Consequences of Nurse Presenteeism in Switzerland and Portugal and Strategies to Minimize It: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Setting and Participants
2.3. Data Collection
2.4. Ethics
2.5. Data Analysis
2.6. Quality Assurance Methods
3. Results
3.1. Participants’ Characteristics
3.2. Focus Group Findings
3.2.1. Consequences of Presenteeism
“You self-medicate to come to work. I don’t know… a cold. I can’t see myself staying at home because I’ve got a simple little cold: I haven’t got to that state yet… You really wait until the last moment to allow yourself—and I mean the words ‘allow yourself’—to stay at home or to call colleagues and say, ‘Oh, I really can’t make it in right now.’”FGD6 (frontline nursing home nurses, Switzerland)
“It’s a snowball effect that—if it doesn’t get interrupted—will generate depression and wear down the professional.”FGD2 (frontline acute care nurses, Portugal)
“Actually, I am very aware of how many times I have ended up completely exhausted at the end of these few days, and then I say to myself, ‘Next time, listen to yourself! You shouldn’t have done that!’”FGD7 (frontline community healthcare nurses, Switzerland)
“Often, being sick, I come home after work and have to face all the family dynamics… the children… not to mention my husband. It’s extremely difficult (…) and there ends up being conflict. The children don’t realize when you’re out of patience.”FGD1 (frontline acute care nurses, Portugal)
“The way the professional sees themself changes; they feels that they are no longer useful in their care unit, that they cannot give more (…) This will also have consequences socially. We are talking about consequences in social interactions, with increasing isolation.”FGD4 (acute care nurse managers, Portugal)
“(…) on shift changes, I’m sitting looking at my colleagues and thinking ‘These people are not capable of doing everything that is required of them’. A professional loses motivation and is no longer as productive as they should be.”FGD1 (frontline acute care nurses, Portugal)
“It is a professional phenomenon that somehow ends up spreading to the whole team, being almost contagious… it’s that phenomenon of the ‘bad apple’ in the fruit basket that ends up infecting the whole team, because when things don’t get done or mistakes are made, gaps have to be plugged, and sometimes from shift to shift.”FGD1 (frontline acute care nurses, Portugal)
“She became irritable. She was so afraid of missing something herself that she was always repeating instructions to the team. She became a little bit aggressive despite herself. And then, I had to call her into a meeting to precisely reframe things, to set objectives.”FGD5 (nursing home nurse managers, Switzerland)
“(…) results in a bad relationship with patients and depersonalization of care. We do everything in a rush because we don’t have the mental availability to be there listening to them [patients].”FGD2 (frontline acute care nurses, Portugal)
“I can’t say that I had a real illness. There wasn’t a diagnosis, but I was hugely fatigued, and I was unwell. And, well, I made a medication error. And if I analyze the situation now, it was because I wasn’t in my right mind: I wasn’t well enough to go to work that day.”FGD6 (frontline nursing home nurses, Switzerland)
“We, as a profession, well, the way we work and the message we send is not the right one. Our image ends up being compromised by our mistakes, by our way of being. After all, we are a class [of professionals]. And that interferes with the view that the people we care for have about us.”FGD2 (frontline acute care nurse, Portugal)
3.2.2. Strategies to Minimize Presenteeism
“I have headaches. There are several types of headaches. They go from the little headache where you take a Dafalgan; you know that it will pass, so you come to work. You take what you need, and you feel that it will pass. If you feel like it’s not going to pass, you don’t come to work. And with no guilt.”FGD6 (frontline nursing home nurses, Switzerland)
“We must know our rights so that we can protect ourselves (…) whenever we have problems, we must negotiate solutions; I think that we can take care of our mental health individually (…) we have to regulate ourselves in order to prevent wear and tear.”FGD2 (frontline acute care nurses, Portugal)
“We took care of that colleague because they were not able to work, and we asked them to go home. It’s about valuing people: observing, giving positive reinforcement, and being able to work with the team.”FGD1 (frontline acute care nurses, Portugal)
“(…) teams are living beings that change and shape themselves as their individual elements grow.”FGD3 (acute care nurse managers, Portugal)
“We must be attentive, and our role is to be attentive to each professional’s wellbeing and to be able to reassure a person, to explain to them that they have the right to be sick, that they can be ill, that every effort will be made to replace them without overloading their colleagues, although perhaps it will be someone from outside.”FGD5 (nursing home nurse managers, Switzerland)
“Focus on the different communication channels about that. It can be quite simple: an article that you see on burnout and its consequences, on exhaustion, etc., and then, in fact, conveying that information. That’s what I was saying in relation to these meeting spaces—that we can already be aware of this phenomenon through information, by disseminating information.”FGD7 (frontline community healthcare in Switzerland)
