Excessive Absenteeism in the Nursing Profession

Is excessive absenteeism a problem at your current nursing position? This article discusses what excessive absenteeism is, characteristics of habitual callouts, causes of callouts, and the potential negative effects on the nursing work environment. The article also includes potential solutions to the problem and opens up a discussion on the issue.

Excessive Absenteeism in the Nursing Profession

Is excessive absenteeism a problem in your healthcare setting? First of all, let's

discuss my definition of excessive absenteeism. Of course, absenteeism is the absence of a staff member from a scheduled workday. Excessive absenteeism refers to habitual absences or call-outs by an individual staff member. For example, is there a nursing staff member who calls off from work three to four times a month? When you come to work and learn that someone called out, do you automatically know who it is? Some characteristics of excessive absenteeism include multiple callouts a month, patterned callouts, and always leaving early or coming in late.

Causes of Excessive Absenteeism in Nursing

Illnesses are one of the most commonly used excuses for call outs by nursing staff. The illness may pertain to the staff member, a family member or child, and may be related to either a chronic or acute condition. A few examples of chronic conditions are migraines, back pain, or abdominal issues. Some examples of acute conditions are the flu, bronchitis, or strep throat. Other call-out excuses may include problems with transportation, child care issues, or a death in the family. Most of these issues are excusable and there may even be an excuse provided by a physician. Excessive patterns of absenteeism may be present when the excuses get odd, made up, or overused. I have heard nurses use the excuse that their goat is sick and their dog was giving birth. Sometimes callouts occur based on staffing. If your facility displays the staffing pattern for the next day, nursing staff may call out because they know that staffing will remain adequate in their absence or they know that staffing is already short-handed. The lack of disciplinary action for excessive absenteeism may also be a cause. When staff know that they will not be held accountable or that the disciplinary action will be minor, they continue their behavior. Although we all have to call out at times, excessive absenteeism in nursing can have negative effects on the profession.

How Excessive Absenteeism Can Negatively Affect the Work Environment

Excessive absenteeism can have various negative effects on the nursing work environment and the nursing profession in general. We are all aware of the global nursing shortage, problems of excessive absenteeism only exacerbate this problem by decreasing

what may be an already shortened staffing pattern. Other examples of the negative effects of excessive absenteeism include low staff morale, increased workloads, decreased productivity, disruption of routine workflow, job dissatisfaction, and a lower quality of patient care. Let's take a more indepth look at some of these negative effects.

Disruption of routine workflow:

Nursing staff generally have the same patient assignments, hall, or unit. When another staff member calls out, assignments have to be rearranged to supplement for the absent staff member. This can cause a disruption in your usual routine and the continuity of care.

Increased workloads:

When nursing staff is absent this generally means that other staff members will have more patients assigned to their workload.

Decreased productivity:

Nursing staff may have less motivation resulting in a decreased output of work, which can be costly to employers.

Low morale:

Nursing staff become unhappy and dissatisfied with their job and have a negative overall outlook of their work environment.

Job dissatisfaction:

Job dissatisfaction related to staffing issues and call outs is can be directly linked to high turnover rates.

Decreased quality of patient care:

Patient satisfaction, which is one of the most important measurements for the quality of patient care, suffers greatly when nurses have low morale, increased workloads, and decreased productivity.

Solutions to Excessive Call Outs in Nursing

What are some interventions that could help decrease excessive absenteeism in the nursing profession?

  1. A firmly set attendance policy
  2. Strict and consistent adherence to the attendance policy
  3. Verbal counseling
  4. Written write-ups
  5. Termination

As nurses, we took an oath to provide good, high-quality patient care to the people whom we deliver care to. A nurse should also be professional, punctual, and a team player because it takes every member of the interprofessional healthcare team to deliver good quality patient care. Attendance plays a huge part in this. We must take into account who might be affected in our absence including your team members, patients, your organization as a whole, and the healthcare system in general. Nursing is not just an 8 or 12-hour job, but a career that requires 24-hour accountability, and excessive absenteeism has no place in the nursing profession.

