Journal of Nursing Management, 2009, 17, 312–330

Predictors of nurse absenteeism in hospitals:

a systematic review

MANDY M. DAVEY B S C N , R N , M N 1, GRETA CUMMINGS PhD, RN

2,3
, CHRISTINE V. NEWBURN-COOK PhD,
2,4
RN and ELIZA A. LO B S C N , R N 2,5
1
Registered Nurse, Bonnyville Health Centre, Bonnyville, AB, Canada, 2Associate Professor, Faculty of Nursing,
University of Alberta, 3Principal Investigator, CLEAR Outcomes Research program; New Investigator, Canadian
Institutes of Health Research; Population Health Investigator, Alberta Heritage Foundation for Medical Research,
University of Alberta, 4Associate Professor & Associate Dean (Research), Faculty of Nursing, University of Alberta
and 5MN Student, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.

Correspondence D A V E Y M . M . , C U M M I N G S G . , N E W B U R N - C O O K C . V . & L O E . A . (2009) Journal of Nursing

Greta Cummings
5-125 Clinical Sciences Building
Edmonton, AB T6G 2G3
Canada
E-mail: greta.cummings@ualberta.ca
Management 17, 312–330
Predictors of nurse absenteeism in hospitals: a systematic review
Aim This study aimed to identify and examine predictors of short-term absences of
staff nurses working in hospital settings reported in the research literature.
Background Front-line staff nurse absenteeism contributes to discontinuity of
patient care, decreased staff morale and is costly to healthcare.
Evaluation A systematic review of studies from 1986 to 2006, obtained through
electronic searches of 10 online databases led to inclusion of 16 peer-reviewed
research articles. Seventy potential predictors of absenteeism were examined and
analysed using content analysis.
Key issue Our findings showed that individual ÔnursesÕ prior attendance recordsÕ,
Ôwork attitudesÕ (job satisfaction, organizational commitment and work/job
involvement) and Ôretention factorsÕ reduced nurse absenteeism, whereas ÔburnoutÕ
and Ôjob stressÕ increased absenteeism. Remaining factors examined in the literature
did not significantly predict nurse absenteeism.
Conclusions Reasons underlying absenteeism among staff nurses are still poorly
understood. Lack of robust theory about nursing absenteeism may underlie the
inconsistent results found in this review. Further theory development and research is
required to explore the determinants of short-term absenteeism of nurses in acute
care hospitals.
Implications for nursing management Work environment factors that increase
nursesÕ job satisfaction, and reduce burnout and job stress need to be considered in
managing staff nurse absenteeism.
Keywords: absenteeism, nurse, predictors, systematic review

Accepted for publication: 6 September 2008

(Taunton et al. 1995, Buschak et al. 1996, Benefits

Introduction
Interface 2000). This issue amplifies the nursing short-
Absenteeism of front-line staff nurses is of increasing age, decreases employee morale (Seago 1996, Haun
concern and a costly problem for hospital employers et al. 2002) and disrupts the continuity of patient care
DOI: 10.1111/j.1365-2834.2008.00958.x
312 ª 2009 The Authors. Journal compilation ª 2009 Blackwell Publishing Ltd

(Taunton et al. 1995) ultimately having a negative im-
pact on the cost and quality of care and outcomes for
patients.
In Canada, absenteeism data of individual nurses are
difficult to find, largely owing to privacy of information
legislation. The Canadian Institute of Health Informa-
tion (CIHI) reports absenteeism statistics that incorpo-
rate and compare all healthcare professionals (including
nurses) to other non-healthcare occupations. On aver-
age, healthcare professionals are 1.5 times more likely
to be absent from work as a result of illness or injury
than other occupations (CIHI 2005). Average days lost
per year for Canadian healthcare professionals range
from 12 to 15 days (CIHI 2005). If a nurse makes $28/
h, works 40 hours a week, and has called in sick six
times in 1 year, it costs the organization $1344.00 (not
including benefits) to pay that nurse while absent. To
replace that nurse at double time (should overtime rates
for replacement be required) costs the organization
$2688; the total cost is $4032. To replace 50 nurses
who are absent six times in one year would cost
approximately $201, 600. Absenteeism is a current and
expensive problem that must be explored in greater
detail.
Defining and measuring absence
ÔAbsenteeismÕ is defined as not coming to work when
scheduled, and is measured by frequency or duration
of work days missed. There are two types of absen-
teeism – Ônon-culpableÕ (involuntary or approved) and
ÔculpableÕ (voluntary or unapproved) absence (Ham-
mer & Landau 1981, Buschak et al. 1996, Australian
Faculty of Occupational Medicine 1999, Thomson
2005). Non-culpable or involuntary absence occurs for
reasons beyond the control of the nurse (e.g. personal
illness, family death, weather, transportation prob-
lems). In contrast, voluntary or motivated absences
occur when the nurse makes a decision to be absent.
Distinguishing between voluntary and involuntary
absences can be very difficult because hospital-based
nurses with formal sick-leave programmes typically
only receive benefits when they Ôcall in sickÕ (Hackett
et al. 1989, Gellatly & Luchak 1998, Hemmingway &
Smith 1999). Thus, virtually all absences are classified
as sick days (i.e. non-culpable; involuntary), whether
the absence is for personal illness or not (for a
description of these classification errors, see Hammer
& Landau 1981).
Although imperfect, a practical way to distinguish
non-culpable from culpable absence is to assess the
frequency and duration of absences/sick days. Research
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Staff nurse absenteeism
has shown consistently that frequency measures provide
a reasonable index of culpable or voluntary absenteeism
(Chadwick-Jones et al. 1971, Hammer & Landau
1981, Hackett & Guion 1985). To measure absence
frequency, each incident or episode of absence is
counted regardless of the duration of absence. Higher
frequency scores are interpreted as a sign of more rather
than less voluntary absence. Duration measures provide
an index of involuntary absence such as the Time Lost
Index (Hammer & Landau 1981, Hackett & Guion
1985). To assess absence duration, the total number of
days lost are tallied, regardless of the number of inci-
dents. Nurses with high rather than low duration scores
tend to have more involuntary absence (e.g. broken leg,
recovering from surgery). Often, studies include one or
more measures of absence.
Predictors of absenteeism
The 2005 CIHI report stated that nurses with absen-
teeism totalling more than 20 days commonly reported
Ôhigh job strain, low supervisor support and high
physical demands on the job, low control over practice,
lack of respect from supervisors, or high role overload
as factors responsible for absenteeismÕ (CIHI 2005,
p. xvi). Additionally, while considerable research has
been conducted identifying factors related to nurse
absenteeism, no current systematic reviews were found
that examined the relationship between individual
and organizational characteristics and absenteeism of
nurses.
Objective
This systematic literature review examined the rela-
tionships between individual and organizational fac-
tors, and absenteeism of staff nurses (Registered Nurses
and Licensed Practical Nurses) in acute care hospital
settings. The following research question guided this
review: ÔWhat are the determinants of individual staff
nurse absenteeism in hospital settings?Õ.
Methods
Search strategy
The search was conducted using 10 online databases:
ABI Inform, Academic Search Complete, CINAHL Plus
with Full Text, Cochrane Library, EMBASE, Health
Source Nursing/Academic Addition, Ovid Healthstar,
Ovid Medline, PsychINFO and SCOPUS. English-only
studies from 1986 to 2006 were accessed.
313

