Factors Influencing Voluntary Absenteeism among Healthcare Workers in The Bahamas.
Investigating the motivation behind withdrawal behaviors in the workplace involves the assumption that absence from work may be an outcome of circumstances beyond an individual's control, or may be premeditated and planned (Tan & Hart, 2011). As a result, absenteeism has commonly been categorized as being either voluntary or involuntary (Hackett, Bycio, & Guion, 1989). Involuntary absenteeism involves cases whereby an employee lacks control over the decision to attend work due to the influence of external factors such as sickness or emergency (Magee, Caputi, & Lee, 2016). Voluntary absenteeism involves absences for which an employee has a choice to attend work but chooses to take a personal day off instead due to lack of motivation or to attend to some other personal interest (Camden & Ludwig, 2013). The main assumption behind the volitional view of absenteeism is the employee makes rational decisions about attending or being absent from work on a given day (Hackett et al., 1989). Consequently, when confronted with an absence-enticing situation, a conscious evaluation of the costs and benefits of staying away from work is triggered within the employee's mind leading him or her to seriously consider missing work on a given day. From this perspective, any attempt to understand the concept of absenteeism might be geared toward identifying absence-inducing factors that would lead an employee to make the rational choice to miss work (Hackett et al., 1989).
A number of previous authors have explored the concept of absenteeism as a voluntary construct associated with various organizational factors that explain why some organizations have lower absenteeism rates than others. For example, Biron and Saksvik (2009) noted employees were inclined to be absent if there was no provision for a substitute or if they knew their work would pile up upon return to the workplace. Prior studies have also identified organizational features such as psychosocial job demands (Griep, Rotenberg, Chor, Toivanen, Landsbergis, 2010; Rugulies et al., 2007), job satisfaction and organizational commitment (Griffeth, Steel, Allen, & Bryan, 2005; Obasan, 2011; Zimmerman, Swider, Woo, & Allen, 2016), shift work (Jamal, 1981; Markham, Dansereau, & Alutto, 1982), and leadership styles (Cummings et al., 2010; Elshout, Scherp, & van der Feltz-Cornelis, 2013) as influencing workplace attendance.
Therefore, voluntary absenteeism suggests absenteeism is a multifaceted phenomenon having many interconnected factors other than health, which may influence an employee's decision to engage in withdrawal behaviors (Magee et al., 2016). These factors, whether personal or organizational, imply voluntary absenteeism is only a symptom of some other underlying problem (Obasan, 2011). Problems associated with involuntary absenteeism can never be fully eradicated from any organization, as there are circumstances in which employees are genuinely incapable of attending work. However, identifying factors that may influence employees' decisions to miss work even when they are fully capable of attending may assist organizations in developing strategies for managing voluntary absenteeism in the workplace. The current research sought to examine organizational factors contributing to voluntary absenteeism among healthcare workers, whereby employees take leave from work for reasons other than genuine illness, injury, or circumstances beyond their control.
The conceptual framework chosen to underpin the current research was the Organizational Dynamics Paradigm of Nursing Absenteeism (Taunton, Hope, Woods, & Bott, 1995) (see Figure 1). The main assumption of this model is that absenteeism is an outcome related to characteristics present in the nurse, manager, work environment, and organization. According to Taunton and co-authors (1995), these characteristics are believed to predict absenteeism through intervening variables such as job stress, job satisfaction, job involvement, and job commitment, as well as an employee's intent to remain employed within an organization. Thus, the model proposed by Taunton and colleagues (1995) can be used to explain the concept of absenteeism and how the characteristics of nurse, organization, manager, and work environment either act as driving forces or deterrents to withdrawal behaviors in employees.
Study design. This descriptive, cross-sectional study used a questionnaire to examine organizational factors contributing to absenteeism among healthcare workers working at a single healthcare facility in The Bahamas.
