Predictors of nurse absenteeism in hospitals: a systematic review

Aim  This study aimed to identify and examine predictors of short-term absences of staff nurses working in hospital settings reported in the research literature.
Background  Front-line staff nurse absenteeism contributes to discontinuity of patient care, decreased staff morale and is costly to healthcare.
Evaluation  A systematic review of studies from 1986 to 2006, obtained through electronic searches of 10 online databases led to inclusion of 16 peer-reviewed research articles. Seventy potential predictors of absenteeism were examined and analysed using content analysis.
Key issue  Our findings showed that individual 'nurses' prior attendance records', 'work attitudes' (job satisfaction, organizational commitment and work/job involvement) and 'retention factors' reduced nurse absenteeism, whereas 'burnout' and 'job stress' increased absenteeism. Remaining factors examined in the literature did not significantly predict nurse absenteeism.
Conclusions  Reasons underlying absenteeism among staff nurses are still poorly understood. Lack of robust theory about nursing absenteeism may underlie the inconsistent results found in this review. Further theory development and research is required to explore the determinants of short-term absenteeism of nurses in acute care hospitals.
Implications for nursing management  Work environment factors that increase nurses' job satisfaction, and reduce burnout and job stress need to be considered in managing staff nurse absenteeism.     

Predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses

BACKGROUND: Stress-related outcomes of job satisfaction and absenteeism among nurses should receive more attention in Hong Kong because absenteeism is costly. Many nurses' complaints are due to organizational change in privatization since the establishment of the Hong Kong Hospital Authority in 1991. Organizational climate is found to be an antecedent of job dissatisfaction and absenteeism in many studies in western societies. AIM: To investigate the role of organizational climate and psychological distress on job satisfaction; and the role of climate, distress and job satisfaction on absenteeism in Hong Kong nurses, while controlling for demographic variables. METHODS: A self-administered questionnaire survey method was used to collect data from two samples of nurses within a 8-month period. They are, respectively, 144 (74 general nurses, 70 psychiatric nurses; 47 males, 97 females) and 114 (85 general nurses, 29 psychiatric nurses; 17 males, 97 females) nurses. RESULTS: Multiple regression analyses revealed that occupational type (psychiatric/general), environment (the physical conditions in the work area) and psychological distress were significant predictors of job satisfaction for sample 1; and well-being (social relations, welfare and health issues) was the only significant predictor of job satisfaction for sample 2. However, age, involvement (the degree of commitment displayed towards employees by the organization), psychological distress and job satisfaction were significant predictors of absenteeism for sample 1; and occupational type, organization (the interaction between the worker and the organization), and involvement were significant predictors of absenteeism for sample 2. CONCLUSIONS: The empirical findings provide support for the climate-job satisfaction and climate-absenteeism relationships. Psychological distress could be an antecedent of job satisfaction; and job satisfaction could be an antecedent of absenteeism. Certain climate dimensions should be improved to enhance job satisfaction and reduce distress, which in turn will reduce absenteeism.     

Why nurses are calling in sick: the impact of health-care restructuring.

Absenteeism among registered nurses is a major concern for employers; it is costly and results in decreased standards of care. Despite the international interest in and research on absenteeism, there is relatively little cumulative knowledge regarding its determinants. This quantitative, non-experimental study profiled the reasons for absenteeism in a random sample of 2,000 front-line nurses in the Canadian province of Saskatchewan. Absence was defined as time away from work excluding holidays, strike, or layoff. Major causes of absenteeism were identified, including minor ailment and fatigue related to work overload. A total of 450 respondents had seriously considered leaving the nursing profession, with 50.4% citing overwork and stress as the primary causes. Higher rates of absenteeism were found to be associated with lower job satisfaction, longer shifts, working in acute care, and working full-time. Moderate job dissatisfaction was found to be associated with longer shifts and working in acute care. In light of the current nursing shortage, strategies for reducing absenteeism and increasing job satisfaction are warranted.     

