Meet the Expert

Jessica Rainbow is an Assistant Professor at the University of Arizona College of Nursing and recently conducted a study of presenteeism with nurses across the country, including here at Stanford Health Care.

Presenteeism and Nursing

Let’s start with a brief definition of presenteeism. Presenteeism is when someone is physically present at work, but not fully engaged or performing. There can be multiple factors causing someone to experience presenteeism such as sickness, and both work and personal stressors, including workplace violence. Nursing has been found to have the highest rates of presenteeism when compared to other professions. Presenteeism in a healthcare setting can lead to negative outcomes for patients, nurses, and healthcare organizations. My interest in presenteeism stemmed from my own experiences with burned out and sick coworkers as an ICU nurse and after interviewing nurses about their fatigue while a nursing Ph.D. student. However, understanding how the different outcomes and factors leading to presenteeism are related, or the best way to measure presenteeism were unknown. I was interested in answering these questions with my dissertation, so I designed and carried out a survey of nurses that compared different existing presenteeism measures and assessed what leads to presenteeism, and what were the consequences of presenteeism. I recruited nurses who provide direct patient care in hospitals from around the country through social media, nursing organizations, and hospitals, including Stanford Health Care.

All in all, 447 nurses from 40 different states participated in the survey. On average, these nurses had 11.3 years of experience, worked 34 hours per week, and on average were 39 years old. Presenteeism rates on our survey were higher across different presenteeism measures than previously published studies, including measures that looked at presenteeism due to sickness, job-stress, and workplace violence.  Higher presenteeism was linked to negative work environment, lower professional value (as described in the American Nurses Association’s Code of Ethics), higher perceived stress, and work-life imbalance. Presenteeism was also linked to lower nurse professional quality of life, higher turnover intention, and more missed patient care.

In summary, our findings indicate that presenteeism is a prevalent problem that can have multiple contributing factors, and can lead to negative consequences for nurses, healthcare organizations, and patients. We still need to learn more about the nurses’ awareness of their own potential presenteeism, their decision-making process about presenteeism, and their perceived consequences of attending work when not at their best. As a researcher, I am working to learn more about how to measure presenteeism and how to intervene to address the issues leading to presenteeism, like work stress, and presenteeism itself.

Thank you to all those who participated in my survey – your responses provide a baseline from which we can build going forward, and future direction for my research. If you are interested in learning more about nurse presenteeism and my research, you can contact me via email at, or follow me on Twitter @JessicaGRainbow.

About the Author: Hello! My name is Jessica Rainbow and I have practiced as a nurse in both critical care and infusion clinic settings in Nevada and Wisconsin. I received my BSN from the Orvis School of Nursing at the University of Nevada, Reno, and my Ph.D. in Nursing from the University of Wisconsin – Madison. I am currently an Assistant Professor at the University of Arizona College of Nursing. I am very passionate about improving the nurse work environment to improve nurse and patient well-being. My passion was part of why I conducted the study on presenteeism.

Article By: Jessica Rainbow

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