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Factors Influencing Nurse Absenteeism in A General Hospital in Durban, South Africa
Factors Influencing Nurse Absenteeism in A General Hospital in Durban, South Africa
Factors Influencing Nurse Absenteeism in A General Hospital in Durban, South Africa
1
Academic Development Officer, School of Nursing, University of KwaZulu-Natal, Howard College Campus,
Durban, and 2Associate Professor, Department of Health Studies, University of South Africa, Theo van Wyk
Building, Pretoria, South Africa
human rights of psychiatric patients. The findings for specialists, 91 for professional nurses, 20 for medi-
revealed that there were high rates of absenteeism cal specialists and 17 for pharmacists.
amongst staff at the hospital, especially on paydays on
the 15th and 30th of each month. Staff were also
Conceptual framework
absent from work due to abuse of alcohol and poor
working conditions (The Commission of Enquiry The conceptual framework of Taunton et al. (1995),
2005). adapted by Nyathi (2005), underpinned this study.
The independent variables of the nurse, nurse man-
ager, work and organisation, the variables-associated
Problem statement
characteristics and dependent variables of nurse absen-
Booyens (1998) states that absenteeism is disruptive teeism, guided this study. Nurse characteristics consist
to patient care and the work environment. Absentee- of: age and gender of nurses, qualifications, health
ism of nurses entails patients being cared for by fewer status, family responsibility, transport problems, work
qualified caregivers, which compromises effective care commitment, opportunities outside the workplace and
and treatment delivery (Booyens 1998). Health Can- income. With regard to age, Josias (2005) states that
ada (2004) highlights that the absenteeism rate of reg- younger employees take shorter periods of sick leave
istered nurses (RNs) in Canada is steadily increasing. than older employees. Alternatively, older workers are
Full-time employed RNs had absenteeism rates due to more prone to sickness absence than younger workers,
illness and injury which was 83% higher than other possibly due to health deterioration and prolonged
full-time employees for the year 2002. Canada faces periods of recovery. With regard to gender, women
severe nurse shortages, causing existing nurses to have display increased rates of absenteeism compared with
an increased workload coupled with increased work men, due to being the primary caregiver in most
hours. All nurses, full- or part-time, suffered high homesteads (Josias 2005). Cullinan (2006) explains
rates of strain due to increased work responsibilities, that nurses are stressed at work as others are absent
leading to absenteeism. In South Africa, Takaki et al. from work to ‘moonlight’ for extra income, supple-
(2006) stated that nurse absenteeism is a widespread menting their smaller salaries. The nurses remaining at
phenomenon. Causal factors for staff absenteeism work are burnt out due to the increased workloads.
could be attributed to increased workloads, worsened Nurse manager characteristics consist of the leader-
due to hospitals being inundated with patients ship styles of the nurse manager. Hayes et al. (2006)
infected with HIV/AIDS-related illnesses. The purpose claimed that nurse managers’ use of position, power
of this study was to establish reasons for nurse absen- and influence over work coordination had a direct link
teeism amongst the nurse categories of professional to employees’ satisfaction in their jobs. Work charac-
nurses (PNs), enrolled nurses (ENs) and enrolled teristics consist of autonomy, routine work and group
nurse auxiliaries (ENAs) from day and night duty in cohesion. Ose (2004) states that if there is work group
medical, surgical, maternity and trauma units of a cohesion in an environment, there is low absenteeism
hospital. due to high job satisfaction. Regarding performing a
Conducting this study was an inherent interest job task, Becker and de Oliveira (2008) state that
towards studying reasons for absence behaviour nursing professionals face long working hours and do
amongst nurses. This study was conducted in a gen- multiple job functions, which is also intensive and at
eral hospital located in Chatsworth in the city of the times physically challenging, subjecting the nurse to
eThekwini City District, South Africa, which primarily accidents and illness, leading to absenteeism.
serves the population of Chatsworth and the sur- Organisational characteristics consist of facilities,
rounding area (R.K. Khan Hospital 2012). The hospi- manpower, career development, absence policy, pro-
tal is a regional and district hospital with 543 beds. motion opportunities, incentives and decentralisation.
