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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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“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].”
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“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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“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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Workaholism and negative work-related incidents among nurses
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Watanabe, N., Furukawa, T. A., Horikoshi, M., Katsuki, F., Narisawa, T., Kumachi, M., Oe, Y., Shinmei, I., Noguchi, H., Hamazaki, K., et al. (2015) · Trials · doi:10.1186/s13063-015-0554-z · Cited by 36
Pereira, F., Querido, A., Bieri, M., Verloo, H., & Laranjeira, C. (2021) · JMIR Research Protocols · doi:10.2196/27963 · Cited by 36
How to Know if You’re Really There
Rainbow, J. G., Gilbreath, B., & Steege, L. M. B. (2018) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001506 · Cited by 36
Presenteeism among nurses: An integrative review
Gerlach, M., Hahn, S., Rossier, C., Geese, F., Hamers, J. P. H., & Backhaus, R. (2024) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2024.100261 · Cited by 35
Transition to practice experiences of first‐ and second‐career nurses: A mixed‐methods study
Rainbow, J. G., & Steege, L. M. B. (2018) · Journal of Clinical Nursing · doi:10.1111/jocn.14726 · Cited by 33
“Presenteeism has been linked to increased medication errors, missed patient care and patient falls (Cassie, 2014; Letvak, Ruhm, & Gupta, 2012).”
BackgroundLiving with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea
Martínez, E. F., Abreu‐Sánchez, A., Velarde‐García, J. F., López, M. T. I., Pérez‐Corrales, J., & Palacios‐Ceña, D. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228527 · Cited by 36
“In the field of nursing, presenteeism has been identified as a risk to patient safety due to possible errors in the administration of medication [50,51].”
BackgroundThe global prevalence of overweight and obesity among nurses: A systematic review and meta‐analyses
Sadali, U. B., Kamal, K. K. B. N., Park, J., Chew, H. S. J., & Devi, M. K. (2023) · Journal of Clinical Nursing · doi:10.1111/jocn.16861 · Cited by 36
Risky Business: A Mediated Model of Antecedents and Consequences of Presenteeism in Nursing
Rainbow, J. G., Gilbreath, B., & Steege, L. M. B. (2020) · Nursing Research · doi:10.1097/nnr.0000000000000484 · Cited by 36
The nurse without a nurse: the antecedents of presenteeism in nursing
Mohammadi, M. M., Nayeri, N. D., Varaei, S., & Rasti, A. (2021) · BMC Nursing · doi:10.1186/s12912-021-00669-1 · Cited by 32
Brborović, H., Brborović, O., & Mustajbegović, J. (2016) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.17795/ijpbs-4587 · Cited by 33
“) employees may need to work despite the impairment (8, 28).”
BackgroundAuthoritarian leadership and nurse presenteeism: the role of workload and leader identification
Shan, G., Wang, W., Wang, S., Zhang, Y., Guo, S., & Li, Y. (2022) · BMC Nursing · doi:10.1186/s12912-022-01119-2 · Cited by 41
Relationship between Work Ability Index and Cognitive Failure among Nurses
Abbasi, M., Zakerian, A., Kolahdouzi, M., Mehri, A., Akbarzadeh, A., & Ebrahimi, M. H. (2016) · Electronic physician · doi:10.19082/2136 · Cited by 34
“The poor mental health of nurses imposes unfavorable effects on them and on the safety of patients under their care (4, 5).”
BackgroundEsbenshade, J. C., Edwards, K. M., Esbenshade, A. J., Rodríguez, V., Talbot, H. K., Joseph, M. F., Nwosu, S., Chappell, J. D., Gern, J. E., Williams, J. V., et al. (2013) · Infection Control and Hospital Epidemiology · doi:10.1086/669857 · Cited by 31
Tang, N., Han, L., Yang, P., Yanhui, Z., & Zhang, H. (2019) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2019.03.004 · Cited by 30
Fiorini, L. A., Houdmont, J., & Griffiths, A. (2020) · Journal of Nursing Management · doi:10.1111/jonm.13065 · Cited by 30
“Reductions in performance have been linked with notable consequences, such as patient falls, errors and poorer levels of care (Letvak et al., 2012).”
BackgroundBouchard, L., & Rainbow, J. G. (2021) · Nurse Education Today · doi:10.1016/j.nedt.2021.104852 · Cited by 28
Banks, C., & Pearson, S. (2021) · Journal of Nursing Management · doi:10.1111/jonm.13443 · Cited by 29
Zhang, Y., Fu, Y., Zheng, X., Shi, X., Liu, J., & Chen, C. (2025) · BMC Nursing · doi:10.1186/s12912-025-02905-4 · Cited by 29
“Moreover, presenteeism poses a serious threat to patient safety, as it is associated with poor outcomes such as missed care, patient falls, disease transmission, epidemic spread, medication errors, and inefficiency [20, 35, 57, 71].”
InfluentialGustafsson, K., Marklund, S., Leineweber, C., Bergström, G., Aboagye, E., & Helgesson, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17072419 · Cited by 29
“Associations between presenteeism and reduced work ability is in line with studies from other countries, although different definitions of work ability and productivity have been applied in the studies [1,7,8,13,15,16,21,30,35,36].”
ResultRelationship between occupational stress, sleep disturbance, and presenteeism of shiftwork nurses
Baek, J., Ki, J., Ryu, J. G., & Choi‐Kwon, S. (2022) · Journal of Nursing Scholarship · doi:10.1111/jnu.12766 · Cited by 29
Ketelaar, S. M., Gärtner, F. R., Bolier, L., Smeets, O., Nieuwenhuijsen, K., & Sluiter, J. K. (2013) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318289ee3e · Cited by 30
“10,33 It consisted of seven steps: (1) discussing expectations; (2) discussing screening results and the characteristics of work functioning and mental health complaints; (3) discussing possible causes in the private, work, and health condition and consequences for work functioning; (4) identifying the problem and off…”
BackgroundCullati, S., Cheval, B., Schmidt, R. E., Agoritsas, T., Chopard, P., & Courvoisier, D. S. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00623 · Cited by 29
“The economic burden of these healthrelated problems is high for institutions (Schultz et al., 2009; Letvak et al., 2012).”
BackgroundBrborović, H., & Brborović, O. (2017) · Archives of Industrial Hygiene and Toxicology · doi:10.1515/aiht-2017-68-2957 · Cited by 30
“So far, this issue has received modest attention (33-35),”
Background
Metadata
- 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 › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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