Absenteeism - Presenteeism Final Report

PRESENTEEISM AND ABSENTEEISM IN HEALTH
CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 1
INTRODUCTION
Nowadays we are experiencing a lot of issues in the workplace. Filling up
these issues with different solutions in order to improve the management of an
organization or institution. Employees are elongated within their capability, going
to work even though not feeling well. Employees who are likely having medical
conditions are less productive in work than those who are physically healthy.
Presenteeism and absenteeism is not easy to measure and a lot or most employers
havent given a lot of time to quantify it. But still many from human resource
department has an interest on this topic on how to gain benefits and as well
solutions to lessen its bad effect to organization or institution.
With this insight gives a suggestion to employers who are concerned of the
productivity of its workforce in the workplace to improve productivity by learning
about presenteeism and absenteeism and taking time to handle such issues. This
would help open our minds how to handle this kind of situations especially to
managers and higher authorities involve with their staffs within their scope of
responsibility.

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 2
PRESENTEEISM
In this recovering economy, employers and their workforces are faced with
the daunting prospect of doing more with less in the race to improve productivity.
And employees are stretched to their limits, likely showing up to work when sick.
Employees who are at work with medical conditions are likely to be less
productive than those at work without medical conditions. That is the essential
meaning of presentism.
According to Webster dictionary, Presenteeism is the act of attending work
while sick. A topic that is at times considered its opposite, absenteeism, has
historically received extensive attention in the management sciences.
What is presenteeism and how can a manager combat it? An illness related
condition that negatively affects on-the-job productivity of an employee is called
presenteeism. Presenteeism does not refer to loss of productivity due to employees
extending their tea/lunch breaks, slacking by surfing the internet or emailing
friends, or pretending to be ill to avoid working (Munro, L., 2007).

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 3
HISTORY
The study of presenteeism is a relatively new field, but the phenomenon is
not a new problem in the workplace. Presenteeism began to be studied around the
year 2000, while its counterpart, absenteeism, has been studied and quantified for
much longer period. As a result, employers may be more likely to be more aware
and willing to address absenteeism, while reluctant to address presenteeism or
unsure where to begin.
Determining the prevalence of illnesses and medical problems that
undermine job performance in the workforce, calculating the related productivity
loss, and combating that loss in cost-effective ways. This is a new area of study, so
questions remain around a host of issues, including the central one: the exact
degree to which various illnesses reduce productivity. But researchers are
discovering increasingly reliable ways to measure this and are concluding that
presenteeism costs companies billions of dollars a year. Emerging evidence

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 4
suggests that relatively small investments in screening, treatment, and education

can reap substantial productivity gains.
TYPES OF PRESENTEEISM
Professor Cooper, in an article written in April 2011 for the HRMagazine
(UK) identified four types of presenteeism.
Fully Functioning Presenteeism.
These people are healthy and rarely take sick days. They are engaged,
they are motivated and they contribute fully to their job and to the organization.
Sickness Presenteeism
These are those who turn up to work but whose health is suffering to
greater or lesser degree. Although they are not well, their job-insecurity is such that
they come to work even when they are feeling ill, but they are largely
unproductive.

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 5
Job Dissatisfied Presenteeism

These people are generally physically and mentally healthy but have more
absences from work than the average person. Their work may not have damaged
them directly, but they are less engaged or committed to their job, either because
there is a mismatch between their personality/competences and their job or role
requirements, or they are poorly managed.
Stressed or the Chronic Unhealthy.
This type of presenteeism is a combination of those who have a serious
chronic health problem, or those whom the job itself has damaged.
The latter three types of presenteeism have the adverse impact on workplace
productivity, safety and organizational health.
CAUSES OF PRESENTEEISM
Increase in dual-earner and "sandwich generation" households

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 6
Dual-earner families now account for about two-thirds of all married

couples, this up from one-third in 1970. With a greater percentage of individuals
lacking a spouse at home to care for a sick child, a number of workers will go to
work when ill in order to save their limited sick days for when their children are
sick. Added to the mix are about one in ten workers, aged 30 to 60, who are now
also caring for aging parents as well as their own children: these individuals called
the "sandwich generation."
Employer expectations
In today's often "leaner-and-meaner" workplaces, some workers trudge off to
work when sick because they fear one or more of the following: appearing less
committed to their jobs, receiving disciplinary action, or even losing their jobs. A
day or more off can also mean burdening coworkers with job duties, coming back
to a heavy backlog of work responsibilities, or missing work deadlines.
Little or no paid sick days

The USDOL Bureau of Labor Statistics reports that in 2006, 57 percent of
private industry workers overall had access to paid sick leave. And according to the

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 7
Families and Work Institute, only 39% of low-wage employees are allowed any
paid time off for personal illness. As a result, a number of workers are reporting to
work when ill to avoid loss of pay.
Additionally, many more employers no longer allow employees to accrue
sick days. It's more common today for workers to have a use-it-or-lose-it
arrangement.
Work / life imbalance

Work/life balance refers to an individuals management of the allocation of
time to work, outside work activities (usually family and friends) and to
maintaining their health. Work/ life imbalance can lead to stress and other health
issues.
Work/life balance may be impacted by: Management and peer expectations;
the individual employees choices.

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 8
Unhealthy lifestyle
An unhealthy lifestyle, for example, smoking, sedentary lifestyle i.e. lack of
exercise, excessive alcohol intake, poor eating habits, and poor sleeping patterns
impact health and wellbeing and workplace productivity. An unhealthy lifestyle
may lead to presenteeism through its impact on an employees health.
HIDDEN COSTS OF PRESENTEEISM

It seems "presenteeism" has become the far worse workplace culprit in
terms of causing loss to U.S. employers; that is, loss of employee productivity and
loss of employer dollars. The bottom line: Presenteeism is costing employers more
than absenteeism.

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 9
Presenteeism was coined to define the practice of workers reporting to work

when ill and not operating to their usual level of productivity. The total cost of
presenteeism to US employers has been increasing, and estimates for current losses
range from about $150 to $250 billion annually. Costs for presenteeism are about
60 percent of the total cost of worker illness.
People who come to work when sick are also likely to infect others; namely,
coworkers and possibly customers or clients. In occupations such as nursing, and
industries such as food service, an infected employee who comes to work ill can
spell disaster -- compromising food safety, and infecting and sickening the public,
to name a few.
BIG PICTURE COSTS

All companies know that productivity can be hamstrung by absenteeism.
Now they have something else to fret over: presenteeism. This newly minted
syndrome is defined as on-the-job slowdowns by workers with a variety of medical
ills, from hypertension to arthritis. According to researchers at Cornell Universitys

CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 10
Institute for Health and Productivity Studies and the health-information firm
Medstat, on-the-job losses are possibly as high as 60 percent of the total cost of
worker illness, exceeding the costs of absenteeism and medical and disability
benefits. Allergies, headaches, arthritis, asthma and mental-health ailments such as
depression cause the greatest on-the-job productivity losses.
All in all, this means that from about one-fifth to three-fifth of the total
dollars attributable to common health conditions faced by employers appear to be
the result of on-the-job productivity losses, says Ron Goetzel, director of IHPS. In
fact, the expense of these losses is in most cases higher than medical costs.
Employers need to weigh the costs of good medical care against the potential for
on-the-job productivity losses, which we see are substantial in many cases.
EMPLOYERS SOLUTION
Recognize the problem.

CARE SETTING:
HOW IT AFFECTS
It is often recognizing a problem is the first step in solving a problem.

Presenteeism is often unrecognized by employers who may not realize the extent
of loss it can cause.
Employers that rely on disciplinary action to control absenteeism and abuse
of sick time are unknowingly encouraging presenteeism.
Develop a workplace policy on presenteeism and inform and educate

employees.
Employees need to know where your company stands on coming to work
sick, and how doing so can infect others. Establish and communicate guidelines.
Help employees understand under what conditions they should stay home, and
when it's OK to return to work.
Provide Paid Sick Leave and/or Paid Time Off to Workers.

According to the National Partnership for Women & Families, US national
economy would experience a net savings of $8.2 billion per year if workers were
provided just seven paid sick days per year. This in addition to employers
benefiting from reduced turnover, higher productivity and reducing the spread of
contagion in the workplace.

CARE SETTING:
HOW IT AFFECTS
Paid Time off (PTO) programs are increasingly being offered by employers.
In these programs, all time off is combined into a single bank of days. Employees
have the flexibility to take these days in a way that will meet their individual
needs.
Make an Effort to Boost Employee Morale.

One way to boost morale is to provide some degree of flexibility in
employees' work arrangements. Employers who do so help employees meet the
pressing demands of both work and family, and aid in their achievement of a
healthy work-life balance.
Offer a flu vaccination program.

One way for employers to combat presenteeism is to pay for medical
measures that can either prevent common illnesses or reduce eisting symptoms.
One such illness that can easily infect just about everyone in an office is influenza,
aka "the flu," which is extremely contagious. Recovery from the flu can take three
to seven days, or longer. After that, a persistent cough and tiredness can persist for
weeks; this along with a persistent decrease in productivity.