At the outset of the study, the researcher was Academic Writing Tips (2012) states that absenteeism
informed by the nurse managers and staff that there from work indicates work dissatisfaction; job satisfac-
was a high absenteeism rate of nurses coupled with tion is how happy or content the individual is with his
severe staff shortages. A report published by Govender or her job. Nyathi (2005) highlights that lack of rec-
(2009) emphasised the problem of nurse absenteeism, ognition towards employees in terms of promotional
highlighting that the general hospital is a busy and a opportunities in the workplace can lead to dissatisfac-
short-staffed one; the report also mentioned that there tion among employees, also possibly leading to absen-
was already a need for staff, with 128 vacant posts teeism.
significantly high proportion of ‘agrees’ for that partic- Combining the closed and open-ended results indi-
ular factor, in which case that factor could be consid- cates the following reasons for nurse absenteeism.
ered as a cause of nursing absenteeism.
Nurse characteristics
Open-ended data analysis
Nurses have family responsibilities to attend to. Fif-
The qualitative software package Nvivo v. 9 was used
teen ENs (72%), 19 ENAs (95%) and 16 PNs
to perform content analysis, code and analyse qualita-
(80%) agreed that this factor causes nurse absentee-
tive data of the open-ended survey by the researcher
ism. Josias (2005) indicates absenteeism due to per-
University of Technology, Sydney (2012). Content
sonal or family-related issues where child, eldercare
analysis of the data entails little interpretation but
and single-parent families have a profound impact
attributes a class of phenomena to a portion of the
on organisational absenteeism.
text. In this study, key words were identified and an
Nurses lack motivation to work due to stress. Fifteen
overall concept was formulated symbolizing a cause
ENs (72%), 15 ENAs (72%) and 20 PNs (100%)
for absenteeism. The codes were represented in a tab-
agreed that this factor causes nurse absenteeism.
ulated format under a specific theme, which allowed
Bakker et al. (2005) state that a job where there is a
for frequency distribution and simple descriptive sta-
high job demand and low resources results in burn-
tistics counts. Newly founded codes outside the coding
out, due to exhaustion, and absenteeism.
source-coding scheme were also listed in tabulated
Nurses have financial problems. Three ENs (25%),
form. Comparisons concerning the relative frequency
three PNs (20%) and three ENAs (25%) agreed that
of scores falling into specific coded categories were
this theme causes nurse absenteeism. Excerpts by
done and highlighted the number of participants
participants include one EN having stated that:
agreed on a code (Brink et al. 2000).
‘Nurses are moonlighting and therefore they can-
not work in the hospital that they are registered to’,
Results
For purposes towards understanding the commonality whilst one ENA stated that there is
of reasons for nurse absenteeism, the results in the
closed and open-ended section only highlight which ‘Unsatisfying salary given to nurses’
factors caused nurse absenteeism agreed by PNs, ENs and, similarly, one PN stated that:
and ENs indicating statistical significance towards
nurse absenteeism. Additionally, responses by partici- ‘Nurses are suffering from burnout due to the
pants which were 75% and above are considered sta- increase in turnover of patients. Other staff
tistically significant towards nurse absenteeism for the members are moonlighting while their colleagues
closed-ended results. have to double up their workload’.
‘Favouritism – gang up with colleagues – show- Similarly, one ENA stated that there is an:
ing favouritism with colleagues for extra breaks’.
‘Overload of work and shortage of staff’,
Hayes et al. (2006) claimed that nurse managers’
use of position, power and influence over work whereas one PN emphasised that there are:
coordination had a direct link to employees’ job sat-
isfaction and absenteeism. ‘Too few staff for large number of patients
which makes us unable to cope with workload’.
Work characteristics
Unruh and Strickland (2007) emphasise that absen-
Nurses are overworked on a ward. All ENs (100%),
teeism from the workplace contributes to an ongo-
20 ENAs (85%) and 19 PNs (95%) agreed that this
ing negative effect of causing increased absenteeism
factor causes nurse absenteeism. According to Dale
by other exhausted employees.
(2006), reports from Canada highlight that nurses
have the highest absenteeism rates of all health care No equipment. Two ENs (17%), four ENAs (17%)
professionals due to work pressure and stress, lead- and two PNs (17%) stated that there is a:
ing to missing working days due to illness and
‘Lack of resources, gloves, aprons, daily towels
injury. Dale (2006) emphasises that recruiting nurses
open to infection due to lack of resources’.
in place of the absent staff leads to the newly
recruited nurses being overburdened by work duties
Excerpts include one EN stating that there is a:
due to a short-staffed workforce, causing fatigue and
absenteeism.
