Journal of Nursing Management, 1996,4, 11-17

Nurse absence-the causes and the consequences

M. BEIL-HILDEBRAND RGN, Nursing Administration (Germany), MSC

PhD student, Department of Nursing Studies, University of E d ~ ~ b u r g U
h ,R

Correspondence BEIL-HILDEBRAND M. Journal of Nursing Management 4,ll-17

M . Beil-Hifdebrand Nurse absence-the causes and the consequences
Landshuter Strasse 44
93053 Regensburg This paper addresses nurse absence as it occurs in health care organizations and as a form
Germany of withdrawal behaviour from work. Absence represents a traditional domain of conflict
between nursing management and their employees in day-to-day practice. The aim of the
following discussion is to extend nursing management’s understanding of the topic as a
precondition for well-balanced schedules and effective human resource planning. A
discussion of planned and unplanned absence thus arises and appropriate types of
measurement, taking employee absence behaviour into account, are outlined. The
implications of the arguments, developed in detail in the first part of the paper, are
applied in the second part using a hypothetical account. In order to illustrate the
importance of managing absence by nursing management, a method for calculating
schedules is described which investigates the organizational control of planned and
unplanned absence. This method proposes a seven stage calculation and highlights the
processes that are essential for taking absence into account.

28 September 1995
Accepted for pub~~cat~on:

Introduction is directly relevant to the effectiveness and efficiency of

human resource management in hospitals. Great oppor-
Since the beginning of the 1980s it is been the aim to
tunities and a challenge for nursing management are given
reorganize the National Health Service (NHS) and hospi-
through the creation of a new kind of schedule. These
tal management boards have concentrated intensively on
new schedules allow nursing management to examine and
the finances and organizational control of their corporate
plan with two different absence variables as a prerequisite
health care systems. Financial and economic balance, the
for well-balanced human resource planning.
introduction of a market economy as well as the trans-
formation into self-governed trusts seem to be the strategic
objectives in this decade. In this current flurry the rapid
What is absence?
political changes within the NHS have led to the growth
of an independently managed service as well as to Absence is a pervasive problem in all working organiza-
increased competition in health care. These changes tions. In the UK alone, about 300 million working days
within the NHS raised questions about the relationship are lost per year, i.e. 13.5 days per employee or about
between cost, quantity and the quality of care delivered 6% of the contracted working hours per year (Argyle
by nursing services. Nevertheless, the absence of nurses 1989).The situation in the United States industry is better
remains a phenomenon rarely addressed, even though it with an absence rate of about 2.5%, and worse in Italy

