Examining presenteeism and productivity losses among nursing workers: a cross-sectional study

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Method A cross-sectional study was conducted with 123 participants from a public hospital and 159 from a private hospital in Manaus, Brazil. The Sociodemographic Health Questionnaire was utilized to assess presenteeism, while the Work Limitations Questionnaire measured productivity losses. Data were analyzed using non-parametric methods. Results Health-related work loss and presenteeism were reported by 50.41% of public sector professionals and 39.62% of private sector professionals. Despite this, presenteeism was more prevalent in the private sector (93.65%) compared to the public sector. Common health issues included musculoskeletal (26.49%), mental/behavioral (19.21%), respiratory (17.22%), neurological (16.56%), and gastrointestinal (5.96%) conditions. Additionally, 54.24% of private sector professionals and 44.23% of public sector professionals did not seek treatment. The private sector exhibited greater limitations in receiving care due to time management (40.34%), mental-interpersonal tasks (49.95%), production tasks (52.54%), and physical tasks (61.30%), resulting in higher productivity losses among nurses (13.46%) and nursing technicians (15.82%). High-complexity sectors demonstrated the greatest productivity losses. Conclusion The study identified significant differences in the characteristics of presenteeism and productivity losses between nursing professionals in the public and private health sectors. These results point to the need to improve management and occupational safety and regulatory measures to solve workers' health problems and mitigate presenteeism and productivity losses in the public and private health sectors. Presenteeism Absenteeism Nursing Occupational Health Health Services Organizational Efficiency Figures Figure 1 Figure 2 Background Presenteeism, also known as presenteeism disease, refers to a behavior where individuals with emotional complaints and/or health problems continue to work despite their debilitating conditions. (1) . Although presenteeism is not a recent phenomenon, it remains under-researched and under-recognized by the scientific community and institutions alike. This is problematic because the negative impacts of presenteeism are evident in both worker health and organizational economics across all professional settings. In terms of overall occupational health, presenteeism significantly deteriorates the physical and mental health of workers, posing a substantial risk factor for future sickness absenteeism and reduced work capacity (2,3) . Economically, presenteeism leads to significant productivity losses, raising costs for organizations, often surpassing those associated with absenteeism and prolonged medical treatment (2,4) . The hidden nature of presenteeism costs stems from extended periods where workers are not performing at full capacity, resulting in long-term losses. Some authors describe presenteeism as an "iceberg effect," where the visible part of work loss is minor compared to the submerged portion ( 5,6) . In the global health sector, the World Health Organization (WHO) reports that nursing workers constitute 59% of the health workforce ( 7 ). Factors influencing presenteeism in nursing include unfavorable working conditions, high workloads, difficulty in finding replacements, low wages, and neglect of personal health ( 8 , 9 ). Presenteeism in nursing is linked to compromised quality of care (e.g., work overload, incomplete tasks, demotivation, dissatisfaction) and an increased risk of adverse events (e.g., attention deficits), with medication errors and patient falls being among the most common (9, 13,14), For instance, the prevalence of presenteeism among nursing professionals in Europe and the United States ranges from 37–83%, resulting in productivity losses of 16.3% and a 12% reduction in workability 1,10) . Brazil exhibits similar trends in presenteeism prevalence and reduced work capacity among nursing professionals, though productivity losses are higher (11,12) . Despite Brazil's Unified Health System (SUS, acronym in Portuguese) ensuring universal access, health services are also provided by private entities, either independently or through government contracts. This dual system creates disparities in care, workforce hiring, and work process organization, contributing to varied experiences of presenteeism and productivity losses across public and private sectors. Efforts to combat presenteeism should focus on improving workplace productivity and promoting health to prevent, minimize, and eliminate health risks, thereby maintaining work capacity (15) . Scientific evidence indicates that workplace health promotion efforts, targeting the physical environment and organizational structure, can positively influence work-related outcomes (23) . Therefore, this study aims to characterize presenteeism and productivity losses among nursing professionals in public and private services in Manaus, Amazonas, to explore specific solutions within the nursing field. Methods This is a cross-sectional observational study conducted from September 2018 to March 2019 in two hospitals in Manaus, AM, Brazil: one federal public hospital and one private hospital. For ethical considerations, the hospital names are omitted. The federal public hospital, with 159 active beds dedicated to the SUS, provides medium and high-complexity care. Nursing professionals here are hired either under the Unified Legal Regime (ULR), used exclusively by public organizations, or the Consolidation of Labor Laws (CLL), used in both public and private sectors. The private hospital has 121 active beds for patients with direct payment or private health insurance, and it also provides medium- and high-complexity care, with all nursing professionals hired under CLL. The public hospital employs 207 nursing professionals (94 nurses and 113 nursing technicians), while the private hospital employs 323 (56 nurses and 267 nursing technicians). For equitable comparison, only CLL-hired nursing professionals from the public hospital were considered. Statistical Analysis The stratified probabilistic sampling technique was employed using Epi Info™ version 7.2 to calculate the sample size for each participating institution. The calculation considered the following: 1) an expected prevalence of 75%, based on the Work Limitations Questionnaire for Brazilian nursing