‘Poor working environment, lack of skilled
An increase of workload. Six ENs (50%), two PNs
workers and lack of equipment’.
(17%) and four ENAs (40%) agreed that this
theme causes nurse absenteeism. Excerpts by partici-
Stressing the same, one ENA stated that:
pants include one EN stating:
‘Shortage of staff, this causes overload of work ‘Sometimes there is not enough equipment to do
which exhausts nurses’. their work’.
In addition, one ENA also stated there is a Similarly one PN stated that there is a:
tions from multiple groups of PNs, ENs and ENAs tions affect staff shortages, as remaining staff burnout
formed the basis of highlighting the results for this further and absent themselves from work.
paper. Findings in the nurse characteristics section Organisation characteristics results due to nurse
highlighted that nurses were absent due to family absenteeism included that unfair promotions, unfair
responsibilities, lacked motivation as they felt tired selection of nurses for training, short-staffed work-
and stressed, and inadequate remuneration. With force causing a heavy workload for nurses, no equip-
regard to the nurses who stated that being tired and ment to carry out work, no reward system and
stressed led to absenteeism, Eriksen et al. (2002) state incoherent decision-making practices for nurses were
that work factors such as job stress, psychological also reasons to absenteeism.
stress, job strain and physical workload are associated Dieleman and Harnmeijer (2006) highlight that con-
with high rates of sickness absenteeism. Similarly, Sa- tinuous career development, an applicable reward sys-
very and Luks (2001) agree that stress manifests in the tem, satisfactory working conditions, teamwork and
form of low morale, high turnover of employees and management support results in reduced employee
absenteeism. In addition, Bennett (2002) states that absenteeism as job satisfaction and motivation of staff
additional job demands, difficult work environment, are enhanced. Reward systems also include non-mone-
and poor social relationships between management tary elements, such as appreciation and recognition, as
and employees coupled with low morale contributed Dieleman and Harnmeijer (2006) highlight.
to employees’ stress, directly or indirectly contributing Becker and de Oliveira (2008) state that in a hospital
to a high level of absenteeism. Equally as stressful to work environment, nurses are susceptible to inappropri-
nurses is inadequate remuneration for work done. ate work conditions, affecting their psychological and
Findings from the nurse manager characteristics data physical well-being. Work tasks may include long
indicated that unfriendly nurse managers and favourit- working hours, physical and mental work that may be
ism caused absenteeism. Munro (2007) found that unbearable, poor interpersonal relations, pressurising
under-trained and less experienced supervisors cause time schedules and absence of a career ascension plan
stress to employees, resulting in absenteeism. In this for the individual.
regard the stress incurred due to the supervisor is due
to performing monotonous work as allocated, low job
Limitations of the study
satisfaction and unfair treatment by the supervisor.
Munro (2007) deemed poor leadership as the root The response rate of the first group of research partici-
cause for job dissatisfaction, leading to stress and pants was poor due to the national strike at the time,
absenteeism. which also affected all public health care workers.
Work characteristics results highlighted staff agree- During this time, there was an additional staff short-
ing that they are moved to a new ward every day to age and nurses could not afford the time to complete
cover staff shortages, overworked on a ward, work the questionnaires. As a result, a second group of
long hours, face unsatisfactory work conditions and nurses was resampled. It is suggestive that if further
have insufficient equipment to do work, causing nurse studies are done in a hospital setting, the researcher
absenteeism. should approach study participants at a time equally
Sekhukhune (2005) also states that nurses’ stressors conducive to both the researcher and research partici-
are due to the work environment. There was not pant. Study participants, as assumed, will not scuttle
enough suitable equipment to deal with patient needs, through the questionnaire without giving due consid-
frustrating nurses as they still had to do patient care eration to their responses, if an appropriate time
with or without equipment. As a result, nurses felt decided by themselves is chosen. Factors such as
stressed and were absent from work, owing to sickness strikes, violence and unrest are all limitations in a
or frustration. Priest (2006) reiterated that nursing as a study and can affect the response rate by study partici-
profession is faced with a serious understaffing crisis. pants and the quality of data produced.
Nurses are therefore forced to cope with inadequate
support from management and the situation at work is
Recommendations
worsened, causing absenteeism.
