Factors influencing nurses absenteeism in a general hospitals in a Saudi Arabia .

Factors Influencing Nurses Absenteeism in a General Hospitals in a Saudi Arabia
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Introduction
The high rate of absenteeism has been argued to be a serious managerial issue in various service sectors including the healthcare sector. Absenteeism among healthcare staff is a notable phenomenon that has been greatly emphasized as an issue that affects organizational productivity. The studies carried out in this area have revealed that within the health care system, absenteeism among nurses is the highest when compared to other workers in the same sector. Sickness is considered the most important factor that causes absenteeism amongst the nurses (Sancinetti et al. 2011). However, Davey et al. (2009) has provided an interesting perspective of looking at the factors leading to absenteeism amongst nurses. They concluded that whatever the reason for absenteeism, the primary cause is work-stress.
Gazzaz (2009) showed that absenteeism amongst nurses has a strong relationship with various factors. Some of the factors associated with stress include organizational commitment, job satisfaction and other determinants of sickness absence. Other factors that have been revealed in research include working conditions, primarily workload and work demands. However, Roelen et al. (2013) suggests that all these factors are preconditions to stress that result in absenteeism.
In Saudi Arabia, like many other countries all over the world, the situation is of no exception.

Previous studies revealed that absenteeism among the most serious issues for health care organizations and. In hospitals, absenteeism has been showed to range from 15 to 36 percent every year (Daouk-Oyry et al. 2014). Thus, nurses’ Absenteeism is particularly the most critical problem, given the fact that the country suffers from the global shortage of nurses (Duclay et al..2014).This problem has negative impacts on the capacity of health care organizations. These impacts include providing optimal and safe care to the patients (Daouk-Oyry et al. 2014), workforce instability, the wellbeing of the nurses and high costs to the system (Gorman, Yu S. & Alamgir 2010).
Absenteeism amongst employees is conceptually defined as failing to go to work when the worker is supposed, and is expected, to be at work (Gorman, Yu S. & Alamgir 2010). Absenteeism can either be voluntary and involuntary, with the former being because of factors that are in the worker’s control and are related to his/her desire to attend. On the other hand, involuntary absenteeism suggests the kind that relates to, or which results from, factors that are not within the control of the employee and he/she cannot attend. Two variables emerge in the attendance decision made by the employee: the capability and motivation to attend (Gorman, Yu S. & Alamgir 2010).
Because of various threats, risks, and other related factors, individuals suffer some stress. Stress at the workplace is the most common cause of the managerial issues facing health care organizations in Saudi Arabia. Stress can be understood as a reaction to the different aspects of the environment and is argued to occur naturally and sometimes it can act as motivation (Heponiemi, et al. 2010). Excessive stress in the workplace is costly because it leads to high levels of absenteeism and even turnover, in extreme cases. Work stress has been revealed as the major occupational health hazard decreasing satisfaction as well as productivity of the health care workers, increasing absenteeism. Continuous stress at the workplace results in worker-burnout, in turn, leading to major emotional and physical problems. Hospital settings have been revealed to have various characteristic factors that make the environment less conducive for the workers for the nurses.
Nurses are particularly subjected to stress due to the rapid changes in their working environment. There has been a decrease in the number of nurses which means that fewer nurses have to take up more loads. For instance, most of the nurses in Saudi Arabia are female, and quite a huge proportion is non-Saudis. The nursing supply from the country’s nursing schools has not been sufficient to meet the demand for nurses in Saudi hospitals. In fact, Saudi nurses make up less than 30 percent of the overall nursing workforce in the country (Gazzaz, 2009). Research shows that the available nurses go through a lot of stress due to the increasing demand for their services (Gazzaz, 2009).
Emotional and physical pressure is the main cause of stress and absenteeism among nurses (Heponiemi, et al. 2010). Such pressure results when resources, skills, and needs of the employees do not satisfy the job requirements (Welker -Hood, 2006).In research conducted by Gazzaz (2009), it was argued that job-related stress is the main cause of negative health outcomes for the nurses. Some of the reasons had been explained as why most nurses will be out of work for many days in a year. The working environment explains the issue because they cause stress detracting the quality of working lives for the nurses. They result in some form of physical illness and can result in emotional and psychological problems leading to inability to work optimally (Gazzaz, 2009).
Research on absenteeism amongst nurses tends to focus on stress as the main factor behind absenteeism. Other factors leading to absenteeism have not been well studied and could be established in the current study. Gazzaz (2009) showed that absenteeism amongst nurses has a strong relationship with various factors. This study focuses on these factors that play out in the tendency toward absenteeism amongst nurses.
