Identify the Causes of Absenteeism in Nurses Mayo Hospital Lahore Pakistan

Absenteeism is a usual pattern of absence from a duty or responsibility. Usually, absenteeism is considered as an indication of person poor performance. In this study a descriptive cross sectional study design was used. A close ended questionnaire was used as a research tool. Convenient sampling technique was used. Data was analyzed on SPSS 20 version. Nurses are absent from their duties because they suffer from minor ailments e.g. headache and backache? In response of this question, 42.5% responded said that they are strongly agreed, 17.5% were agreed, 8.8% were neutral, 21.3% were disagreed, and 10% were strongly agreed. Nurses do absent from their work because workload is too heavy, 42.5% were agreed, 30% were strongly agreed, 12.5% were neutral,7.5% were disagreed and 7.5% were also strongly disagreed. The lack of appropriate recognition and reward could lead to dissatisfaction and absenteeism among nurses, in response of this question nurses asked that they do absent 31.3% agreed, 41.3% strongly agreed, 15.0% are neutral, 12.5%are disagreed and 0% are strongly disagreed. Staff absenteeism is a growing management concern. It can contribute to sickness absence, staffing instability, work overload and job dissatisfaction that could have a negative impact on patient care. The rate of absenteeism can be reduced by productive management, and loyal leadership. It will not only reduce absenteeism rate but also improve quality of care toward the patients. In return of good performance nurses need appraisal.


Introduction
Absenteeism is a usual pattern of absence from a duty or responsibility.Usually, absenteeism is considered as an indication of person poor performance (Johns, 2011).Like other professions, absenteeism is considered an important dilemma in nursing profession.Nursing is a caring profession.Absenteeism is a bigger problem that a nurse manager has to face in daily routine.It affects not only delivering patient care but also effect staff moral and ethics.The impact of nurse's absenteeism on patient care is that patients will be neglected.A study stated that if the rates of absenteeism will increased in daily basis it will become the problem for health care units and also for nurse manager.It will not only put burden on other nurses but quality of care will also be affected (Pacheco et al., 2009).
There are many causes of absenteeism in staff nurses e.g.work overload, stress related to duty, job dissatisfaction shortage of staff nurses, salary issues, strict timing schedule, behavior of nursing managers and sickness in nurses.A study conducted in 2003 suggest that there are different causes of absenteeism among different nurses even at the same place and fluctuate overtime.(Johnson et al., 2003) Sometime nurses have to do more work.Nurses are in continuous contact with patients who are ill.According to Tonya in 2009 causes of absenteeism including: dissatisfaction with their jobs, illness, parenthood duties or responsibilities, fixed time table, work-related injury and illness, and nurses' attitudes regarding absenteeism.The one cause of absenteeism that is classified as heavy workload.It can be defined as nurses are doing duties more than the expected.If health care units received more duties than expected it will keep their minds all time frustrated and pressurized.Moreover the one cause of absenteeism is long duty hours that will lead to heavy workload.Burke and Greenglass stated that if nurses did not avail the facility of tea breaks or any other refreshment and they are doing continue work.It will increase nurses' level of stress and this may in turn lead to absence from work.(Burke, 1997) Dabboussy & Uppal conducted a study in 2012 they said that rightful sickness is still considered as relation for the majority of employee absences, but some studies have

Research Article
shown that the rate of absenteeism from work is less than one third because of poor health.Absenteeism rate is very high in health care workers.It is suggested that on average health care workers are likely to be absent from work as a result of illness or injury rather than other occupations.(Dabboussy & Uppal, 2012) Nursing shortage is caused by stressful work environments due to work overload, lack of support and an inadequately equipped work environment.(Committee, 2004) A study conducted in 2009, they said that the primary reasons of high turnover among nurses also increase the chances of absenteeism.When rate of absenteeism increased there will be poor quality of care towards the patients.It will also increase the job dissatisfaction and job insecurity.(Pillay, 2009)

Purpose of Study
The purpose of study was to identify the causes of absenteeism in staff nurses.