Sample. The target population consisted of 408 healthcare workers employed in four different roles at a healthcare facility in The Bahamas: registered nurse (RN) completed a 4-year program and has a license to practice nursing; trained clinical nurse (TCN) completed an 18-month certificate program in nursing; nursing auxiliary (female nursing assistant) and attendant (male nursing assistant). A statistical power analysis was conducted to select an appropriate sample size for a one-way Analysis of Variance (ANOVA) with four groups in GPower 3.0. The analysis indicated a sample size of 180 would be required to obtain a medium effect size (f=0.25) at a power of 0.8 and significance of 0.05. A stratified random sample was used to select a sample of 186 healthcare workers. For this research, the population was divided according to their primary roles.
Procedure. A contact person on each unit of the facility was used to assist in administering questionnaires. Selected employees received detailed verbal and written information about the nature and purpose of the study and were provided with surveys during their work schedule. Participants were informed that surveys would be collected 1 week from the date of distribution. Return of surveys indicated consent to participate in the study. Data were collected from June-August 2016.
A questionnaire was developed based upon information derived from the conceptual framework proposed by Taunton and co-authors (1995) and a review of the literature. It consisted of three sections and a total of 18 questions. Section 1 of the questionnaire consisted of 10 pre-structured statements which solicited responses from participants using a six-point Likert-like scale ranging from strongly agree to strongly disagree. Participants were asked to rate the extent to which they agree certain factors would contribute to their taking sick leave. Section 2 of the questionnaire required participants to indicate if they have ever taken sick leave for reasons other than genuine sickness and to suggest ways to discourage non-sickness related absenteeism among employees at the institution. The questionnaire concluded with six questions about demographic variables. The final survey instrument was tested using Cronbach's alpha to determine reliability. For section 1, Cronbach's alpha was 0.84, indicating a satisfactory reliability score.
Data Analysis Strategy
Descriptive statistics were used to describe and summarize data such as frequencies and percentages. Quantitative data were coded and analyzed using SPSS (version 22). Comparison between groups was initiated using one-way ANOVA. For this study, significance level was set at p=<0.05 for interpreting results of significance. For analysis, in Section 1 the scoring of strongly agree, somewhat agree, and agree were categorized as "a contributing factor" (and coded as 1), while the scoring of strongly disagree, somewhat disagree, and disagree were categorized as "not a contributing factor" (and coded as 0). To analyze the open-ended responses in the questionnaire, data were read/reread a number of times and coded by identifying recurrent themes or concepts.
This study was approved by the country's ethics review board. Prior to conducting the study at the study site, approval was also granted by the institution's hospital administrator. Informed consent was obtained from each participant and confidentiality and anonymity maintained throughout the research process. Participants received both written and verbal information that instructed them of the nature and purpose of the study and were given the option to withdraw from the study at any time. Measures also maintained participant anonymity, such as not disclosing individual names or using personal identifiers.
Surveys were distributed to 186 healthcare workers; 150 completed surveys were received from 150. The largest group of respondents were females (65.3%; n=98). Participants predominantly fell in the 25 to <35 age range (34%; n=51) and had been employed for 20 or more years (31.3%; n=47). Of participants employed at the healthcare facility, 39.3% (n=59) worked as RNs while 14.7% (n=22) were TCNs. The highest educational level of participants was at the high school level (42%; n=63). Participants worked in four different settings at the institution under study: substance abuse (12.7%, n=19), chronic (27.3%, n=41), psychiatric (41.3%, n=62), and geriatric settings (18.7%, n=28).
Participants' demographic characteristics are presented in Table 1.
Organizational Factors Contributing to Absenteeism
Employees were asked to specify the degree to which different factors influence their choice to take sick leave from work for reasons other than legitimate sickness. The most frequently identified factors believed to contribute to workplace absences were disputes over scheduling (66%; n=99), organizational culture (61%; n=91), and having call-in sick benefits (47%; n=70). Table 2 ranks organizational factors contributing to absenteeism in order of importance.
One-way ANOVA was conducted to determine if there were any significant differences in taking sick leave for reasons other than legitimate sickness among staff with different roles in the institution. However, no significant findings were noted (p= >0.5). Participants were also asked to indicate if they had ever taken sick leave from work for reasons other than legitimate sickness. The largest group of responses came from participants who indicated they had taken sick leave from work for reasons other than being genuinely sick (60.7%; n=91). Respondents were also provided with an opportunity to describe their views related to what they believed would discourage the abuse of sick leave benefits. Participants provided 119 responses regarding their views on discouraging non-sickness related absences. The top three themes which arose from participants' responses were scheduling practices, use of incentives, and proper staffing. Table 3 displays the major themes and responses which arose from this item.