Most of the studies on nursing absenteeism have been carried out in Western Europe and North America, with minimal attention to the problem as it affects health care systems in other parts of the world including the Middle East (Jalal et al. 2014). Moreover, regardless the fact that this is a universal problem affecting the quality of care in all parts of the world, previous research work revealed that little attention has been placed on the issue as it affects health care in the Kingdom of Saudi Arabia Johnson & Cowin, 2013; Jalal et al. 2014; This is. Thus, the purpose of the current study is to explore the factors contributing to absenteeism among nurses working in a general hospital in Kingdom of Saudi Arabia and determine whether characteristics of the nurse, manager, work environment, and organization influence their absenteeism.
Aim of the study
The purpose of the current study will be to explore the factors influencing absenteeism amongst nurses working in a general hospital at Kingdom of Saudi Arabia.
Literature Review
The issue of absenteeism has a long history and has, as a result, attracted major research interest. Research has been carried out on various aspects of the issue of nurse absenteeism to shed light on the efforts to address it. Among the areas that have been researched are the factors that are related to the problem. A meta-analysis carried out by Johnson & Cowin (2013) has revealed a strong positive association behavioral intentions and nurse absenteeism, a major negative association between job satisfaction and behavioral intentions, as well as a minor negative association between job satisfaction and absenteeism.
Various factors behind nurse absenteeism were identified by Galletta, et al. (2013) as age, job satisfaction, tenure, perceived job possibilities, organizational commitment, and quality of supervision. The current research shows that absenteeism amongst nurses relates to various factors. A systematic review carried out by Rajbhandary & Basu (2010) revealed that organizational commitment, job satisfaction, and job stress age the most important pointers of absenteeism related to sickness. Research evidence shows that working conditions and workload have a critical role to play in absenteeism tendencies (Roelen et al. 2013; Jalal et al. 2014). Work characteristics and demographic variables have a strong relationship to absenteeism as revealed in various studies. Rajbhandary & Basu (2010) showed that factors like auxiliary personnel, full-time employees, older age and low wages of nurses are related to higher rates of absenteeism. Nursing schedule, work setting, and the duration of work schedule also impact on the decision to be absent from work.
An analysis done by Currie & Carr Hill (2012) revealed that internal environmental predictors like stress emanating from staffing shortages, supervisory relations, leadership style, advancement opportunities as well as inflexible management policies are related to the increase in nurse absenteeism. Studies carried out in the United States, Canada, the United Kingdom, Scotland, and Germany reveal that factors such as emotional exhaustion and issues related to work design as associated with the high rate of absenteeism in nursing. Job satisfaction has in most studies been revealed to be a consistent fundamental factor interacting with other factors related to the workplace as well as individual factors in a complex manner.
Occupational incidents and health issues are showed to have a direct relationship to sickness absence amongst nurses. Musculoskeletal problems, for instance, were showed to be the most important factor in work-related illness amongst nurses in the UK (Hussey et al. 2012). Infections, respiratory illness, and injury are other important factors that cause absenteeism, and they were the most important factors in India (Tripathi et al. 2010). The modern literature shows that sickness absenteeism can be affected by the leadership effectiveness of nurse managers (Schreuder et al. 2011).
Evidently, most of the researchers on absenteeism amongst nurses have looked at the issue either from the perspective of the nurse or via data analysis from sick leave and absence records. Nonetheless, there are no studies that have investigated the issue from the point of view of the management. Due to the important role played by the management taking into consideration management and leadership styles, their effect on the nurses can determine the level of absenteeism (Schreuder et al. 2011).
Stress resulting in the workplace has been showed to result from strained relationships, as related to leadership styles and quality of supervision. Where the relationship between the nurses and the superiors are strained, the nurses are likely to operate in a stressful environment. This means that it is possible for the managers to evaluate the relationships between themselves and the nurses as well as between the nurses themselves as a way of addressing the problem of absenteeism. Stress can be as a result of various factors resulting from both within and outside the workplace setting. Foremost, stress can be generated by the large volume of work and high demands resulting from a shortage of nurses. Li & Jones (2013) refer to this as treadmill syndrome. The issue can be characterized by the employees working their entire work shift with no breaks. Such overworking is considered as one of the major sources of stress in nursing can lead to high levels of absenteeism.