M. M. Davey et al.
Inclusion criteria
Titles and abstracts were screened twice for the fol-
lowing keywords: ÔhospitalÕ, Ôtertiary care centreÕ, Ônur-
ses (RNs, LPNs)Õ and ÔabsenteeismÕ or Ôsick leaveÕ, to
ensure that key articles were not missed. Only primary
reports of qualitative or quantitative research published
in peer-reviewed journals were included. Absenteeism
must have been measured or qualitatively analysed.
Articles were excluded that reported absenteeism of
student nurses, nursing attendants, psychiatric nurses,
or nurses who worked in public health, the community,
or in long-term care facilities. Only studies that sampled
nurses from hospitals were included. Articles discussing
absenteeism related to true (certified) mental or physical
illness, pregnancy or injury were excluded; these
determinants would have skewed the results as they are
legitimate causes of unplanned absenteeism.
Screening
From the review of titles and abstracts, full manuscripts
were retrieved for screening using the primary inclusion
criteria. To meet the final inclusion criteria, a relation-
ship between the determinant (independent variable)
and absenteeism (dependent variable) had to be re-
ported and measured. No qualitative studies were found
that met the inclusion criteria.
After initial screening, articles that met the inclusion
criteria discussed a predictor or determinant and
absenteeism. These articles were then grouped into
two categories, those that measured the independent
variable and absenteeism, and those that discussed a
non-measurable intervention or strategy to influence
absenteeism. As a result of the lack of precision in
measuring the relationship between independent and
dependent variables, research studies that measured only
absenteeism, but not the independent variable, were
removed. Only studies that measured the relationship
between absenteeism and its predictors were analysed.
A second reviewer independently screened 30 ran-
domly selected articles to ensure inter-rater reliability.
One discrepancy between the reviewers regarding the
inclusion of an article was dealt with by consensus.
Methodological assessment
A methodological quality assessment was completed on
each included study using a tool adapted from prior
published systematic reviews (Estabrooks et al. 2001,
Cummings & Estabrooks 2003, Estabrooks et al. 2003,
Wong & Cummings 2007). Thirteen items in this tool
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were used to rate four areas of research: design, sam-
pling, measurement and statistical analysis. Twelve out
of 13 items scored 1 point. An additional point was
awarded if absenteeism was observed rather than self-
reported. If authors did not report an item addressed in
the quality assessment tool, zero points were assigned.
The total quality assessment scores ranged from 1 to 14
and, each article was categorized into low (1–4), med-
ium (5–9) or high quality (10–14). Studies of low
quality were excluded.
Results
Search results
The initial search yielded 2401 titles and abstracts. Of
these, 423 papers were retrieved for screening and 71
papers met the inclusion criteria. Thirty-three papers
were removed because they did not measure a predictor
or influence of absenteeism (an intervention designed to
influence absenteeism). Twenty-two papers were of low
quality and removed from the review. These papers had
discrepancies in the reliability and validity of their
instrumentation; eleven did not use a prospective
design, and all had sampling deficiencies. In total, 16
articles were included. Two authors (Boumans &
Landeweerd 1993, 1994, Gellatly 1995, Gellatly &
Luchak 1998) used the same sample and data in each of
two papers, reporting separate analyses in each paper.
Therefore, each of these two sets of papers was con-
sidered as one study, to prevent inflation of reported
results, leaving a total of 14 studies for analysis. Table 1
provides a summary of the search strategy results.
Table 2 provides a summary of the strengths and
limitations for the final group of 14 studies (which had
yielded 16 papers).
Of the 16 papers included in the systematic review,
three were published between 1986 and 1989, 10
between 1990 and1999, and three between 2000 and
2002. Table 3 summarizes the characteristics of each
paper. This reflects that most data were collected in the
1980s and 1990s, even although some studies were
published between 2000 and 2002.
Seven studies were conducted in the USA and three in
Canada. One Canadian study was published in 2002,
the remainder in the 1990s. Two studies were con-
ducted outside of North America, one in the Nether-
lands and the other in Israel. Two researchers did not
report which country their data came from.
Demographics were reported in 13 out of the 14
studies. Eleven studies reported the age of the nurses,
and the mean age across studies was 35.1 years. All
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Staff nurse absenteeism

Table 1
Search strategy

Database 1986–October 2006 Search terms Number

ABI Inform Absenteeism OR sick leave AND nurse (KW) 42

Academic Search Premiere Absenteeism OR sick leave AND nurse (KW & Heading) 101
CINAHL Plus with Full Text Absenteeism OR sick leave AND nurse (KW & Heading) 175
Cochrane Library (CDSR, ACP Journal Club, DARE, CCTR) Absenteeism OR sick leave AND nurse (KW) 115
EMBASE Absenteeism OR sick leave AND nurse 344
Health Source: Nursing/Academic Edition Absenteeism OR sick leave AND nurse (KW) 74
Ovid Healthstar Absenteeism OR sick leave AND nurse (KW) 561
Ovid Medline Absenteeism OR sick leave AND nurse (KW) 552
PsychINFO Absenteeism OR sick leave AND nurse (KW) 85
SCOPUS Absenteeism OR sick leave AND nurse (KW) 335
Manual Search of Journal of Organizational Behavior Absenteeism OR sick leave AND nurse (KW) 17
Total Titles and Abstracts 2401
Articles retrieved and screened 423
First selection of articles 71
Second selection of articles 38
Final Selection of included articles 16
Final Selection of included studies 14

Table 2 independently from other healthcare workers in each

Quality assessment of included studies
Summary of quality assessment – 14 studies included
Criteria
Yes
Design:
Prospective studies
Used probability sampling
Sample:
Appropriate/justified sample size
Sample drawn from more than one site
Anonymity protected
Response rate >60%
Measurement:
Determinant measured reliably
Determinant measured with a valid instrument
Absenteeism observed rather than self-reported*
Internal consistency ‡ .70 when scale used
Theoretical model/framework used
Statistical analyses:
Correlations analysed when multiple
determinants studied
Management of outliers addressed
*This item scored two points. All others scored one point.
other studies reported the average nurse age range as
mid-thirties to early forties. In all studies, the majority
of respondents were female (>90%). The unit of anal-
ysis in four studies was at the individual level and in
three studies was at the group level. The remaining nine
studies did not identify the unit of analysis. Each study
discussed collecting data at the individual level, but did
not explain how the results were analysed and reported
(individual or group). This is problematic, as nurse
information and results were not consistently reported
sample.
Number of
studies Absenteeism
No The most common measure of absenteeism reported
was Ôabsence frequencyÕ, which was defined as the
7 7 number of days absent (incidents) over a given period of
3 11 time. Other measures used were total days, duration
0 14 and percentage. Three studies asked participants to self-
7 7 report their personal absenteeism rates (Boumans &
3 11 Landeweerd 1993, 1994, Gellatly 1995, 1998, Gold-
5 9
berg & Waldman 2000).
12 2 Four studies reported using a theoretical framework
3 11 that directly conceptualized absenteeism and its rela-
11 3
tionship with other factors (Hackett et al. 1989, Gel-
0 14
11 3 latly 1995, 1998, Taunton et al. 1995, Goldberg &
Waldman 2000). Ten papers (nine studies) included a
10 4 conceptual model or theoretical framework that incor-
0 14 porated absenteeism, but absenteeism was not the cen-
tral focus (Boumans & Landeweerd 1993, 1994,
Somers 1995, Taunton et al. 1995, Seago 1996, Griff-
eth et al. 1997, 1998, Zboril-Benson 2002). Two
studies did not report using a theoretical framework
(Blau 1986, Parker & Kulik 1995). Each of the absen-
teeism theoretical frameworks was different. Gellatly
(1995) and Gellatly and Luchak (1998) used an absence
culture framework by Nicholson and Johns (1985),
which suggests that the level of trust and salience of the
culture are necessary for members to develop an ab-
sence culture (p. 1086). Four different absence cultures
were presented based on high and low dimensions of
trust and salience. This framework suggests that