Participants commonly indicated they had taken sick leave for reasons other than being genuinely sick (60.7%; n=91). This finding could suggest a culture of acceptance toward absenteeism. According to Johns and Nicholson (1982), organizational absence culture refers to a shared set of beliefs, values, and behavior patterns regarding absenteeism. Johns (1997) posits that absence behaviors result from a collective consensus about how much absence is expected and pressures from other employees to increase or decrease individual absence to socially accepted norms already established within an organization's culture. Johns and Nicholson (1982) further described an absence culture which they termed Type IV Absence Culture, whereby absenteeism is viewed by employees as an entitlement, strong interdependent and cohesive relationships are shared among employees, and there is generally mistrust and defiance toward leadership injunctions.
An entitlement attitude toward absenteeism may lead to persistent withdrawal behaviors among healthcare workers, jeopardizing delivery of quality patient care and influencing patient outcomes. Previous authors agree on the negative impact absenteeism may have on standards of care (Gaudine & Gregory, 2010; Laschinger, Finegan, & Wilk, 2009; Liu et al., 2012). Moreover, consequences of absenteeism, including reduced staffing levels and heavier nursing workloads, are associated with poor patient outcomes such as increased patient mortality and failure-to-rescue rates (Furillo & McEwen, 2012). In contrast, increased RN presence has been linked to lower patient mortality and failure-to-rescue rates, fewer incidences of pressure ulcers, and shorter hospital stays (Chau et al., 2015). These outcomes imply the influence of management practices (e.g., providing safe staffing levels) on the provision of quality nursing care.
In the current study, scheduling grievances were also cited as an explanation for nonsickness related absences. This included factors such as requests not being honored or employees being floated to cover other areas. This finding implies changes to managerial scheduling practices may discourage absenteeism among employees. A review by Davey, Cummings, Newburn-Cook, and Lo (2009) reported absenteeism decreased when leaders showed employees consideration. Previous studies investigating supervisory approaches to professional interaction with employees found effective leadership practices such as conveying respect toward subordinates and creating a supportive organizational climate were associated with lower absenteeism levels (Schreuder et al., 2010; Stone, Du, & Gershon, 2007).
Scheduling grievances among respondents in the current study also imply employee feelings of anger or resentment toward managerial practices. Chadwick-Jones, Nicholson, and Brown (1982) hypothesized absenteeism should be viewed as a form of negative exchange behavior, whereby employees withhold their presence as a means of compensating for negative aspects of their jobs. Robinson and Rousseau (1994) proposed that when expectations of reciprocity are presumed to have been violated, employees may act upon feelings of betrayal and mistrust through withdrawal reactions. Consequently, employees may become demotivated if they perceive inequitable work relationships, which may result in work withdrawal and decreased productivity. The influence of employee absence on productivity has been substantiated in the literature. Kalisch (2006) found absence of healthcare workers contributed to poor employee performance including not meeting patients' hygienic needs, delayed or missed feedings, and failure to implement patient teaching.
Mudaly and Nkosi (2015) supported the influence of managerial practices on absenteeism. In their study, unfriendliness, perceived unfairness, and favoritism by nurse managers increased absenteeism rates. Other researchers found sickness absence was increased in organizations with generous sickness benefits (Markussen, Roed, Rogeberg, & Gaure, 2011). The current study corroborated this finding, as 47% of employees indicated sick leave benefits contributed to absenteeism.
Participants were also given the opportunity to provide their opinions concerning what could be done about the high rate of sickness absences observed within their organization. Respondents stated changing management practices (such as scheduling decisions and providing incentives) were the solution to the high rate of absences. These findings suggest respondents were dissatisfied with certain managerial procedures. Employee dissatisfaction has been linked to absenteeism within organizations. For instance, a study by Gardulf and colleagues (2005) found job dissatisfaction may result in further absenteeism or even encourage professional exit. The unavailability of healthcare workers may also produce an overall negative impact on the financial performance of organizations, especially those with already-constrained budgets who must redirect much needed financial resources toward replacing employees with unscheduled absences. Problems associated with absenteeism may be further compounded by rising healthcare expenditures and competing priorities for healthcare funds.