This article is just some of my thoughts on the issue. Is this a problem in your healthcare setting? What interventions would you recommend to resolve the problem?

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MasterStreet

About MasterStreet, MSN, RN

I am a 10 year Registered Nurse with experience in Med/Surg, long-term care, Hospice, and Rehabilitation. I have held multiple leadership positions and recently graduated with a master's degree in nursing education.

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Specializes in Tele, ICU, Staff Development.

I think employers should offer mental health days for nurses. No blame, and not subject to discipline.

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Specializes in SICU, trauma, neuro.

Hmmm I think most of us have the integrity to be mindful of absenteeism. I can only speak for myself (although I have heard others agree with me) -- but if I have "excessive" call ins, it's because they are necessary.

I can think offhand of a few times where we have had influenza or a GI virus make the rounds of my house. I have required a few days for myself and a few days when my children got sick. (Backup childcare? Yeah not an option if said children are VOMITING, or even running a fever. Dad? I'm a staff nurse... Dad is the CFO. I can be replaced with float pool -- his work will accumulate.)

On the other side of the toilet... if my colleague is VOMITING or otherwise inappropriate to work... I WANT THEM TO CALL OFF. I don't want what they have.... and I don't want PATIENTS/families/colleagues to have what they have.

(To be clear, I don't call off for the sniffles. I call off for symptoms that make me unfit for duty -- and I call off if one of my children need me for similar reason.)

One thing that no professional should have to consider when they are SICK: Anything that doesn't have to do with fitness for work, or recovery.

Personally I resent the idea that as a professional, we should have to worry about being disciplined for calling in sick -- or even required to have a doctor's note. What do we teach others about viral illnesses -- rest and fluids. Going to the clinic for 12 hours of vomiting or a few days of a dry hacking cough is all kinds of inappropriate.

And really.... I have to question the professionalism, integrity, and clinical competence of a manager who would strong-arm a nurse into working sick.

I expect that as a professional -- and one who has never broken trust, say by calling off and then posting party pics on FB -- that if I need to call off, my judgment in the matter will be respected.

I've never taken an oath related to nursing, but I have set the personal and professional standard for myself that I will not work sick. In making the decision to work or not, I weigh it from all angles... because after all, I am a professional with integrity.

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I would disagree with your definition of excessive absenteeism, "Excessive absenteeism refers to habitual absences or call-outs by an individual staff member."

I would argue that excessive should be defined by absenteeism exceeding the allotted sick-time, PTO, or other predefined absences the employer/employee agreed to.

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Solution? How about starting with adequate or beyond adequate staffing instead of trying to do as much as possible with as few staff as possible?

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Downplay reasons people call in - check.

Elaborate on how difficult this is for employer - check.

Mention the Code of Ethics - check.

Act like staff nurses are the only ones bound by Code of Ethics - check.

[Edit.....]

And [Edit.....]

That's what I think about it!!

Disclosure: Personal rate of call in is

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Specializes in oncology, MS/tele/stepdown.

I was a Call Out Queen in my first couple years. Our schedule was two 12's and two 8's with every 3rd weekend, and I rotated days and nights. So every 3 weeks I would work 64 hours in 7 days without OT, sometimes switching back and forth between sleep schedules in between. Ex two night 12's, then two day 8's, day off, two night 12's. It wasn't that bad every time, but it frequently wasn't good. The other factor was when I got sick, I would call in to request not to have any neutropenic patients on my assignment; this way I could work but not have the highest risk patients if I wasn't sick enough to call out. But frequently when I would do that I'd be given them anyway, so I stopped trying and just called off.

I ended up exceeding my absences and getting written up. My NM let me work the occasional 36 hour week, giving me an extra day off every once in awhile. That and my fear of getting written up further helped. Maturing probably helped too. It's pretty rare for me to call out now; in the past year I called off once for mental health and left early once for physical health. But I don't work there anymore and with travel nursing I can frequently pick and choose what schedule I want.