Disordered eating and job stress among nurses

Aim  The purpose of this study was to examine disordered eating behaviours among nurses in the state of Ohio.
Background  Individuals involved in disordered eating tend to report more frequent and higher levels of perceived stress than their counterparts. As nurses regularly perform stressful roles and responsibilities within a high-stress environment, this group may be at elevated risk of disordered eating.
Method  A 65-item survey was mailed to a random sample of 1000 nurses in the state of Ohio.
Results  A total of 435 nurses (47%) returned completed surveys. Most (93%) were registered nurses (RNs) and 87% were over 31 years old. Results indicated that disordered eating differed significantly based on perceived job stress and perceived body satisfaction. Nurses with high levels of perceived job stress and low levels of body satisfaction had higher disordered eating involvement.
Conclusions  Nurses reporting high levels of job stress are at increased risk of disordered eating behaviours. Recommendations for future research are offered.
Implications for nursing management  Employee wellness programmes should be developed that educate and support nurses to make healthy lifestyle choices.     

Occupational stress and constructive thinking: health and job satisfaction

BACKGROUND: Occupational stress is associated with specific situations, characteristics of the work environment, and individual perceptions and reactions in the context of the workplace, but many nursing studies of occupational stress have tended to analyse aspects related to the job itself. In Brazil nursing is acknowledged as a stressful occupation whose stresses are generally associated with the job itself, while the effects of personal characteristics on an individual's response to occupational stress are dismissed. AIMS: The aim of this paper is to describe: (1) occupational stress, job satisfaction and state of health in Brazilian nurses, and (2) the relationship of these variables to a constructive thinking coping style. METHODS: A correlational study was performed during 1999 with 461 nurses recruited from the public health and education system in the Federal District of Brazil. Instruments used were the Nursing Stress Inventory, Constructive Thinking Inventory, subscales of the Occupational Stress Indicator, and a researcher-designed questionnaire. RESULTS: Normal distributions were found for occupational stress, state of health (physical and psychological), and job satisfaction. Results suggest that nurses have fewer psychological health problems and similar job satisfaction compared with other Brazilian government white-collar workers. Occupational stress was directly associated with state of health, and inversely associated with global constructive thinking and job satisfaction. CONCLUSIONS: Brazilian nurses in this study seem to have adapted satisfactorily to their profession, but the finding that constructive thinking was significantly related to psychological ill-health, occupational stress and physical ill-health highlights a need to value individual coping styles in the work environment.     

Testing the relationship between job stress and satisfaction in correctional nurses

BACKGROUND: Correctional nurses function in a high stress environment due to the nature of their clients and the primacy of environmental security. Job stress and satisfaction are theorized relational concepts that influence intent to stay and turnover as described in the anticipated turnover model. An increased understanding of the nature and sources of stress and satisfaction provides necessary information about correctional nursing. OBJECTIVE: To (a) replicate an earlier study of correctional nurses to determine whether similar findings could be duplicated in a study of prison nurses from another state and (b) test the concepts of stress and satisfaction as represented in the anticipated turnover model. METHODS: Using the Index of Work Satisfaction and the Nurse Stress Index, a correlational mail survey was designed to assess job stress and satisfaction among 454 nurses in a northeastern state prison system. RESULTS: Overall stress scores were not significantly different from the original study despite differences in demographic characteristics. Highest to lowest mean scores on actual sources of satisfaction include physician-nurse interaction, autonomy, professional status, task requirements, organizational policies, and pay. Satisfaction scores were significantly higher in the original study. An inverse relationship exists between job stress and satisfaction among correctional nurses. Job stress was a significant predictor of job satisfaction, supporting the theorized conceptual relationship between job stress and job satisfaction as described in the anticipated turnover model. DISCUSSION: Stress levels and the top two sources of stress were essentially the same for both groups of correctional nurses. Sources of satisfaction are ranked similarly but subscale and overall scores indicate that the nurses in the replication study were more dissatisfied. Findings validate the theoretical proposition in the anticipated turnover model that job stress is a major predictor variable in explaining job satisfaction.     

