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Public >> Systematic Reviews \ Meta-Analysis

Predictors of nurse absenteeism in hospitals: a systematic review
Author(s): Davey,M. M.; Cummings,G.; Newburn-Cook,C. V.; Lo,E. A.
Journal: Journal of nursing management
Publication Year: 2009 Volume: 17 Issue: 3 Pages: 312-330
PMID: 19426368
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.
Public Key Messages
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Scientific Key Messages
  • History of work absence was the best predictor of absenteeism - when a workplace has a culture of absence, that culture supports future absences. Previous attendance and perceived absence norm was the best predictor of absenteeism, with greater than 50% significant results. If perceived absence norms, prior individual absence or poor attendance records have been high, then current absenteeism may increase, as absence cultures may develop. When the culture supports poor attendance, future individual attendance will align itself with cultural norms and expectations.
  • Included studies found inconsistent individual and organizational predictors of unplanned short-term absences. Factors identified for workers with mild injury or illness included: Greater decision latitude, greater job satisfaction, managerial influence and personnel resources, higher job involvement and organizational commitment predicted reduced risk of unplanned, short-term absences, very weak evidence of a relationship between leadership quality and increased job well-being, greater turnover, overstaffing, and increased part time staffing ratio and work unit separation were associated with absenteeism for nurses. The presence of burnout and job stress was associated with increased risk of unplanned, short-term work absences in workers with psychosocial health concerns. Access to compassionate leave and better retention factors were associated with increased risk of unplanned, short-term work absence.
  • The findings show trends toward individual nurses' prior attendance records, work attitudes (job satisfaction, organizational commitment and work/job involvement) and retention factors reducing nurse absenteeism, with burnout and job stress increasing absenteeism. However, the findings suggest that research on hospital nurse absenteeism provides no conclusive evidence about the predictors of staff nurse absenteeism. As long as the predictors remain unclear, efforts at dealing with the costly problems associated with absenteeism will be less fruitful.
Scientific Rating:
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Research Strengths
    This systematic review was rated a high quality review. The authors reported sufficient detail in methods and presentation of included studies and a clear synthesis. The study could have been improved if researchers reported on quality assessment of the primary studies included.
Research Weakness
    Many studies on absenteeism (both included and not included in this review) rely on only self-report data, or on past absenteeism records. Both of these methods may increase error in the study results. To strengthen the use of self-reported absence measures, these measures can be verified through comparisons with actual administrative data. The reporting on the study would have been improved with quality weighting in synthesis to help readers better appreciate the level of evidence supporting identified risk factors. The systematic review was limited by the quality/ limitations of primary studies available.
    Screening prior absence behaviour of potential employees and monitor attendance behaviour of current employees for patterns in absenteeism may be useful in identifying people at higher risk of absenteeism. Finding such attendance patterns will allow administrators and researchers to implement interventions in collaboration with individuals or groups to improve absenteeism rates. Only organizational commitment was significantly related to lower absenteeism in three studies. Organizational commitment has been shown to be influenced by work environment factors, such as leadership style and organizational culture Researchers and healthcare organizations should invest in long-term partnerships to examine the root causes of nurse absenteeism using longitudinal prospective designs and robust theory.
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