professionals ( 16 ); 2) a 95% confidence level; 3) a 5% margin of error; and 4) a 10% increase to account for losses. To stratify the samples, BioEstat® version 5.3 was used to determine the distribution of strata in each service based on sample and population sizes. The final sample size included 132 participants (60 nurses and 72 nursing technicians) from the public service and 167 participants (29 nurses and 138 nursing technicians) from the private service. Participants were included if they: 1) had worked at least one year in the institution; 2) were not on vacation or leave during data collection; 3) agreed to participate by signing the Free and Informed Consent Form. The data collection instruments included qualitative interviews with the participants. The sectors and shifts of the study were chosen randomly to avoid bias and ensure an equitable distribution of information. The first instrument, the Sociodemographic and Health Questionnaire (QSS), which was developed for this study and has an English version available, aimed to characterize the study sample by capturing socioeconomic variables related to occupation and health status. The second instrument, the Work Limitations Questionnaire (WLQ), measures presenteeism by assessing the degree of interference of health problems on work tasks and the resulting impact on productivity (17) . The WLQ was translated and adapted for Brazilian Portuguese (18) . It evaluates physical and/or psychological health issues that occurred in the 14 days prior to completing the self-administered questionnaire, which consists of 25 items grouped into four work limitation domains: 1) Time Management (TM) – measures difficulty in fulfilling schedules and tasks within expected times; 2) Physical Tasks (PhT) – measures ability to perform tasks requiring body strength, endurance, movement, coordination, and flexibility; 3) Mental-Interpersonal Tasks (MIT) – measures difficulty in performing cognitive tasks and interacting with people at work; 4) Production Tasks (PT) – measures difficulty in completing the quantity and quality of work tasks on time (18) . WLQ scores range from 0 (no limitation) to 100 (limitation all the time), except for the physical tasks domain, which is inversely scored from 0 (limitation all the time) to 100 (no limitation). The WLQ Productivity Loss Index, which indicates the percentage of productivity loss over the past two weeks relative to a healthy sample (maximum productivity loss is 24.9%), is calculated without adjustments for age, sex, or other demographic characteristics (18) . SPSS Statistics® version 26 was used for statistical analyses, with α = 0.05 and a 95% confidence interval. SDSQ results were presented using absolute and relative frequencies. For the WLQ, the internal consistency of its domains was measured using Cronbach's alpha coefficient (19) . WLQ data were described using interquartile ranges due to non-normal distribution, verified by the Kolmogorov-Smirnov test. Ethical considerations All participants received written information about the project, had the opportunity to ask the researcher questions and signed a consent form. The questionnaires were completed anonymously. The study was approved by the Research Ethics Committee of the Federal University of the State of Rio de Janeiro, Brazil, under the Certificate of Submission for Ethical Appraisal number: 91296218.7.0000.5285. Findings In the public sector, 95.93% of participants work 36 hours a week, whereas in the private sector, 57.23% work 36 hours, and 40.25% work 40 hours or more. Only 1.63% of public sector professionals and 2.52% of private sector professionals work 30 hours per week. The majority (72.33%) in the private sector have only one employment contract, while a similar percentage (72.35%) in the public sector have more than one bond, resulting in 71.55% of public sector professionals working more than 60 hours per week. Regarding self-reported monthly income, a large portion (67.92%) of nursing professionals in the private sector earn between USD 260.66 and USD 781.98, whereas 60.17% of public sector professionals earn between USD 1,042.64 and USD 2,345.94. Additionally, only 1.89% of private sector participants reported an income of USD 2,606.60 or more, compared to 24.38% in the public sector. When asked if they had experienced physical and/or mental health problems in the 14 days prior to the study, 62 (50.41%) participants from the public sector and 63 (39.62%) from the private sector responded affirmatively. Of these, 52 public sector professionals and 59 private sector professionals indicated they had attended work despite being ill. Consequently, the prevalence of presenteeism was 83.87% in the public sector and 93.65% in the private sector (Fig. 1 ). The most prevalent health problems reported included musculoskeletal (26.49%), mental/behavioral (19.21%), respiratory (17.22%), neurological (16.56%), and gastrointestinal (5.96%) issues. Despite these problems, a significant portion of participants in both sectors did not seek treatment: 44.23% in the public sector and 54.24% in the private sector. Among those who sought treatment, the majority underwent clinical treatment (67.65% in the public sector and 83.84% in the private sector), followed by mental health treatment (17.65% and 3.33%) and physical therapy (2.94% and 10%). The reliability analysis of the WLQ considered 25 items grouped into four domains and 11 presenteeism variables to verify valid responses. Cronbach's alpha coefficient ranged from 0.799 to 0.940, indicating good to very good consistency ( 19 ). Analysis of participant responses to the WLQ domains (Fig. 2 ) showed that private sector professionals reported greater work limitations – "part of the time (50%)" to "all the time (100%)" – compared to public sector professionals in Time Management (TM) (40.34% vs. 29.61%), Mental-Interpersonal Tasks (MIR) (62.56% vs. 25.21%), and Production Tasks (PT) (52.54% vs. 27.31%). This trend was also observed in Physical Tasks (PhT), where 61.30% of private sector participants reported greater limitations – "able for part of the time (50%)" to "able at no time (0%)" – compared to 33.33% in the public sector. As shown in Table 1 , in 75% of the private sector sample, the limitation in MIR was up to 56.95% for nurses and up to 62.50% for nursing technicians, while productivity loss was up to 13.46% for nurses and up to 15.82% for nursing technicians. In the public sector, for 75% of the sample, the