Original Research: Nurses' Presenteeism and Its Effects on Self-Reported Quality of Care and Costs
Abstract
OBJECTIVE: Although research has been conducted on how nurse staffing levels affect outcomes, there has been little investigation into how the health-related productivity of nurses is related to quality of care. Two major causes of worker presenteeism (reduced on-the-job productivity as a result of health problems) are musculoskeletal pain and mental health issues, particularly depression. This study sought to investigate the extent to which musculoskeletal pain or depression (or both) in RNs affects their work productivity and self-reported quality of care and considered the associated costs. METHODS: Using a cross-sectional survey design, a random sample of 2,500 hospital-employed RNs licensed in North Carolina were surveyed using a survey instrument sent by postal mail. Specific measures included questions on individual and workplace characteristics, self-reported quality of care, and patient safety; a numeric pain rating scale, a depression tool (the Patient Health Questionnaire), and a presenteeism tool (the Work Productivity and Activity Impairment Questionnaire: General Health) were also incorporated. A total of 1,171 completed surveys were returned and used for analysis. RESULTS: Among respondents, the prevalence of musculoskeletal pain was 71%; that of depression was 18%. The majority of respondents (62%) reported a presenteeism score of at least 1 on a 0-to-10 scale, indicating that health problems had affected work productivity at least "a little." Pain and depression were significantly associated with presenteeism. Presenteeism was significantly associated with a higher number of patient falls, a higher number of medication errors, and lower quality-of-care scores. Baseline cost estimates indicate that the increased falls and medication errors caused by presenteeism are expected to cost $1,346 per North Carolina RN and just under $2 billion for the United States annually. Upper-boundary estimates exceed $9,000 per North Carolina RN and $13 billion for the nation annually. CONCLUSION: More attention must be paid to the health of the nursing workforce to positively influence the quality of patient care and patient safety and to control costs.
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Anxiety and depression symptoms in nurses are associated with poor job satisfaction, nursing quality, work performance, and increased absenteeism and turnover.
“These symptoms have been found to be associated with poor job satisfaction, nursing quality, work performance, and increased absenteeism and turnover among nurses [4-6].”
Psychological distress among workers results in decreased work performance, especially quality of care provided by nurses.
“and in decreased work performance, especially quality of care provided by nurses9–13.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [12]
Psychological distress (depression and anxiety) among workers results in substantial deterioration in workers' quality of life and economic loss in the workplace.
“It is known that psychological distress (i.e., depression and anxiety) among workers results in substantial deterioration in workers’ quality of life and economic loss in the workplace, and in decreased work performance, especially quality of care provided by nurses9–13.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [12]
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- Authors
- Letvak, S. A., Ruhm, C. J., & Gupta, S. N.
- Affiliations
- University of North Carolina at Greensboro (US)
- Venue
- AJN, American Journal of Nursing
- Published
- 2012-02
- Volume
- 112
- Issue
- 2
- Pages
- 30-38
- ISSN
- 0002-936X (ISSN-L)
- OpenAlex
- W1531597194
- Cited by
- 322
- References
- 58
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 26 · 2023: 24 · 2022: 29 · 2021: 39 · 2020: 34 · 2019: 30 · 2018: 27 · 2017: 21 · 2016: 16 · 2015: 14 · 2014: 9 · 2013: 13 · 2012: 2
- FWCI
- 21.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- AJN American Journal of Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- musculoskeletal pain, depression, quality of care, patient safety, patient falls, medication errors, nursing workforce health, cost estimation, registered nurses
- MeSH terms
- Accidental Falls, Adult, Aged, Cross-Sectional Studies, Depressive Disorder, Efficiency, Female, Humans, Male, Medication Errors, Middle Aged, North Carolina, Nursing Staff, Hospital, Quality of Health Care, Prevalence, Health Care Costs, Musculoskeletal Pain, Patient Safety
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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