D 1996 Blackwell Science Ltd 11

M. Beil-Hildebrand
with 14% (Pluecker 1990). This variety of absences would
be a challenge for research since the worldwide diversity
of human beings provides a complex material for dis-
covering forms of absence behaviour related to the norms
of cultural life.
Furthermore, it has been recognized for many years
that absence in industry is a widespread and an increasing
problem (Froggatt 1970; Jones 1971) and its cost is roughly
equivalent to the total expenditure of the National Health
Service (Taylor 1974). Reports from the Industrial Society
(1993) and the Confederation of British Industry (1993)
described a higher employee absence in the NHS than in
most other sectors of the economy. The absence rates in
the US health sector are just as high as other areas in US
industry, although a comparison of absence rates across
industry is pointless because of different workforce com-
positions and work patterns (Seccombe & Buchan 1993).
Definitions
Many related terms are used to describe absence, such
as absenteeism, non-attendance, sickness absence, non-
sickness absence, and short/long-term absence, etc.
(Redfern 1978). It can be claimed that absence is one
specific phrase which is applied to describe a variety of
behaviours that take place in organizational life. In exam-
ining nurse absence, a broad distinction can be made
between planned absence, such as holidays, study leave,
public or statutory holidays, where management have had
notice of absence and can influence it by accurate planning
procedures, and unplanned absence, often short-term and
sometimes voluntary in nature, when nurses call in sick
at short notice, or do not arrive at their place of work
(Eichhorn 1975; Pluecker 1990; Seccombe & Buchan
1993).Literature has supplied several definitions: Taunton,
Krampitz and Woods (1989: p. 14) defined absence as ‘a
failure to appear for a scheduled work day’ and Cannavo
(1970) circumscribed absence as the failure to report for
the job when the employer has no reason to expect that
the employee will not be available at the specific time.
As can be seen from the above, both definitions refer
to unplanned absence that results from sickness, illness
or staying away from the workplace due to (un-)specific
reasons. In the attempt to define absence it can be claimed
that absence is every day or hour for which work was
contracted with an employee, which must be paid for by
the employer without getting performance from an
employee at hidher place of work. In other words, absence
is the planned and unplanned time which is going to be
financed by the employer, although the institution does
not get anything in return.
12
Why does unplanned absence occur?
The effects of unplanned nurse absence on the employing
organization can be significant in terms of the impact 011
the organizational workflow and in relation to the qualit?,
and continuity of care provided, since service and atten-
tion to patient’s needs cannot be postponed. In many
ways, unplanned absence is disruptive to the working
environment because of its unpredictability and sud-
denness. Surveys undertaken by the Institute of Manpoweir
Studies show that the reported incidence of unplanned
absence is higher within the National Health Service antl
within hospital nursing than in non-NHS nursing antl
community settings (Seccombe & Buchan 1993). However,
the explanation for higher unplanned absence rates in
NHS institutions may reflect the fact that the occurrence
of absence could be dependent on several causes. Although
some current articles reflect concern about absence vari-
ables, hard data or national statistics on nursing absencl:
describing the incidence, patterns and troublesomeness of
absence among hospitals and other health care agencies
is unavailable. Most published research assumes that
some portion of unplanned absence is preventable and
voluntary and researchers have made attempts to identify
the contributory causes (Cohen-Mansfield & Rosenthal
1989; Hackett, Bycio & Guion 1989; Lee & Eriksen 1990::.
Hackett et al. (1989) refers to three related theoretical
factors that attempt to advance the understanding of the
absence phenomenon. They pointed out that first, absence
represents a flight from negatively valued aspects of work
experience; secondly, absence is a result of organizational
socialization and other adaptive processes to job demand?;;
and thirdly, absence results from a rational decision or
choice process directed toward the attainment of valued
goals.
That means that the first two perspectives tend to
emphasize the importance of employees’ affective reaction
to hidher work environments. The third component
highlights the purposive, volitional aspect of absence
behaviour (Hackett et al. 1989). In contrast, Redfern
(1978) recognized factors associated with absence and
grouped them in three categories; first, personal and
demographic characteristics: i.e. grade, age and tenure,
sex, marital status and family responsibility, absence
proneness and personality. Secondly, work context varr-
ables: i.e. size and type of organization and work unit;
full/part-time status, hours and shifts of employment,
supervision, job satisfaction, days of the week and rest
days. Thirdly, external variables: i.e. travelling to work,
and unemployment, medical certificates. In doing so,
Redfern (1978) has developed the generated categories in
0 1996 Blackwell Science Ltd, Journal of Nursing Management, 4, 11-1 7