limitation in PT was up to 45.75% for nurses and in PhT was up to 44.79% for nursing technicians, with productivity losses up to 11.44% for nurses and up to 9.64% for nursing technicians. Table 1 – Score of the WLQ* and WLQ* Productivity Loss Index domains, according to the professional category of the participants. Manaus, AM, Brazil, 2019. Professional Categories / Domains and WLQ Index* Public Service (%) Private Service (%) 25 † 50 ‡ 75 § 25 † 50 ‡ 75 § Nurses Time Management 15 25 50 13.75 32.50 52.50 Physical Tasks 11.25 25 40.63 22.92 31.25 50 Mental-Interpersonal Tasks 11.11 18.06 41.66 15.28 25 56.95 Production Tasks 10 20 46.75 32.50 37.50 48.25 WLQ Productivity Loss Index 3.96 5.92 11.44 6.93 8.63 13.46 Nursing Technicians Time Management 7.19 20 33.75 17.50 30 47.50 Physical Tasks 12.50 31.25 44.79 27.09 45.83 56,67 Mental-Interpersonal Tasks 5.56 13.89 24.31 12.50 32.14 62.50 Production Tasks 10 20 43.75 20 45 70 WLQ Productivity Loss Index 2.86 5.06 9.64 5.42 10.90 15.82 *WLQ = Work Limitations Questionnaire † 1st quartile, ‡ median and § 3rd quartile In 75% of the private sector sample, the greatest work limitations and productivity losses occurred in the Intensive Care Unit (up to 62.50% in TM, up to 58.33% in PhT, up to 71.88% in MIR, up to 75% in PT, and productivity losses up to 17.16%) and in the Sterile Materials Center (up to 57.92% in PhT, up to 75% in MIR, up to 77.50% in PT, and productivity losses up to 17.35%). In the public sector, the greatest work limitations and productivity losses occurred in the Surgical Center (up to 72.50% in TM, up to 52.78% in MIR, up to 72.50% in PT, and productivity losses up to 15.92%) and in the Sterile Materials Center (up to 80% in TM, up to 74.31% in MIT, up to 92.50% in PT, and productivity losses up to 19.43%). Table 2 – Score of the WLQ* and WLQ* Productivity Loss Index domains, according to the work sector of the participants. Manaus, AM, Brazil, 2019. WLQ Domains and Index* / Labor Sectors Civil service Private Service 25 † 50 ‡ 75 § 25 † 50 ‡ 75 § Time Management Outpatient 3.75 20 28.75 11.25 22.50 22.50 Administrative/Advisory 0 7.50 11.25 18.75 30 26.25 Inpatient Units 13.75 20 32.50 14.38 27.50 40 Surgical Center 21.25 30 72.50 14.38 17.50 52.50 Sterile Materials Center 8.13 40 80 20 35 40 Intensive Care Unit 20.31 30 50 15 40 62.50 Physical Tasks Outpatient 2.08 10.42 25.63 18.75 33.34 31.25 Administrative/Advisory 6.5 31.25 40.63 15.62 39.58 43.75 Inpatient Units 21.25 39.59 57.29 21.87 43.75 57.29 Surgical Center 4.17 29.17 39.59 19.79 35.42 50 Sterile Materials Center 13.75 20.83 41.67 30 37.50 57.92 Intensive Care Unit 21.87 33.34 48.96 25 45.83 58.33 Mental-Interpersonal Tasks Outpatient 3.47 8.33 15.28 6.25 31.95 41.67 Administrative/Advisory 2.09 2.78 2.09 8.33 13.89 12.50 Inpatient Units 9.72 16.67 30.56 8.33 26.39 48.61 Surgical Center 11.81 15.28 52.78 7.64 19.45 45.75 Sterile Materials Center 9.72 44.44 74.31 25 56.25 75 Intensive Care Unit 11.81 18.06 41.66 16.67 37.50 71.88 Production Tasks Outpatient 2.0 12.50 18.75 18.75 40 41.25 Administrative/Advisory 7.50 10 7.50 7.50 17.50 18.75 Inpatient Units 10 20 40 6.25 27.50 53.75 Surgical Center 10 17.50 72.50 10 35 51.25 Sterile Materials Center 15 40 92.50 37.50 45 77.50 Intensive Care Unit 2.50 22.50 48.75 25 50 75 WLQ Productivity Loss Index Outpatient 1.57 3.19 5.11 3.71 9.05 9.86 Administrative/Advisory 1.21 2.77 2.94 2.99 5.86 5.79 Inpatient Units 3.45 5.37 9.44 3.43 7.91 11.91 Surgical Center 3.94 5.78 15.92 4.41 7.52 13.4 Sterile Materials Center 3.44 11.11 19.43 8.45 12.24 17.35 Intensive Care Unit 3.45 6.72 11.74 6.77 13.39 17.16 *WLQ = Work Limitations Questionnaire † 1st quartile, ‡ median and § 3rd quartile Discussion The prevalence of presenteeism among nursing professionals described in this study exceeded those previously observed in both national( 9,11) and international (1,8) studies. This demonstrates that presenteeism, despite being an old issue, is continuously growing. In the public sector, many participants had more than one job, which meant that they exceeded the 60-hour working week limit set by the Superior Court of Justice. This limit is important to "safeguard the physical and mental integrity of the worker and the efficiency of the work" ( 11 , 13 ). Multiple employment contracts and excessive weekly working hours contributed to the higher percentage of illness among public service workers. However, presenteeism was more prevalent in the private sector. This could be attributed to the fact that, unlike private sector workers, public sector workers in Brazil enjoy a higher degree of job protection (e.g., job stability, better wages, prolonged leave without salary losses), which influences their decision between missing work due to illness (absenteeism) or attending work while sick (presenteeism). One study (12) indicates that the likelihood of presenteeism among nursing professionals with permanent employment was 112% higher. Nevertheless, the patterns of absenteeism and presenteeism vary according to the health condition of the workers, influenced by various organizational and individual factors. In this study, the prevalence of presenteeism was higher among nursing professionals in the private sector, who reported lower incomes compared to their public sector counterparts. This finding aligns with other studies (22), which observed that most presenteeism workers had low income, low education, and seasonal work contracts, suggesting a relationship between monthly income and presenteeism. Organizational culture also plays a role in presenteeism, particularly regarding the emphasis on workplace presence. Many policies aimed at reducing absenteeism (e.g., awards, benefits, promotions) can inadvertently encourage presenteeism. In such cases, workers may stay on the job as long as possible, potentially suffering greater health damage (20) . Additionally, workers interested in salary increases, bonuses, promotions, or maintaining their reputation may engage in "competitive presenteeism" as a way to "make a presence" in the organization (21) . The health problems reported in this study are consistent with those found in other national (9,12) and international (10,13) studies, indicating a trend of health issues related to presenteeism among nursing professionals.. Regarding the treatment of reported health problems, most participants in both public and private sectors did not seek treatment. This is concerning, as remaining untreated can lead to further health