Job stress and job satisfaction among new graduate nurses during the first year of employment in Taiwan

Nurse graduates are leaving their first employment at an alarming rate. The purpose of this study was to explore the relationships between job stress, job satisfaction and related factors over time among these nurses. This study applied a longitudinal design with three follow‐ups after nurse graduates' first employment began. Using convenience sampling, participants were 206 new graduates from a university. The Work Environment Nursing Satisfaction Survey and the Clinical Stress Scale were used in this study. Results indicated that job stress remained moderate across three time points. Participants working 12 h shifts exhibited less job stress. Job satisfaction significantly increased in the twelfth month. Participants working 12 h shifts had a higher degree of job satisfaction. Job stress was negatively correlated with job satisfaction. The 12 h work shifts were related to job stress and job satisfaction. These results implied that health‐care administrators need to provide longer orientation periods and flexible shift schedules for new graduate nurses to adapt to their work environment.     

A comparison of psychiatric nurses' and general nurses' reported stress and counselling needs: a case study approach

Because of the increasing devolution of responsibility for health care, personnel management and organizational policies to the trust level, it is self-evident that staff morale and job satisfaction will depend to an ever larger extent on the quality of the individual management style and the corporate culture it fosters. This study was prompted by mounting concern within a health authority about levels of absenteeism and workforce dissaffection. To examine the extent and nature of these problems, a survey of nurses in a psychiatric Trust and a comparable general acute unit was conducted. In particular, the study investigated occupational stress levels among the two cohorts of nurses and their preparedness to use workplace counselling to manage their problems. A stratified random sample of 50  psychiatric and 50 general nurses was selected from the cognate units and a questionnaire was distributed. The results were subjected to a range of statistical analyses. Overall it was found that general nurses reported stress levels that were significantly higher than those of psychiatric nurses ( P <0·05) and that they would be more likely to use workplace counselling services ( P <0·01). These results did not accord with previous studies of this type and are explained in terms of relative organizational cultures and potential interventions designed to reduce occupational stress. The need for local surveys in identifying stress levels and understanding both its sources and solutions is emphasized.     

Workplace empowerment, job satisfaction and job stress among Italian mental health nurses: an exploratory study

Aim  The purpose of the present study was to investigate the relationship between staff nurses' structural empowerment, work stress and job satisfaction in two health care settings in Italy using Kanter's Empowerment Theory.
Background  With the current scarcity of economic resources and shortage of nurses, it is essential to empower nurses to perform at a high level to ensure high-quality patient care. Structural empowerment is a process that can optimize use of nursing skills and professional expertise, thereby increasing job satisfaction among nurses.
Method  A convenience sample of 77 nursing staff employed in the Department of Mental Health in central Italy was used in this study (return rate 64%).
Results  Structural empowerment was significantly related to their job satisfaction ( r  = 0.506, P  < 0.001), as was global empowerment ( r  = 0.62). Empowerment also had a significant negative relationship to nurses' work stress ( r  = −0.28, P  < 0.05).
Conclusion  The results of this study support Kanter's theory of structural empowerment in an Italian nursing sample – a previously unstudied population.
Implications for nursing management  Organizational administration must make every effort to create organizational structures and systems that empower nurses to practice according to professional standards and optimize the use of their knowledge and expertise.     

The relationship between nursing leadership and nurses' job satisfaction in Canadian oncology work environments

Background  Current Canadian oncology work environments are challenged by the same workforce statistics as other nursing specialties: nurses are among the most overworked, stressed and sick workers, and more than 8% of the nursing workforce is absent each week due to illness.
Aim  To develop and estimate a theoretical model of work environment factors affecting oncology nurses' job satisfaction.
Methods  The sample consisted of 515 registered nurses working in oncology settings across Canada. The theoretical model was tested as a structural equation model using LISREL 8.54.
Results  The final model fitted the data acceptably ( χ ² = 58.0, d.f. = 44, P  =   0.08). Relational leadership and physician/nurse relationships significantly influenced opportunities for staff development, RN staffing adequacy, nurse autonomy, participation in policy decisions, support for innovative ideas and supervisor support in managing conflict, which in turn increased nurses' job satisfaction.
Conclusions  These findings suggest that relational leadership and positive relationships among nurses, managers and physicians play an important role in quality oncology nursing environments and nurses' job satisfaction.
Implications for nursing management  Oncology nursing work environments can be improved by focusing on modifiable factors such as leadership, staff development and staffing resources, leading to better job satisfaction and hopefully retention of nurses.     