CARE SETTING:
HOW IT AFFECTS
Paying for employee flu shots or providing an onsite flu clinic is a definite
cost-effective measure employers can take. Reducing the number of employees
who contract and spread the flu is a win-win scenario for all: increased
productivity and workplace morale, and a healthier bottom line.
5 STEPS YOU CAN TAKE TO SOLVE COMPANYS

PRESENTEEISM PROBLEMS
Reviewing workplace policies.

Ensure that there is nothing that might encourage or make employees to feel
forced to show up to work when they feel sick or should be on holiday. If possible,
often telecommunicating for work at home options should the employee be unwell
and feel compelled to work.
Developing a policy on presenteeism, inform and educate all employees on

it
Discipline, monitor or dismiss workers who violate the policy because there
could be serious health repercussions.

CARE SETTING:
HOW IT AFFECTS
Establishing and communicating sick leave guidelines

As to when employees should stay at home or when they should return to
work.
Ensuring facilities are kept clean.

Use health posters to educate employees and prevent spread of germs.
Advocate proper hand-washing techniques and good personal hygiene.
Boosting employee morale

Companies with a low morale have more ill employees with a problem of
presenteeism
THE MODEL OF PRESENTEEISM

CARE SETTING:
HOW IT AFFECTS
Presenteeism is increasingly being seen as a threat to employee efficiency

and workplace safety. Although employers groups have often been reluctant to
address problems of presenteeism, individual employers are beginning to take the
issue more seriously with the establishment of occupational health and exible
working. In this section, we review the international literature on presenteeism,

CARE SETTING:
HOW IT AFFECTS
drawing out the key themes to develop a model (see Figure 1) for use in further
analysis.
A UK mixed method study by Grinyer and Singleton (2000) compared two
public sector offices, one with higher long-term sickness than the other.
Organizations were matched on key criteria such as size, employee prole and
location, and employees were interviewed regarding two specic organizational
factors related to the non-use of sick leave: obligation to colleagues (an internal
pressure) and fear of reaching trigger points (an external pressure). Work
attendance was greater in those who felt strongly committed to serving others
(clients or patients) or felt their absence would have negative consequences for
themselves, colleagues or a third party. Organizational policies introduced to
reduce casual sickness, such as increased monitoring of short-term sick leave,
made staff fearful of being absent, which then left them feeling stressed and
resentful. Policies were viewed as penalizing the genuinely sick, as staff feared
reaching a trigger point which would result in disciplinary action.

CARE SETTING:
HOW IT AFFECTS
5 WAYS TO ADDRESS PRESENTEEISM

Be aware of presenteeism, diagnose and measure it. You cant manage
presenteeism if you cant measure it.
Build a resilient organization.
Improve staff selection and recruitment the right fit for the
organization
Improve workplace culture by creating an engaged and values driven
culture
Develop and Implement a Health and Wellbeing Program.
Develop and implement appropriate policies, e.g. subsidise gym
memberships, personal training, regular breaks, provide fruit, health
cover, influenza vaccines, counselling services
Identify the symptoms of presenteeism and address the causes early.
Manage the cause/problem not the symptom
Provide and promote flexible management of sickness absence
Minimize job stress e.g. review and improve work practices and
business processes e.g. better roster management
Build better relationships

Educate, encourage and support management and employees to have a
better understanding of health in the workplace

CARE SETTING:
HOW IT AFFECTS
Surprise staff with activities that are all about them. Reward them. Let
them know you value them and appreciate their hard work
Evaluate, and if necessary change your management style. How you
engage, lead, manage and communicate with your employees and
contractors will influence their level of engagement and commitment to
the workplace and their level of productivity
ABSENTEEISM
Employees presence at work place during the scheduled time is highly
essential for the smooth running of the production process in particular and the

CARE SETTING:
HOW IT AFFECTS
organization in general. When an employee is hired, it is expected that the

employee will be regularly available for work as scheduled in return for payment
for those days of work. The habitual pattern of missing work on a relatively
frequent basis is called absenteeism.
According to Websters Dictionary, absenteeism is the practice or habit of
being an absence and an absentee is one who habitually stays away. Oxford
Dictionary define Absenteeism as the frequent absence from work, especially
without good reasons. Any failure to report for or remain at work as scheduled,
regardless of reason according to Cascio, W., et al. (2011).
Employees persistent or excessive absenteeism is one of the most common
problem and frustrating issues faced by employers in todays workplace (McNeil
2011). It becomes an expensive occurrence for both employers and employees
seemingly unpredictable in nature (Rathod, et. al, 2011). Despite the significance
of their presence, employees sometimes fail to report at the work place during the
scheduled time. Cascio, W., et al. (2011) states that the use of the word scheduled
is significant, for this automatically excludes vacation, personal leave, jury-duty
leave, and the like. A great deal of confusion can be avoided simply by recognizing
that if an employee is not on the job as schedule, he or she is absent, regardless of

CARE SETTING:
HOW IT AFFECTS
cause. We focus here on unscheduled absence because it tends to be the most

disruptive and costly of the situations when an employee is not at work. The
employee is not available to perform his or her job as expected. This often means
that the work is done less efficiently by another employee or is not done at all and
the potentially cost consequences of absence will be greater.
Douglas Hawks, an instructor of study.com presents that There are a lot of
reasons employees don't show up for work every once in a while. Sometimes they
take sick days, others earn vacation days, and sometimes they just don't show up.
Legitimate illnesses still account for the majority of employee absences, but some
studies have shown that less than one-third of absences from the workplace are
related to poor health.
Traditionally, absenteeism has been viewed as an indicator of poor
individual performance as presented by Dr. Douglas Hawks (2013-2015), as well
as a breach of an implicit contract between employee and employer; Even if it is
the smartest person in the office, absenteeism comes with a high cost to the
employer. It was seen as a management problem, and framed in economic or quasieconomic terms. George Ritzer (2007), states that more recent scholarship seeks to

CARE SETTING:
HOW IT AFFECTS
understand absenteeism as an indicator of psychological, medical, or social

adjustment to work (Johns, 2007).
While all employers recognize that sometimes absences are unavoidable,
poor attendance by employees can affect the bottom line by negatively impacting
productivity, work quality, morale and customer service and satisfaction. More
fundamentally, excessive absenteeism strikes at the heart of the employment
bargain which employers pay employees in exchange for work. (McNeil, 2011).
Most employers offer their workers vacation, sick leave, paid time off, or other
kinds of paid and unpaid leave but sometimes end up being an absentee.

CARE SETTING:
HOW IT AFFECTS
HISTORY
If we look back the history, there is only a small written history of
absenteeism in business literature, apparently because until the 20th century
businesses had a clear rule, "No work: no pay." Then labour unions forced the
companies into agreements to allow employees to take time off from work for
illness or vacations and the practice of offering paid "sick days" become
widespread. These practices still vary among companies and union contracts and
normally there is an average of four to ten sick days per year is standard.
Companies have realized that human absence management policies are cost
effective; even many companies were unwilling to off paid leave to their
employees. In fact, there is an estimate in the current studies regarding absenteeism
that those company who have effective employee absence strategies can reduce
their overall payroll costs by atleast 10 percent.

CARE SETTING:
HOW IT AFFECTS
WORKING CONDITIONS THAT CONTRIBUTE TO

ABSENTEEISM AMONG NURSES IN HOSPITALS
It is a global occurrence among workers and in Nigeria it is a source of
concern in view of the weak national economy and of the health system. The
researchers conducted a study to determine the overall absenteeism rate and the
factors that conduces to absenteeism among hospital workers. Results shows using
a Cross sectional descriptive type is that though the overall absenteeism rate (1.7)
was lower than the level of 4 considered to be excessive, 53% of the study
population had been absent from work at least once in the study year. The habitual
practice of failing to turn up for work leads to reduced productivity and constraints
the economic viability of any nation (Isah, E.C, et al, 2008).
Absenteeism results in an increased workload for nurses who stand in for
colleagues and can lead to situations in which a lack of motivation among nurses
and a lowering of the quality of patient care may occur. The researcher observed
that certain conditions, such as inflexible working schedules, were given as reasons
for the absenteeism in units in a provincial hospital. A non-experimental,
descriptive, quantitative study was undertaken to describe the working conditions
that contribute to absenteeism among the professional and sub-professional nurses

CARE SETTING:
HOW IT AFFECTS
at a provincial hospital in the Limpopo province of South Africa. The findings of

the study indicated that personal and managerial characteristics, and organizational
and working conditions may lead to absenteeism in the workplace. (Nyathi, M.
and, Jooste K.)
The article focuses on the working conditions that are constraints, namely
inadequate group cohesion, inadequate delegation of autonomy, role ambiguity,
ineffective routinisation and the effect of the workload in the workplace.
Recommendations are made for improving working conditions to combat
absenteeism among nurses.
TYPES OF ABSENTEEISM
Human Resources professionals suggest that there are two types of
absenteeism. First, it is important to distinguish between the two major types of
absences which, under the law, must be dealt with in different ways:
Blameworthy, or culpable, absenteeism

Innocent, or non-culpable, absenteeism
Blameworthy, or culpable, absenteeism

CARE SETTING:
HOW IT AFFECTS
Is absenteeism when the employee doesn't provide a legitimate reason for

missing work. For example, an employee who sleeps through her alarm clock, or
takes a sick day when she is not sick, is engaged in culpable absenteeism.
1. Unauthorized Absenteeism
If an employee absents himself from work without informing or taking
permission and without applying for leave.
2. Willful Absenteeism
If an employee absents himself from duty willfully.
Innocent, or non-culpable, absenteeism
When the employee does give a legitimate reason for mission work. Occurs
when an employee is, for reasons outside her control, not able to work. (McNeil,
2011). For example, an employee who cannot perform her duties at work due to
illness or injury is absent for non-culpable reasons.
1. Authorized Absenteeism
If an employee absents himself from work by taking permission n from his
superior and applying for leave.