deterioration, reduced work capacity, increased absenteeism, overburdening colleagues, and compromising the quality of nursing care and patient safety (5,13) . The higher percentage of untreated health issues in the public sector may reflect a lack of monitoring or insufficient monitoring of workers' health and patient care. For those who sought treatment, the majority underwent clinical treatment, with fewer seeking mental health or physiotherapeutic treatment, despite the high prevalence of musculoskeletal and mental/behavioral disorders. This highlights the need for early diagnosis of workers' health problems to better direct occupational health actions. Due to the high prevalence of musculoskeletal and mental/behavioral disorders, the non-adherence to treatment, and the low demand for mental and physiotherapeutic treatment, private sector participants reported greater work limitations in all domains of the WLQ and, consequently, greater productivity losses among both nurses and nursing technicians compared to the public sector. In the private sector, the Intensive Care Unit and the Sterile Materials Center exhibited the greatest work limitations and productivity losses, while in the public sector, this was observed in the Surgical Center and the Sterile Materials Center. The high technological density and repetitive tasks in these sectors likely contribute to the increased workload, stress, and strain on nursing professionals compared to units handling low/medium complexity or technological density health services. These findings differ from other national studies (17,21), which found greater work limitations and productivity losses in open sectors that do not require intensive specialization. This indicates that Brazilian nursing workers are experiencing worsening health conditions and that presenteeism is on the rise. Conclusion In Brazil, the nursing field is characterized by multiple work bonds, low wages, long working hours, late retirement, and precarious working conditions. Despite these challenges, nursing professionals are more likely to work while sick (presenteeism) than to miss work (absenteeism). Therefore, it is crucial to study the characteristics of presenteeism in Brazilian nursing, investigate related factors, and quantify productivity losses at work. This study highlighted that nursing professionals' behaviors in response to illness vary depending on their work relationship. Public sector professionals are more prone to absenteeism, while private sector professionals exhibit higher rates of presenteeism. Factors contributing to this include the protectionism of the public service, working conditions, job flexibility, and precariousness, as well as an organizational culture that combats absenteeism but inadvertently encourages presenteeism. As a result, the greatest work limitations and productivity losses were observed among nursing workers in the private sector. Professionals working in high-complexity, closed sectors presented the highest rates of work limitations and productivity losses. These findings necessitate urgent attention from managers for diagnosis, planning, and implementation of actions to combat presenteeism through occupational health programs. This study aims to provide data that can guide preventive, promotive, and restorative health actions for these workers through Occupational Health and Safety Programs. These programs could include initiatives such as ergonomics, mental health support, vaccinations, use of personal protective equipment, creation of a healthy work environment, occupational gymnastics, noise reduction, and adequate nutrition, among others. Limitations This study was limited to nursing professionals governed by the CLL. Therefore, additional studies are necessary to compare the characteristics of presenteeism between statutory servants (from federal, state/district, and municipal levels) and other public employees. Abbreviations CLL: Consolidation of Labor Laws MIT: Mental-Interpersonal Tasks PhT: Physical Tasks SDSQ: Sociodemographic and Health Questionnaire SPSS: Statistical Package for the Social Sciences SUS: Unified Health System TM: Time Management ULR: Unified Legal Regime WHO: World Health Organization WLQ: Work Limitations Questionnaire Declarations Ethics approval and consent to participate This study was conducted in accordance with the research ethics standards established by the Brazilian National Health Council, which are based on the Declaration of Helsinki. All participants received written information about the project, had the opportunity to ask the researcher questions and signed the consent form. Everyone was treated anonymously. The study was approved by the Research Ethics Committee of the Federal University of the State of Rio de Janeiro, Brazil, under the Certificate of Submission for Ethical Appraisal number: 91296218.7.0000.5285. Consent for publication Not applicable Availability of data and materials Data will be available on reasonable request from the corresponding author. Competing interests The authors declare that they have no competing interests. Funding Funding solely for the publication of this manuscript was made possible (in part) through T37MD008647 from the National Institute on Minority Health and Health Disparities. The views expressed in this manuscript do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, business practices, or organizations imply endorsement by the U.S. Government. Authors' contributions DB provided the conceptualization, investigation, methodology, writing of the original draft, software/data collection, analysis, and visualization; NB, SS, and AA participated in conceptualization, investigation, and writing of the original draft; HS, NR, TS, ES, and TF participated in providing educational resources, helping with formal analysis and visualization of data and revision writing for final submission; JO participated in the revision and editing for the final submission. After reviewing the work, each author gave their approval. Acknowledgements We sincerely appreciate the support and encouragement provided by the Minority Health and Health Disparities Research Training (MHRT) Program (T37 MD008647) coordinated by the School of Nursing and Health Studies of the University of Miami, due to the partnership with the GERIR Research Group of the School of Nursing of the Federal University of Bahia, Brazil. 