ª 2009 The Authors. Journal compilation ª 2009 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 312–330 315
 Table 3

316
Characteristics of included studies

Author(s) Year Journal & Country Sample Measurement/Instruments Scoring Reliability Validity Analysis

Blau 1986, 228 RNs (82 sub-sample) Job Involvement (no title: Kanugo 1982) 10 items, a = .84 Varimax Hierarchical
J Manage USA 1 city hospital Organizational Commitment (no title: modified 5 pt scale a = .86 Rotation Regression
M. M. Davey et al.

scale Porter et al. 1976) 9 items, a = .63 Varimax

Unexcused absence (# of individual absences 5 pt scale Rotation
without permission in 3 time blocks) ƒ (days) NR
Boumans & Landeweerd1993, 305 ICU nurses Social & Instrumental Leadership (Leadership 20 items, a = .90 & .82 Factor ANOVA
J Adv Nurs Netherlands 256 general nurses Behavior Questionnaire: Stogdill 1963) 5 pt scale r = .75 Analysis ANCOVA
16 hospitals Absenteeism (self report) ƒ (days) Piloted FisherÕs Z
Regression
Boumans & Landeweerd1994, 305 ICU nurses Work Situation Characteristics 40 items NR NR Regression
Heart & Lung Netherlands 256 general nurses job characteristics, feedback & clarity, work Same as Same as above Same as T-Test
16 hospitals pressure, autonomy, promotional & growth above above
opportunities (Items derived from Hackman &
OldhamÕs Job Diagnostic Survey and a study by Alegra)
See above for other measures
Cohen2000, 283 nurses Organizational Commitment (Organizational 9 items a = .92 NR Structural
Hum Relat Israel 3 hospitals Commitment Questionnaire-Short: Porter et al. 1974) 8 items a = .83 NR Equation
Occupational (Career) Commitment (no title: Blau 1985) 10 items; a = .76; a = .74 NR Modeling
Job Involvement & Work Involvement (no title: 6 items a = .71 NR
Kanungo 1979, 1982) 6 items NR NR
Group Commitment (no title: Randall & Cote 1991) 5 items NR NR
Work Commitment Constructs (no title or author) Total days NR NR
Absenteeism (1 year – hospital records) 3 items,
Turnover Intention (self report) 5 pt Likert
Gellatly & Luchak1998, 164 hospital employees Perceived Absence Norm (estimate average # of NR NR NR Hierarchical
Hum Relat Canada (nurses included) days other employees were absent during N/R NR NR Regression
1 hospital previous 12 months – self report) Equation NR NR
Prior Individual Absence (# of days absent during ƒ (days) NR NR
previous 12 months-self report)
Group-Level Absence (average level of actual
absenteeism within immediate work group –
from hospital records at individual level)
Future Individual Absence (# days absent over
12-months following survey)
Gellatly1995, 135 nurses Absenteeism (12 months post survey – hospital records) ƒ & total days r = .58 & .26 NR Structural
J Organ Behav Canada 31 food services Group-Absenteeism (ƒ & total days absent for Mean NR NR Equation
1 hospital each unit for 12 months prior to survey) NR r = .84 Prior Modeling
Perceived absence norm (average # of days others 8 item, a = .86 & .72 Experience
were absent during previous 12 months – self report) 7 pt scale a = .65 & .55 NR
Organizational Commitment (Affective & Continuance 4 item a = .94 NR
Commitment: Allen & Meyer 1990; Meyer & 10 items, NR
Allen 1984, 1991) 7 pt scale
2 additional continuance commitment scales used
Interactional Justice (Interactional Justice Scale:
Moorman 1991)

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 Table 3
Continued

Author(s) Year Journal & Country Sample Measurement/Instruments Scoring Reliability Validity Analysis

Goldberg & Waldman2000, 244 nurses & other Wage Equation NR NR Partial Least
J Organ Behav USA (Only 98 absence Job Characteristics (no title, no author) 4 items, a = .76 NR Squares
records obtained) Role Ambiguity & Conflict (no title: Rizzo et al. 1970) 5 pt scale a = .74 NR Root Mean
1 hospital Organizational Permissiveness (no title: Brooke & 5 items, NR NR Square
Price 1989) 5 pt scale a = .86 NR Residual
Job Satisfaction (no title: Price & Mueller 1981) 1 item, NR NR Squared
Absenteeism (self reported ƒ, time lost & 5 pt scale a = .88 NR multiple
records-based time lost) 3 items, NR NR correlation
Descriptives 5 pt scale NR NR
Health ƒ & total days NR NR
Position level 4 pt scale NR NR
Tenure Coded scale
Marital status NR
No of children NR
NR
Griffeth et al.1997, 221 new nurses Recruiting Sources (no title: no author) Blank NR Multiple Structural
J Manage Country NR 1 hospital Individual Differences (Applicant Quality Index: responses a = .86 authors Equation
interview – 7 dimensions) 4 pt scale a = .83 NR Modeling
Role Clarity (no title: Rizzo et al. 1970) 6 items, a = .79 NR
Commitment to Job Choice (no title: Colarelli 1984) 5 pt Likert a = .82 NR
Met Expectations (no title: no author) Average a = .93 NR
Coping (Index Coping Effectiveness, Dugoni & Ilgen 1981) of items a = .94 NR
Job Satisfaction (no title: Hom & Griffeth 1991; 28 facets) 2 items NR NR
Absenteeism (did not attend work when scheduled during NR NR
1st year of employment) NR
Total days
Hackett et al.1989, Phase 1: Phase 1 NR NR NR Principal
Acad Manage J Country NR 140 nurses Questionnaires regarding descriptive work-related attitudes, 2-items NR NR Components
Phase 2: values & stressors of their personnel 20 items a = .30–.97 NR Multiple
54 nurses Included self-reported reasons for absences & attendance Regression
2 hospitals (General & Peds) (no title, researcher made)
Phase 2
Questionnaire for each shift (4–5 mo) to monitor occurrence

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of absence-relevant events (no title, researcher made)
Hemmingway & Smith1999, 252 RNs Occupational Climate (work pressure, autonomy, 10 true/false a = .52–.73 NR Hierarchical
J Occup Organ Psych Canada 4 hospitals supervisor, support & peer cohesion subscales of Work per subscale a = .50 NR Regression
Environment Scale; Moos & Insel 1974) 8 items a = .78 NR
Role Conflict (no title: Rizzo et al. 1970) 6 items a = .79 NR
Role Ambiguity (no title: Rizzo et al. 1970) 6 item, a = .81 NR
Workload (Nursing Stress Scale, Grey et al. 1981) 4 pt scale NR NR
Death & dying of patients (Nursing Stress Scale, 7 items
Grey et al. 1981) ƒ
Absenteeism (short-term, 2 days or less –
self report of previous 6 months)

317
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 318
Table 3
Continued
M. M. Davey et al.