CARE SETTING:
HOW IT AFFECTS
2. Absenteeism Caused by Circumstances beyond Ones Control

If an employee absents himself from duty owing to the circumstances
beyond his control like involvement in accidents or sudden sickness.
When dealing with culpable absences, the appropriate response is
progressive discipline. The right disciplinary response will depend on the
circumstances, including the employees overall employment record, length of
service, the nature and severity of the incident(s), and how similar situations have
been treated in the past.
More commonly, however, employers must manage innocent absenteeism.
Since an innocent absence is not the fault of the employee, discipline, such as a
suspension or termination, is not an appropriate response.
Further, if the
employees absences are related to a disability, the employer has an obligation

under human rights law not to discriminate against the employee and to
accommodate the employees disability, including disability-related absences, up to
the point of undue hardship (McNeil, 2011).

CARE SETTING:
HOW IT AFFECTS
CAUSES OF ABSENTEEISM
The causes of non-culpable absenteeism are generally not a big concern.
Because employees inform managers ahead of time they won't be able to work, the
impact isn't a serious as with the unanticipated, culpable absenteeism.
The causes of culpable absenteeism are important, as it can provide
managers with important feedback, either about a single employee or about
workplace morale.
People miss work for a variety of reasons, many of which are legitimate and
others less so. Some of the common causes of absenteeism include (but are not
limited to):
Bullying and harassment Employees who are bullied or harassed by
coworkers and/or bosses are more likely to call in sick to avoid the situation
Burnout, stress and low morale Heavy workloads, stressful
meetings/presentations and feelings of being unappreciated can cause

employees to avoid going into work. Personal stress (outside of work) can
lead to absenteeism.

CARE SETTING:
HOW IT AFFECTS
Childcare and eldercare Employees may be forced to miss work in
order to stay home and take care of a child/elder when normal arrangements
have fallen through (for example, a sick caregiver or a snow day at school)
or if a child/elder is sick.
Depression According to the National Institute of Mental Health, the
leading cause of absenteeism in the United States is depression. Depression

can lead to substance abuse if people turn to drugs or alcohol to selfmedicate their pain or anxiety.
Disengagement Employees who are not committed to their jobs,
coworkers and/or the company are more likely to miss work simply because
they have no motivation to go.
Illness Injuries, illness and medical appointments are the most
commonly reported reasons for missing work (though not always the actual
reason). Not surprisingly, each year during the cold and flu season, there is a
dramatic spike in absenteeism rates for both full-time and part-time
employees.

CARE SETTING:
HOW IT AFFECTS
Injuries Accidents can occur on the job or outside of work, resulting
in absences. In addition to acute injuries, chronic injuries such as back and

neck problems are a common cause of absenteeism.
Job hunting Employees may call in sick to attend a job interview,
visit with a headhunter or work on their resumes/CVs.
Partial shifts Arriving late, leaving early and taking longer breaks
than allowed are considered forms of absenteeism and can affect

productivity and workplace.
Individual Factors Illness, disease and workplace attendance
Individual factors appear linked to absenteeism: past absence history,
education, personality and the abuse of drugs and alcohol. The largest single
component of sickness absenteeism is associated with genuine incapacity
attributable to illness and injury. Surprisingly, health status is only a minor
contributor although this depends upon definition. Health status (by self-report)
was not found to influence absenteeism significantly. This, in part, supports the
hypothesis that sick leave use also has non-medical determinants. Disease and
illness are rarely discussed in most models of workplace absenteeism, yet they

CARE SETTING:
HOW IT AFFECTS
form the bulk of the cause and provide a legitimate explanation for much of its
occurrence. Many of these factors are prevalent in society and are open to
interventions in the public arena as well as the workplace. For example the
workplace can be a vehicle for the amplification of public health messages dealing
with cigarette smoking, drug and alcohol use, diabetes and influenza for mutual
benefit.
Thus illness related leave might be unfairly considered unavoidable from a
workplace or medical perspective. Various estimates have indicated that disease
accounts for 50-75% of work absences, colds and flus are most likely to account
for short absences of 1-2 days.
Motivation
Employee absenteeism costs employers an average of $2,500 a day in
expenses, according to Benefits.org. While employees get sick and need time off,
other factors contribute to absenteeism including low morale, boredom, poor
management and stress. To limit the time employees take off from work,
businesses should develop an attendance policy as well as create an environment
that is conducive to work, supports employees and fosters morale. Work attendance

CARE SETTING:
HOW IT AFFECTS
motivation is subject to the compound and dynamic between the importance and
value of work and non-work alternatives.
Motivation is easier said than done, but it can be accomplished by enhancing
the intrinsic motivation employees receive from their job by making production
goals more realistic, increasing desirable job responsibilities, and improving
working conditions. An employer can also increase extrinsic motivation by
implementing a type of recognition or reward program.
Distance from work
Distance from work also appears to influence likelihood of sickness absence
because of distance or transport difficulties, which may be magnified by illness or
by presenting additional barriers or disincentives. Generally a minority of workers
account for the majority of leave taken. Some 30% of employees accounted for
70% of leave taken in a study of Telecom employees. The authors felt that this was
attributable to a sizeable minority of chronically ill employees who take long
absence spells. In a model involving a measure of avoidable absence just over
25% of workers accounted for all the avoidable leave taken. Past absence history
is moderately predictive of future absences, with absence frequency rather than
duration being the key indicator. Most studies seem to review absence history

CARE SETTING:
HOW IT AFFECTS
within an organization and it is uncertain whether the pattern of behavior is

transferable to new work situations. The residual leave available appears to
influence the probability of absenteeism.
CONSEQUENCES OF ABSENTEEISM
Companies expect employees to use some sick days from time to time. Life
happens, and family issues, injuries and sickness will interfere with the work
schedule of a company's employees.
However, excessive absences can quickly become costly for employers.
Even a single sick day may reduce productivity, but when absenteeism becomes an
extensive problem, the effects may negatively affect the morale, productivity and
finances of a company. (Burgess, Joy, 2013)
The effects of Absenteeism

CARE SETTING:
HOW IT AFFECTS
Lost productivity of the absent employee

Overtime for other employee to fill in
Decreased overall productivity of those employees
Any temporary help cost incurred
Possible loss of business or dissatisfied customers
Problems with employee morale
HIDDEN AND INDIRECT COSTS

Decrease in Productivity
employees may be carrying an extra workload or supporting new or
replacement staff
employees may be required to train and orientate new or replacement
workers
staff morale and employee service may suffer
Financial Costs
payment of overtime may result
cost of self-insured income protection plans must be borne plus the wage
costs of replacement employees

premium costs may rise for insured plans
Administrative Costs
staff time is required to secure replacement employees or to re-assign the
remaining employees
staff time is required to maintain and control absenteeism

CARE SETTING:
HOW IT AFFECTS
Potential benefits of work absence include:

Benefits Being away from work for legitimate reasons can be beneficial
for the workplace and the individual. Award provisions serve a function in
providing workers with the right not to attend work when physical or
psychological capacity is diminished. This reduces the risk of injury not only to
themselves but also possibly to others and allows a productive workforce to
operate. Employees who fail to take time off appropriately may represent a health
and safety hazard. Taking of sick leave may act as a safety valve mitigating
personal, external and workplace factors. Workers may utilise sporadic sick leave
for workplace conditions, particularly cumulative trauma disorders or workplace
stress. In a survey of Commonwealth Government workers, 49% of interviewed
staff reported that they experienced an episode of illness or injury that had some
association (in their view) with work. Only one of the staff had lodged a claim,
with the majority dealing with such problems through accessing sick pay if leave
was required.
There are also legitimate reasons for employees to be absent unrelated to
personal illness. This may include emergency childcare for well children; care for