a more comprehensive picture and considered the internal
and external surroundings of an individual employee.
The measurement of absence
The precondition for wo/man power planning and sched-
uling is accurate monitoring and measurement of
employee absence variables. There are a number of
measurement options open to managers faced with nurse
absence. In deciding which one is most appropriate,
considerations of employee absence behaviours must be
balanced against impact on the human resource planning
procedures and attendance management strategies.
Attempts have been made to classify absence by
expressed cause, or to distinguish between voluntary or
unavoidable absence on the one hand, and voluntary and
avoidable absence on the other. Redfern (1978) refers to
Jones’ (1971) investigation and states that classifying
unplanned absence by cause is unreliable because it is
impossible to ensure that the expressed cause is the true
cause. Chadwick-Jones, Brown and Nicholson (1973)
differentiated unavoidable/avoidable absence in a type A
and type B dichotomy as an apparently simple matter
since illness, sickness, medical treatment, compassionate
leave (bereavement), and jury service (lay assessor), etc.
are obviously unavoidable. In practice it is difficult to
classify certain unplanned absences, especially sickness
absence, because individual criteria of sickness vary enor-
mously and people are not always absolutely honest. This
means that an investigation by management to identify
various absences (specifically by sickness) is only of
significance if a correct statistical examination can be
employed. Redfern (1978) described three meaningful
types of absence; first, scheduled or unscheduled absence;
secondly, short-term (i.e. 3 days or less) or long-term (i.e.
4 days or more) absence; and thirdly, certified and uncerti-
fied absence. Unscheduled absence can be regarded as
unplanned and is therefore a totally independent factor,
i.e. it occurs, in contrast to scheduled absence, auton-
omously from the working situation. Short/long-term
absence can be considered as dependent on and indepen-
dent of the working situation, but it is a problem in its
own right and research revealed that approximately 80%
of all unplanned absences were for 1-7 days (Benbow
1989). A certificate for sickness or jury service has to be
obtained from medical doctors or public authorities and
thus can be precisely measured.
Review of research
In the National Health Service concentration on the
problem of absence started in the late 1960s, when Brown
0 1996 Blackwell Science Ltd, Journal of Nursing Management, 4, 11-17
Nurseabsence-thecausesandtheconsequences
(1968) reviewed absence-related aspects (sickness absence
levels, causes and costs) and found a sickness absence
correlation with age, part-time employment, and staff
turnover. Brookes and Gardener (1972) examined the
incidence rates, time-lost percentages, seasonal and daily
patterns and mentioned problems of analysis due to
deficient record-keeping. Moreover, the Maplin report of
the Department of Health and Social Security (1977)
pointed out that absence is measured in a variety of ways.
There were 16 methods outlined, which have been used
in institutions of the National Health Service. It can be
claimed that the use of multiple techniques make com-
parisons and meaningful statistics between studies or
institutions impossible.
The review of research undertaken in the past and
recently (Sadik 1981; Cohen-Mansfield & Rosenthal 1989;
Taunton et al. 1989; Seccombe & Buchan 1993) employed
either a time-lost index or a frequency of incidents
measurement, or both. Redfern (1978: p. 233) defined
frequency rates as ‘the number of absences in a given
time period per 100 employees’. This technique has been
found to be a reliable measure, because it presents the
spells of absence per month or year and is suitable to
attendance management strategies. Chadwick-Jones
(1971) identified the so-called attitudinal index, i.e. the
numbers of one or two day spells of absence, and
described it as fairly reliable, although less so than the
frequency index. It is a relatively reliable element of
voluntary absence and, possibly, morale. Furthermore,
Chadwick-Jones et al. (1971) described the time-lost index
as the numbers of hours or days lost in a period expressed
as a percentage of total man hours or days required. It
measures absence duration with a particular emphasis on
the total absence hours (planned and unplanned) per year
in order to estimate the effective or actual working hours
for the calculation of nursing staff or the scheduling of
holidays. The time-lost index can be regarded as the most
reliable quantitative measure because it presents the sum
of total absence hours or days. This is the criterion which
has to be applied in human resource planning procedures
in order to achieve a balance between supply of and
demand for nursing staff. Such information is obviously
vital for nursing managers in order to plan and schedule
strategically.
The calculation of the time lost index is presented as
a practical example; 5 working days per week, a 15%