Author(s) Year Journal & Country Sample Measurement/Instruments Scoring Reliability Validity Analysis

Parker & Kulik1995, 73 RNs Burnout (Maslach Burnout Inventory-3 subscales: 22 item, a = .78–.90 NR Multiple
J Behav Med USA 1 hospital Maslach & Jackson 1986) 7 pt scale NR NR Regression
Emotional exhaustion NR NR NR
Depersonalization NR NR NR
Personal accomplishment ›values = NR NR
Absenteeism (# days absent in past 6 months – fl burnout
self report & hospital records for 46 nurses) ƒ
Seago1996, 67 nursing units Workgroup Culture (Organizational Culture 120 items, a = .94 Factor Correlation
J Nurs Adm USA 5 hospitals Inventory: Cooke & Lafferty 1987) 5 pt Likert a = .69–.77 Analysis
Workplace Stress (Job Content 15 items a = .83 NR
Questionnaire: Karasek 1979) 50 True/ NR NR
Hostility (Cook & Medley Hostility Scale: False items NR
Cook & Medley 1954) %
Absenteeism (percentage of shifts not at work
as scheduled over 3 months – hospital records)
Somers1995, 303 nurses Organizational Commitment (Affective, NR a = .71–.81 NR Logistic
J Organ USA 1 urban hospital Continuance, & Normative – no title: NR a = .88 NR Regression
Allen and Meyer 1990) ƒ NR NR
Job Withdrawal Intention (no-title: Bluedorn 1982)
Absenteeism (Total absences during a 12 month
period & Annexed absences –attached to weekend/
holiday periods for same 12 months – hospital records)
Taunton et al.1989, 71 workers Retention (no title: Price & Mueller 1981) % IRR 100% All factor Correlation
JONA USA (59 RNs) Turnover (no title: Price & Mueller 1981) stayer or leaver IRR 100% analyzed
1 hospital Job Satisfaction (no title: Price & Mueller 1981) range 7–35 a = .87 except last
Intent to Stay (no title: Price & Mueller 1981) range 2–10 a = .85 variable
Opportunity Elsewhere (no title: Price & Mueller 1981) range 4–17 a = .75 NR
Social Integration (no title: Price & Mueller 1981) range 4–23 a = .84
Education (no title: Price & Mueller 1981) degree or higher NA
Kinship Responsibility (no title: Price & Mueller 1981) range 2–6 NA
Routinization (no title: Price & Mueller 1981) range 4–20 a = .82
Participation (no title: Price & Mueller 1981) range 4–20 NR
Instrumental Communication (no title: range 7–35 a = .90
Price & Mueller 1981) NA IRR 100%
Pay (no title: Price & Mueller 1981) Range 3–18 a = .76
Distributive Justice (no title: Price & Mueller 1981) Range 8–40 a = .93
Promotional Opportunity (no title: Price & Mueller 1981) ƒ NR
Absenteeism (Time Lost, Absence Spells, 1–2 day
Absence Spells)

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 Table 3
Continued

Author(s) Year Journal & Country Sample Measurement/Instruments Scoring Reliability Validity Analysis

Taunton et al.1995, 1107 nurses Nurse Characteristics (9 dimensions) NR NR NR ANOVA

Nurs Econ USA 4 church hospitals Work Involvement (Kunungo 1982) NR NR NR Duncan
Works full/part time (< or >32 hours/week) NR NR NR post hoc
Health Status (9 sub scales: Ware, 1976) NR NR NR Pearson
Opportunity Elsewhere (Price & Mueller 1986) NR NR NR Correlation
Unit Separation (stayer or leaver) NR NR NR
Marital Status NR NR NR
Job Decision Priorities, Work Environment NR NR NR
Responsibility NR NR NR
Manager Characteristics (3 dimensions) ratio NR NR
Power (2 subscales: Sheridan & Vredenburgh 1978)
Influence (2 subsales: Moch et al. 1983)
Leadership Style (2 dimensions: Kruse & Stogdill 1973)
Organizational Characteristics (5 dimensions)
Distributive Justice (Price & Mueller 1981)
Promotional Opportunity (Price & Mueller 1981)
Control over Nursing Practice (5 subscales:
Hinshaw et al. 1987)
Pay
Permissiveness
Work Characteristics (4 dimensions)
Routinization (Price & Mueller 1986)
Autonomy (Hinshaw et al. 1987)
Instrumental Communication (Price & Mueller 1986)
Group Cohesion (HInshaw et al. 1987)
Job Stress (no title: Hinshaw et al. 1987)
Job Satisfaction (no title- 8 subscales: Hinshaw et al. 1987)
Job Involvement (Kanungo 1982)
Commitment (Price & Mueller 1986)

ª 2009 The Authors. Journal compilation ª 2009 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 312–330
Zboril-Benson2002,
Can J Nurs Res Canada
1079 nurses
Multiple Acute & Long-Term Care
Intent to Stay (Price & Mueller 1981)
Absenteeism (failure to report for a scheduled day of
work-total # 1-day absences over 6 months)
Absenteeism (Questionnaire) 6 items Piloted Piloted Chi
# of absences, ƒ of & susceptibility to absenteeism, 5 pt scale Piloted Piloted Square
rate causes, open ended questions
on intent-to-leave & recommendations to reduce absenteeism
Job Satisfaction (no title; researcher made)

