MANAGING ABSENTEEISM,

REDUCING TURNOVER,
RETAINING STAFF
Dr. Islam Al-Oweidat RN, PhD

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LEARNING OUTCOMES
After completing this chapter, you will be
able to:
1. Explain absenteeism.
2. Discuss ways to manage absenteeism.
3. Describe how nursing turnover
affects the organization.
4. Explain voluntary turnover.
5. Discuss what organizations can do to
improve retention of nurses.
6. Discuss what managers can do to
help retain nurses
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INTRODUCTION

 keeping higher-performing
nurses is a priority in health
care.
 In order to understand why
nurses are absent or leave the
organization and develop
ways to retain them, it is
necessary to consider
absenteeism, turnover, and
retention

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MANAGING ABSENTEEISM
Outline…Managing Absenteeism
1. Definition absenteeism.
2. Model of Absenteeism.
3. Managing Employee Absenteeism.
4. Selecting employees & monitoring absenteeism.
5. Absenteeism Policies.
6. Family and Medical Leave
ABSENTEEISM
 Absenteeism has been one of the most common
causes of staff shortage in healthcare setting.
 Absenteeism is a term generally used to refer to
unscheduled employee absences from the
workplace.
 Absenteeism effect on health
organization:
I. Very expensive cost.
II. Effect on the work lives of the other staff.
III. Working short-handed (extended period of
time, can create both physical and mental strain).
IV. affect the delivery of quality healthcare services
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MODEL OF ABSENTEEISM

A-Voluntary Absenteeism B-Involuntary Absenteeism

 Absenteeism under the employee’s control. • Absenteeism is largely outside of the

employee’s control.
 When:
• When:
• Double jobbing .
• Crises ( taking a sick day because of food
• Low self-esteem, low self- confidence.
poisoning ).
• Conflict with supervisor,
• Chronic illness.
• coworkers .
• Heavy family responsibility.
• Insufficient job autonomy .
• Transportation problems
• Monotonous job tasks.
** All are considered barriers to attendance

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 •

WAY THEY MEASURE

ABSENTEEISM A Diagnostic
model of
1- Total time lost : the number of employee
scheduled days an employee misses. It is attendance.
not a perfect measure of voluntary
absenteeism.

2- Absence frequency : the total number

of distinct absence periods, regardless of
their duration.

* An employee’s attendance at work is

largely a function of two variables: the
individual’s ability to attend and Employee attitudes,
motivation to attend values, and goals

portrayed in Figure 20-1 are ALPINE SKI HOUSE 7

MODEL OF EMPLOYEE ATTENDANCE

1.The Job Itself:

 Enriched jobs may increase attendance motivation.
 The nature of a job influences attendance.
2.Organizational Practices:
 absence control policies that reward employees for
good attendance and/or punish them for excessive
absenteeism.
 Organizational practices(carefully recruiting,
attendance motivation, organization activities).
3.Absence Culture
 Some work units have an absence culture that reflects a
tolerance for absenteeism. Other units have a culture in
which being absent is frowned upon.
 It is also affected by informal norms that develop among
workgroup members, organizational practice & nature of
jobs involved.
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CONT.,

4.Generational Differences: 6.Labor Market:

• days workforce includes nurses from four generations, and  If the nurse believes that plenty of equivalent
each cohort( traditional, baby boomers, Generation X,
jobs are available locally, he or she might be less
Generation Y) Has different expectations in the workplace
younger nurses expect to have flexible scheduling and motivated to attend than if fewer jobs were
may uses absenteeism to achieve it. & technology skills available.
different.
7. Personal Characteristics:
5.Management:
 Employees’ attitudes, values, and goals can also
 Management influences attendance motivation of all staff
have a direct effect on attendance motivation
as well.

 A shared governance organizational model encourages

attendance because of the emphasis on cooperative
decision making.