CARE SETTING:
HOW IT AFFECTS
sick children; care for adult relatives; or the performance of important personal
business
WORKPLACE STRATEGIES IN MANAGING ABSENTEEISM

Absenteeism in workplace can be defined as failure of employees to report
to work when they are scheduled to work.
Absence management is an ongoing problem for many small businesses with
owners, managers and HR professionals not realizing the huge financial costs it
can incur. Not only does ongoing absenteeism cost financially, but it can also cause
problems for the entire culture of a business, leading to low levels of engagement
and a high turnover of staff. However, with the right communication processes in
place and the implementation of efficient workforce management systems,
absenteeism can be successfully managed and controlled. (Business Matters, 2015)

CARE SETTING:
HOW IT AFFECTS
Absenteeism is a serious problem for management because it involves heavy

additional expenses. The management should take the following measures to
reduce the rate of absenteeism:
Provide Incentives-An incentive provides an employee with a boost to
their motivation and avoid unnecessary absenteeism
Employee Assistance Program-If you confront an employee about his
or her frequent absenteeism
Sickness Reporting - Tell employees that they must phone in as early
as possible to advise why they are unable to make it to work and when
they expect to return
Return to Work Interview- When an employee returns to work then
ensure that they have a return to work interview
THE RESPONSIBILITIES OF THE HUMAN RESOURCES

Absenteeism is often seen as an indicator of poor performance. Even if it is
the smartest person in the office, absenteeism comes with a high cost to the
employer.
Measurements of absenteeism

CARE SETTING:
HOW IT AFFECTS
For calculating the rate of absenteeism we require the number of people scheduled
to work and number of people actually present.
Absenteeism can be find out of absence rate method
Rate of absenteeism = No. of man days lost
100
No. Of man days planned to work

Example:
a)
b)
c)
d)
e)
Average number of employees in work force: 100

Number of available workdays during period: 20
Total number of available workdays (a x b): 2,000
If Total number of lost days due to absences during the period: 93
Absenteeism percent (d [divided by] c) x 100: 4.65%
absenteeism %
93 X 100
2000
Since absenteeism is a major barometer of employee morale, absenteeism

above 5 percent has to be considered as very serious (across most industries
3 percent is considered standard).
Below are seven tips on how to effectively manage absenteeism in the workplace:

CARE SETTING:
HOW IT AFFECTS
Train your managers and HR professionals thoroughly so that they know

how to implement effective management systems and can deal with
disgruntled staff members accordingly. They need to be approachable so that
employees feel comfortable talking to them about concerns or problems they
may have. By solving any issues early on you can prevent problems getting
out of control.
Be as understanding as possible with your employees. Try to be aware of the
reasons behind an employees absenteeism and determine whether the
problem is widespread. People encounter a number of difficulties outside of
a working environment so make sure you understand whats going on before
pointing the finger. Mental health issues such as stress and anxiety are
becoming more and more evident as causes of absenteeism, but are not
always overtly apparent to an employer. Therefore, its important for
businesses to make sure employees feel comfortable talking to managers or
HR about such problems.
A business culture is one of the most important things to consider when
attempting to engage staff and reduce absenteeism. It can be difficult to
make everyone happy all of the time, however trying to get that balance
right will prove to your employees that youre serious about their wellbeing.

CARE SETTING:
HOW IT AFFECTS
Try developing a mission statement and a set of values for your business
which will help to create a unified working environment.
Offering incentives for staff members who have shown good attendance and
performance levels will help with absenteeism. Offering extra holidays or
rewards for exceptional attendance records can help to motivate and engage
employees. The HR department can help set up these kinds of incentives and
rewards for your employees.
Remember to communicate with your workforce. Nowadays, with so much
reliance on technology, it can be easy to forget about face-to-face
communication, but your employees welfare depends on it. Make sure you
show your employees that you care about their wellbeing and happiness at
work. Show them you appreciate their time and dedication and are available
to talk through any problems they may be having.
Being organized is critical when it comes to trying to manage absenteeism.
Employees need to know that they work for an organized and wellstructured company with the correct, legal procedures in place. They want to
know they are being treated fairly and in the same way as everyone else.
Managers and HR teams should ensure that they implement effective
procedures and continually uphold them.
Investing in workforce management systems can really help with your
businesses organization. Hardware that can track an employees whereabouts

CARE SETTING:
HOW IT AFFECTS
will help monitor absenteeism, allowing you to efficiently manage and

control any issues before they take hold. Such systems can also calculate
working hours and holiday entitlement accurately, which ensures all
employees are being monitored and treated fairly. Employees are much more
likely to stay engaged and focused when they know they are being treated in
the same way as their colleagues.
Low employee attendance can be a difficult problem to monitor with many
small and medium sized businesses not realizing the detrimental effects it can have
on a company. However, by combining good communication systems with the
effective training of managers and HR professionals, robust and well organised
procedures can be implemented in order to create a desirable business culture and
healthy working environment. This, combined with effective workforce
management systems and the latest technology, will help monitor, control and
effectively combat everyday absenteeism in the workplace.
Characteristics of the nurse
Marital status:

CARE SETTING:
HOW IT AFFECTS
It is likely that married womens greater responsibility for unpaid work in

the home make them more exposed to physical and mental exhaustion and raised
the benefits of absenteeism. (Mastekaasa & Modesta Olsen 1998: 202). Single
employees are absent more frequently than married employees.
Age:
Younger employees are absent more frequently than older employees but the
latter are absent for longer periods of time.
Gender
Women are absent more frequently than men. Women are more likely to
report poor health status and chronic conditions (Paringer 1983: 124-125;
Mastekaasa & Olsen 1998: 203). Women and men have typically different wages
and different roles in the home. The importance of the gender wage gap for
absenteeism is an open question as it involves both income and substitution effects.
Substance abuse
Drug use, abuse, or addiction among employees and their family members
can cause expensive problems for business and industry, ranging from lost

CARE SETTING:
HOW IT AFFECTS
productivity, absenteeism, injuries, fatalities, theft and low employee morale, to an

increase in health care, legal liabilities and workers' compensation costs.
Sickness
Poor health is often considered to be the most important cause of
absenteeism. Some illnesses or injuries are so serious that going to work is hardly a
choice. Other health problems are possible to combine with work, but with greater
or smaller levels of inconvenience. Health does not only seem to be associated
with age but also with sex.
Characteristics of the manager
The costs of absenteeism are particularly high where worker productivity is
interdependent, that means where work is performed in teams (Heywood & Jirjahn
2004). The historical literature is often emphasizing how managers used
punishments to maintain discipline. Those who failed to show up could get wage
reductions or even be fired. But managers had also other means. One way, was to
select workers according to perceived group characteristics or, which became
widely spread during the twentieth century, to use medical expertise to screen
workers before hiring. Furthermore, as respected members of society, owners and

CARE SETTING:
HOW IT AFFECTS
managers could encourage the virtues of punctuality, orderliness and sponsor

health improving activities, such as sports or temperance organizations (c.f.
Williams 1997). Yet, managers have not always been successful in their attempts to
improve attendance and have instead adapted the work organization to high levels
of absenteeism, for example by overstaffing (Clark 2007: 353-370)
Managers' who use participative management style and employees'
perceptions of participative strategic planning processes are positively associated
with high levels of job satisfaction. Effective supervisory communications in the
context of the strategic planning process are positively associated with high levels
of job satisfaction. Participative management that incorporates effective
supervisory communications can enhance employees' job satisfaction. In this
regard, organizational leaders in the public sector should emphasize changing
organizational culture from the traditional pattern of hierarchical structure to
participative management and empowerment
Autocratic and laissez-faire leaders affect employee motivation employee
performance negatively (Versteeg and Couper, 2011: 09). Benjamin (2006: 142).
Submits that, laissez-faire leaders with poor quality of leadership, escalates
employee absenteeism resulting in poor patient care.

CARE SETTING:
HOW IT AFFECTS
Autocratic managers focus on institutional goals and disregards employees

needs as a result, employees become hostile, aggressive, apathetic, less motivated
and trusting (Roussel, 2006:99). It must be recognized that changes necessary
within the healthcare system cannot be implemented using a dictatorial
management style that enforces change using a top down management approach.
laissez-faire leadership was found to be the highest observed leadership style in
hospitals, If this trend is continued throughout these hospitals where it is already
perceived that leaders have poor supervisory, management, leadership skills and
competencies, then a relationship regarding the existence of laissez-faire style
managers, and a lower level of employee motivation, decreased performance and
an increased level of absenteeism may be established. Some staff indicated that
participative and democratic styles were practiced in their institutions. These
leadership styles seem particularly suitable for hospitals.
Characteristics of the work
Job Satisfaction.

