Tackling staff absenteeism

Issues involved in introducing the 12-hour shift

The requirement to ensure that practice is evidence-based, means that all aspects of the structure, process and outcome of nursing care need to be subjected to critical review. This report attempts to do this in regard to the 12-hour shift pattern. Twelve-hour shifts are being introduced by an increasing number of managements, a practice which has raised concerns since there is some evidence indicating that 12-hour shifts affect the amount of care patients receive, and that there are possible links between length of shift worked, nurses' stress and fatigue levels and the impact these might have on the quality of care. This review discusses the main effects of the change in shifts on nurses and patients alike. The review focuses on studies since 1980 and on studies carried out in the United Kingdom. The search produced a considerable number of references; however, only those which met the inclusion criteria are included in this paper; a complete list is available on request. Much of the published work currently available lacks rigour. Yet, this is an important topic on which sound information is needed to inform decision-making.

Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality

AIM

This paper is a report of a study to assess the impact of nurse absenteeism on the quality of patient care.

BACKGROUND

Nurse absenteeism is a growing management concern. It can contribute to understaffed units, staffing instability, and other factors that could have a negative impact on patient care. The impacts of absenteeism on the quality of nursing care have rarely been studied.

METHOD

Retrospective monthly data from incident reports and staffing records in six inpatient units for 2004 were analysed. Dependent variables were the numbers of restraints, alternatives to restraints, incident reports, deaths, and length of stay. Explanatory variables were nurse absenteeism hours, patient days per nursing staff, and interaction between these variables. Controls were patient acuity and unit characteristics. Fixed effects regressions were analysed as regular or negative binomial models.

FINDINGS

Neither high Registered Nurse absenteeism nor high patient load was related to restraint use when taken separately. However, high Registered Nurse absenteeism was related to restraint use when patient load was high. Registered Nurse absenteeism was related to a lower use of alternatives to restraints. Incident reports were increased by high patient load, but not absenteeism, or absenteeism given patient load. When both patient load and absenteeism were high, deaths were higher also.

CONCLUSION

Absenteeism alone may not be a strong factor in lowering quality, but the combination of high Registered Nurse absenteeism and high patient load could be a factor. Staffing and absenteeism may be part of a vicious cycle in which low staffing contributes to unit absenteeism, which contributes to low staffing, and so on.

Factors influencing turnover and absence of nurses: a research review

This review of the nursing literature aims to identify the factors with the greatest influence on turnover and absence of qualified nurses, possible common factors influencing both, and the relationship between absence and turnover. A hypothetical model grounded in the literature which depicts the expected relationships between these variables is presented for testing in an empirical study. The review identifies intent to stay in current employment as the variable with the greatest influence on turnover. Intent to stay is in turn most strongly associated with job satisfaction. Other variables are identified by single studies as having an influence on intent to stay, but are not supported by the results of other studies; exceptions are pay, opportunity for alternative employment and kinship responsibility, which are supported by the results of two studies. The relationship between job satisfaction and absence is unclear and requires further investigation. However, job satisfaction is identified as possibly influencing both absence and intent to stay and kinship responsibility is identified as a common antecedent of absence and intent to stay. Similarly, absence is identified as an antecedent to turnover. Thus, it is expected that absence would be positively related to turnover and negatively related to intent to stay. Understanding such relationships should allow identification of management strategies to reduce both turnover and absence.

Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta

This study used a cross-sectional, correlational design to test a model of absence and turnover of registered nurses developed from a review of the research literature (Gauci Borda and Norman, 1997). Testing the model involved comparing the relationship between job satisfaction, kinship responsibility, pay, employment opportunity, intent to stay in employment and absence for male and female registered nurses. All registered nurses (n = 254) working in clinical areas on a full-time shift basis, in one large general hospital in Malta were surveyed by questionnaire and their absence data were obtained from the hospital personnel records. A response rate of 67% (n = 171) was achieved. The results showed that nurses were satisfied with their job and intended to stay in their present employment for the next 12 months. Relationships between variables differed between male and female nurses, with job satisfaction being associated with intent to stay for male nurses but not for females and kinship responsibility and intent to stay being associated with absence in female but not male nurses. In contrast to many previous studies of nurses, an association was found between job satisfaction and absence. Several variables, including fear of change, which may influence intent to stay of Maltese nurses, were identified. The proposed model of absence and turnover stood up reasonably well to testing, but the results for the whole sample, and the sub-samples of male and female nurses supported different parts of the model. The main implication for future research is that male and female nurses should be studied separately due to differences found between the two groups.