A study by Li & Jones (2013) suggested that the concerns related to nursing absenteeism tend to originate from non-economic as well as economic sources. From the point of view of the non-economic sources, there are issues related to the practicalities: retention of sufficient numbers of nurses to aptly provide safe and quality care; overburdening of the remaining nurses with more workload and demands that may cause more nurses to leave, and attracting and recruiting quality nurses to fill vacancies. From the economic sources point of view, concerns emanate about the loss of nursing human capital, costs of absenteeism, and the possible.
Absenteeism in hospitals can be caused by personal reasons, and there can be feeling that this is a reason that is out of control of the hospital or the managers. Nevertheless, some of these reasons can be mitigated. One such reason is compassion fatigue, such as when the nurse has to deal with a lot of high-risk patients. Burnout can result causing them to be absent some nurses can feel that they have hit “glass ceiling.” This means that some nurses can become highly comfortable with their skills and will need a greater challenge. Some of these reasons, if identified early can be addressed thus retaining regular attendance by nurses. It is important for the managers to engage the nurses on a regular basis to ensure that they are content (Johnson & Cowin, 2013).
Currie & Carr Hill (2012) reveals problem associated with staffing that can cause nurse absenteeism in a health care organization. Where there is an inadequate level of staffing, nurses likely develop a propensity for absenteeism. Also, where the unit is not properly organized, there is the possibility of nurses being regularly absent. Others remain absent most of the time in case they feel that they are getting inequitable assignments or feel that they are assigned to difficult clients more than colleagues (Currie & Carr Hill, 2012). Dealing with staffing issues is very important for the managers. This should begin from staffing and scheduling to ensure that the right staff is hired for the right jobs and that there is an adequate number of nurses for the unit. Making decisions based on reliable data is very important, and, therefore, it is important that the managers have a way of collecting such data on staffing. There should be in place system to keep track of activities in the unit, such as the patients assigned to which nurse, virtually avoiding inequitable assignments. Such a system can help in the evaluation of staffing practices (Johnson & Cowin, 2013).
The cost of absenteeism has received major research interest. Absenteeism in nursing can have major effects on the ability of the health care organization to cater to the needs of the patients as well as to provide quality of care. Both direct and indirect costs are incurred by healthcare organizations due to this problem. Direct costs are related to labor costs, and they are incurred in recruitment, selection as well as training of nurses. On the other hand, indirect costs are related to the negative influence of this issue on the productivity of the unit, greater burden for the remaining nurses, reduced job satisfaction, as well as decreased quality of care (Gazzaz, 2009).
Various researchers have provided some estimates of the cost related to absenteeism in nursing. Currie & Carr Hill (2012) estimated the total cost of absenteeism of a single hospital-based RN ranging from $62,000 to $67,000, but the value depends on the service line. While the estimates of cost depend on the manager reports of reduction in productivity, it is obvious that there are preventable organizational financial and human costs that are associated with high absenteeism of nurses in the medical-surgical unit as well as in other units. Past studies have provided the estimated cost of replacing a medical-surgical registered nurse (RN) at a value ranging from $30,000 to $50,000. Recruitment and training of a medical-surgical registered nurse is normally a costly and time-consuming task. This is the reason nurse retention of should be the main concern for managers in health care organizations. It is important for the leaders to prevent nurse absenteeism as much as possible (Galletta, et al. 2013).
Schreuder et al. (2010) suggest the need for nurse managers in Saudi health care organizations to develop strategies for addressing the problems that might cause their remaining out of work regularly. Such issues should be considered in such a strategy: the staff should be empowered, given more control, autonomy, and improved work environment; implementing work team model with the aim of enhancing input and involving the nurses in decision making; self-leadership to give the nurses stronger feelings of purpose, competence, mental job redesign, and self-design; job support and information from leaders to lower stress; support from colleagues especially for new staff; social support as well as practical help from the leaders, provision of adequate resources, task-relevant feedback, and motivation through such means as compensation, praise, considering to their opinions, and show of concern; and provision of mentorship programs (Johnson & Cowin, 2013).
While there is a great deal of research on the issue of nurses absenteeism, Cohen & Golan (2007) cites the inadequacy of research evidence on the problem in hospital settings outside North America and Western Europe. Nonetheless, Daouk-Oyry et al. (2014) acknowledges that hospital settings face similar challenges as they are similar in nature. This means that most of the problems that face health care workers are universal and should be understood. Davey et al. (2009) suggest the need for more research in settings outside these two regions, particularly in Saudi Arabia. The findings from this research will be critical in filling this major gap. The scope of the research will answer the question of whether or not the factors are universal, or there are some which are unique to Saudi hospital settings.
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