CARE SETTING:
HOW IT AFFECTS
A prerequisite for employee performance in any organization. It is important

for both the employee and the employer. For the employee, job satisfaction gives
them a sense of security and fulfillment. In return, it leads to employee
commitment, decreased absenteeism and reduced employee turnover. For the
employer, employee job satisfaction ensures committed staff and stable workforce
which reduce cost of recruitment and training. One of the biggest preludes to the
study of job satisfaction was the Hawthorne studies. These studies (1924-1933),
primarily credited to Elton Mayo of the Harvard Business School, sought to find
the effects of various conditions (most notably illumination) on workers
productivity. These studies ultimately showed that novel changes in work
conditions temporarily increase productivity (called the Hawthorne Effect).
Job satisfaction is therefore a result of employees perceptions of how well
their job provides those things viewed as important. According to Armstrong
(2006), job dissatisfaction results in absenteeism and turnover.
Proper planning, feedback, and employees recognition were top on the
respondents list, for management to implement in order to increase motivation,
improve performance and reduce absenteeism. Katz (2005: 498) cites that
managers need to give specific objectives and accurate performance feedback and,

CARE SETTING:
HOW IT AFFECTS
praise where necessary - this promotes employee commitment and ownership on

performance.
Characteristics of the organization
Absence and control policies:
Have a clearly defined attendance policy

Ensure that employees have a clear understanding of the expectation of
attendance and understand what is expected from them when they have to be away
from work. Who do they need to call in to and how soon? When do they need to
supply a doctors note? What happens if they dont comply with the policy?
Identify roles and responsibilities

Absence management strategies work best when there are designated
champions who own the process. When an employee is away, whos responsible
for letting human resources or payroll know, and at what point do they need to be
informed? If an employee is absent several days in a row, who is responsible for
contacting them? If the absence progresses to a short-term disability claim, whats
the process?

CARE SETTING:
HOW IT AFFECTS
Track absences and look for trends

Take a look at absence data for your organization in aggregate and in
subsets, for example, by location, or by business unit or department. Examine
whether there are specific days of the week like Mondays or Fridays or during
particular times of the year where absences are a particular issue.
Have a plan
If and when the times comes that you must take steps to address excessive
absenteeism, have a plan and a process for doing so that is applied consistently at a
pre-determined threshold. Make sure that the employee is aware of resources
available to them to assist them in improving their attendance, like counselling or
work-life services through your organizations EAP, or the availability of a
flextime program. Make a plan of action and a time frame for improvement, and
follow up on the employees progress.
Similarly, have a plan in place for how your organization will deal with noncompliance to the absence policy, with the associated disciplinary action. Include
information about the consequences of non-compliance in your attendance policy,
so that everyones expectations are managed.

CARE SETTING:
HOW IT AFFECTS
Integrate your absence management with disability management

Review your sick leave and absence policies against your short-term
disability contract and your organizations disability management policy to ensure
that there are no gaps or duplication.
The purpose of attendance management is to develop a willingness on the
part of all our employees to attend work regularly and to assist them in motivating
their coworkers to attend work regularly. This can be done through:
addressing the physical and emotional needs of our employees
communicating the attendance goals of the organization so employees can
understand and identify with them
dealing with cases of excessive absenteeism effectively and fairly so
deterrence can occur

Successful administration of an attendance management program requires
managers and supervisors to be aware of and create work environments in which
the following can be actualized:

CARE SETTING:
HOW IT AFFECTS
The greater the extent to which individuals identify their goals with the goals
of the organization and care what happens to it, the greater their motivation
to be regular in attendance.
The more people find their jobs meaningful to them, the greater their
motivation to be regular in attendance.
As employees workload increases due to the absence of a co-worker, peer
pressure is exerted on the absent co-worker to attend work on a regular
basis.
The more people like working for the organization the higher their
motivation to attend regularly. Recognition of good employee attendance
helps improve attendance.
Employees will have a lower absence ratio if they feel free to discuss their
on-the-job problems with their immediate supervisor.
Employees with a low absence ratio have attitudes of confidence and "team"
spirit.
Low absence ratio employees are found to be more satisfied with their
opportunity for promotion and upgrading.
Certification
This seeks to enhance the changes in medical certification (particularly the
introduction of the fit note) made following the 2008 Black Review. For longerterm absences (four weeks or more), or difficult cases, employers and doctors

CARE SETTING:
HOW IT AFFECTS
(usually General Practitioners (GPs)) would welcome independent authoritative

advice about what support would be most effective in returning an individual to
work. This would help doctors, who usually do not consider themselves expert in
this area, and employers who need advice to support their employees to return to
work. Many large companies already purchase such advice from occupational
health providers. However, many medium and small employers find it difficult to
access similar services because of the costs involved.
The Review therefore recommends that the Government should fund a new
Independent Assessment Service (IAS). The IAS would provide an in-depth
assessment of an individuals physical and/or mental function. It would also
provide advice about how an individual on sickness absence could be supported to
return to work. The assessment could be used by employers to help support a
return to work, and by doctors to inform their advice to patients. This service
should usually be accessed when an individuals absence has lasted around four
weeks, at which point there is a heightened risk of a significant spell of longer-term
absence. The service should be quality-assured and provided by healthcare
professionals with appropriate skills. To build on improvements already made to
certification from the fit note, the Government should also:
revise fit note
guidance to ensure that judgements about fitness to work move away from only

CARE SETTING:
HOW IT AFFECTS
job-specific assessments; and z do more to improve knowledge and awareness

among healthcare professionals, particularly those involved in certification, of the
WCA and the benefits system generally and the importance of work for health.
The Return-to-Work Interview
Research indicates that carrying out Return to Work Interviews is the most
effective measure employers can take to reduce absence levels. Failing to carry out
Return to Work Interviews (or conducting them but getting them wrong) can cost
business time and money and can also send out the wrong message to otherwise
committed and engaged employees.
Managers are required to acknowledge and discuss each period of sickness
absence with an employee following their returning to work. In many cases this is
likely to need only a light touch discussion, and a brief note to record that this has
been undertaken.
However, where the absence is becoming a cause for concern e.g. if an
absence pattern is evident or there is a potential underlying health issue or where
there is persistent short term absence or work related issues, in some cases it may
be necessary to have a structured return to work (RTW) interview.

CARE SETTING:
HOW IT AFFECTS
Both light touch discussions and more structured interviews represent good
practice in terms of supporting the employee to attend work and identify any
actions needed to achieve this. Advice and support can be gained from your
Faculty HR Team contact. In cases where disability related absences are identified
managers should liaise with HR before determining next steps.
The below information is for guidance purposes only and aims to support
managers in undertaking such discussions/interviews. It is, however, recognized
that the manager will need to determine how best to structure each such
discussion/interview to best reflect the given circumstances of the case.
Light Touch RTW Discussions

These should be undertaken to acknowledge each absence, and to:
Welcome the employee back to work.
Seek confirmation that the individual is fit to work
Seek the cause(s) of absence giving the employee the opportunity to
highlight any relevant issues.
If the employee raises any issues, try to offer solutions and if
appropriate, refer to employee support mechanisms, for example Staff
Counselling.
If appropriate, agree a review period and/or any actions required.

CARE SETTING:
HOW IT AFFECTS
Retain a brief note confirming the discussion, as this would be needed

should the absences require more structured and potentially more formal
intervention and support.
RTW Interviews
To carry out an effective RTW interview, managers should consider the
following:
1. be prepared
In advance, review the employees attendance record over the
previous 12 months and notes/action points arising from any previous
return to work discussions/meetings.
Meet with the employee on the first day back at work, or shortly
afterwards. Make sure that the meeting is held in a private space, out
of the earshot of colleagues or students.
It is important that a record of the RTW interview is kept by the
manager. A suggested RTW form is available within the toolkit.
2. during the Meeting
Welcome the employee back to work. Explain purpose of the meeting
and that it is informal. Encourage a two-way discussion.

CARE SETTING:
HOW IT AFFECTS
Seek confirmation that the individual is fit to work if there is any

doubt as to this, seek advice from Workplace Health & Wellbeing.
2.1 Where there are on-going health issues:
Be clear that the purpose of the meeting is to provide support the
individual in his/her return to work.
Review with the employee their attendance record/previous RTW
interviews and establish what help/support/treatment the employee is
currently receiving (from their GP etc). If appropriate, discuss and agree
a referral to Workplace Health & Wellbeing.
Establish whether there are any underlying personal or work-related
concerns. If there are personal issues, discuss whether there are any
support mechanisms/actions that the employee or the manager may
reasonably take to seek to alleviate the problems, e.g. access to
counselling, staff helpline etc. If the problems are work-related (see also
section 2.3 below for additional considerations).
Establish if any reasonable adjustments are required to their role or
work environment.
If appropriate agree a review period and/or any actions required.
If absences relate to disability, pregnancy or a work related accident,
undertake a risk assessment seek Human Resources advice on this if
necessary.

