Research Brief: Nurse Presenteeism

A team at the University of North Carolina, Greensboro, led by Susan Letvak and Christopher Ruhm, evaluated the influence of presenteeism (decreased productivity due to health problems) on hospital registered nurses' (RNs) quality of patient care. This study focused on presenteeism among RNs suffering musculoskeletal pain and/or depression. In addition, they assessed the economic costs to the health care system associated with presenteeism. Using a mixed methods approach, including a survey and focus groups of RNs in North Carolina, researchers documented a depression prevalence of 18% in hospital nurses. Seventy-one percent of nurses interviewed reported working with some pain and the majority of nurses interviewed reported that a health problem had negatively affected their productivity on the job in the previous two weeks. The team found that pain and depression were significantly associated with presenteeism and that presenteeism was significantly associated with patient falls, medication errors and the perceived quality of care. Finally, the team found that the productivity loss due to pain and/or depression was $14,339 per nurse and $876.9 million for the state of North Carolina. If these numbers were extrapolated to the nation, the productivity loss would be $22.7 billion.

Access the research brief.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

If I’d Only Known Then What I Know Now (A Letter to Myself)

We asked our grantees to write a letter to their "pre-INQRI" selves to share what they would have wanted to know before their funding began. Susan Letvak PhD, RN, FAAN, Professor of Nursing, UNC Greensboro, shares hers:

Dear Susan,

Just over three years from now you will have finished your Robert Wood Johnson INQRI-funded research project. While you were grateful you were able to finish your project on time, there are things you would do differently. Most importantly, when you started the project you never would have known the impact your study will have on nurses. I’m writing this letter to share some of those lessons.

1. Interdisciplinary teams can work together very well, even though you have not always had positive experiences as a co-investigator on other teams. Choosing a team that was vested in the project and in nursing outcomes made all the difference.

2. Stuffing envelopes takes longer than you think it will. While you had done mailed survey projects in the past, you never had to stuff 2,000 envelopes before. Thank goodness you had a research assistant built into the budget or you may still be stuffing envelopes today.

3. Your decision to use a professional graphic designer to design the survey was a great idea. The colorful and expertly designed survey was instrumental in the high response rate you received.

4. Your findings will not make everyone happy and you should be prepared for the angry responses you will receive from some nurses. Your findings will support that health problems in nurses leads to presenteeism which has a negative impact on quality of care. You will learn learn to always present positive strategies to overcome presenteeism so those nurses who have health problems will not feel maligned.

5. You will learn the importance of social media and blogs for reaching large audiences. In the past you relied only on manuscript publication and conference presentations to disseminate your research. This project will allow you to garner national attention in health blogs (including the NY Times) and as a guest on NPR.

6. You will not realize the positive impact you will make on increasing awareness and recognition of mental health problems in nurses and healthcare workers. At the onset of the project you thought that nurse pain would be the largest problem impacting nurses. Surprisingly your team found an 18% rate of depression in nurses. You remember reading the following poem written by Annabel Sheila:

Until it affects someone we love, 

We don’t even know it’s there. 

It’s really not our problem, 

So why should we care. 

The statistics are quite shocking, 

One in four they say 

Will suffer from depression 

In their lives one day. 

No one would choose to live with it, 

And some don’t even try. 

Most people turn the other cheek, 

They’ve been doing it for years. 

But it takes only one… 

ONE to know they care. 

You never realized the ONE would soon be you.

Have a great time with your INQRI project and the terrific people you will meet on your journey.

Susan

Nurse Burn-Out and Infections

A new study, published in the American Journal of Infection Control, presents the work of researchers at the University of Pennsylvania, who analyzed nurses' attitudes related to their work.  The team compared a hospital's percentage of "burned-out" nurses to its rates of surgical site infections and catheter associated urinary tract infections.  They found that every 10% increase in the number of high-burnout nurses correlated with two additional surgical site infections and one additional catheter associated urinary tract infection per 1,000 patients annually.

The INQRI program has also generated evidence that depression among nurses could have an impact on patient safety.  INQRI researchers Sue Letvak, Chris Ruhm, and their team evaluated the influence of presenteeism (decreased productivity due to health problems) on hospital registered nurses' quality of patient care.  The team found that pain and depression were significantly associated with presenteeism and that presenteeism was significantly associated with patient falls, medication errors and the perceived quality of care.

Of course, INQRI research has also shown that nurses can have a strong impact on keeping patients safe from infections.  Led by David Thompson and Jill Marsteller, a team at Johns Hopkins conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. This study, conducted in ICUs in 12 states, has shown that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts.

An INQRI team led by Eileen Lake and Jeannette Rogowski has demonstrated the importance of nurse staffing and the professional practice environment in preventing infection among tiny babies in neonatal intensive care units (NICUs). Their findings show that babies in units where nurses have less support and limited professional practice are at higher risk of developing infections. Higher levels of NICU experience are associated with better infant outcomes.