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Siqueira V de B, Rocha A de SL, Schwingel PA, Carvalho FM. Prevalence of Presenteeism in Agricultural Workers: Systematic Review. Workplace Health & Safety. 2023;0(0). doi:10.1177/21650799231154281. Grimani, A., Aboagye, E. & Kwak, L. The effectiveness of workplace nutrition and physical activity interventions in improving productivity, work performance and workability: a systematic review. BMC Public Health 19, 1676 (2019). https://doi.org/10.1186/s12889-019-8033-1 Additional Declarations No competing interests reported. Supplementary Files SDHQ.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4739078","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":341573728,"identity":"cbe8d312-456d-4970-8613-365c6cec83d5","order_by":0,"name":"David Márcio de Oliveira Barreto","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie3Qv0oDMRzA8V84qEvOW3Mo9hUuUwcVXyXhoC7SpSAOUiKBewRJ8fQxOqcE7HK0ayEOB0KnCte5IN7dUBB6540O+RISMnzIHwCX6z+my4Grue4BgnrFAKwLQQIyCEUXAgeCkg7kdJFRvYWP/uDFLPLdmyHBs0b5VwKjgThOwuwumqewoelyyJ+mM0OIZR59TWB8ro+TSA+ZwWCQwphKf2YmYFnvzE+Aq4aLRatNTW4UDnbSTw3pW3aybyXrWFeEl6cg6QtDovIUr42E609dvSVWuEen6v2WUMtlmC7JmDT92IrLovyxa4W9vCgeL8mFjefF9v5q1ETq0PfvrSinVuByuVyuP/oB2xFikGlfGcwAAAAASUVORK5CYII=","orcid":"","institution":"School of Nursing, Universidade Federal Do Amazonas","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"Márcio de Oliveira","lastName":"Barreto","suffix":""},{"id":341573729,"identity":"9a08069b-0f26-42e8-8172-609113186368","order_by":1,"name":"Normeíza Márcia Fonseca Barreto","email":"","orcid":"","institution":"School of Nursing, Universidade Federal Do Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Normeíza","middleName":"Márcia Fonseca","lastName":"Barreto","suffix":""},{"id":341573730,"identity":"2c231401-e098-427d-b430-f74dac648551","order_by":2,"name":"Sanay Victorino de Souza","email":"","orcid":"","institution":"School of Nursing, Universidade Federal Do Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Sanay","middleName":"Victorino","lastName":"de Souza","suffix":""},{"id":341573731,"identity":"c884d975-e8c1-4f56-a4f0-4da0c46d076b","order_by":3,"name":"Andréa Costa de Andrade","email":"","orcid":"","institution":"School of Nursing, Universidade Federal Do Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Andréa","middleName":"Costa","lastName":"de Andrade","suffix":""},{"id":341573732,"identity":"437afc98-80e1-494f-859d-599305954955","order_by":4,"name":"Handerson Silva-Santos","email":"","orcid":"","institution":"School of Nursing, Universidade Federal da Bahia","correspondingAuthor":false,"prefix":"","firstName":"Handerson","middleName":"","lastName":"Silva-Santos","suffix":""},{"id":341573733,"identity":"483a6a9f-a892-4557-988b-c5f2c1b515dc","order_by":5,"name":"Neha Reddy","email":"","orcid":"","institution":"School of Nursing and Health Studies, University of Miami","correspondingAuthor":false,"prefix":"","firstName":"Neha","middleName":"","lastName":"Reddy","suffix":""},{"id":341573734,"identity":"50158a59-0184-42a5-a360-d2d93cb948f8","order_by":6,"name":"Tatiane Araújo-dos-Santos","email":"","orcid":"","institution":"School of Nursing, Universidade Federal da Bahia","correspondingAuthor":false,"prefix":"","firstName":"Tatiane","middleName":"","lastName":"Araújo-dos-Santos","suffix":""},{"id":341573735,"identity":"c4d5f96f-2db9-4549-b4ce-08b48eff8732","order_by":7,"name":"Ednir Assis Souza","email":"","orcid":"","institution":"School of Nursing, Universidade Federal da Bahia","correspondingAuthor":false,"prefix":"","firstName":"Ednir","middleName":"Assis","lastName":"Souza","suffix":""},{"id":341573736,"identity":"c54c9289-9bd8-4358-a638-020e886677c5","order_by":8,"name":"Johis Ortega","email":"","orcid":"","institution":"School of Nursing and Health Studies, University of Miami","correspondingAuthor":false,"prefix":"","firstName":"Johis","middleName":"","lastName":"Ortega","suffix":""},{"id":341573737,"identity":"71c924a0-0127-4d67-8947-cf41c52e2a43","order_by":9,"name":"Tatiane Cunha Florentino","email":"","orcid":"","institution":"School of Nursing, Universidade Federal da Bahia","correspondingAuthor":false,"prefix":"","firstName":"Tatiane","middleName":"Cunha","lastName":"Florentino","suffix":""}],"badges":[],"createdAt":"2024-07-14 15:27:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4739078/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4739078/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63272274,"identity":"140c26c8-cb5f-4291-b8a8-f26816b0f932","added_by":"auto","created_at":"2024-08-26 11:30:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54395,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResearch participants who reported health problems, according to the prevalence of presenteeism. Manaus/AM, Brazil, 2019.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4739078/v1/1cda1e8b757fc6bbb22e83ab.png"},{"id":63272275,"identity":"4fababf7-86ae-4f3e-9551-7a32bd963aa4","added_by":"auto","created_at":"2024-08-26 11:30:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":731762,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePresenteeism in nursing professionals, according to the frequency of answers* on the domains of the \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eWork Limitations Questionnaire \u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e- WLQ. Manaus/AM, Brazil, 2019.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e* Only valid answers were considered\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4739078/v1/8122e497c206302348046db7.png"},{"id":64888708,"identity":"64b3284a-523c-47d1-878e-484f37dc7116","added_by":"auto","created_at":"2024-09-20 05:34:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1571820,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4739078/v1/a75e7995-94e1-4d88-bb06-9108d39bba81.pdf"},{"id":63272276,"identity":"c1463d06-05b3-4d8d-8bdf-2504c8d5b443","added_by":"auto","created_at":"2024-08-26 11:30:19","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":98245,"visible":true,"origin":"","legend":"","description":"","filename":"SDHQ.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4739078/v1/fcf4894f9a2a2937fcd5863d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining presenteeism and productivity losses among nursing workers: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003ePresenteeism, also known as presenteeism disease, refers to a behavior where individuals with emotional complaints and/or health problems continue to work despite their debilitating conditions. \u003csup\u003e(1)\u003c/sup\u003e. Although presenteeism is not a recent phenomenon, it remains under-researched and under-recognized by the scientific community and institutions alike. This is problematic because the negative impacts of presenteeism are evident in both worker health and organizational economics across all professional settings.