Reasons for absenteeism from work among staff nurses working in healthcare settings: A descriptive study

Uninformed absenteeism among nurses seems to be a multidimensional occurrence and is a cause of distress that affects the day-to-day managing of staff schedules, eventually compromising safe and effective healthcare delivery. This study has aimed to determine the other reasons for absenteeism from work among nurses. A descriptive cross-sectional design was used to conduct this study for around three months beginning on 16 September 2021-26 November 2021. A total of 70 nurses working in different units of the hospital were selected through the non-probability convenience method. The majority of nurses i.e. 60% rated the ineffective policy of sick leaves as the most common reason for absenteeism from work and 55% graded nurse-to-patient ratio amongst the leading causes, other reasons reported were delay in payback and/or denial of overtime payment, lack of policies lack of motivation and inspiration, etc. In conclusion to the findings of this article, there is a dire need to find a solution to the reasons that lead to absence from work.


Introduction
Uninformed absenteeism among nurses seems to be a multidimensional occurrence and is a cause of distress that affects the day-to-day managing of staff schedules, eventually compromising safe and effective healthcare delivery 1 .There is a growing acknowledgment in middle to low-income countries that well-being and other socioeconomic determinants affecting the professional's health are vital in enhancing their productivity at the workplace 2 .Conferring to the findings of some scholars, stress at work is the major element in 70% of cases of absenteeism and kills approximately 10% of the gross national merchandise 3 .Increased work burden, shortage of manpower, conflicts of interest, insufficient rewards, and deprived work conditions (e.g., lack of self-sufficiency, no support from administration, and lack of teamwork) facilitate the vulnerability of fatigue among nurses4.Presenteeism is another term often used for a condition where individuals keep on working in spite of sickness that should be dealt with a break and leave from work immediately and nurses tend to continue working due to increased work burdens, shift work, and shortage of staff5.Previous studies have concentrated more on the role of health and disease because most of the cases of presenteeism and absenteeism are typically initiated by illness6.Therefore, this study has aimed to determine the other reasons for absenteeism from work among nurses.

Study Design & Duration
A descriptive cross-sectional design was used to conduct this study at a tertiary care hospital in Lahore, Pakistan.The study was performed over a span of around three months beginning on 16 September 2021-26 November 2021.

Target Population & Sample
Nurses were selected as the target population for this study.A total of 70 nurses working in different units of the hospital were selected through the non-probability convenience method and interviewed to investigate the reasons for absenteeism from work.

Data Collection
Nurses working in different units of the hospital were interviewed to assess the causes of absenteeism using a predesigned questionnaire (research instrument).A self-administered questionnaire was distributed among the participants after signing the consent form.The research instrument was composed of two components:

Tool A
This component inquired about demographic variables (age, gender, marital status, working experience, education) of the participants.

Tool B
This component was comprised of items to enquire about reasons for possible absenteeism from work.

Data analysis
The collected responses were analyzed using descriptive statistics (mean, median, mode, frequency, and percentages) and data were presented in figures and tables.

Results
The nurses from the concerned hospital were interviewed through a self-administered questionnaire to measure their responses.Among the 70 participants, the majority of nurses were females i.e. 86% and 49% were between the age group of 20-25 years.When inquired about the qualifications of the participants, 61% of registered nurses were graduates of diplomas in general nursing & and midwifery, and 29% graduated with a bachelor in science of nursing.Out of 70 participants, 61% responded as unmarried and 50% of the participants had a work experience of 2-5 years.Table I illustrates the demographic characteristics of the participants.Tool II of the questionnaire was comprised of items to investigate the reasons for absenteeism from work and after measuring the responses to these items highlighted very significant causes.The majority 60% of nurses rated the ineffective policy of sick leaves as the most common reason for absenteeism from work and 55% graded nurse to patient ratio as the 2 nd among the reasons followed by delay in payback and/or denial of overtime payment which was answered by 50% of nurses.Forty-four (44%) of the participants think that they miss the work shifts because they think that no strict action would be taken for repeated absence, and 44% agreed with the statement that their managers lack skills of motivation and inspiration.It was very alarming to know that 39% of the nurses responded that they were unaware of the policies of the hospital and 37% thought they felt that they were not considered as a part of the team taking care of the patients.Forty-three percent (43%) of the participants missed their work schedule due to unplanned and abrupt changes in the duty roster.However, the less common reasons for absenteeism were difficulties in the availability of transportation (30%), and other social reasons (27%).
participants characterized this as one of the most common reasons that lead to physical strain and eventually forcing absenteeism from work.Shdaifat, Alolayyan, Rosario, and Al-Ansari found similar findings in their study stressing that increased workload leads to fatigue among nurses 7 .
Everyone dreams of financial stability and expects their employers to pay wages as per the benchmark rates.This is one of the reasons for absenteeism from work among nurses as 50% of subjects rated it as a leading cause, similar findings were endorsed by a study conducted by Wee et al 2 .There are numerous other reasons for absenteeism from work and among them, one of the very significant reasons is related to organizational factors.It has been reported in the findings of this study that participants do not feel motivated to go to work, similar findings were presented by Varasteh et al. in their study.The majority of nurses partaking in the study of Varasteh et al. deliberated the presence of internal motivations, such as pledge, integrity, importance of nursing, and sense of accountability, as the most significant elements in keeping them motivated to stay put in their career but organization fails to provide them inspiration in terms of promotion and/or performance rewards 8 .Halder and Mahato reported in a study conducted on healthcareskilled workers that nurses are affected more by work-related stress than physicians, paramedics, and technicians 3 .

Conclusion
In conclusion to the findings of this article, there is a dire need to find a solution to the reasons that lead to absence from work.Nurses are a vital part of the healthcare team and their absence leaves a huge gap that results in the inability to provide quality care to the patients.Therefore, healthcare institutions must design effective policies to cater the concerns like delays in paybacks, standardized nurse-to-patient ratios, etc.Furthermore, they can provide amenities like continued education to keep them motivated and transportation and daycare for their children to minimize any distractions that can affect their performance at work.

Table 1
Tool I. Demographic characteristics of the participants