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Original Research: Nurses' Presenteeism and Its Effects on Self-Reported Quality of Care and Costs

Letvak, Susan A. PhD; Ruhm, Christopher J. PhD; Gupta, Sat N. PhD

AJN, American Journal of Nursing: February 2012 - Volume 112 - Issue 2 - p 30–38
doi: 10.1097/01.NAJ.0000411176.15696.f9
Feature Articles

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.

This study investigated the extent to which musculoskeletal pain or depression (or both) in RNs affects their work productivity and self-reported quality of care provided, and also considered the associated costs.

Susan A. Letvak is an associate professor in the Community Practice Department, School of Nursing, University of North Carolina at Greensboro (UNCG). Christopher J. Ruhm is a professor in the Frank Batten School of Leadership and Public Policy at the University of Virginia in Charlottesville and a research associate at the National Bureau of Economics Research, Cambridge, MA. Sat N. Gupta is a professor in the Department of Mathematics and Statistics at UNCG. Funding for this study was provided by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative through an unrestricted educational grant. Contact author: Susan A. Letvak, The authors have disclosed no potential conflicts of interest, financial or otherwise.

© 2012 Lippincott Williams & Wilkins, Inc.