CARE SETTING:
HOW IT AFFECTS
2.2 Where there is persistent short term absence or a pattern of absence is

developing:
Discuss the cause(s) of absence and the likelihood of the illness
recurring and give the employee the opportunity to highlight any
relevant issues.
Try to offer solutions to any issues raised. Refer to employee support
mechanisms if appropriate, for example Staff Counselling:
Remind the employee of the mutual obligations i.e. that it is the
individuals responsibility/contractual obligation to attend work, and the
employer/manager has a corresponding responsibility and concern for
the employees wellbeing.
Explain the effect their absence has had on colleagues and the
departments ability to deliver the service/meet its broader objectives.
Re-establish your expectations regarding attendance, at work and any
associated actions (e.g method for reporting sickness absence). Set a
date to review the absence. Discuss the next steps within the sickness
absence management procedure should there be further absence during
the review period (see section 9 of the procedure for further details).
2.3 Where the employee believes the absence is work related (e.g. stress,
relationship
issues):

CARE SETTING:
HOW IT AFFECTS
Discuss the cause(s) of absence and the likelihood of the illness

recurring and give the employee the opportunity to highlight any
relevant issues.
Listen carefully. You will need to illicit sufficient information for you to
be able to understand/articulate the main issue(s). Explain that you will
reflect on the matter and consider next steps/options. Seek advice from a
Human Resources colleague after the meeting.
Undertake a risk assessment, if appropriate seek Human Resources
advice if necessary.
Agree with the individual any appropriate action/review periods, if
appropriate
3. after the Meeting
Update/amend electronic records (uBASE), if relevant. For example:
1.
Tick the work related or disability related flag if from these

discussions it becomes evident the employee considered the absences
2.
aggravated or due to either issue.

Ensure that the date of the RTW discussion is recorded where either
flag was used or a cause for concern has been identified.

CARE SETTING:
HOW IT AFFECTS
Use the RTW form to capture relevant factual information (avoid
assumptions), and note the agreed actions/timeframe. Both parties should

sign the form if actions have been agreed. Mark this confidential and store
the form securely.
Ensure you undertake action points you are responsible for and let the
employee know.
Be available to talk to/meet with the employee, should they have any
issues following the RT
NURSING TURNOVER
Nurse absenteeism is a growing management concern. It can contribute to
understaffed units, staffing instability, and other factors that could have a negative
impact on patient care. The impacts of absenteeism on the quality of nursing care
have rarely been studied.

CARE SETTING:
HOW IT AFFECTS
Nursing turnover is a major issue impacting the management and

profitability of healthcare organizations. Healthcare organizations require a stable,
highly trained and fully engaged nursing staff to provide effective levels of patient
care. Yet a growing shortage of qualified nurses has led to a steady increase in the
turnover rate among nurses. This turnover rate is likely to become even worse over
the coming years as the growth of the healthcare industry continues to outstrip the
available supply of nurses.
Nurses in most healthcare organizations have some of the highest levels of
direct patient contact of any employees. As a result, they play a pivotal role in the
financial performance of these companies. The financial cost of losing a single
nurse has been calculated to equal about twice the nurses annual salary. The
average hospital is estimated to lose about $300,000 per year for each percentage
increase in annual nurse turnover. One 9000 person healthcare organization
estimated that nursing turnover was contributing to a loss of over $15 million per
year.
The costs associated with nursing turnover are both varied and extensive.
Most of these costs are associated with performance problems caused by the
staffing shortages that result from high levels of nurse turnover. People have

CARE SETTING:
HOW IT AFFECTS
argued that the single greatest way for healthcare organizations to improve their
performance is to simply increase the levels of their nursing staff. But such a
strategy can never work unless organizations can effectively reduce and manage
nursing turnover.
Two approaches have been used to diagnose the causes of nursing turnover.
The first is to identify why nurses choose to work in different jobs and then
determine if those needs are being met. In other words, are employers supporting
the employment value proposition that led nurses to originally accept a job offer.
The second approach is to identify things that occur after nurses are hired that lead
them to quit jobs even though the jobs may have met their initial job expectations.
This approach focuses on identifying specific events or conditions that lead nurses
to conclude that their current job no longer matches their personal career goals
and/or job needs.
Research suggests that the primary factors that influence nurses choice of
employers are work schedules, career development opportunities, and commuting
distance. However the relative importance of these factors varies widely across
nurses. Nursing, like many other professional hourly jobs, attracts individuals with
an extremely wide range of career interest and goals. Some nurses place a premium

CARE SETTING:
HOW IT AFFECTS
on job schedules that do not interfere with their commitments outside of work.
Others look for jobs that give them opportunities to develop their professional
skills and capabilities.
FACTORS DRIVING NURSING TURNOVER
Feeling overworked; not being able to manage workload
Lack of role clarity and low sense of control over job performance
Not feeling respected and valued for contributions and capabilities
Poor communication with management around critical issues affecting
work
Not receiving recognition or rewards for accomplishments Lack of
career opportunities and support for career development
Lack of trust and effective collaboration with coworkers
Work schedule does not match job needs or expectations
Work is too physically

CARE SETTING:
HOW IT AFFECTS
The factors identified, which leads nurses to quit jobs are often considerably
different from the factors that led them to accept the jobs in the first place. Issues
that have been identified as primary factors in nurses decision to quit their jobs.
The issue at the top of the list, feeling overworked is largely a result of low
staffing levels which is itself primarily caused by nursing turnover (the vicious
cycle of ever increasing nursing turnover discussed earlier). In fact, one study of
601 registered nurses found that 43% of nurses would actually prefer increased
staffing levels over increased wages or scheduling.
Most of the issues are directly related to the behavior of nursing managers. It
is often said that employees dont quit companies, they quit managers, and it
appears that this is the case for nursing as well. Studies have found that longer
tenured nurse managers tend to have lower levels of turnover than less experienced
manager. This suggests that more experienced nursing managers may be more
effective at creating work environments that support the unique needs of nurses.
These managers are more likely to have developed effective techniques for clearly
defining nurses job expectations, managing their workloads, and recognizing and
rewarding nurses for their accomplishments. Experienced nursing managers may

CARE SETTING:
HOW IT AFFECTS
also have developed unique skills to help nurses cope with the highly stressful and
emotionally exhausting aspects of their work.
NURSE ABSENTEEISM AND STAFFING STRATEGIES FOR
HOSPITAL INPATIENT UNITS
Inpatient units are often organized by nursing skills required to provide care.
A typical classification of inpatient units includes the following tiers: intensive care
(ICU), step-down, and medical/surgical. Multiple units may exist within a tier,
each with a somewhat different specialization. For example, different ICUs may
take care of a common pool of patients and in addition have a few beds that are
reserved for subpopulations such as cardiac and vascular, surgical, trauma, and
pediatric patients. Nurses whose skills are adequate for assignment to a particular
type of unit may be assigned to any one of the multiple units of that type, which is
then called their home unit. When nurses take care of a special subpopulation of
patients within their home unit, they undertake training that is specific to the needs
of that patient group. Hospitals also provide periodic learning opportunities to
nurses to keep their skills up to date.
Some hospitals create a pool of nurses, referred to as the float pool, who
may be assigned to different units depending on short-term variation in nursing

CARE SETTING:
HOW IT AFFECTS
needs. However, hospitals generally do not dynamically assign non-float-pool

nurses to different units to balance nursing needs in the short term because of the
potential negative impact on patient safety (especially when patient requirements
are different) and increased stress on nurses from working in unfamiliar physical
environments, using unfamiliar equipment, and having unfamiliar coworkers
(Ferlise and Baggot 2009). Some contract rules in fact prevent nurse managers
from temporarily reassigning nurses to work in different units (California Nurse
Association and National Nurses Organizing Committee 2012). Hence, an
important long-term staffing decision is to find an allocation of non-float pool
nurses to different nursing units to minimize understaffing costs while accounting
for nurses unplanned absences.
Nurses absentee rates are high in U.S. hospitals. According to the Veterans
Administration (VA) Outcomes Database, the average unplanned absentee rate
across all hospitals in the VA Health Care System was 6.4% for a 24-week period
between September 2011 and February 2012. [In the VA data, unplanned absences
include sick leaves and leaves without pay.] This statistic is significantly higher
than absentee rates among healthcare practitioner/technical occupations and all
occupations in the United States, which happen to be 3.7% and 3% respectively
(Bureau of Labor Statistics 2011), underscoring the importance of considering

CARE SETTING:
HOW IT AFFECTS
absenteeism in nurse staffing models. We argue in this paper that in addition to

balancing demand and supply, careful assignment of nurses to their home units can
help lower staffing costs due to unplanned nurse absenteeism.
Nurse absenteeism exacerbates the difficulty of matching supply and
demand for nursing services in an economical manner. Nurse shortage jeopardizes
quality of care and patients safety, increases length of stay, and lowers nurses job
satisfaction (e.g. Unruh 2008, Aiken et al. 2002, Needleman et al. 2002, Cho et al.
2003, Lang et al. 2004, and Kane et al. 2007). For these reasons, hospitals
generally find replacements to fill in absent shifts as much as possible even if this
practice is costly.
Nurse Managers or supervisors may use a nurses attendance history to
predict his or her likelihood of being absent in a future shift. This information can
be utilized within easy to implement staffing heuristics labeled H1 and H2, to
reduce staffing costs. The use of such heuristics does not require much effort on
part of nurse managers. The contribution of this paper lies in (1) developing
detailed analyses of data and documents from multiple inpatient units to identify
observable predictors of nurse absenteeism, (2) establishing structural properties of
optimal assignment strategies, and (3) developing and testing easy-to-implement