• A nurse manager can influence the nature of a staff nurse’s

job and a work unit’s absence culture by stressing the
importance of good attendance
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MANAGING EMPLOYEE ABSENTEEISM
Absenteeism management strategies that a nurse manager might consider include:
1. Enriching the staff nurse’s job by increasing its
responsibility, variety, or challenge.
2. Reducing job stress.
3. Creating a norm of excellent attendance.
4. Improving coworker relations.
5. Enhancing advancement opportunities.
6. Trying to select employees who will be satisfied
with and committed to their jobs.
7. Being a good role model by rarely taking sick
days.
8. Discussing the employee’s attendance during
the performance appraisal interview.
9. Rewarding good attendance with salary
increases and other rewards.
10. Enforcing absenteeism control policies
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 JORDANIAN POLICIES

According to the Jordanian Ministry of Labor law

 the normal working hours shall be eight hours per

day, provided that the working hours do not exceed
forty-eight hours per week.

 With his consent, the worker may be employed for

more than the daily or weekly working hours,
provided that the worker receives for the additional
working hour a wage of no less than 125% of his
usual wage.

 If the worker works on his weekly day off, religious

holidays, or official holidays, he shall receive an
additional wage for his work for that day not less
than (150%) of his usual wage.

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CONT.
Friday of every week shall be
the weekly holiday for the worker
unless the nature of the work
requires otherwise.
The worker, with the approval of the
employer, may collect the days of his
weekly vacation and obtain them within
a period not exceeding one month.

The weekly holiday shall be for the

worker with full pay.

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JORDANIAN MINISTRY OF LABOR LAW ON ABSENTEEISM

• According to Article 21 of the Jordanian • Leaves stipulated by Jordanian labor law:

Ministry of Labor Law
 Annual holiday : (14) days per year of service.
 If the worker is absent from work without a valid
 Sick leave: (14) days during one year based on a
reason for more than twenty days intermittently,
report from the physician approved by the
during any one year, or for more than ten
employer.
consecutive days, provided that a written notice is
sent to his address before dismissal by registered  maternity leave: 10 weeks (The leave is granted
mail and published, at least once in a local daily before and after deliver).
newspaper; It is permissible for the employer to
 breastfeeding hour: An hour a day within a year
dismiss the worker from the job
from the date of birth.

 study leave: 4 months.

 Additional leave to perform Hajj: 14 days.

 Religious and official holidays: full on vacation

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 Click icon to add picture

REDUCING TURNOVER
Out line

1) What is turnover.

2) Types of turnover.

3) Causes of turnover.

4) Cost of nursing turnover.

5) How to reduce employee turnover

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REDUCING TURNOVER

What is turnover? • Types of turnover:

 Employee Turnover: is the
1. voluntary (controlled): the employee chooses
movement of members across the
to leave the organization( such as personal
boundary of an organization.
events as change in martial status, and
 Any time a current employee
movement to anther job.)
leaves the company and is
replaced by a new employee. 2. Involuntary (uncontrolled) :the employee
 High turnover indicate: termination by the employee (such as dismissal,
retirement, laziness, or death.)
A. unhappy with the work or company.
B. Unsafe or unhealthy condition 3. Functional : is when low Performing Employees
leave.
C. few employees give satisfactory
performance (due to unrealistic 4. Dysfunctional : loosing nurse who is an
expectations, inappropriate excellent performer
processes or tools)

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VOLUNTARY TURNOVER

 Employees willingly choose to leave their positions.

 Employees might choose to vacate their jobs for a variety of reasons.
 causes maybe personal or external factors

Personal factors External factors:

• Education - Job opening at other organizations
• Area of specialization - Non health-care organizations hiring nurses

• Age - Economy
• Contacts at other hospitals.