In addition to job strain are the long work hours. The findings suggested that recording absenteeism of
Chauke (2007) found that an organisational contribu- each employee throughout the year assists in monitor-
tor to absence from work was the long shifts. Basu ing absenteeism. This includes recording the duration
and Gupta (2007) also state that poor working condi- and reason for an employee’s absenteeism. An organi-
sation needs to produce policies to address the under- why, Canada. Available at: http://www.hc-sc.gc.ca/sr-sr/pubs/
lying causes of absenteeism. hpr-rpms/buI1/2007-nurses infirmieres/7_e.html, accessed 14
February 2012.
With regard to findings of lack of recognition and
Becker S.G. & de Oliveira M.L.C. (2008) Study on the absen-
rewards, a career ladder for demonstration of compe- teeism of nursing professionals in a psychiatric center in Man-
tency, professional recognition and introduction of aus, Brazil. Available at: http://www.scielo.br/scielo, accessed
monetary incentives should be introduced in the hospi- 14 February 2012.
tal. Rewards could be in the form of training pro- Bennett H. (2002) Employee commitment: the key to absence
grammes or monetary incentives. management in local government? Leadership and Organiza-
tional Development Journal 23 (8), 1–9.
Bislimi R., Bischofberger I., Drewe J. et al. (2009) Research
with Human Subjects: A Manual for General Practice. Swiss
Conclusion and implications for nursing Academy of Medical Sciences (SAMS), Switzerland. Available at:
management www.samw.ch/dms/en/Publications/…/e_Leitfaden_Forschung_
def.p, accessed 1 November 2012.
The inclusion of open-ended questions allowing par-
Booyens S.W. (1998) Dimensions in Nursing Management, 2nd
ticipants to freely express what they thought could edn, Kenwyn: Juta, Cape Town.
have also caused absenteeism. This new information is Brink H.I., van der Walt C. & vanRensburg G. (2000) Funda-
very useful in understanding the factors of absenteeism mentals of Research Methodology for Health Care Profes-
which may have missed as questions on the closed- sionals, Kenwyn: Juta, Cape Town
Chauke B.P. (2007) The Impact of Absenteeism on the Private
ended survey questionnaire. A few recommendations
Security Industry in Gauteng Province, South Africa, Univer-
have been provided, so that management could apply sity of South Africa.
some of these techniques to reduce absenteeism. Cooper C. & Dewe P. (2008) Well-being – absenteeism, presen-
Essentially, what can be deduced is that most causes teeism, costs and challenges. Occupational Medicine 58, 522–
of absenteeism arise from the nature of the organisa- 524.
tion. A person working in a better working environ- Cooper D.R. & Schindler P.R. (2006) Business Research Meth-
ods, 9th edn. McGraw-Hill: Boston, MA.
ment is more likely not to absent him- or herself from
Cullinan K. (2006) Hospitals in crisis. Special investigation.
work than a person working in a physically exhaust- South Africa. Available at: http://www.healthe.org.za/news/
ing and psychologically depressing environment. article.php?uid=2003 1495, accessed 14 February 2012.
Nurse managers employed in the hospital can play Dale D. (2006) Workload Taking its Toll on Nurses. The Nug-
an important role in reducing absenteeism by address- get, Victorian Order of Nurses, Ontario, CA.
Davey M.M., Cummings G., Newburn-Cook C.V. & Lo E.A.
ing all the factors that were identified by the nurses.
(2009) Predictors of nurse absenteeism in hospitals: a system-
atic review. Journal of Nursing Management 17 (3), 312–
330.
Source of funding
Dieleman M. & Harnmeijer J.W. (2006) Improving health
The authors did not receive any funding for this worker performance: in search of promising practices, The
paper. Netherlands. Available at: http://www.who.int/hrh/resources/
improving_hw_performance.pdf, accessed 14 February 2012.
Eriksen W., Bruusgaard D. & Knardahl S. (2002) Work factors.
Ethical approval A predictor of sickness absence: a three-month prospective
study of nurses’ aides. Available at: http://oem.bmjjoumals.
Ethical approval was obtained from UKZN EXPO com/cgi/content/full/60/4/27 l, accessed 14 February 2012.
18/06. Govender R. (2009) The Express online: staff shortage at Dur-
ban Hospital, South Africa. Available at: http://www.expres
sonline.co.zalindex2.php?option=com_content&do_pdf=1&
References id=943, accessed 24 February 2009.