planned absence rate and a 6% unplanned absence rate
per employee and 8.0 shift hours are used as a hypotheti-
cal account:
365 days per year
- 105 Saturdays/Sundays
13
M.6ei~"HiIdebran~
-10 public and statutory holidays per year
=250 working days per yearifuII-time employee
As can be seen, there are 250 working days per year
for every full-time employee. If one working day involves
8.0 hours on average, one full-time employee has to
work 2000 contracted working hours per year (i.e. 250
days x 8.0 h=2OOO hf.
20oQ.00 h contracted working hours per fuI1-time
empf oyeeiyear
-420.00 h. 21% absence rate {planned 1SX and
unplanned 6 % )
= 1580.00 h egective working hours per employeeiyear
= 131.66 h effective working hours per employeel
month
One full-time employee has to work the contracted
2000.00 h per year. If 15% planned absence and 6%
unplanned absence are lost, 1580.00 effective working
hours per year, which is equivalent to 131.66 effective
working hours per month ( i s . 1580h-12 month=
131.66 h) are left. An absence rate, e,g. of 21% evolves
by adding up all planned and uiip~annedabsence hours
lost in a 1 year period and expressing this as a percentage
of the total contracted working hours from all employees
per year.
Minimizing unplanned absence by
organizational control
What leads to the decision to go to work? Hackett et aE.
(1989) identified two interrelated perspectives which con-
firm the individual's choice and desire to be absent from
work. The first stage can be considered as stimultis event
producing a desire to be absent; stage two i s the actual
decision either to report for u7ork or t o stay away (Hackert
et al. 1989). This means that if the first stimulus event
Ieaves the individual no choice, a decision must be made.
Therefore, the employee must decide whether the stimulus
event justifies the absence or not by considering the costs
and benefits desired,
Employer casts
When unplanned absence occurs, the hospital may pay
overtime to nursing personnel or premium pay to an
agency, or a repl~cementnurse may be available. These
cover options may have adverse effects on the quality of
care and OKIstaff morale but also on the budget because
covering of unplanned absence leads to non-prospective
calculated casts (Seccombe & Buchan 1993). Therefore,
nurse absence can represent and be reflected as significant
costs to an employer in terms of money. It must be in
14
the interest of nursing management to ensure that counter-
active poticy and practices are going to be followed.
Sometimes sanctions of absence-a sequence of oral ancl
written warnings may be used, Seccombe and Buchart
(1993: p. 6) refer to the 'good practice guide' published
by the MDG (1993) of the Scottish health service, and
pointed out that there is a need for attendance manage-
ment to be 'at the heart of every line manager's objectives'
in an organization where performance management i 4
becoming a priority. But is influence by management
indeed possibIeZ Different types of ~ ~ are ~ ~
required at different levels in the organization. At thz
nursing director level, information is required compara -
tively infrequently but in an aggregate form, for dis-
cussions in clinical directorate meetings and for strategic
human resource planning. Detailed information for ward
sisters is necessary on a daily or weekly basis. In Seccombc
and Buchan's (1993) survey it was found that in unics
where absence is regularly reviewed, aggregate monitoring
is applied. For an optimal review in practice, an adequate
and comprehensive information and communication
system is necessary in order to allow nursrng manage men^
to react and act according to their responsibilities. It can
be said that most managers have taken a reactive view,
rather than attempting to reduce absence rates by positive,
active interventions in employment practice. The active
involvement of ward sisters can be seen as the key to
successful human resource management. Examples of
active involvement are regular contact between absentee
and ward sister, informal discussion and formal review
of absence, reviewing alternative work patterns, or occu-
pational health attendance (Seccombe & Buchan 1993).
Furthermore, employees should notify the ward sister of
their inabiky to come in for duty and this information
be duly passed on, Management attendance must include
a proactive approach to absence, identi€ying the reasons
of unplanned absence, and preventing and covering
absence where a scope for positive intervention is possible.
Therefore, management action could include the proper
education and training of all staff, the provision of flexible
hours, the counselling of frequent absentees, back to work
interviews, or target setting in problem areas.
Organizational control taking planned absence
into account
The permission to be absent is often very easy to get and,
in the past, nursing managers made no comment following
the scheduiing of planned absence. However, the schedul-
ing of planned absence can be seen as a challenge in
balancing cost with positive impact on che quality and
0 1996 Blackwell Science Ltd, Journai of Nuning Management, 4 1 1 -1 7