319
Staff nurse absenteeism

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M. M. Davey et al.
absenteeism is not an individual-level phenomenon, but
a socially constructed event.
Goldberg and Waldman (2000) amalgamated two
theories by Brooke and Price (1989) and Steers and
Rhodes (1978), to create a conceptual model. In short,
individual predictors (marital status, number of chil-
dren, health, tenure and position level) and situational
predictors (organizational permissiveness, role prob-
lems, pay and job characteristics) influenced both job
satisfaction and absenteeism.
Building on Morgan and HermanÕs (1976) earlier
research, Hackett et al. (1989) discussed absenteeism as
a volitional behaviour in that employees choose whe-
ther or not they attend work. Zboril-BensonÕs (2002)
followed NicholsonÕs (1977) framework, which dis-
cussed attendance at work as a ÔnormalÕ behaviour.
People attend work regularly, until absence-inducing
advents Ôinterrupt the regularity of attendanceÕ (p. 92).
Nicholson explained this theory using a continuum
from unavoidable to avoidable absences. The theoreti-
cal frameworks are summarized in Table 4.
Predictors of absenteeism
Using content analysis, a total of 70 independent vari-
ables (potential predictors) were categorized into eight
types of determinants: prior attendance, work attitudes,
retention, burnout and stress, manager characteristics,
human resource management practices, nurse charac-
teristics, and work and job characteristics (Table 5).
ÔAttendanceÕ was defined as being present at work
when scheduled. Using structural equation modelling,
Gellatly (1995) and Gellatly and Luchak (1998) found
that perceived Ôabsence normÕ (what individuals thought
about the unitÕs absenteeism rate) and Ôprior individual
absenceÕ were significantly related to absenteeism. As
absence norms and prior absences increased, so did
absenteeism. However, group level absence was not a
predictor of individual absenteeism. Poor standing,
referring to previous attendance records (Hackett et al.
1989), was significant and positively related to nine out
of 51 nursesÕ desire to be absent, whereas significant and
negatively related to two out of 51 nursesÕ desire to be
absent. In addition, actual absenteeism significantly
increased for three out of 22 nurses and significantly
decreased for two out of 22 nurses when poor standing
increased.
ÔWork attitudesÕ refer to personal feelings or beliefs
associated with work, such as job and work involve-
ment, organizational commitment, group commitment,
occupational commitment and job satisfaction or dis-
satisfaction. Job satisfaction significantly predicted
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absenteeism in three studies (Hackett & Guion 1985,
Taunton et al. 1989, 1995) in that as job satisfaction
increased, absenteeism decreased. Zboril-Benson (2002)
reported that as job dissatisfaction increased, self-re-
ported absenteeism increased.
The direct relationship of job involvement to absen-
teeism was not significant in two studies (Blau 1986,
Taunton et al. 1995); however, Taunton et al.Õs study
showed a significant negative relationship of job
involvement and absenteeism if job involvement and
organizational commitment were both high. Cohen
(2000) reported that, as job involvement increased,
absenteeism significantly decreased. Cohen also de-
scribed a significant positive relationship between work
involvement and absenteeism. Job involvement differed
from work involvement in that Ôjob involvementÕ de-
scribed a general attitude towards an organization as a
whole (Kanungo 1982). ÔWork involvementÕ described
how much the job can satisfy present needs (Kanungo
1982).
Five studies discussed the relationship between orga-
nizational commitment and absenteeism (Blau 1986,
Gellatly 1995, Somers 1995, Taunton et al. 1995,
Cohen 2000). Five out of 12 results were significant and
negatively related to absenteeism (Gellatly 1995, Som-
ers 1995, Taunton et al. 1995), indicating that the more
committed one was to the organization, the less one was
absent from work.
ÔRetentionÕ refers to any type of attitude or behaviour
associated with staying or leaving the job, including
turnover, turnover intentions, intent-to-stay, promo-
tional opportunities and opportunities elsewhere. In
three studies, retention, intent-to-stay and promotional
opportunities were negatively and significantly related
to absenteeism (Taunton et al. 1989, 1995, Boumans &
Landeweerd 1994). Turnover was significantly and
positively related to absenteeism (Taunton et al. 1989).
Overall, retention factors were related to lower nurse
absenteeism.
ÔBurnout and stressÕ were grouped together because
the two concepts are closely linked. ÔBurnout is a syn-
drome of emotional exhaustion and cynicism that
occurs frequently among individuals who do Ôpeople
workÕ of some kindÕ (Maslach & Jackson 1981, p. 99).
Taunton et al. (1995) described two types of stress:
personal and situational. ÔPersonal job stressÕ involves
Ôjuggling multiple care expectations of various profes-
sionals as well as clientsÕ (p. 228). ÔSituational job stressÕ
involves Ôconflicting values between professional and
bureaucratic demandsÕ (p. 228). One dimension of
burnout (personal accomplishment) was significantly
and negatively related to absenteeism (as personal
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Staff nurse absenteeism

Table 4
Theoretical frameworks

Articles Theoretical framework

Goldberg & Brook & Price (1989) developed this model based on the work of Steers and Rhodes. Goldberg and Waldman
Waldman 2000 used the simplified model (drawn below) which includes only Ôthose variables that were significantly related
to absenteeismÕ. (Brooke & Price 1989, p. 12).

Path diagram of the causal model of absenteeism. (Brooke & Price 1989, p. 3).
Hackett et al. 1989 Morgan and Herman (1976) conceptualized absenteeism in terms of two categories of consequences - deterrent
and motivating. Deterrent consequences, Ôcan be controlled by the organization and are directly associated with the job
(e.g., loss of pay, co-workers having to work harder)Õ. Motivating consequences Ôare controlled by the employee and are
not directly associated with the job (e.g., being absent to recover from illness or to have more leisure time)Õ (Morgan &
Herman 1976, p. 738). They hypothesized that Ôemployees will decide whether or not to attend work by weighing the
deterrent and motivating consequences of being absentÕ. (p. 173).
Zboril-Benson 2002 NicholsonÕs (1977) theoretical framework assumes that attendance is a ÔnormalÕ behavior (Zboril-Benson 2002).
Nicholson characterized employee absence on an A–B continuum by identifying the avoidability of absence-inducing
events (Nicholson 1977, p. 231). A-type events are unavoidable (choice cannot influence absence) and B-type events
are avoidable (employee has control over decision). This theory addresses the role that individual attributions play in
absenteeism (Zboril-Benson 2002, p. 92).
Gellatly 1995, Nicholson and Johns (1985) developed this framework as a Ôset of shared understandings about absence
Gellatly & Luchak legitimacy…and the established ``custom and practice'' of employee absence behavior and its controlÕ
1998 (Johns & Nicholson 1982, p. 136)
Absence culture depends on two factors (Nicholson & Johns 1985) – the level of trust and the salience of the culture to
members (Gellatly & Luchak 1998, p. 1087).
There are 4 types of absence cultures; Type 1 (low salience & high trust); Type 2 (high salience & high trust); Type 3 (low
salience & low trust); Type 4 (high salience & low trust).
ÔIt can be hypothesized that more salient cultures have more extreme absence levels (high or low) and less variation
among employees than less salient culturesÕ (Nicholson & Johns 1985, p. 403).

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M. M. Davey et al.

Table 4
Continued

Articles Theoretical framework

Goldberg & Steers and RhodesÕ (1978) theoretical framework premises employee attendance on two things – motivation
Waldman 2000 to attend and ability to attend (Steers & Rhodes 1978, p. 392). Factors that affect an employeeÕs decision and ability to
come to work arise both from the individual (e.g., personal work ethic, demographic factors) and from the work
environment (e.g., the job situation, incentive/reward systems, work group norms) (1978, p. 401).