• Transportation.
• Geographic mobility

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CONSEQUENCES OF EMPLOYEE TURNOVER

A- Negative consequences B- Positive consequences

a) Recruitment and Selection costs. a) Increased Performance.

b) Training and Development Costs. b) Reduction of entrenched conflict.

c) Operational Disruption. c) Increased mobility and morale.

d) Demoralization of Organizational membership d) Innovation and adaptation

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CAUSES OF TURNOVER
a. low income ( financial payment).
b. Lack of Respect
c. Lack of Appreciation
d. Less frequency in Giving Rewards.
e. The Mismatch Between Job and
Person.
f. Lack of Support.
g. Stress From Overwork and Work-Life
Imbalance.
h. No Flexible work schedules.

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 COST OF NURSING
TURNOVER
1. Advertising and recruitment cost .

2. Vacancy costs (e.g., paying for agency

nurses, over Hiring.

3. Orientation and training cost.

4. Decreased productivity.

5. Potential patient errors, compromised

quality of care.

6. Loss of organizational knowledge.

7. Replacement cost .

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 HOW TO REDUCE EMPLOYEE
TURNOVER

1. Hire the right people

2. Fire the people who don’t fit.

3. Encourage generosity and gratitude

4. Give prize.

5. Show the career path.

6. Allow flexible work schedule.

7. Prioritize employee happiness

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RETAINING STAFF

Outline

1. Retaining Staff.

2. Factors affecting job satisfaction.

3.Strategies to increase staff retaining.

4.Additional Retention Strategies

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RETAINING STAFF

 Job satisfaction is a key component to retaining staff.

 Job satisfaction is affected by various

facets :
a. Relationships with the nurse manager, other staff
nurses and unit employees, patients, and physicians.

b. Shift worked (e.g., day versus evening, rotating

versus fixed) .

c. Fit between nurse values and institutional culture.

d. Expectations of practice setting .

e. Compensation level .

f. Equal and fair distribution of rewards and

punishments.

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 STRATEGIES TO RETAIN STAFF

• A-Employee Engagement : is being inspired by B- Healthy Work Environment :

the organization, willing to invest effort, likely to
recommend the organization, and planning to
remain in the organization.
• Key factors of engagement :
1.Control over practice professional development and
growth.
2.Teamwork.
 A healthy work environment increases nurse job
satisfaction, a necessary condition for retaining
nurses.
• Criteria for a healthy work environment :
1. Skilled communication.
2. True collaboration between and among nurses and
other health care professionals.

3.Nurse-Physician collaboration 3. Effective decision making involved as partners in

making policy and leading organizations.
4.Salary and benefits.
5.Having a structure that encourages staff input, and 4. Appropriate staffing (patient needs vs nurse
attention to problems as soon as they occur competencies ) .
5. Meaningful recognition for value of work.
6. Authentic leadership leaders embrace, live, and
engage others in it
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CONT.
C- Improving Salaries :
 Paying new nurses a higher starting salary or
rewarding those with fewer years of experience
with higher increases results in the salaries of
long-term employees.
• being at or below those of less-experienced
nurses (salary compression)
•
D-Recognizing Staff Performance :
Examples:
 Provide personalized immediate feedback of a job
well done.
 Write a personal note acknowledging an
employee’s good performance.
 Publicly recognize an employee’s good
performance at staff meeting.
 Encourage staff to post notes on the bulletin board
to thank a coworker for a great job.
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REWARDING EMPLOYEES

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 ADDITIONAL RETENTION
STRATEGIES

1. Providing a realistic job preview to new

hires.
2. Facilitating movement within the
organization.
3. Coordinating with other managers to
influence organizational policy.
4. Adapting to turnover rate :
• Manage beliefs about why a nurse left.
• Provide human resources with a preferred list of
replacement workers.

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 THANK
YOU
References
1.Sullivan, E. J. (2012). Effective leadership
and management in nursing. Boston:
Pearson
2.National Labor Law Profile: Jordan.
3. Moberly, T. (2021). Sickness absence rates
across the NHS. Bmj, 361.
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