Grantee Profiles
Susan Letvak
The negative effects of "presenteeism"—lower productivity at work due to employee health problems—are widely known in business circles.
But what does presenteeism mean for the health care industry, and particularly for nurses—the largest group of health care professionals in the country—and their patients?
Susan Letvak, R.N., Ph.D., an Interdisciplinary Nursing Quality Research Initiative (INQRI) researcher and an associate professor of nursing at the University of North Carolina at Greensboro, has the answer: Keeping nurses healthy will help keep patients healthy, too.
In a study examining the influence of nurse presenteeism on the quality of patient care, Letvak and INQRI co-researcher Christopher Ruhm, Ph.D., an economist at the University of North Carolina at Greensboro, found that nurses in poor mental or physical health reported a diminished ability to care for their patients.
"Nurses with health problems do have lower productivity, and that is impacting their perceived ability to give care," Letvak says.
Letvak became interested in the effects of "presenteeism" after studying the aging nursing workforce. Many nurses, she observed, donned their scrubs even if they were in poor physical or mental health. One senior nursery nurse, she recalls, feared her chronic knee pain would prevent her from saving infants in emergency situations.
To explore the link between nurse productivity and quality of care, Letvak sent anonymous surveys to 2,500 hospital nurses in North Carolina and received 1,171 completed surveys back. Letvak and her research team also conducted six focus groups throughout North Carolina of nurses who had health problems, nurses who worked with other nurses with health problems and nurse managers.
Preliminary results show that nurses with chronic depression or musculoskeletal pain—two major causes of presenteeism—reported lower productivity and lower quality care and higher rates of medication errors and patient falls.
When compared with the general population, nurses have high rates of chronic musculoskeletal pain and depression. Almost three out of four nurses worked with some degree of pain on a daily basis, and almost one in five experienced depression, she found.
These problems come at a high price. Nurse presenteeism costs $2 billion nationwide, according to the study's most conservative cost estimate.
Yet nurses often come under great pressure to show up at work even if they are in poor health, Letvak says. Nurses may worry that a colleague will have to pick up extra patients or work a longer shift if they stay home for health reasons. Or they may fear that they will lose their job if they don't come in to work.
"In hospitals today, minimal staffing is the maximum staffing," Letvak says. "There's no room for someone calling in sick."
These fears are particularly intense for older nurses, even though they are the ones who are most likely to have health problems, Letvak says. As the nursing workforce ages (the average age of a registered nurse is currently 45, Letvak notes) nurses—and their patients—will likely be even more burdened by health problems, she says.
Health care organizations, meanwhile, often penalize nurses for staying home when they are sick or injured. Some hospitals, for example, reward perfect attendance or force nurses to use vacation time when they are sick or injured, Letvak says.
The good news, though, is that there are straightforward solutions that can be implemented quickly. These include more flexible staffing policies and procedures, redesigned workplaces, safe lifting programs, more supportive work environments for nurses, and counselors or occupational health specialists for nurses with health problems.
"This isn't Pollyanna stuff," Letvak says. "We know we have a workforce with significant health concerns, and today we can start doing something about it."