Rational of the Study
I choosed this topic because I found this problem very common in nurses of Mayo hospital Lahore.This practice is very common in staff nurses especially in young nurses.My purpose of this study was to identify the causes why nurses adopt this behavior.I want to help the organization by this study.After results, the organization will control the absenteeism rate in staff nurses.

Study Design
The research design was descriptive cross sectional study carried out in February 2015 to June 2015.

Research Tool
A questionnaire was used to interview the nurses.Data included was name, age, marital status, qualification and experience in the field.

Targeted Population
Data was collected from staff nurses of Mayo Hospital Lahore.

Inclusion Criteria
Staff nurses of other departments in Mayo hospital Lahore, other nurses in Pakistan and all over the world excluded in this study.

Exclusion Criteria
Staff nurses of other department in Mayo hospital Lahore and other nurses in Pakistan and all over the world excluded in this study.

Sampling Technique
Convenient sampling was used.

Sample Size
Sample size was determined by using the following formula: Where, desired sample size= n=? Population= N= 100 Margin of error= E= 0.05% (If we take confidence interval 95%)

Data Gathering
Data was gathered by distributing questionnaire in nurses.

Data Analysis
Data was analyzed by using Package for Social Sciences (SPSS) 20 version.

Ethical Consideration
This study was conducted in hospital.The rules and regulation of hospital was not being violated.Every person related to this study was respected.All information kept confidential.Ethical values of every person considered.The results of this study were informed to organization.So that they can control it by making suitable strategies.

Absenteeism due to workload
Nurses are absent from work because the workload is too heavy, the respondents of this question are 42.5% are agreed,30.0%are strongly agreed,12.5% are neutral, 7.5% are disagreed and 7.5% are also disagreed (Table 6).The association of level of staffing is insufficient to handle the patient are 33.8% are agreed, 45.0% are strongly agreed, 13.8% are neutral, 6.3% are disagreed and 1.3% are strongly disagreed (Table 7).

Absenteeism due to dissatisfaction
The lack of appropriate recognition and reward could lead to dissatisfaction and absenteeism among nurses, in response of this question nurses asked that they do absent 31.3%agreed, 41.3% strongly agreed, 15.0% are neutral, 12.5%are disagreed and 0% are strongly disagreed (Table 8).

Discussion
The aim of study was that to identify the causes of absenteeism in nurses.After analyzing the data on SPSS 20 version the result of this study support the alternative hypothesis.
Absenteeism in any department rather in nursing or any other department it will disturb everyone.The supervisior have to more work to compensate the defiiciency.When someone is absent from their duty different things happened.One is the work of that employee is not done, the replacement of that person is required so someone has to hire in order to provide patient care.Absenteeism is very costly for both employee and managemnt team.It will make all person to suffer.
Nurses are absent from work because they suffer from minor ailments e.g.headache and backache?The response rate of this study is 42.5% was agreed and 17.5% was strongly agreed as compared to study of Singh in 2012.The result of their study was 78% was agreed that sickness cause absenteeism either minor or major.According to his study, the cause of absenteeism is illness that may be serious and negligible.If someone suffers from illness, it will affect the productivity of work and also worries the management of hospital.Sickness that is considered unexpected and put pressure on all administration.
Nurses do absent from their duties because the workload is very heavy.In this study 42.5% were agreed and 30% were strongly agreed that heavy workload lead toward absenteeism as compared to the study conducted in 2009.
The result of their study was 105 nurses were agreed that work overload cause absenteeism in nurses.They understand that workload put the pressure on nurses and lead them toward absenteeism.General job stress and overwhelming workloads, due dates that should be kept, requests on benchmarks, extreme authoritative obligations, poor time administration, long working hours, absence of support and requests made by asset issues all add to the anxiety levels bringing on burnout that prompts to nonattendance.The result of their study was 105 nurses were agreed to their question.They understand that workload put the pressure on nurses and lead them toward absenteeism.(Davey et al., 2009).
Nurses in the organization have necessary authority to perform their duties effectively.The result of this study in response of this question is 27% were agreed and 23% were strongly agreed.Self-sufficiency is depicted as having the specialist to settle on choices and the flexibility to act as per one's information.Self-sufficiency is empowered by shared administration or participative administration where representatives are allowed to take part in basic leadership.Role uncertainty and work weight result in an absence of self-rule that makes push, bringing about non-appearance.Association of nurses in shared administration and participative administration energize clinical basic leadership, self-sufficiency, control, certainty and trust, that lead to fulfilled nurses and lessens absenteeism.(Takase, 2010) One cause of absenteesim is dissatisfaction from their jobs is found among those nurses who are loyal with their works and duties.They are not rewarded regards their good and efficient work.due to this lacking of reward or apprasial they are dissatisfied with their jobs and they do absenteesim.In this study 31.3% were agreed and 41.3% were strongly agreed with the statement of lacking of reward could lead to disatisfaction and absenteeism.It is as compared to the study of Prado and Chawla.The result of their study is 99% of nurses were agreed that reward system should be there.According to Prado and Chawla in 2006 believed that those employee whose attendance is good and absenteesim rate is low.They all should be rewarded with bonus and any other incentives.This reward system will decrease the absenteesim and dissatisfaction.(García-Prado & Chawla, 2006) Nurses are absent from their duties due to stress.They take stress because of minor illness e.g.tiredness.The result of this study was 37.5% were agreed and 18.8% were strongly agreed as compared to the study.In their study, 86% were agreed that stress of work cause absenteeism in nurses.In their study it was also evident that elevated levels of stress negatively impact the physical and psychological wellbeing of nurses.(Devi et al.).