CARE SETTING:
HOW IT AFFECTS
heuristics for use by nurse managers. The structural properties we establish provide
insights for developing staffing strategies in environments where work is
performed by groups or teams of employees.
The savings are of the order of 3-4% of overtime costs, which may be
considered small by some. It is important to document or note that our approach
reduces variance in rate of attendance and its approach makes it easy-toimplement. Nurse managers dont need to exert much effort to realize the benefit
of reduced cost and reduced day-to-day variability in the number of additional
nurses they will need to find to meet the requirements in each duty shift. The
proposed strategies utilize information that is easy to track from historical datanurses absentee rates and inpatient units demand distributions. The former may be
estimated from nurses attendance records whereas the latter may be estimated
from census data and documentation and tare nurse-patient ratios in duty shift.
INEFFECTIVE ROUTINIZATION
Factor 4 ( 0.6954) comprises reasons for absenteeism that are classified
under ineffective routinization because they deal with the daily operational

CARE SETTING:
HOW IT AFFECTS
activities in the workplace. A lot of reasons for absenteeism in place of work are
connected with the unit routine. According to Johnson and Indvik (1997),
monotonous jobs with no room for creativity can lead to a low morale and the
absenteeism of nursing staff. Kass et al. (2001) stated that those repetitive tasks
that under-utilized ones ability lead to feelings of boredom and fatigue, which
result in absenteeism of nurses in the workplace. The individuals scope is
systematically underutilize, and one may find the job boring and this may lead to
absenteeism. No significant responses to items in factor 4 were identified.
EFFECT OF WORKLOAD IN THE WORKPLACE

Factor 5 ( 0.6627) comprises reasons for absenteeism that are classified
under the effect of workload in the workplace because it indicates that nurses are
doing more than is expected, which results in their expecting work pressure. A lot
of reasons for absenteeism are associated with workload. These reasons may
include long working hours such as 12-16 hours of duty and nurses being subjected
to alarming workload levels. Bruke and Greenglass (2000) state that missing tea
breaks and being subject to a high workload can increase nurses stress levels and
this may, in turn, lead to absence from work.

CARE SETTING:
HOW IT AFFECTS
FINDINGS AND CONCLUSIONS:

There are significant differences of opinion between the professional and
sub professional nurses, and younger nurses than 40 and to those whose age is 40
years and older were identified on certain items. These items should seriously be
considered as working conditions that lead to absenteeism.
Ineffective group cohesion
This study indicates that there are differences of opinion on the extent to
which ineffective group cohesion contributes toward absenteeism. The sub
professional nurses were less inclined than the professional nurses to indicate that
nurses are absent from work because of tolerance of absenteeism in the unit, and
lack of culture of work attendance among peers. Erickson et al. (2000) state that
absenteeism is higher in some work units that reflect tolerance of excessive
absenteeism in the workplace, and lower in a workgroup where absenteeism is
frowned upon.
Delegation of autonomy
The delegation of autonomy factor, significant differences of opinion on the
extent to which skills requirements contribute towards absenteeism were obtained.

CARE SETTING:
HOW IT AFFECTS
The sub professional nurses were more inclined than the professional nurses to
indicate that nurses are absent from work because they have to do a job that
requires more skills than they have in the present.
Allgood et al. (2000), stated that autonomy contributes more to absenteeism
among nurses with lower educational qualifications than those with higher
qualifications. The findings indicated that the sub professional nurses are more in
agreement with this statement than the professional nurses.
Role ambiguity
The role ambiguity factor, its significant differences on the extent to which
role ambiguity contributes towards absenteeism were identified. Nurses younger
than 40 years were significantly more inclined than nurses who are 40 years and
above older to indicate that absenteeism is due to having to work fluctuating shifts
and to perform duties without a job description.
Nurses who experience role conflict in their workplace shows inadequate
work commitment and have high rates of absenteeism. The findings indicate that
younger nurses are more in agreement with these views than nurses above 40 years
older. About the factors ineffective routinisation and the effect of workload in the

CARE SETTING:
HOW IT AFFECTS
workplace neither of the items revealed significant differences between the

responses of the specified groups of respondents.
CONCLUSION
Presenteeism is intertwined with loss of productivity due to real health
problems of employees, such as allergies, rheumatoid arthritis, chronic back pain,
and so on. These health problems are not severe hence the employees report for
duty but their productivity will be below par. Presenteeism is a complex issue and
its impact in the workplace is only just beginning to be recognized. It is an
emerging issue, though it has remained hidden and undetected for a long time. It is
difficult to identify and measure and in view of the magnitude of its economic
impact on business and employee health and safety, presenteeism is an issue that
all managers will need to address at some point in their career.

CARE SETTING:
HOW IT AFFECTS
Absenteeism, the health employees have to substitute for the absent

colleagues in order to cover up the lack of staff in a shift ad it is one indirect effect
of absenteeism having an extra work of load. It was highlighted and reviewed the
different consequences of absenteeism with such an expense in providing more
staff and overtime for the replacement of staff. There are many contributing factors
that impact on an organizations objectives but one of the most costly is
absenteeism. Employers need to handle all forms of absenteeism in a fair and
transparent manner to minimize disharmony in the workplace.
Studies undertaken on absenteeism suggest that presenteeism causes greater
loss to an organization than the costs attributed to absenteeism. Absenteeism and
Presenteeism in an institution or organization is a problem that sometimes being
neglected by the management and authorities responsible.
As we work toward creating work environments where all employees are
valued, engaged and able to realize their potential; challenges like absenteeism and
its silent partner, presenteeism, will become less pervasive and less damaging.
A few of the authorities responsible gives time to measure the cost and
impact of presenteeism in their workplace, but they knew that it is there. Even
though this type of measurement might be difficult in undertaking but there are

CARE SETTING:
HOW IT AFFECTS
enough researches that gives evidence that presenteeism is a real phenomenon and
costs more than absenteeism, health care and pharmaceutical benefits combined.
Employers need to take more care to their employees about their health and
presenteeism and know how to recognize each effort of the staff to be present.
Nurse Managers should have the control and support to enhance the practice
environment to productive one without having hindrances in the workplace and
balance the capacity of each staff. The above review contains different views on
various aspects on characteristics of nurse, manager, and work and organizations.
Although numerous researches have been implied on contributing factors about
absenteeism, still it is a growing problem now a days in the organizations. In order
to lessen it, it is important to understand its causes and become evident.
Traditional health management programs are usually implemented to this
end and standards workplace possibilities program demonstrates an effective
alternative. By providing an extent solutions to these problem, health resources,
productivity, and credibility of each worker can be quickly improve to those at
work with medical conditions and struggling with presenteeism.

CARE SETTING:
HOW IT AFFECTS
REFERENCES
Websites/books
Black Business Leaders. (2004). Health and Productivity: Presenteeism
Costs Big Bucks. Retrieved from
http://www.tnj.com/archives/2004/september/health-and-productivity
Employee Absenteeism and Attendance in the Workplace | HR Topics
for human resources. (n.d.). Retrieved August 3, 2015, from
http://topics.hrhero.com/absenteeism-and-attendance/

CARE SETTING:
HOW IT AFFECTS
Essays, UK. (November 2013). The History Of Absenteeism

Management Essay.Retrievedfrom
http://www.ukessays.com/essays/management/the-history-ofabsenteeism-management-essay.php?cref=1, on Aug. 14, 15
Managing absenteeism in the workplace - Business Matters. (2015,
March 20). Retrieved August 9, 2015, from
http://www.bmmagazine.co.uk/in-business/advice/managingabsenteeism-in-the-workplace/
Oxford Advanced Learner's Dictionary (7th Special Edition ed.). (2000).
Oxford University Press.
What is absenteeism? definition and meaning. (n.d.). Retrieved August
3, 2015, from
http://www.businessdictionary.com/definition/absenteeism.html#ixzz3hi
MpIsYH
Work attendance, gender and marital status: Absenteeism among
Swedish tobacco workers, 1919-1950 Tobias Karlsson Department of
Economic History Lund University tobias.karlsson@ekh.lu.se Paper
prepared for the session Gender at the European Historical Economics
Society Conference, London. (6th and 7th September 2013), Retrieved
August 9, 2015, from http://www.ehes.org/karlsson.pdf
(n.d.). Retrieved August 14, 2015, from
https://en.wikipedia.org/wiki/Presenteeis
https://www.uonbi.ac.ke/florence_muindi/files/relationship_between_par
ticipation_in_decision_making__and_job_satisfaction__among_accade
mic_staff_in_sob.
http://www.arabianjbmr.com/pdfs/OM_VOL_4_(2)/5.pdf
http://ncadd.org/index.php/learn-about-drugs/workplace

