additionally, 54.24% of private sector professionals and 44.23% of public sector professionals did not seek treatment. The private sector exhibited greater limitations in receiving care due to time management (40.34%), mental-interpersonal tasks (49.95%), production tasks (52.54%), and physical tasks (61.30%), resulting in higher productivity losses among nurses (13.46%) and nursing technicians (15.82%). High-complexity sectors demonstrated the greatest productivity losses.

Conclusion

The study identified significant differences in the characteristics of presenteeism and productivity losses between nursing professionals in the public and private health sectors. These results point to the need to improve management and occupational safety and regulatory measures to solve workers' health problems and mitigate presenteeism and productivity losses in the public and private health sectors.

Common mental disorders, productivity and presenteeism in nursing workers

OBJECTIVE

To investigate the association between the occurrence of common mental disorders with loss of productivity and presenteeism in nursing workers at a public health service.

METHOD

This is a cross-sectional study, with 291 workers from Midwestern Brazil. Data collection carried out from October 2019 to January 2020, with instruments for sociodemographic characterization, labor and health conditions: Self Reporting Questionnaire-20, Standford Presenteeism Scale and Work Limitations Questionnaire. Data were analyzed using descriptive and inferential statistics, with Mann-Whitney tests and logistic regression, respecting a significance level of 5%.

RESULTS

The occurrence of common mental disorders was 4.27 times more likely to experience presenteeism, 10.17% of compromised overall productivity, and impairment of mental/interpersonal and production demands.

CONCLUSION

The occurrence of common mental disorders was associated with presenteeism, with repercussions in loss of productivity of nursing workers.

Mediating effects of psychological capital on the relationship between workplace violence and professional identity among nurses working in Chinese public psychiatric hospitals: a cross-sectional study

OBJECTIVE

To examine the relationship between workplace violence (WPV) and professional identity among Chinese psychiatric nurses and the mediating effects of psychological capital (PsyCap) from this association.

SETTING

Seven public tertiary psychiatric hospitals in Liaoning Province, China.

PARTICIPANTS

A total of 952 psychiatric nurses were recruited for this study. Registered nurses who have been engaged in psychiatric nursing for more than 1 year were eligible as participants in this investigation.

OUTCOME MEASURES

Questionnaires consisting of the Workplace Violence Scale, the Occupational Identity Scale, the Psychological Capital Questionnaire and a demographic data sheet were used to collect participant information. We used hierarchical multiple regression and asymptotic and resampling strategies to examine the mediating role of PsyCap in the relationship between WPV and professional identity.

RESULTS

WPV was negatively associated with professional identity after controlling for demographic factors (β=-0.353; p<0.001). PsyCap mediated the relationship between WPV and professional identity, according to the mediation analysis (a×b=-0.150, bias-corrected and accelerated 95% CI (BCa 95% CI) (-0.185 to -0.115); p<0.001). In addition, two dimensions of PsyCap: hope (a×b=-0.075, BCa 95% CI (-0.104 to -0.049); p<0.001) and resilience (a×b=-0.064, BCa 95% CI (-0.090 to -0.039); p<0.001) mediated the association between WPV and professional identity. For professional identity, hope, resilience and PsyCap mediation accounted for 21.6%, 18.1% and 42.4%, respectively.

CONCLUSIONS

Based on these findings, PsyCap could partially mediate the relationship between WPV and professional identity. Therefore, hospital administrators should implement measures to prevent and reduce WPV and provide nurses with skills training programmes to improve the PsyCap such as hope and resilience.

Transtornos mentais comuns, produtividade e presenteísmo em trabalhadores de enfermagem

RESUMO Objetivo: Investigar a associação entre a ocorrência de transtornos mentais comuns com a perda de produtividade e o presenteísmo em trabalhadores de enfermagem de um serviço de saúde público. Método: Estudo transversal, com 291 trabalhadores da região Centro-oeste do Brasil. Coleta de dados realizada de outubro de 2019 a janeiro de 2020, com instrumentos para caracterização sociodemográfica, condições laborais e de saúde: Self Reporting Questionnaire-20, Standford Presenteeism Scale e Work Limitations Questionnaire. Os dados foram analisados por estatística descritiva e inferencial, com Testes de Mann-Whitney e regressão logística, respeitando o nível de significância de 5%. Resultados: A ocorrência de transtornos mentais comuns apresentou chances 4,27 maiores para vivenciar o presenteísmo, com 10,17% da produtividade geral comprometida e prejuízos para as demandas mental/interpessoal e de produção. Conclusão: A ocorrência de transtornos mentais comuns esteve associada ao presenteísmo, com repercussões em perda de produtividade dos trabalhadores de enfermagem.

Contributing Factors of Presenteeism among Portuguese and Swiss Nurses: A Qualitative Study Using Focus Groups

Evidence of nurse presenteeism has mainly focused on quantifying its prevalence and consequences on productivity, quality of care, and patient safety. Few data exist on nurses’ perceptions of their presenteeism and its related causes. We explored concepts of presenteeism and its contributing factors with frontline nurses and nurse managers in different healthcare settings in Portugal and Switzerland. Our qualitative study design involved 8 online focus groups involving 55 participants. The transcribed data was explored using thematic analysis. Three main reasons for presenteeism were identified: unfamiliar terminology; the paradoxical effect of `being present’ but absent; and presenteeism as a survival strategy. Six contributing factors were also recognized: (a) institutional disinterest toward employees; (b) paradigm shift: the tension between person-centered and task-centered care; (c) sudden changes in care practices due to the COVID-19 pandemic; (d) a lack of shared work perspectives with hierarchical superiors; (e) the financial burden of being absent from work; and (f) misfit of human responses. This study generates valuable, in-depth knowledge about the concepts and causes of presenteeism, and significant suggestions for the broader audience of nurse managers and leaders seeking to improve the quality of care.