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Had a co-worker claim FMLA almost every weekend shift. People stopped answering their phones on weekends. They knew what the issue was and it was getting old. I had to fight a write up for myself. I had conjunctivitis and was told to stay home till the doctor cleared me. Out Friday, off the weekend, then I got the OK to go back Wednesday and it was counted as three occurrences. Had the note and it was technically one long absence. Sad but it was the first I was able to use vacation.

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Specializes in Travel, Home Health, Med-Surg.

""This article is just some of my thoughts on the issue. Is this a problem in your healthcare setting? What interventions would you recommend to resolve the problem?""

Thank-you for the article, here are a few of my suggestions...

1) fix the environment so when nurses have had a horrendous 12 hour day they do not already know that the next day will also be equally horrendous, thus if just having a minor "not feeling well" could have probably worked

2) let nurses take vacation/PTO and stop with the lame excuses why they cannot

3) stop blaming the sick nurse for the problems of the unit because of their illness, it is the responsibility of staffing/management to MANAGE...

4) MANAGE by filling in the empty position with registry/float etc, when the workload gets dumped on other nurses THIS is what hurts morale and job satisfaction etc, not the fact that your coworker was sick

5) have fair sick policies, like Chrispy11 mentioned, only 1 occurrence should be used for 1 occurrence, many facilities play with this at the nurses detriment

6) agree with nurse Beth, let nurses take mental health days, the unit would know ahead of time and be able to staff, win win

I do agree though that nurses should be professional and not call off and then post on FB etc.

Managers/admin also need to remember that nursing is very hard work and sick policies should take that into account.

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When it's next to impossible to take a vacation day, it sometimes requires you to call in sick. Where I work, if we really need or want a day off, it's "safer" to call in sick than to ask for it off. Yes, of course we signed up for a job that is 24/7, but when I die, I am not going to lay on my death bed thinking gee, I wish I missed my kid's graduation or wedding so I could work.

Now, how far to take this thinking? I don't know. Missing 2nd grade softball practice is probably a sacrifice you should make.

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You shouldn't have to call in sick. You should get an allotted amount of short-notice time-off and that is it. I actually get a week of that at my current workplace and I love it, no excuses and no lies. I use it when I am sick, I use it when I need a mental health day, and I use it when I don't feel like wearing pants that day.

The only time sick-time comes into play is for long-term disability stuff.

You either get time off or you don't get time off, you shouldn't have to explain yourself or feel guilty. Time called off outside of that allotment should be harshly punished.

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Specializes in ED, ICU, Prehospital.

There are far more variables that effect call outs and they are legitimate, and purposefully not being addressed by employers, NMs and the favorites of each crew.

First, fatigue. Did you all just read what Swellz just wrote?? EXCUSE me? Rotating shifts and 4 days per week. Absolutely ZERO chance to rest. I have no idea what unit Swellz was on at that time, but lemme tell ya...if i had to walk in to a pt load of 8, and my schedule looked like that? I ould never have taken the job in the first place, but if it was a bait and switch or i had to take it as a new grad...i would do it for a year and then walk.

The reason employers get away with this ridiculous and grjnding scheduling setup is because RN staff allows it. I worked at a place that the favorites got shifts like 9a-9p and mo weekends. When i asked for that shift when one of them quit to travel, i was told it was being phased out. Turn around, a few months later, they wanted to poach a MPCU nurse and the only way she would transfer to our quickly deteriorating (morale in the crapper and 50% personnel loss r/t our new "non nurse" director) unit was to offer her a 9A-9P.

How about the night I showed up and not only had 3 nurses called out, the CN4 who took over scheduling techs had brilliantly decided to save money by simply forcing the nurses to do the work and not scheduled any help....and i was stuck with one other RN, in a level 1 trauma ED and 12 patients EACH.

There are outliers, i get it. I watched a girl once (a unionized small hospital that eventually was shut down and the union broken because of abuses like this girls) sit with her schedule and count the number of days she had to work in order to accumulate enough hours to call off and be paid. I get it. But those ae rare.