Finally, respondents noted the institution under study was ineffective in discouraging the abuse of sick leave benefits. Consequently, 66.7% of participants reported the institution did not strongly discourage non-sickness related absences, implying current organizational procedures for controlling absenteeism may be unsuccessful. This finding was consistent with those from a previous study conducted by Walker and Bamford (2011) who found managers were ineffective in handling employee absenteeism. Consequently, the complex nature of absenteeism requires its management be addressed from both employee and managerial standpoints.
Implications for Nursing Management
Findings from this study point to the need for nurse managers to be aware of how their practices may influence workplace attendance. Organizations may benefit from having nurse managers who select practices that encourage work attendance, such as promoting an overall healthy organizational culture and being sensitive to employees' needs and concerns. This is important since organizational commitment to reducing absenteeism may result in improvements to quality of care, organizational productivity, and overall financial stability. Consequently, effective management of absenteeism may require certain management practices be addressed at top organizational levels.
This study involved collection of data from employees at one healthcare institution in The Bahamas. Care should be used in generalizing findings outside of the study setting. Insufficient statistical power due to the small sample size may have contributed to the inability to detect a significant finding in this study. The author did not present any information about the absenteeism rates of employees in the study. Therefore, the findings could be subject to the ability of respondents to self-assess their own attendance trends. A review of absenteeism records may have determined participants' actual absence trends. Use of a quantitative data collection approach was also a limitation of this study. Triangulation of research approaches such as the incorporation of face-to-face interviews or focus group sessions may have provided a deeper insight into the perceptions of healthcare workers concerning the factors influencing absenteeism. Further research is needed to examine how individual organizational factors contribute to absenteeism among employees.
To overcome some challenges associated with workplace absence and improve work attendance, strategies such as promoting an overall healthy organizational culture and being sensitive to employee needs and concerns may be beneficial. However, because a number of interconnected factors exist which can influence an employee's choice to engage in voluntary absenteeism, finding effective solutions to the problem will remain challenging for healthcare organizations. $
Daphne Christine Duncombe, MSC, RN
Public Hospitals Authority
Biron, C., & Saksvik, P. (Eds.). (2009). Sickness presenteeism and attendance pressure factors: Implications for practice. In C.L. Cooper, J.C. Quick, & M. Schabracq, Work and health psychology: The handbook (3rd ed., pp. 77-96). Chichester, UK: Wiley.
Camden, M., & Ludwig, T. (2013). Absenteeism in health care: Using interlocking behavioral contingency feedback to increase attendance with certified nursing assistants. Journal of Organizational Behavior Management, 33(3), 165-184. doi: 10.1080/0160806 1.2013.814521
Chau, J.P.C., Lo, S.H.S., Choi, K.C., Chan, E.L.S., McHugh, M.D., Tong, D.W.K., ... Lee, D.T.F. (2015). A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals. BMC Health Services Research, 15, 538. doi:10.1186/s12913-015-1198-0
Chadwick-Jones, J.K., Nicholson, N., & Brown, C. (1982). Social psychology of absenteeism. New York, NY: Praeger.
Cummings, G., MacGregor, T., Davey, M., Lee, H., Wong, C.A., Lo, E., ... Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 47(3), 363-385.
Davey, M.M., Cummings, G., Newburn-Cook, C.V., & Lo, E.A. (2009). Predictors of nurse absenteeism in hospitals: A systematic review. Journal of Nursing Management, 17(3), 312330. doi:10.1111/j.1365-2834.2008. 00958.x
Elshout, R., Scherp, E., & van der Feltz-Cornelis, C.M. (2013). Understanding the link between leadership style, employee satisfaction, and absenteeism: A mixed methods design study in a mental health care institution. Neuropsychiatric Disease and Treatment, 9, 823-837.
Furillo, J., & McEwen, D. (2012). State-mandated nurse staffing levels lead to lower patient mortality & higher nurse satisfaction. Silver Spring, MD: National Nurses United.
