Effort-reward imbalance is associated with the frequency of sickness absence among female hospital nurses: a cross-sectional study

Int J Nurs Stud. 2010 May;47(5):569-76. doi: 10.1016/j.ijnurstu.2009.10.002. Epub 2009 Nov 11.


Background: Most research on sickness absence among nurses has focused on long-term work disability. Absence from work due to short-term sickness, however, is more common and frequent short absences result in understaffing and increased workload of nursing teams.

Objectives: To investigate health and work factors in relation to the frequency of short-term sickness absence among nurses.

Design: A cross-sectional study linking self-reported health and work factors to the frequency of registered sickness absence episodes in the preceding 3 years.

Settings: A regional hospital in the Dutch province Friesland employing 1153 persons.

Participants: 459 female nurses working at least 3 years in the clinical wards (n=337) or the outpatient clinic (n=122) of the hospital.

Methods: Perceived general health, mental health, demand/control (DC) ratio, workplace social support, effort/reward (ER) ratio, and over-commitment (i.e. the inability to withdraw from work obligations) were assessed by a self-administered questionnaire. The associations between the questionnaire results and the registered number of sickness absence episodes were analysed by negative binomial regression analysis, distinguishing between short (1-7 days) and long (>7 days) sickness absence episodes and controlling for age, hours worked, and duration of employment.

Results: 328 (71%) female nurses completed their questionnaires and of these 291 were eligible for analysis. High frequent absentees perceived poorer health, had lower over-commitment scores, and reported higher ER-ratios than low frequent absentees. Esteem rewards were related to sickness absence whereas monetary rewards were not. Feeling respect from the supervisor was associated with fewer short sickness absence episodes and respect from co-workers was associated with fewer long sickness absence episodes.

Conclusions: Effort-reward imbalance was associated with frequent short sickness absence episodes among nurses. Work efforts and rewards ought to be potentially considered when managing nurses who are frequently absent from work as these factors can be dealt with by managers.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Health Status
  • Humans
  • Models, Psychological
  • Netherlands
  • Nursing Staff, Hospital* / psychology
  • Reward*
  • Sick Leave / statistics & numerical data*
  • Stress, Psychological
  • Surveys and Questionnaires
  • Workload