Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality

Authors

  • Lynn Unruh,

    1. Lynn Unruh PhD RN LHRM
      Fellow in Nursing Policy and Philanthropy
      Robert Wood Johnson Foundation, Princeton, New Jersey, USA, and
      Associate Professor
      Health Services Administration, Department of Health Professions, College of Health and Public Affairs, University of Central Florida, Orlando, Florida, USA
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  • Lindell Joseph,

    1. Lindell Joseph PhD RN
      Candidate and Nurse Researcher
      Center for Nursing Research and Innovation, Florida Hospital Medical Center, Orlando, Florida, USA
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  • Margaret Strickland

    1. Margaret Strickland BSN RN
      Chief Nursing Officer
      Florida Hospital Altamonte, Administrative Offices, Altamonte Springs, Florida, USA
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L. Unruh: e-mail: lunruh@mail.ucf.edu

Abstract

Title. Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality

Aim.  This paper is a report of a study to assess the impact of nurse absenteeism on the quality of patient care.

Background.  Nurse absenteeism is a growing management concern. It can contribute to understaffed units, staffing instability, and other factors that could have a negative impact on patient care. The impacts of absenteeism on the quality of nursing care have rarely been studied.

Method.  Retrospective monthly data from incident reports and staffing records in six inpatient units for 2004 were analysed. Dependent variables were the numbers of restraints, alternatives to restraints, incident reports, deaths, and length of stay. Explanatory variables were nurse absenteeism hours, patient days per nursing staff, and interaction between these variables. Controls were patient acuity and unit characteristics. Fixed effects regressions were analysed as regular or negative binomial models.

Findings.  Neither high Registered Nurse absenteeism nor high patient load was related to restraint use when taken separately. However, high Registered Nurse absenteeism was related to restraint use when patient load was high. Registered Nurse absenteeism was related to a lower use of alternatives to restraints. Incident reports were increased by high patient load, but not absenteeism, or absenteeism given patient load. When both patient load and absenteeism were high, deaths were higher also.

Conclusion.  Absenteeism alone may not be a strong factor in lowering quality, but the combination of high Registered Nurse absenteeism and high patient load could be a factor. Staffing and absenteeism may be part of a vicious cycle in which low staffing contributes to unit absenteeism, which contributes to low staffing, and so on.

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