Major influences on employee attendance (Steers & Rhodes, 1978).

accomplishment increased, absenteeism decreased).
Taunton et al. (1995) reported that as job stress
increased, absenteeism increased in one out of four
hospitals. Only one study measured workplace stress as
a predictor of nurse absenteeism (Seago 1996). In this
study, decision latitude (a dimension of workplace
stress) was negatively and significantly related to
absenteeism; however, decision latitude was not
defined. Overall, burnout and stress predicted increased
absenteeism.
ÔManager characteristicsÕ refer to traits or behaviours
such as leadership, influence and power, used by man-
agers to help guide staff members. Leadership was
examined in two studies. Leaders with high social and
high instrumental leadership or low social and low
instrumental leadership had the lowest rates of
employee absence (Boumans & Landeweerd 1993).
A significant negative relationship was reported – when
leaders showed consideration to employees, employee
absenteeism decreased. One manager characteristic
(influence in personnel resources) was significantly and
negatively related to staff nurse absenteeism in two out
of four hospitals. Overall, these few significant results in
this category suggest that relational leadership practices
of managers may reduce absenteeism.
ÔHuman resource management practicesÕ include
those policies, programmes or managerial activities
endorsed by the organization, such as distributive jus-
tice, pay, permissiveness, overstaffing, staffing ratios,
recruiting sources and control over nursing practice.
Taunton et al. (1995) showed that distributive justice
was significantly and negatively related to absenteeism
in one out of four hospitals. Pay was significantly and
negatively related to absenteeism in one study (Gold-
berg & Waldman 2000) but not in the others (Taunton
et al. 1989, 1995). Organizational permissiveness,
control over nursing practice, graduate nurse-filled full-
time equivalent (FTE) ratio and BSN-filled FTE ratio
were not significant predictors of absenteeism.
Overstaffing was significantly and positively related to
desired (18.9% of sample) and actual absenteeism
(0.5% of sample) (Hackett et al. 1989). As overstaffing
increased, the desire to be absent significantly decreased
for eight out of 10 nurses. Both the part-time staffing
ratio and recruiting sources significantly and negatively
predicted absenteeism. Overall, most results in this
category were not significant and no consistent pattern
was found.
ÔNurse characteristicsÕ in single studies were found to
be significantly related to nurse absenteeism: age, ten-
ure, marital status, education, position level, health,
disrupted sleep, doldrums, home responsibilities,
compassionate leave and unit separation. Doldrums
describe Ôlow spirits, emotional and physical fatigue,

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Staff nurse absenteeism

Table 5
Predictors of absenteeism by category

Significant
relationship
Determinant Source with absenteeism Comments

Prior attendance
Perceived absence norm Gellatly & Luchak 1998 +
Gellatly 1995 +
Prior individual absence Gellatly & Luchak 1998 +
Group level absence Gellatly & Luchak 1998 NS
Gellatly 1995 NS
Poor standing Hackett et al. 1989 + 9/51 staff (Desire to be absent)
) 2/51 staff (Desire to be absent)
NS 40/51 staff (Desire to be absent)
+ 3/22 staff (Actual absence)
) 2/22 staff (Actual absence)
NS 17/22 staff (Actual absence)
Work Attitudes
Job satisfaction (JS) Goldberg & Waldman 2000 NS
Hackett & Guion 1985 )
Taunton et al. 1989
Taunton et al. 1995 ) Organizational JS & Hospitals C B & D
) Organizational JS in Hospital A
NS Professional JS in all 4 hospitals
NS
Job dissatisfaction Zboril-Benson 2002 +
Job involvement Blau 1986 NS
) Job involvement x Commitment
Cohen 2000 ) Direct Model
NS Indirect Model A
NS Indirect Model B
Taunton et al. 1995 NS
Work involvement Cohen 2000 + Direct Model
NS Indirect Model A
NS Indirect Model B
Organizational commitment (OC) Blau 1986 NS
-Affective Commitment (AC)
-Continuance Commitment (CC) Cohen 2000 NS
-Normative Commitment (NC)
Somers 1995 ) AC & annexed absences
) AC x CC & annexed absence
NS All subscales of OC & total absences
NS CC NC & AC x NC CC x NC &
annexed absence
Gellatly 1995 ) AC & absence frequency (Models A & B2)
NS AC & absence frequency (Model B1)
) AC & Total days absent (Model B1)
NS AC & total days absent (Models A & B2)
NS CC & absence frequency & total days
absent (Models A B1 & B2)
Taunton et al. 1995 ) Hospital B
NS Hospitals A C & D
Occupational commitment Cohen 2000 NS
Group commitment Cohen 2000 NS
Retention factors
Retention Taunton et al. 1989 )
Turnover Taunton et al. 1989 +
Turnover Intentions Cohen 2000 NS
Intent to Stay Taunton et al. 1989 )
Taunton et al. 1995 NS
Promotional Opportunity Taunton et al. 1989 NS
Taunton et al. 1995 )
Boumans & Landeweerd 1994 NS Non-ICU nurses
) ICU-Nurses

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M. M. Davey et al.

Table 5
Continued

Significant
relationship
Determinant Source with absenteeism Comments

Opportunity Elsewhere Taunton et al. 1989, 1995 NS

Burnout/Stress
Burnout Parker & Kulik 1995 ) Personal Accomplishment &
Hospital Record Sick Leave
NS Emotional Exhaustion depersonalization
& reported absenteeism
Job Stress Taunton et al. 1995 NS
+
Workplace Stress Seago 1996 ) Decision Latitude – a component
of workplace stress
NS Psychological Demand – a
component of workplace stress
Manager Characteristics
Leadership Boumans & Landeweerd 1993 NS Social & Initiating Structure (Leadership)
) Leader with ›social & ›instrumental
or flsocial & flinstrumental
NS
Boumans & Landeweerd 1994
Taunton et al. 1995 )
NS
Influence Taunton et al. 1995 NS All 4 hospitals (Work coordination
-manager influence variable)
) Hospital C & D (Personnel resources
– manager influence variable)
Power Taunton et al. 1995 NS Manager position (variable
included in power)
NS Manager power
Human Resource Management Practices
Distributive Justice Taunton et al. 1989 NS
Taunton et al. 1995 ) Hospital D
NS Hospital A B & C
Pay Goldberg & Waldman 2000 )
Taunton et al. 1989, 1995 NS
Organizational Permissiveness Goldberg & Waldman 2000 NS
Taunton et al. 1995 NS

Overstaffing Hackett et al. 1989 ) 8/51 staff (Desire to be absent)

+ 2/51 staff (Desire to be absent)
NS 41/51 staff (Desire to be absent)
+ 1/22 staff (Actual absenteeism)
NS 21/22 staff (Actual absenteeism)
Graduate Nurse/ Filled FTE Ratio Taunton et al. 1995 NS
BSN/Filled FTE Ratio Taunton et al. 1995 NS
Part-Time/Filled FTE Ratio Taunton et al. 1995 ) Hospital C & D
NS Hospital A & B
Recruiting Sources Griffeth et al. 1997 )
Control Over Nursing Practice Taunton et al. 1995 NS
Nurse Characteristics
Age Gellatly 1995 ) Model A B1 & B2 & absence frequency
NS Model A B1 & B2 & total days absent
Taunton et al. 1995 NS
Tenure Goldberg & Waldman 2000 NS
Gellatly 1995 NS Model A B1 & B2 & absence frequency
+ Model A B1 & B2 & total days absent
Tenure Expectations Taunton et al. 1995 NS
Marital Status Goldberg & Waldman 2000 NS
Taunton et al. 1995 ) For single & divorced people &
only in Hospital B
NS Hospital A C & D