The reason for the extreme fatigue and burnout are msnifold, and its coming from the top down, not the occasional abuser of sick time.

Grinding schedules, low pay, management fiddling with overtime or bonuses or critical staffing pay....my former RN mgr routinely would offr critical staffing slots, at a rate thwt would hsve netted me around $1200 per shift. When i woild arrive for a posted critical staffing shift, after driving for an hour and making arrangements to be there, i would be met t the timeclock with.....OH house staffing office gave us a float tonight and you wont get critical staff pay, but you can stay for strwight time if you want !!

Last time i ever did that. I ignored any and all calls for overtime or critical staffing. He had done it to many others as well. People voted with their feet. He lost 50% of the senior staff and others transferred out of the unit.

Fatigue makes you vulnerable to serious mistakes. Short staffing or thin line staffing is not safe. These Mgrs who live and die by Press Ganey cant understand why pts are furious that they sat for hours before someone saw them or took care of a problem.

Want to know why people call out? Unsafe working conditions. Fatigue. Lack of unit cohesion, fostered and encouraged by RN Mgrs who play favorites....worse still, the Mgr who goes home and turns off the phone or isnt anywhere to be found when they are supposed to be on unit...because they just dont want to hear it or deal with real problems

How about tuose RN Mgrs who routinely short staff or thin staff...being required to come in and take the same assignment as the RNs she is so blithely cracking the whip over and writing up for having the audacity to be TIRED and SICK ?

I did work at a critical access hospital where the director routinely donned scrubs and got her butt out onto the floor and i worked like a dog for her. That showed LEADERSHIP. Not like these favorites who hide in the back office and chat it up bc the RN Mgr and the RN went to school together or their kids are in the same class.

One last thing. Combining PTOand Sick Time was a monumentsl gift to employers. You get sick? You have to use vacation time! Bonus for them! How about not having banked vacation granted because the RN Mgr wont staff to capacity or have PRN staff ready to fill in. The rules normally require months of notice for a vacaction request...abolutely ZERO reason for management not to be prepared.

I pesonally would drive 3 hours in the opposite direction or consider MOVING if an employer attempted to place me on rotating shifts or 4 day workweeks (that were not 10 hour shifts each and i agreed to that), and I have. I was offerrd a sweet position, high paying, in a cath lab. Every fourth week on call. Hmm. Asked specifics of call. Was glossed over by management...couldnt get a straight answer.

I told them, no answer, i dont accept the position. (Btw, i was flown in from california to a new england state for the interview, plus hotel. For a CATH.LAB.JOB. RED FLAGS ANYONE?)

I finally got this minimizing, half assed explanation of how....i would work 12 hours, hold a pager for that same week of work (7 days). Guaranteed that 3 of those days i was taking call while working a full 12. Do i get the following day off? No. I would essentially be required to work 12, possibly (probably) get called in overnight and work until all those cases are done...and SHOW UP FOR MY 12 THE NEXT DAY.

She said this with a straight face.

I said....then hire a second shift! Only midnight to 7a for call. Nope. This is how they had been abusing their nurses for years, and the nurses took it. This is what we have to do they said. This is how it is.

No, it isnt. I walked amd told them why. I figured i would never be considered for another job there....but lo and behold....i was bombarded with requests from other recruiters in other units to intreview for them.

At the end of the day, call ins happen and any good manager can roll with those punches. But the majority of the stories i have heard and what i have been witnessing is a crush by management to force rns to do more with less and just suck it up. Fatigue and burnout are real, lethal mistakes happen in these circumstances, both tonpatients and to nurses attempting to satisfy some manager who wont do what shes asking her staff to do.

I am leaving floor nursing for just this reason, and many others are as well. We aent allowed to get sick, have s sick kid, have surgery, experience a death, get deployed....without being threatened or terminated. Maybe management needs to take s hard look at their practices before punishing a nurse for being human.

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