It’s cold and flu season and many of my non-nursing friends are shocked when I tell them that hospitals have unwritten rules about nurses calling into work when they are sick. Sure, nurse recruiters tell new hirers that they can call in sick, but in reality, nothing could be farther from the truth. I’ve actually heard a nursing supervisor refuse to accept a nurse’s callout because there was no one that could take her place on the unit. There are consequences for calling in sick. Nurses that choose to take care of themselves when they are ill face the wrath of their employer when they return to work. Most nurses choose to work when they are sick. This scenario plays out everyday in hospitals and it’s called presenteeism.

How many times have you gone into work feeling like you had to die first before you could start feeling better? I know I have. Why? I’ve had to save my sick time for when my children got sick or for when I was really dying. And then there is the threat of being written up for an unexcused absence. Those come back to haunt nurses at their end of the year evaluation. Annual raises are affected by how many times a nurse calls out sick during the year.

The concept of presenteeism has been around for a long time, but it’s relatively new to the health care arena. According to an article written by Donna J. Middaugh, PhD, RN and published in Dermatology Nursing, April 2007, Presenteeism is the opposite of absenteeism. Nurses report to the nurses station but are functionally absent. Researchers have equated presenteeism to two different employee behaviors. The first group goes to work when they are sick or tired. These employees are not productive because they are suffering from stress, depression, illness, headaches, or other disorders. The second group of employees put in excessive work hours as an expression of commitment or ways of coping with job insecurity. Even though both groups of employees are at work, neither group is working at their peak capacity. This puts them, their co-workers, and patients at risk for illness. In addition, these nurses are at an increase risk of making a medical error.

There are solutions to presenteeism, but it requires cooperation between management and labor. Hospital administrators need to understand how a sick nurse can impact patient care and ultimately the hospital’s bottom line. Nurses need to stand together and tell administrators, “We’re mad as hell and we’re not going to take it anymore.” Yes, I know that sounds like a line out of a movie—because it is—but nurses must understand that they are risking their patients’ health as well as their nursing license when they come into work sick. Remember, one small mistake in calculating a medication dose can kill a patient. Nurses must be alert and at their peak performance when they are work.

Middaugh suggests that nursing managers conduct anonymous job satisfaction and stress surveys of staff, and allow staff members to include details of specific stressors or dissatisfiers and also offer suggestions for improvement. She also suggests that they confer with other mangers, and review human resource policies and benefits that support work/life balance.