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Staff nurse absenteeism

Table 5
Continued

Significant
relationship
Determinant Source with absenteeism Comments

No. Children Goldberg & Waldman 2000 NS

Nursing Education Taunton et al. 1989 )
Taunton et al. 1995 NS
Position Level Goldberg & Waldman 2000 )
Years in Profession Taunton et al. 1995 NS
Years in Job Taunton et al. 1995 NS
Years in Hospital Taunton et al. 1995 NS
Health Goldberg & Waldman 2000 )
Taunton et al. 1995 NS Current health
) Resistance to illness
) Rejection of sick role
NS Health outlook
NS Sickness Orientation
NS Health worry/Concerns
) Prior health
NS Attitude toward going to physician
NS Drug use
Disrupted Sleep Hackett et al. 1989 + 2/51 staff (Desire to be absent)
) 3/51 staff (Desire to be absent)
NS 47/51 staff (Desire to be absent)
+ 5/22 staff (Actual absence)
) 2/22 staff (Actual absence)
NS 17/22 staff (Actual absence)
Doldrums Hackett et al. 1989 ) 36/51 staff (Desire to be absent)
NS 15/51 staff (Desire to be absent)
+ 8/22 staff (Actual absence)
NS 14/22 staff (Actual absence)
Home Responsibilities Hackett et al. 1989 + 8/51 staff (Desire to be absent)
) 3/51 staff (Desire to be absent)
NS 40/51 staff (Desire to be absent)
+ 1/22 staff (Actual absence)
) 6/22 staff (Actual absence)
NS 15/22 staff (Actual absence)
Kinship Responsibility Taunton et al. 1989 NS
Responsibility Taunton et al. 1995 NS
Compassionate Leave Hackett et al. 1989 + 4/51 staff (Desire to be absent)
) 3/51 staff (Desire to be absent)
NS 44/51 staff (Desire to be absent)
+ 2/22 staff (Actual absence)
NS 20/22 staff (Actual absence)
Hostility Seago 1996 NS
Works Full-time/Part-time Taunton et al. 1995 NS
Job Decision Priorities Taunton et al. 1995 NS
Unit Separation (stayer/leaver) Taunton et al. 1995 + Hospital D
NS Hospital A B & C
Work & Job Characteristics
Routinization Taunton et al. 1989, 1995 NS
Instrumental Communication Taunton et al. 1989, 1995 NS
Work Responsibilities Hackett et al. 1989 + 4/51 staff (Desire to be absent)
) 1/51 staff (Desire to be absent)
NS 46/51 staff (Desire to be absent)
+ 2/22 staff (Actual absence)
) 1/22 staff (Actual absence)
NS 19/22 staff (Actual absence)
Job Characteristics Goldberg & Waldman 2000 NS
Role Ambiguity Goldberg & Waldman 2000 NS
Role Conflict Goldberg & Waldman 2000 NS
Participation Taunton et al. 1989 NS
Social Integration Taunton et al. 1989 NS

ª 2009 The Authors. Journal compilation ª 2009 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 312–330 325

M. M. Davey et al.
Table 5
Continued
Determinant Source
Work Group Culture Seago 1996
Group Cohesion Taunton et al. 1995
Interactional Justice Gellatly 1995
Complexity/Difficulty Boumans & Landeweerd 1994
Feedback/Clarity Boumans & Landeweerd 1994
Work Pressure Boumans & Landeweerd 1994
Autonomy Boumans & Landeweerd 1994
Taunton et al. 1995
Task Allocation Boumans & Landeweerd 1994
Unit Workload Taunton et al. 1995
and feeling down-troddenÕ (Hackett et al. 1989) How-
ever, in other studies many of these same characteristics
did not significantly predict absenteeism rates. For
example, Gellatly (1995) reported that as age increased,
absenteeism decreased. Taunton et al. (1995) found
that absenteeism was not related to age. Gellatly (1995)
also reported that as tenure increased, total days absent
increased. Goldberg and Waldman (2000) found no
relationship between tenure and absenteeism. Taunton
et al. (1995) found that being single or divorced nega-
tively and significantly predicted nurse absenteeism in
one out of four hospitals. Thus, no consistent pattern
between demographic characteristics and absenteeism
was shown in this review.
Two studies suggested a relationship between nursesÕ
health and their absence rates. Goldberg and Waldman
(2000) reported that health was significantly and neg-
atively related to absenteeism. Taunton et al. (1995)
reported that in three out of four hospitals, as resistance
to illness increased, absenteeism decreased. Rejection of
the sick role and prior health were both significantly
and negatively associated to absenteeism.
ÔWork and job characteristicsÕ were associated with
the work or job itself, and included routinization,
instrumental communication, work responsibilities, job
characteristics, role ambiguity, role conflict, participa-
tion, social integration, work group culture, group
cohesion, interactional justice, complexity/difficulty,
feedback/clarity, work pressure, autonomy, task allo-
cation and unit workload (see Table 5). The impact of
work responsibilities on absenteeism was equivocal –
some studies reported significant associations (Hackett
et al. 1989, Boumans & Landeweerd 1994, Taunton
et al. 1995), whereas other studies found no significant
associations (Taunton et al. 1989, 1995, Boumans &
Landeweerd 1994, Gellatly 1995, Seago 1996, Gold-
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Significant
relationship
with absenteeism Comments
NS
)
NS
NS
NS Non-ICU nurses
) ICU nurses
NS
NS
NS
NS
NS
berg & Waldman 2000). This category of predictor
variables was not associated with staff nurse absentee-
ism.
Discussion
In Canada, absenteeism of front-line staff nurses is a
concern for administrators and health care organiza-
tions. CIHI (2005) denotes absenteeism as a current
issue in Canada, yet the majority of nursing and inter-
disciplinary healthcare research on absenteeism was
conducted in the United States. Studying the predictors
of nurse absenteeism in the Canadian context is
important because of differences in the US and Cana-
dian healthcare systems.
Predictors of absenteeism
Attendance (i.e. previous attendance and perceived
absence norm) was the best predictor of absenteeism,
with greater than 50% significant results. If perceived
absence norms, prior individual absence or poor atten-
dance records have been high, then current absenteeism
may increase, as absence cultures may develop. When
the culture supports poor attendance, future individual
attendance will align itself with cultural norms and
expectations (Nicholson & Johns 1985). This suggests
that it is important for administrators to screen prior
absence behaviour of potential employees and monitor
attendance behaviour of current employees for patterns
in absenteeism. Finding such attendance patterns will
allow administrators and researchers to implement
interventions in collaboration with individuals or
groups to improve absenteeism rates.
The CIHI (2005) reported that nurses rated unit
leadership and personal health as important predictors