“(…) involving people in defining the team’s goals, even institutional goals, makes everybody responsible for the issue. And, therefore, I think that this co-accountability can translate into a lower level of presenteeism.”FGD1 (frontline acute care nurses, Portugal)
“But it’s true that presenteeism means that sometimes, because they absolutely want to keep on working, you have to find ways for them to work and be safe too. So this can quickly require some difficult adaptation.”FGD8 (community healthcare nurse managers, Switzerland)
“(…) For someone who regularly resorts to absenteeism—to see the person and all—we have a whole procedure to go through and which is written down, but (…) there’s nothing written down in relation to presenteeism. There is no procedure. It’s really about taking the initiative to meet with them, but we don’t have a written procedure. Indeed, this is something that could be put in place.”FGD5 (nursing home nurse managers, Switzerland)
“(…) we are really living in an age where everything has to be quantified, weighed, and measured, and if we don’t have that, I have a bit of an impression that we are talking into the void. Because we can talk, but things are not moving forward. Because we must not only talk about the frequency of the problem, but above all what it costs. Because that’s the big argument. Because as long as it costs nothing, who cares. But if we finally start to quantify everything that presenteeism costs an institution, well then, maybe mentalities might change.”FGD7 (frontline community healthcare nurses, Switzerland)
4. Discussion
4.1. Study Strengths and Limitations
4.2. Individual, Professional, and Organizational Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Sociodemographic and Professional Characteristics | Participants (n = 55) |
---|---|
Sex | |
Female (%) | 49 (89.1) |
Male (%) | 6 (10.9) |
Age | |
Mean ± SD (range) | 45.0 ± 8.5 (25–61) |
Country | |
Portugal | 39 (70.9) |
Switzerland | 16 (29.1) |
Workplace function | |
Frontline nurses | 28 (50.9) |
Nurse managers | 27 (49.1) |
Years of experience in healthcare | |
Mean ± SD (range) | 19.3 ± 10.0 (3–40) |
Healthcare setting | |
Acute care (Portugal) (%) | 39 (70.9) |
Primary care (Switzerland) (%) | 6 (10.9) |
Long-term care (Switzerland) (%) | 10 (18.2) |
Self-reported evaluation of health status (1 = bad; 2 = reasonable; 3 = good; 4 = very good; 5 = excellent) | |
Mean (range) | 3.7 (2–5) |
Broad Themes | Themes | Subthemes |
---|---|---|
Individual impact (nurse level) | Nurses’ health and wellbeing | The physical, psychological, and mental impact |
Self-medication to keep working | ||
Frustration and job dissatisfaction | ||
Family/social relationships | Failing capacity to manage relationships | |
Committed family dynamics | ||
Collective impact (professional level) | Workplace dynamics | Decrease in productivity |
Team overload | ||
Peer “contagion” effect | ||
Interpersonal conflict with peers and patients | ||
Social impact (patient and population level) | Quality of care and patient safety | Depersonalization of careCompromised safety of care |
Professional image in society |
Broad Themes | Themes | Subthemes |
---|---|---|
Individual strategies (nurse level) | Favoring professionals’ self-knowledge | Using assertiveness at work |
Promoting a work–life balance | ||
Collective strategies (team level) | Creating a positive working atmosphere | Valuing teamwork |
Supporting peers (through digital social networks, events, etc.) | ||
Facilitating communication channels | Supporting communication from the “bosses” to staff | |
Being attentive to employees’ needs | ||
Sharing information coming from employees | ||
Developing a positive organizational culture | Encouraging collaborative and active employee participation | |
Encouraging employee-centered leadership styles | ||
Institutional strategies (organizational and structural level) | Implementing preventive/curative institutional actions | Planning and adapting working contexts |
Promoting occupational mental health programs | ||
Preparing procedures for situations of presenteeism | ||
Ensuring specialized support (from occupational health and psychology professionals) | ||
Identifying and documenting situations involving presenteeism | Assessing and quantifying the impact of presenteeism |
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Pereira, F.; Querido, A.; Verloo, H.; Bieri, M.; Laranjeira, C. Consequences of Nurse Presenteeism in Switzerland and Portugal and Strategies to Minimize It: A Qualitative Study. Healthcare 2022, 10, 1871. https://doi.org/10.3390/healthcare10101871
Pereira F, Querido A, Verloo H, Bieri M, Laranjeira C. Consequences of Nurse Presenteeism in Switzerland and Portugal and Strategies to Minimize It: A Qualitative Study. Healthcare. 2022; 10(10):1871. https://doi.org/10.3390/healthcare10101871
Chicago/Turabian StylePereira, Filipa, Ana Querido, Henk Verloo, Marion Bieri, and Carlos Laranjeira. 2022. "Consequences of Nurse Presenteeism in Switzerland and Portugal and Strategies to Minimize It: A Qualitative Study" Healthcare 10, no. 10: 1871. https://doi.org/10.3390/healthcare10101871