\u003c/p\u003e \u003cp\u003eIn terms of overall occupational health, presenteeism significantly deteriorates the physical and mental health of workers, posing a substantial risk factor for future sickness absenteeism and reduced work capacity \u003csup\u003e(2,3)\u003c/sup\u003e. Economically, presenteeism leads to significant productivity losses, raising costs for organizations, often surpassing those associated with absenteeism and prolonged medical treatment \u003csup\u003e(2,4)\u003c/sup\u003e. The hidden nature of presenteeism costs stems from extended periods where workers are not performing at full capacity, resulting in long-term losses. Some authors describe presenteeism as an \"iceberg effect,\" where the visible part of work loss is minor compared to the submerged portion (\u003csup\u003e5,6)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the global health sector, the World Health Organization (WHO) reports that nursing workers constitute 59% of the health workforce (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Factors influencing presenteeism in nursing include unfavorable working conditions, high workloads, difficulty in finding replacements, low wages, and neglect of personal health (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Presenteeism in nursing is linked to compromised quality of care (e.g., work overload, incomplete tasks, demotivation, dissatisfaction) and an increased risk of adverse events (e.g., attention deficits), with medication errors and patient falls being among the most common \u003csup\u003e(9, 13,14),\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor instance, the prevalence of presenteeism among nursing professionals in Europe and the United States ranges from 37\u0026ndash;83%, resulting in productivity losses of 16.3% and a 12% reduction in workability\u003csup\u003e1,10)\u003c/sup\u003e. Brazil exhibits similar trends in presenteeism prevalence and reduced work capacity among nursing professionals, though productivity losses are higher \u003csup\u003e(11,12)\u003c/sup\u003e. Despite Brazil's Unified Health System (SUS, acronym in Portuguese) ensuring universal access, health services are also provided by private entities, either independently or through government contracts. This dual system creates disparities in care, workforce hiring, and work process organization, contributing to varied experiences of presenteeism and productivity losses across public and private sectors.\u003c/p\u003e \u003cp\u003eEfforts to combat presenteeism should focus on improving workplace productivity and promoting health to prevent, minimize, and eliminate health risks, thereby maintaining work capacity \u003csup\u003e(15)\u003c/sup\u003e. Scientific evidence indicates that workplace health promotion efforts, targeting the physical environment and organizational structure, can positively influence work-related outcomes \u003csup\u003e(23)\u003c/sup\u003e. Therefore, this study aims to characterize presenteeism and productivity losses among nursing professionals in public and private services in Manaus, Amazonas, to explore specific solutions within the nursing field.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a cross-sectional observational study conducted from September 2018 to March 2019 in two hospitals in Manaus, AM, Brazil: one federal public hospital and one private hospital. For ethical considerations, the hospital names are omitted.\u003c/p\u003e \u003cp\u003eThe federal public hospital, with 159 active beds dedicated to the SUS, provides medium and high-complexity care. Nursing professionals here are hired either under the Unified Legal Regime (ULR), used exclusively by public organizations, or the Consolidation of Labor Laws (CLL), used in both public and private sectors. The private hospital has 121 active beds for patients with direct payment or private health insurance, and it also provides medium- and high-complexity care, with all nursing professionals hired under CLL.\u003c/p\u003e \u003cp\u003eThe public hospital employs 207 nursing professionals (94 nurses and 113 nursing technicians), while the private hospital employs 323 (56 nurses and 267 nursing technicians). For equitable comparison, only CLL-hired nursing professionals from the public hospital were considered.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003e The stratified probabilistic sampling technique was employed using Epi Info\u0026trade; version 7.2 to calculate the sample size for each participating institution. The calculation considered the following: 1) an expected prevalence of 75%, based on the Work Limitations Questionnaire for Brazilian nursing professionals (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e); 2) a 95% confidence level; 3) a 5% margin of error; and 4) a 10% increase to account for losses. To stratify the samples, BioEstat\u0026reg; version 5.3 was used to determine the distribution of strata in each service based on sample and population sizes. The final sample size included 132 participants (60 nurses and 72 nursing technicians) from the public service and 167 participants (29 nurses and 138 nursing technicians) from the private service. Participants were included if they:\u003c/p\u003e \u003cp\u003e1) had worked at least one year in the institution;\u003c/p\u003e \u003cp\u003e2) were not on vacation or leave during data collection;\u003c/p\u003e \u003cp\u003e 3) agreed to participate by signing the Free and Informed Consent Form.\u003c/p\u003e \u003cp\u003eThe data collection instruments included qualitative interviews with the participants. The sectors and shifts of the study were chosen randomly to avoid bias and ensure an equitable distribution of information. The first instrument, the Sociodemographic and Health Questionnaire (QSS), which was developed for this study and has an English version available, aimed to characterize the study sample by capturing socioeconomic variables related to occupation and health status.