Conclusion
This study highlighted the causes that contribute to absenteeism amongst nurses in the Mayo Hospital Lahore.
Staff absenteeism is a growing management concern.It can contribute to sickness absence, staffing instability, work overload and job dissatisfaction that could have a negative impact on patient care.Therefore, it concluded from this study that there are identifiable causes of absenteeism in nurses.This study supports the alternate hypothesis.So organization should made specific policies to reduce the rate of absenteeism in nurses.There should be some reward system to reduce job dissatisfaction.

Limitations
As a student, this was my first research work so I have to face many problems like developing questionnaire, analysis of data and reviewing latest literature related to my study.
This was my first experience as a researcher.So I have many deficiencies and also lack of knowledge to conduct the research.I conduct this study in one hospital if I have funds and more time I will do it in other hospital of Pakistan.

Recommendations
1. Stress management programmes should be offered to nurses in an attempt to cope with their stress levels.2. Nurses need to be provided with information on the causes of stress and ways of preventing and coping with stress.3.More nurses should be recruited, and trained to ease the workload of nurses.4. Salaries for nursing personnel should be more lucrative in order to retain staff.
5. All vacant posts should be identified, and filled as soon as possible to reduce the strain on already over worked nurses.6.There should be reward for those workers who are regular and loyal regarding their duties.

7.
A yearly awards function should be held to recognize and motivate the dedicated staff.

Table 1 :
Age of the Respondents

Table 3 :
Experience of Respondents

Nurses are absent from their duties because of sickness
Table 4 shows that total number of nurses which use to absent from duty because of minor ailments e.g.headache and backache is 42.5% agree with this statement, 17.5% is strongly agreed,8.8% is neutral, 21.3% are disagreed and 10% are strongly disagreed.Nurses are absent from their duties because they suffer from stress related illness, e.g.tiredness are 37.5% are agreed with this.18.8% are strongly agreed, 17.5% are neutral, 18.8% are disagreed and 7.5% are strongly disagreed (Table

Table 4 :
Do nurses absent from work because they suffer from minor ailments e.g.headache and backache?

Table 5 :
Do nurses absent from their duties because they suffer from stress related illness, e.g.tiredness?

Table 6 :
Do nurses absent from work because the workload is too heavy?

Table 7 :
Does the level of staffing is insufficient to handle the number of patients?

Table 8 :
Does the lack of appropriate recognition and reward could lead to dissatisfaction and absenteeism among nurses?