Gardulf, A., Soderstrom I.-L., Orton M.-L., Eriksson L.E., Arnetz, B., & Nordstorm G. (2005). Why do nurses at a university hospital want to quit their jobs? Journal of Nursing Management, 13(4), 329-337.
Gaudine, A., & Gregory, C. (2010). The accuracy of nurses' estimates of their absenteeism. Journal of Nursing Management, 18(5), 599-605
Gorman, E., Yu, S., & Alamgir, H. (2010). When healthcare workers get sick: Exploring sickness absenteeism in British Columbia, Canada. Work, 35(2), 117-123.
Griep, R., Rotenberg, L., Chor, D., Toivanen, S., & Landsbergis, P. (2010). Beyond simple approaches to study the association between work characteristics and absenteeism: Combining the DCS & ERI Models. Work & Stress, 24(2), 179-195.
Griffeth, R.W., Steel, R.P., Allen, D.G., & Bryan, N. (2005). The development of a multidimensional measure of job market cognitions: The Employment Opportunity Index (EOI). Journal of Applied Psychology, 90(2), 335-349.
Hackett, R., Bycio, P., & Guion, R. (1989). Absenteeism among hospital nurses: An idiographic-longitudinal analysis. Academy of Management Journal, 32(2), 424-453.
Jamal, M. (1981). Shift work related to job attitudes, social participation
and withdrawal behaviours: A study of nurse and industrial workers. Personnel Psychology, 34(3), 535-554.
Johns, G., & Nicholson, N. (1982). The meaning of absence: New strategies for theory and research. Research in Organizational Behavior, 4, 127-172.
Johns, G. (1997). Contemporary research on absence from work: Correlates, causes and consequences. International Review of Industrial and Organizational Psychology, 12, 115-173.
Kalisch, B.J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality, 21(4), 306-313.
Kao, F., Ceng, B., Kuo, C., & Huang, M. (2014). Stressors, withdrawal and sabotage in frontline employees: The moderating effects of caring and service climates. Journal of Occupational & Organizational Psychology, 87(4), 755-780.
Laschinger, H.K.S., Finegan, J., & Wilk, P. (2009). The impact of unit leadership and empowerment on nurses' organizational commitment. Journal of Nursing Administration, 39(5), 228-235.
Liu, K., You, L.M., Chen, S.X., Hao, Y.T., Zhu, X.W., Zhang, L.F., & Aiken, L.H. (2012). The relationship between hospital work environment and nurse outcomes in Guangdong, China: A nurse questionnaire survey. Journal of Clinical Nursing, 21(9-10), 1476-1485.
Magee, C.A., Caputi, P., & Lee, J.K. (2016). Distinct longitudinal patterns of absenteeism and their antecedents in full-time Australian employees. Journal of Occupational Health Psychology, 21(1), 24-36. doi:10.1037/a0039138
Malak, N. (2017). Nurse absenteeism and benefit generosity: Evidence from Canada. Journal of Health & Human Services Administration, 40(1), 44-78.
Markham, S.E., Dansereau, F., & Alutto, J.A. (1982). Group size and absenteeism rates: A longitudinal analysis. Academy of Management Journal, 25(4), 921927.
Markussen, S., Raed, K., Rageberg, O.J., & Gaure, S. (2011). The anatomy of absenteeism. Journal of Health Economics, 30(2), 277-292.
Mudaly, P., & Nkosi, Z.Z. (2015). Factors influencing nurse absenteeism in a general hospital in Durban, South Africa. Journal of Nursing Management, 23(5), 623-631.
Obasan, K. (2011). Impact of job satisfaction on absenteeism: A correlative study. European Journal of Humanities and Social Sciences, 1(1).
Robinson, S.L., & Rousseau, D.M. (1994). Violating the psychological contract: Not the exception but the norm. Journal of Organizational Behavior, 15(3), 245-259.
Rugulies, R., Christensen, K., Borritz, M., Villadsen, E., Bultmann, U., & Kristensen, T. (2007). The contribution of the psychosocial work environment to sickness absence in human service workers: Results of a 3-year follow-up study. Work & Stress, 21(4), 293-311.