of absenteeism, and therefore the results reported in this
review were expected to support this relationship. Yet,
work attitudes, along with characteristics of the man-
ager, organization, work and the individual nurse,
provided inconclusive and mixed results about the
predictors of staff nurse absenteeism. Less than half of
the results within each category were significant. Only
organizational commitment was significantly related to
lower absenteeism in three studies. Organizational
commitment has been shown to be influenced by work
environment factors, such as leadership style and
organizational culture (McNeese-Smith 1995, Zboril-
Benson 2002). This indirect effect may explain why the
majority of the direct relationships between work
environment factors and absenteeism were not signifi-
cant. The lack of theoretical frameworks on absentee-
ism in nursing that specifically address these indirect
effects may also have contributed to the gap between
what nurses report, how studies are designed and what
is actually measured.
It is also possible that methodological errors (sam-
pling technique, retrospective design, self-report data,
unit-of-analysis, etc) in the studies reviewed also
contributed to the non-significant results. Vigorous
research is needed in this area to discover and conclude
whether these characteristics are predictors of absen-
teeism.
Theoretical framework
One of the objectives of doing research is to build and
test theory. A theoretical framework helps guide the
method and intervention(s) appropriately. Initially,
absenteeism was conceptualized to be an individual
phenomenon. Steers and RhodesÕ (1978) model
described a variety of factors that influence motivation
and ability to attend. Many researchers have studied the
hypothesized predictor variables in that framework, but
have not found strong relationships in the data. A recent
movement to look at absenteeism from an organiza-
tional perspective began with Chadwick et al. (1971)
and was later developed by Nicholson and Johns (1995).
Absence culture, from a social-networking standpoint, is
beginning to dominate the multidisciplinary world of
absenteeism. This implies that absenteeism may be so-
cially created within groups of people (friends, peers,
colleagues, etc.). From this social-exchange perspective,
absenteeism can be seen to be exchanged for negative
managerial behaviours. A social-exchange framework
suggests that Ôpeople enter into relationships to acquire
valuable resourcesÕ (Fuller & Hester 2006), which can
be material goods or social goods.
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Staff nurse absenteeism
Shamian and El-Jardali (2007) discussed the impor-
tance of creating healthy Canadian workplaces to
reduce organizational outcomes such as absenteeism
and turnover. Theory must be tested and developed in
this area to determine if these variables consistently
predict absenteeism. Once predictors are identified, it
may be easier for administrators to implement inter-
ventions that foster healthy work environments to
promote attendance and reduce absenteeism.
The majority of included studies did not explicitly
follow a theoretical framework focused on absenteeism.
This may have been as a result of inadequate theoriza-
tion of nursing absenteeism as well as its determinants
and consequences. This is reflected in the number of
studies where absenteeism was examined as an ancillary
variable rather than as the primary focus of the study. In
order to advance this area of organizational behaviour,
refinement and development of existing theories are
needed to guide future research and interventions to
reduce absenteeism.
Absenteeism
Self-report, retrospective research designs may not be as
accurate as direct observation or recording owing to
unreliable memory or social desirability forces. Self-
report designs may lead to false–negative or false–posi-
tive results when potential for behavioural judgements
exist, influencing the significance of the relationships
found. In this review, self-report bias may have con-
tributed to type 2 error, leading to a false representation
of the number of non-significant results.
The focus of this review was on reported relationships
between measured predictors and individual absentee-
ism. Additionally, a large body of literature on absen-
teeism among nurses examined the influence of an
unmeasured intervention, such as a programme or
development session, to reduce nurse absenteeism.
These interventions/strategies may influence absentee-
ism and must be considered in future review studies.
This review has several potential limitations.
A reporting bias may exist as only published studies in
English were included and published studies tend to
over-report positive findings. The unit of analysis was
unclear in more than half of the studies, thus affecting
how the results were reported (group or individual) and
specific nurse outcomes may be contaminated with
outcomes from other healthcare professionals or con-
textual factors influencing the sample. We did not
conduct a meta-analysis because of the variation in
independent variables and the heterogeneity of this
group of studies. None of the studies in this review were
327

M. M. Davey et al.
conducted in rural hospital settings, making rural con-
texts a current and important area to research.
Based on our results, several recommendations are
provided for healthcare organizations and researchers
interested in staff nurse absenteeism. First, researchers
and healthcare organizations should invest in long-term
partnerships to examine the root causes of nurse
absenteeism using longitudinal prospective designs and
robust theory. This will help both administrators and
researchers to understand possible predictors of absen-
teeism within the organizationÕs context.
Second, it is clear from this review that the predictors of
short-term nurse absenteeism are still largely unknown.
Well-designed studies, using solid theoretical frame-
works, must be conducted in order to accurately display
the variables that significantly influence absenteeism.
Structural equation modelling techniques (Gellatly 1995,
Griffeth et al. 1997) would provide information about
the causal relationships between specific organizational
and individual level determinants of absenteeism,
including both indirect and direct effects.
Third, many studies on absenteeism (both included
and not included in this review) rely on only self-report
data, or on past absenteeism records. Both of these
methods may increase error in the study results. To
strengthen the use of self-reported absence measures,
these measures can be verified through comparisons
with actual administrative data. Collecting data in real
time increases the accuracy of the results, thus reducing
bias and error (Hackett et al. 1989, Gellatly 1995,
Gellatly & Luchak 1998). Absence behaviour is also
only detected over time. Therefore, repeated longitudi-
nal data collections are necessary to observe trends or
changes in absenteeism behaviour. Developing part-
nerships between organizations and researchers may
give rise to analysis of anonymized prospective per-
sonnel absenteeism data without violating the privacy
of individual nurses. Analysing group absence by
aggregating individual measures would also provide
useful correlates with absence cultures and be less
threatening to individual nurses.
Fourth, random sampling increases the generaliz-
ability of the results and reduces convenient and
voluntary sampling bias. Random sampling was a
limitation in the majority of the papers included in this
review. It is difficult to use prospective sampling within
hospitals because random selection immediately reduces
the sample size; and, as the sample population is already
small, the effect size is limited. However, sufficient
capacity to conduct such research designs can be cre-
ated through partnerships between researchers and
large health regions/organizations.
328 ª 2009 The Authors. Journal compilation ª 2009 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 312–330
13652834, 2009, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2834.2008.00958.x by Universidad del Bio Bio, Wiley Online Library on [21/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Conclusion
In this systematic review, we examined and integrated
70 independent variables from 14 different studies into
eight predictive categories of absenteeism. Our findings
show trends toward individual nursesÕ prior attendance
records, work attitudes (job satisfaction, organizational
commitment and work/job involvement) and retention
factors reducing nurse absenteeism, with burnout and
job stress increasing absenteeism. However, our find-
ings suggest that research on hospital nurse absenteeism
provides no conclusive evidence about the predictors of
staff nurse absenteeism. As long as the predictors
remain unclear, efforts at dealing with the costly
problems associated with absenteeism will be less
fruitful. Future research should be conducted in Cana-
dian contexts to provide Canadian healthcare organi-
zations with generalizable information, to use
prospective and longitudinal designs and to be theory
driven, using or developing robust absenteeism theory.
Partnerships between researchers and Canadian
healthcare organizations and predictive theory about
the determinants of absenteeism in nursing would guide
the development of individual and organizational
interventions to address this costly issue for individuals
and organizations in order to improve the continuity
and quality of care for patients.
Acknowledgement
Peter Davey for providing much needed support throughout
this review and assistance as a second reviewer.
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