continuity of care, since scheduled absence has caused an
enormous sway in productivity and continuity of care in
the past. The following model considers the calculation
of planned absence as a method of calculating schedules
in day-to-day management practice and is used in practice
in the following German hospitals: North and South
Clinic of the city of Nurnberg and the St Joseph Hospital
in Regensburg.
The scheduling of planned absence in February 1995
Within a 1-month schedule there are a specific number of
shifts available for scheduling planned absence and there
is a time budget for unplanned absence which can be
used in a flexible manner. The method of calculating
schedules is presented as a practical example; 5 working
days per week, 15% planned absence rate, 6% unplanned
absence rate, 8.0 shift hours, minimum of three nurses in
every shift, 30 holiday shifts per employee/year are used
in this hypothetical case.
1. How many nurses have to be on schedule?
3 full-time nurses early shift
+3 full-time nurses late shift
+3 full-time nurses night shift
=9 full-time nurses per day as minimum for all
three shifts
x 8.0 shift hours per nurse
=72.0 shift hours per day for nine full-time nurses
x 28 days per month (February ’95)
= 2016.00 hours
If the demand for nursing personnel is based on optimal
nursing care with a minimum of three nurses in every
shift (with 8.0 h) necessary, then 2016.00 h are worked
effectively on this ward during the 28 days in February
1995.
2. How many nurses are essential for February 1995?
2016.00 hlward
- 131.66effective working hours per nurse (see calcu-
lation 1 on pp. 13-14)
= 15.31 full-time nurses
2016.00 effective working hours on this ward in February
1995 divided by 131.66 effective working hours per nurse/
month = 15.31 full-time nurses, given that a minimum of
three nurses per shift on this ward are needed for a period
of 28 days, with 21% rate of absence taken into account.
3. How many absence days occur per year in the case o f
15.31 full-time nurses?
First step in the calculation:
15% planned absence
+ 6% unplanned absence
0 1996 Blackwell Science Ltd, Journal of Nursing Management, 4, 1 1 -1 7
Nurseabsence-thecausesandtheconsequences
= 21a/‘ absence
21% absence=420.00 h nurselyear (see Figure 1)
420.00 h absence per nurse/year
x 15.31 nurses (see number 2)
= 6430.20 h
If the ward has, on average, a 21% rate of planned
and unplanned absence per year and 15.31full-time nurses
are employed, then 6430.00 h total absence hours are
going to occur.
Second step in the calculation:
6430.20 hours absence
+ 8.00 daily shift hours
= 803.78 absence shifts per year
In dividing the total absence hours of the ward by 8.0
hours for every day shift, a total of 803.78 absence shifts
per year results. But before doing so, the amount of
holiday shifts for 15.31 employees must be calculated.
Third and final step in the calculation:
15.31 nurses
x 30 holiday shifts per nurse/year
= 459.30 holiday shifts per year in total
803.78 absence shifts per year for all 15.31
employees (100.00Y0)
- 459.30 holiday shifts total/year for planned absence
(57.14%)
= 344.48 shifts available for unplanned absence
(42.86%)
With a minimum of three nurses on every shift on
every day of the year, 803.78 absence shifts per year
(100%) are possible; 15.31 employees are going to take
459.30 holiday shifts in 1 year as planned absence
(57.14%); therefore 344,48 shifts for unplanned absence
(42.86%) are calculable for a period of 12 months.
4. How many contracted working hours must be
worked in February 1995 by 15.31 full-time nurses?
15.31 full-time nurses
x 20 contracted working days/February
x 8.0 shift hours
= 2449.60 hours
If 15.31 full-time nurses have to work an average of
20 days in February and every shift lasts 8.0 hours, then
2449.60 working hours have to be rendered.
5 . How many absence hours in February 1995 can be
tolerated?
2449.60 contracted hours for 15.31 full-time nurses
- 2016.00 effective shift hours per month (see
point 1)
= 433.66 hours absence is possible in February 1995
15
M. Beil-Hildebrand
15.31 full-time nurses had to work 2449.00h in the
month of February 1995, but for a minimum of three
nurses in every shift, 2016.00 h are actually necessary.
Thus, there are 433.66 h available to absorb 15% planned
and 6% unplanned absence rates.
6. How many absence shifts in February 1994 are
possible?
433.66 possible absence hours
+ 8.0 shift hours
= 54.20 possible planned absence shifts in February195
There are 433.66 hours available for planned and
unplanned absence in the month of February 1995. By
dividing 433.66 h by 8.0 (the number of hours per shift)
we arrive at the total of 54.20, i.e. the amount of possible
absence shifts in the month of February 1995.
7 . How many planned absence shifts in February can
be scheduled?
54.20 possible absence shiftdmonth
x 57.14°/~for planned absence
= 30.97 planned absence shifts (e.g. holidays)
54.20 possible absence shiftdmonth
x 42.86% for unplanned absence
= 23.23 unplanned absence shifts
If 54.20 shifts of absence are possible in the month of
February 1995, then 54.20 absence shifts have to be