\u003c/p\u003e \u003cp\u003eThe second instrument, the Work Limitations Questionnaire (WLQ), measures presenteeism by assessing the degree of interference of health problems on work tasks and the resulting impact on productivity \u003csup\u003e(17)\u003c/sup\u003e. The WLQ was translated and adapted for Brazilian Portuguese \u003csup\u003e(18)\u003c/sup\u003e. It evaluates physical and/or psychological health issues that occurred in the 14 days prior to completing the self-administered questionnaire, which consists of 25 items grouped into four work limitation domains: 1) Time Management (TM) \u0026ndash; measures difficulty in fulfilling schedules and tasks within expected times; 2) Physical Tasks (PhT) \u0026ndash; measures ability to perform tasks requiring body strength, endurance, movement, coordination, and flexibility; 3) Mental-Interpersonal Tasks (MIT) \u0026ndash; measures difficulty in performing cognitive tasks and interacting with people at work; 4) Production Tasks (PT) \u0026ndash; measures difficulty in completing the quantity and quality of work tasks on time \u003csup\u003e(18)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWLQ scores range from 0 (no limitation) to 100 (limitation all the time), except for the physical tasks domain, which is inversely scored from 0 (limitation all the time) to 100 (no limitation). The WLQ Productivity Loss Index, which indicates the percentage of productivity loss over the past two weeks relative to a healthy sample (maximum productivity loss is 24.9%), is calculated without adjustments for age, sex, or other demographic characteristics \u003csup\u003e(18)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSPSS Statistics\u0026reg; version 26 was used for statistical analyses, with α\u0026thinsp;=\u0026thinsp;0.05 and a 95% confidence interval. SDSQ results were presented using absolute and relative frequencies. For the WLQ, the internal consistency of its domains was measured using Cronbach's alpha coefficient \u003csup\u003e(19)\u003c/sup\u003e. WLQ data were described using interquartile ranges due to non-normal distribution, verified by the Kolmogorov-Smirnov test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e All participants received written information about the project, had the opportunity to ask the researcher questions and signed a consent form. The questionnaires were completed anonymously. The study was approved by the Research Ethics Committee of the Federal University of the State of Rio de Janeiro, Brazil, under the Certificate of Submission for Ethical Appraisal number: 91296218.7.0000.5285.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eIn the public sector, 95.93% of participants work 36 hours a week, whereas in the private sector, 57.23% work 36 hours, and 40.25% work 40 hours or more. Only 1.63% of public sector professionals and 2.52% of private sector professionals work 30 hours per week. The majority (72.33%) in the private sector have only one employment contract, while a similar percentage (72.35%) in the public sector have more than one bond, resulting in 71.55% of public sector professionals working more than 60 hours per week.\u003c/p\u003e\n\u003cp\u003eRegarding self-reported monthly income, a large portion (67.92%) of nursing professionals in the private sector earn between USD 260.66 and USD 781.98, whereas 60.17% of public sector professionals earn between USD 1,042.64 and USD 2,345.94. Additionally, only 1.89% of private sector participants reported an income of USD 2,606.60 or more, compared to 24.38% in the public sector.\u003c/p\u003e\n\u003cp\u003eWhen asked if they had experienced physical and/or mental health problems in the 14 days prior to the study, 62 (50.41%) participants from the public sector and 63 (39.62%) from the private sector responded affirmatively. Of these, 52 public sector professionals and 59 private sector professionals indicated they had attended work despite being ill. Consequently, the prevalence of presenteeism was 83.87% in the public sector and 93.65% in the private sector (Fig. \u003cspan\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe most prevalent health problems reported included musculoskeletal (26.49%), mental/behavioral (19.21%), respiratory (17.22%), neurological (16.56%), and gastrointestinal (5.96%) issues. Despite these problems, a significant portion of participants in both sectors did not seek treatment: 44.23% in the public sector and 54.24% in the private sector. Among those who sought treatment, the majority underwent clinical treatment (67.65% in the public sector and 83.84% in the private sector), followed by mental health treatment (17.65% and 3.33%) and physical therapy (2.94% and 10%).\u003c/p\u003e\n\u003cp\u003eThe reliability analysis of the WLQ considered 25 items grouped into four domains and 11 presenteeism variables to verify valid responses. Cronbach\u0026apos;s alpha coefficient ranged from 0.799 to 0.940, indicating good to very good consistency (\u003cspan\u003e19\u003c/span\u003e). Analysis of participant responses to the WLQ domains (Fig. \u003cspan\u003e2\u003c/span\u003e) showed that private sector professionals reported greater work limitations \u0026ndash; \u0026quot;part of the time (50%)\u0026quot; to \u0026quot;all the time (100%)\u0026quot; \u0026ndash; compared to public sector professionals in Time Management (TM) (40.34% vs. 29.61%), Mental-Interpersonal Tasks (MIR) (62.56% vs. 25.21%), and Production Tasks (PT) (52.54% vs. 27.31%). This trend was also observed in Physical Tasks (PhT), where 61.30% of private sector participants reported greater limitations \u0026ndash; \u0026quot;able for part of the time (50%)\u0026quot; to \u0026quot;able at no time (0%)\u0026quot; \u0026ndash; compared to 33.33% in the public sector.\u003c/p\u003e\n\u003cp\u003eAs shown in Table \u003cspan\u003e1\u003c/span\u003e, in 75% of the private sector sample, the limitation in MIR was up to 56.95% for nurses and up to 62.50% for nursing technicians, while productivity loss was up to 13.46% for nurses and up to 15.82% for nursing technicians. In the public sector, for 75% of the sample, the limitation in PT was up to 45.75% for nurses and in PhT was up to 44.79% for nursing technicians, with productivity losses up to 11.44% for nurses and up to 9.64% for nursing technicians.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u0026ndash; Score of the WLQ* and WLQ* Productivity Loss Index domains, according to the professional category of the participants. Manaus, AM, Brazil, 2019.