Hayes L.J., O’Brien-Pallas L., Duffield C. et al. (2006) Nurse
Academic Writing Tips. (2012) Job satisfaction and absentee- turnover: a literature review. International Journal of Nursing
ism. Available at: http://academicwritingtips.org/component/ Studies 43, 237–263.
content/article/56-management-/641-job-satisfaction-and-abse- Health Canada. (2004) Our Health, Our future: creating quality
nteeism.html, accessed 14 February 2012. workplaces/HR Canadian nurses. Final Report of the Cana-
Bain L.J. & Engelhardt M. (1992) Introduction to Probability and dian Nursing Advisory Committee, Canada. Available at:
Mathematics Statistics, 2nd edn. Duxbury Press, Boston, MA. http://www.hc-sc.gc.calhcs-sss/pubs/nurs-infirm/2002-cnac-ccc
Bakker A.B, Demerouti E. & Euwema M.C. (2005) Job si-final/cnaccccsi5e.html#2, accessed 29 May February 2007.
resources buffer the impact of job demands on burnout. Hobfoll S.E. (2001) The influence of culture, community and
Journal of Occupational Health 10 (2), 170–180. the nested-self in the stress process: advancing conservation of
Basu K. & Gupta A. (2007) The working conditions of nurses: resources theory. Applied Psychology: An International
confronting the challenges: nursing shortages, where and Review 50, 337–369.
Josias B.A. (2005) The relationship between job satisfaction and Savery L.K. & Luks J.A. (2001) The relationship between
absenteeism in a selected field services station within an electric- empowerment, job satisfaction and reported stress levels:
ity utility in the University of Western Cape, South Africa. Avail- Some Australian evidence. Available at: http://www.emerald
able at: http://verfroller.nl/rio.pdf, accessed 14 February 2012. insight.com/, accessed 8 November 2007.
Martocchio J.J. & Jimeno D.J. (2003) Employee absenteeism as Sekhukhune D. (2005) A Model to Facilitate a Quest for
an affective event. Human Resource Management Review 13, Emotional Maturity of Psychiatric Nurses in Producing their
227–241. Mental Health, University of Johannesburg.
Munro L. (2007) Absenteeism and presenteeism: possible causes Takaki J, Mutsuhiro N., Karta K., Nishikitani N. & Yona E.
and solutions. South Africa, Durban. Available at: http:// (2006) Relationship between effort–reward imbalance, over-
www.sar.org.za/index.php/sar/article/viewFile/76/82, accessed commitment and fatigue in Japanese information-technology
14 February 2012. workers. Journal of Occupational Health 48, 6264.
Nyathi N.M. (2005) Identifying Factors that Contribute to the Absen- Taunton R.L., Hope K., Woods C.Q. & Bott M.J. (1995) Pre-
teeism of Nurses in the Workplace, University of South Africa dictors of absenteeism among hospital staff nurses. Nursing
Ose S.O. (2004) Working conditions, compensation and absen- Economic 13 (4), 217–229.
teeism. Journal of Health Economics 24, 161–188. The Commission of Enquiry. (2005) Reports, South Africa.
Phelan C. & Wren J. (2005–2006) Exploring reliability in aca- Available at: http://www.kznhealth.gov.za/townhill/report.pdf,
demic assessment. University of Northern Iowa. Available at: accessed 29 May 2007.
http://www.uni.edu/chfasoa/reliabilityandvalidity.htm, University of Technology, Sydney. (2012) Nvivo. Available at:
accessed 10 April 2013. http://www.itd.uts.edu.au/services_facilities/nvivo.html, accessed
Priest A. (2006) What’s ailing our nurses? A discussion of the 11 February 2013.
major issue affecting nursing human resources in Canada Unruh J. & Strickland M. (2007) Nurse absenteeism and work-
(Ontario). Available at: http://www.chrsf.ca, accessed 14 Feb- load: negative effect on restraint use, incident reports and
ruary 2012. mortality. Journal of Advanced Nursing 60, 673.
R.K. Khan Hospital. (2012) Available at: http://www.anything- van der Westhuizen C. (2006) Work-related attitudes as predictors
medical.co.za/index.php/component/mtree/hospitals/public-hos of employee absenteeism. University of South Africa. Available
pitals/kwazulu-natal/rk-khan-hospital, accessed 12 April 2013. at: http://etd.unisa.ac.zal, accessed 8 November 2007.