Schreuder, J.A.H., Roelen, C.A.M., Van Zweeden, N.F., Jongsma, D., Van Der Klink, J.J.L., & Groothoff, J.W. (2010). Leadership styles of nurse managers and registered sickness absence among their nursing staff. Health Care Management Review, 36(1), 58-66.
State of the Nation Report. (2016). Vision 2040: National development plan of The Bahamas. Retrieved from www.vision 2040bahamas.org/media/uploads/State _of_the_Nation_Summary_Report.pdf
Stone, P.W., Du, Y., & Gershon, R.R.M., (2007). Organizational climate and occupational health outcomes in hospital nurses. Journal of Occupational and Environmental Medicine, 49(1), 5058.
Tan, J., & Hart, P. (2011). Voluntary and involuntary absence: The influence of leadership, work environment, affect and group size. Retrieved from https://www. researchgate.net/publication/265976205 _Voluntary_and_Involuntary_Absence_ The_Influence_of_Leadership_Work_ Environment_Affect_and_Group_Size
Taunton, R.L., Hope, K., Woods, C.Q., & Bott, M.J. (1995). Predictors of absenteeism among hospital staff nurses. Nursing Economic$, 13(4), 218.
Walker, V., & Bamford, D. (2011). An empirical investigation into health sector absenteeism. Health Services Management Research, 24(3), 142-150. doi:10.1258/hsmr.2011.011004
Zimmerman, R., Swider, B., Woo, S., & Allen, D. (2016). Who withdraws? Psychological individual differences and employee withdrawal behaviours. Journal of Applied Psychology, 101(4), 498-519.
Caption: Figure 1.
Conceptual Framework: Organizational Dynamics Paradigm of Nursing Absenteeism
Source: Taunton et al., 1995. Reprinted with permission of publisher.
Table 1. Demographic Characteristics of Participants (n=150) Characteristic n % Gender Female 98 65.3 Male 52 34.7 Age Range <25 7 4.7 25 < 35 51 34 35 < 45 33 22 45 < 55 41 27.3 >55 17 11.3 Primary Role Registered nurse 59 39.3 Trained clinical nurse 22 14.7 Nursing auxiliary 28 18.7 Attendant 41 27.3 Highest Qualification High school 63 42 Certificate 20 13.3 Diploma 7 4,7 Associate 30 20 Baccalaureate 30 20 Length of Employment <5 years 35 23.3 5 < 10 years 36 24 10 < 15 years 11 7.3 15 < 20 years 21 14 >20 years 47 31.3 Primary Work Area Psychiatric 62 41.3 Chronic 41 27.3 Substance abuse 19 12.7 Geriatric 28 18.7 Table 2. Organizational Factors Contributing to Workplace Absence (n=150) Rank Frequency order Factor (n) % 1 Disputes over scheduling 99 66 2 Organization culture (expectation that 91 61 colleagues will miss work) 3 Having call-in sick benefits 70 47 4 Institution does not strongly discourage 67 45 sick leave abuse 5 Manager's leadership style makes the work 65 43 environment more stressful 6 Discouragement due to staff/supply 62 41 shortages 7 Having split days off 54 36 8 Manager takes full authority over writing 51 34 the off-duty schedule 9 Inability to take scheduled breaks 45 30 without a hassle 10 Lack of motivation 39 26 Table 3. Staff Suggestions for Discouraging Non-Sickness Related Absenteeism Theme Frequency Illustrative Responses Scheduling 44 * They should honor requests practices * Rotate floated staff * Sensitivity to staff needs * Give staff more weekends off Incentives 32 * Compensation and awards * Motivate staff * Add incentives * Stress days Proper staffing 16 * Sufficient staff on each ward * Better ward coverage * Ensure adequate staffing Nothing 12 * Nothing can stop it Communication/ 7 * Talk to staff to find out Collaboration * Individual session with absent staff * Find out from the staff * Work with them to help them Don't know 5 * I don't know Penalties 3 * Penalty if found abusing sick leave Total 119
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|Author:||Duncombe, Daphne Christine|
|Date:||Mar 1, 2019|
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