co-ordinated according to the planned and unplanned
absence rates described in point 3. It is therefore possible
to schedule 30.97-30.00 holiday shifts in the month of
February 1995. While an average rate of 6% unplanned
-
absence occurs every month, 23.23 23.00 unplanned
absence shifts are possible in order to keep a minimum
of three nurses on schedule. It is therefore, obvious that
accurate and precise planning throughout the whole year
can be carried out, with the minimum of three full-time
nurses in every shift still in place.
Conclusion
In this article I have discussed planned and unplanned
absence and its measurement. Furthermore, I have pre-
sented a method for calculating schedules. Background
knowledge, such as the accurate definition of both forms
of absence, is essential, because absence comprises
unplanned and planned hours or days which are going to
be financed although the employer does not get any work
in return. Moreover, the occurrence of unplanned absence
has disruptive effects on the organizational workflow and
the continuity of care provided. However, a proactive
management approach in employment practice is most
likely to achieve a decrease in the unplanned absence
16
trend. Various methods of measurement are available and
it is especially necessary to build up and keep a time-losr
index. So that planning and scheduling procedures can bt
carried out in order to achieve a balance between supplj
of and demand for nursing staff. The method of planned
absence analysis and calculating schedules, which I see a?,
being the pursuit of the qualitative argument by quantitat
ive means, guarantees effectiveness and efficiency based
on human resource planning. In short, it achieves ari
enhanced and improved utilization of wo/man power. A.;
an end in itself in day-to-day practice, wards will be run
on a minimum of staff and will enable those who are i r i
charge of it to improve the workflow organization. Taking
absence into account will have significant implications for
a more balanced organization as well as for the quality
and continuity of nursing care provided.
References
Argyle M. (1989) T h e Social Psychology of Work. 2nd edn. Penguin
Group, London.
Benbow E. (1989) Absent Friends. Health Service Journal February
2, 144-45.
Brookes R. & Gardener J. (1972) Sickness and absence levels of
nursing staff for the mentally handicapped in the Birmingham
Region. Nursing Times January 20, pp. 9-12.
Brown, I (1968) Hospital staff sickness absence. T h e Hospitai',
March, pp. 94-97.
Cannavo J.J. (1970) Absenteeism and benefit claims controi.
Occupational Health Nursing 18, 11-16.
Chadwick-Jones J.K., Brown C.A. & Nicholson N. (1973) Absence
from work: its meaning, measurement and control. Znternationd
Review of Applied Psychology 22, 132-154.
Chadwick-Jones J.K., Brown C.A., Nicholson N. & Sheppard C.
(1971) Absence measures: their reliability and stability in a n
industrial setting. Personnel Psychology 24, 463-470.
Cohen-Mansfield J . & Rosenthal, A.S. (1989) Absenteeism of nurs-
ing staff in a nursing home. International Journal of Nursing
Studies 26, 187-194.
Confederation of British Industry (1993) Too Much Time Our.
CBI, London.
Department of Health and Social Security (1977) Absence from
Work. Manpower Planning and Personnel Information, N o 1,
Second Report of the Joint DHSS/NHS Subgroup, London.
Eichhorn S. (1975) Krankenhausbetriebslehre: Theorie und Praxis
des Krankenhausbetriebes. 2nd edn. Verlag W Kohlhammer,
Koln, pp. 381-435.
Frogatt P. (1970) Short-term Absence from Industry: Literature,
Definitions, Data and the Effect of age and Length of Service.
British Journal of Industrial Medicine 27, 199-201.
Hackett R.D., Bycio P. & Guion R.M. (1989) Absenteeism among
hospital nurses: an idiographic-longitudinal analysis. Academy of
Management Journal 32, 424-453.
Industrial Society (1993) Wish You Were Here. Industrial Societv,
Egbaston.
Jones, R.M. (1971) Absenteeism. Department of Employment
Manpower Papers, No. 4 HMSO, London.
0 1996 Blackwell Science Ltd, Journal of Nursing Management, 4, 11 -1 7

Lee J.B. & Eriksen L.R. (1990) The effects of a policy change on
three types of absence. journal of Nursing Administration 20,
37-41.
MDG-Management Development Group (1993) Attendance
Management: Good Practice Guide. MDG, Edinburgh.
Pluecker W. (1990) Fehlzeiten im Krankenhaus. Kranken-
hausumschau 46.
Redfern, S.J. (1978) Absence and wastage in trained nurses: a
selective review of the literature. Journal of Advanced Nursing
3 , 231-249.
0 1996 Blackwell Science Ltd, Journal of Nursing Management, 4, 11-1 7
Nurse absence-the causes and the consequences
Sadik, A.M. (1981) Sickness and Absenteeism Survey. Nursing Times
June 11, pp. 1023-1025.
Seccombe I. & Buchan J. (1993) Absent nurses: the costs und
consequences. University of Sussex, Institute of Manpower
Studies.
Taunton R.L., Krampitz S.D. & Woods C.Q. (1989) Absenteeism -
retention links. Journal of Nursing Administrution 19, 13-20.
Taylor P.J. (1974) Sickness Absence: Facts and Misconceptions.
Journal of the Royal College of Physicians 8, 315-333.
17