CARE SETTING:
HOW IT AFFECTS
http://www.benefits.org/optimize/risk-sharing/attendance-management?
showall=&start=2
http://onlinelibrary.wiley.com/doi/10.1111/0033-3352.00173/abstract
Articles/Journals and related studies:

Anderson, B., Geldenhuys, D.J. The relationship between absenteeism
and employer-sponsored child care. Retrieved August 3, 2015, from
http://www.unisa.ac.za/contents/faculties/service_dept/docs/SABVIEW1
5_3_CHAP2.pdf

CARE SETTING:
HOW IT AFFECTS
Baker-McClearn, Denise, Greasely, Kay, Dale, Jeremy and Griffith,

Frances. (2010). Absence Management and Presenteeism: The Pressures
on Employees to Attend Work and the Impact of Attendance on
Performance. Human Resource Management Journal, 20(3), pp-pp.311328 doi: 10.1111/j.1748-8583.2009.00118.x
Burgess, J. (2013). Top causes of absenteeism and how to fix them.
MultiBriefs Exclusive Articles. Retrieved August 6, 2015, from
http://exclusive.multibriefs.com/content/top-causes-of-absenteeism-andhow-to-fix-them/civil-government
Cascio, W., & Boudreau, J. (2011). The Hidden Costs of Absenteeism. In
Investing in people: Financial impact of human resource initiatives (2nd
ed., p. 52). Upper Saddle River,, New Jersey: Pearson Education,
Publishing as FT Press.
Douglas H. Absenteeism in the Workplace: Causes, Costs & Types |
Study.com. (n.d.). Retrieved August 3, 2015, from
http://study.com/academy/lesson/absenteeism-in-the-workplace-causescosts-types.html
Isah, E. C., Omorogbe, V. E., Orji, O., & Oyovwe, L. (2008). SelfReported Absenteeism Among Hospital Workers in Benin City, Nigeria.
Ghana Medical Journal, 42(1), 27.
Iten, Karin. (2013). Presenteeism Cost Companies Four Times More
than Absenteeism. Retrieved from
http://fspbusiness.co.za/articles/discipline-and-dismissal/presenteeismcosts-companies-four-times-more-than-absenteeism-1637.html
Encyclopedia of Sociology (p. 4). Blackwell Publishing.
Jos dos Reisa, R.,Silveirab, A.M., De Freitas La Roccaa, P., Bonillac, I.,
Ginc, A., Martin, M., (n.d.). Factors related to sickness absenteeism
among nursing personnel. aHospital das Clnicas da Universidade

CARE SETTING:
HOW IT AFFECTS
Federal de Minas Gerais. Belo Horizonte, MG, Brasil. b Faculdade de

Medicina da Universidade Federal de Minas Gerais. Belo Horizonte,
MG, Brasil. cLaboratori de Estadistica i Epidemiologia. Facultat de
Medicina. Universidad Autonoma de Barcelona. Barcelona, Spain.
Retrieved August 6, 2015, from
http://www.scielo.br/pdf/rsp/v37n5/en_17477.pdf
Kim, S. (2002). Participative Management and Job Satisfaction: Lessons
for Management Leadership. Public Administration Review, 231-241.
doi:DOI: 10.1111/0033-3352.00173
Malatesta, Irene. (2015). Presenteeism: The Surprising Problem thats
Stealing Your Employees Productivity. Retrieved from
http://www.lifedojo.com/blog/presenteeism-the-surprising-problemthats-stealing-your-employees-productivity
Munro, L. (2007). Absenteeism and presenteeism: Possible causes and
solutions. 45(1). Retrieved August 14, 2015, from
http://www.sar.org.za/index.php/sar/article/view/76.pdf
Nyathi, M., & Jooste, K. (2008). Working conditions that contribute to
absenteeism among nurses in a provincial hospital in the Limpopo
Province. Curationis Curationis. Retrieved August 9, 2015, from
http://www.ncbi.nlm.nih.gov/pubmed/18592946
Rathod, P., Patil, A., More, D., Kamble, S., & Fuse, G. (2011, March
20). Absenteeism and consequences. Retrieved August 9, 2015, from
https://www.scribd.com/doc/51138855/Absenteeism-and-consequences
Reyes, S. (2014, January 13). Presenteeism: The One Thing Worse than
Absenteeism. Retrieved August 15, 2015, from
http://tribehr.com/blog/presenteeism-the-one-thing-worse-thanabsenteeism/

CARE SETTING:
HOW IT AFFECTS
Schaefer, Patricia. (2014).The Hidden Cost of Presenteeism: Causes and

Solutions. Retrieved from
http://www.businessknowhow.com/manage/presenteeism.htm
Schreuder, J., Roelen, C., J. J. L. Van Der Klink, & Groothoff, J. (2013).
Characteristics of zero-absenteeism in hospital care. Occupational
Medicine, 266-273.
http://www.benefitscanada.com/benefits/disabilitymanagement/managing-workplace-absenteeism-51709
The Standards. (2012). Productivity Insight # 3: Understanding
Presenteeism. Retrieved from https://workplacepossibilities.com/wpcontent/uploads/Productivity_Insight_3_Understanding_Presenteeism.pd
f
TMS Consulting. (2015). Workforce Productivity: Effects of
Presenteeism. Retrieved from http://www.tmsconsulting.com.au/wscontent/uploads/TMS_Consulting_-_Presenteeism.pdf

Absenteeism - Presenteeism Final Report

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Absenteeism - Presenteeism Final Report

Încărcat de

Drepturi de autor:

Formate disponibile

PRESENTEEISM AND ABSENTEEISM IN HEALTH

PRESENTEEISM AND ABSENTEEISM IN HEALTH

PRESENTEEISM AND ABSENTEEISM IN HEALTH

PRESENTEEISM AND ABSENTEEISM IN HEALTH

suggests that relatively small investments in screening, treatment, and education

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Job Dissatisfied Presenteeism

Increase in dual-earner and "sandwich generation" households

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Dual-earner families now account for about two-thirds of all married

Little or no paid sick days

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Work / life imbalance

PRESENTEEISM AND ABSENTEEISM IN HEALTH

HIDDEN COSTS OF PRESENTEEISM

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Presenteeism was coined to define the practice of workers reporting to work

BIG PICTURE COSTS

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Recognize the problem.

PRESENTEEISM AND ABSENTEEISM IN HEALTH

It is often recognizing a problem is the first step in solving a problem.

Develop a workplace policy on presenteeism and inform and educate

Provide Paid Sick Leave and/or Paid Time Off to Workers.

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Make an Effort to Boost Employee Morale.

Offer a flu vaccination program.

PRESENTEEISM AND ABSENTEEISM IN HEALTH

5 STEPS YOU CAN TAKE TO SOLVE COMPANYS

Reviewing workplace policies.

Developing a policy on presenteeism, inform and educate all employees on

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Establishing and communicating sick leave guidelines

Ensuring facilities are kept clean.

Boosting employee morale

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Presenteeism is increasingly being seen as a threat to employee efficiency

PRESENTEEISM AND ABSENTEEISM IN HEALTH

PRESENTEEISM AND ABSENTEEISM IN HEALTH

5 WAYS TO ADDRESS PRESENTEEISM

Build better relationships

PRESENTEEISM AND ABSENTEEISM IN HEALTH

PRESENTEEISM AND ABSENTEEISM IN HEALTH

organization in general. When an employee is hired, it is expected that the

PRESENTEEISM AND ABSENTEEISM IN HEALTH

cause. We focus here on unscheduled absence because it tends to be the most

PRESENTEEISM AND ABSENTEEISM IN HEALTH

understand absenteeism as an indicator of psychological, medical, or social

PRESENTEEISM AND ABSENTEEISM IN HEALTH

PRESENTEEISM AND ABSENTEEISM IN HEALTH

WORKING CONDITIONS THAT CONTRIBUTE TO

PRESENTEEISM AND ABSENTEEISM IN HEALTH

at a provincial hospital in the Limpopo province of South Africa. The findings of

Blameworthy, or culpable, absenteeism

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Is absenteeism when the employee doesn't provide a legitimate reason for

PRESENTEEISM AND ABSENTEEISM IN HEALTH

2. Absenteeism Caused by Circumstances beyond Ones Control

employees absences are related to a disability, the employer has an obligation

PRESENTEEISM AND ABSENTEEISM IN HEALTH

Bullying and harassment Employees who are bullied or harassed by

Burnout, stress and low morale Heavy workloads, stressful

meetings/presentations and feelings of being unappreciated can cause