Professionalism: the major factor influencing job satisfaction among Korean and Chinese nurses

Background:  The nursing shortage has become an internationally important issue. Nurses' professionalism and job satisfaction have been recognized as strong factors influencing their turnover. As international interchanges in nursing education are growing between Korea and China, understanding the commonalities and differences in factors associated with job satisfaction is critical to improving nurses' job retention.
Aim:  To compare the factors influencing job satisfaction among Korean and Chinese nurses.
Method:  A cross-sectional survey was conducted. The participants were comprised of 693 nurses at three general hospitals in Jinan, People's Republic of China and 593 nurses at two general hospitals in Seoul, Korea. A questionnaire was designed to measure the nurses' professionalism and job satisfaction. Stepwise multiple regression analysis was performed to identify factors related to job satisfaction.
Results:  Professionalism was the common factor influencing job satisfaction in Korean and Chinese nurses. Professionalism was positively related to job satisfaction in both groups. Additional factors associated with job satisfaction were demographics and job characteristics such as age, job position and department of work, which were significant only in Korean nurses.
Conclusions:  Professionalism was the most important factor influencing job satisfaction in both Korean and Chinese nurses. Enhancing nursing professionalism is recommended as a common strategy to improve nurses' job retention across different healthcare systems.     

Rotating shift-related changes in hormone levels in intensive care unit nurses

Title.  Rotating shift-related changes in hormone levels in intensive care unit nurses.
Aim.  This paper is a report of a study to investigate if an irregular rotating shift system, including night shifts, can cause changes to the secretion of hormones in nurses.
Method.  In 2006, 32 healthy intensive care unit nurses completed the Standard Shiftwork Index (SSI) and blood samples were collected from each participant at the beginning and end of each shift. Change in hormone levels between the beginning and end of morning shifts were examined and compared between nurses on morning only and rotating shifts. Correlations between change in hormone concentrations and scores from the SSI are presented.
Results.  The mean reduction of cortisol level between the two measurements was statistically significantly greater for the 'rotating' than 'morning' shift group ( P  = 0·032). There were no statistically significant differences between the two groups in overall mean change from the first to the second measurement of prolactin, triiodothyronine and thyroid-stimulating hormone. Levels of thyroxine increased statistically significantly in the 'rotating' group ( P  = 0·049) but not in the 'morning' group. The morningness scale score was greater for the 'rotating' group, while greater job satisfaction levels were found in the 'morning' group. Statistically significant correlations were found between thyroid-stimulating hormone, triiodothyronine, thyroxine and prolactin changes and specific scales of the SSI questionnaire.
Conclusion.  Ergonomic shift schedules sympathetic to the body clock and nurses' preferences should be adopted to mitigate the adverse effects on health.     

An analysis of the relationship between job satisfaction and job stress in correctional nurses

Stamps and Piedmonte's Index of Work Satisfaction and Harris's Nurse Stress Index were completed by 287 registered nurses employed in state prison health care facilities in order to assess job satisfaction and job stress among correctional nurses. Correctional nurses' expectations about job satisfaction were influenced by pay and autonomy. This finding was consistent with studies of hospital nurses. Important sources of job satisfaction were professional status and interaction with employees. Analysis of differences between expectations and sources of job satisfaction may provide understanding of career benefits and sources of dissatisfaction. Time pressures and organizational support and involvement were sources of stress. Multivariate analyses showed an inverse relationship between stress and job satisfaction. Information about job satisfaction and work stress and their correlates may be used to develop strategies to improve the recruitment and retention of correctional nurses.     

Getting back to school

Two nurses in Essex are tackling absenteeism among primary school pupils by educating children and their parents about how to manage minor illnesses. The school liaison nurses provide a telephone helpline and home visits, and support with the management of chronic conditions such as asthma.