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProfessional Categories / Domains and WLQ Index*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePublic Service (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePrivate Service (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u0026dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e50\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e75\u003c/strong\u003e\u0026sect;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u0026dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e50\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e75\u003c/strong\u003e\u0026sect;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNurses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical Tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental-Interpersonal Tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProduction Tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWLQ Productivity Loss Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNursing Technicians\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical Tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56,67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental-Interpersonal Tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProduction Tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWLQ Productivity Loss Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e*WLQ\u0026thinsp;=\u0026thinsp;\u003cem\u003eWork Limitations Questionnaire\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026dagger; 1st quartile, \u0026Dagger; median and \u0026sect;\u0026nbsp;3rd quartile\u003c/p\u003e\n\u003cp\u003eIn 75% of the private sector sample, the greatest work limitations and productivity losses occurred in the Intensive Care Unit (up to 62.50% in TM, up to 58.33% in PhT, up to 71.88% in MIR, up to 75% in PT, and productivity losses up to 17.16%) and in the Sterile Materials Center (up to 57.92% in PhT, up to 75% in MIR, up to 77.50% in PT, and productivity losses up to 17.35%). In the public sector, the greatest work limitations and productivity losses occurred in the Surgical Center (up to 72.50% in TM, up to 52.78% in MIR, up to 72.50% in PT, and productivity losses up to 15.92%) and in the Sterile Materials Center (up to 80% in TM, up to 74.31% in MIT, up to 92.50% in PT, and productivity losses up to 19.43%).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u0026ndash; Score of the WLQ* and WLQ* Productivity Loss Index domains, according to the work sector of the participants. Manaus, AM, Brazil, 2019.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWLQ Domains and Index* / Labor Sectors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCivil service\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePrivate Service\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u0026dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e50\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e75\u003c/strong\u003e\u0026sect;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u0026dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e50\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e75\u003c/strong\u003e\u0026sect;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdministrative/Advisory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSterile Materials Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdministrative/Advisory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSterile Materials Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental-Interpersonal Tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdministrative/Advisory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSterile Materials Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProduction Tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdministrative/Advisory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSterile Materials Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWLQ Productivity Loss Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdministrative/Advisory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSterile Materials Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e*WLQ\u0026thinsp;=\u0026thinsp;\u003cem\u003eWork Limitations Questionnaire\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026dagger; 1st quartile, \u0026Dagger; median and \u0026sect;\u0026nbsp;3rd quartile\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of presenteeism among nursing professionals described in this study exceeded those previously observed in both national(\u003csup\u003e9,11)\u003c/sup\u003e and international\u003csup\u003e(1,8)\u003c/sup\u003e studies. This demonstrates that presenteeism, despite being an old issue, is continuously growing.\u003c/p\u003e \u003cp\u003eIn the public sector, many participants had more than one job, which meant that they exceeded the 60-hour working week limit set by the Superior Court of Justice. This limit is important to \"safeguard the physical and mental integrity of the worker and the efficiency of the work\" (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Multiple employment contracts and excessive weekly working hours contributed to the higher percentage of illness among public service workers.\u003c/p\u003e \u003cp\u003eHowever, presenteeism was more prevalent in the private sector. This could be attributed to the fact that, unlike private sector workers, public sector workers in Brazil enjoy a higher degree of job protection (e.g., job stability, better wages, prolonged leave without salary losses), which influences their decision between missing work due to illness (absenteeism) or attending work while sick (presenteeism). One study\u003csup\u003e(12)\u003c/sup\u003e indicates that the likelihood of presenteeism among nursing professionals with permanent employment was 112% higher. Nevertheless, the patterns of absenteeism and presenteeism vary according to the health condition of the workers, influenced by various organizational and individual factors.\u003c/p\u003e \u003cp\u003eIn this study, the prevalence of presenteeism was higher among nursing professionals in the private sector, who reported lower incomes compared to their public sector counterparts. This finding aligns with other studies \u003csup\u003e(22),\u003c/sup\u003e which observed that most presenteeism workers had low income, low education, and seasonal work contracts, suggesting a relationship between monthly income and presenteeism.\u003c/p\u003e \u003cp\u003eOrganizational culture also plays a role in presenteeism, particularly regarding the emphasis on workplace presence. Many policies aimed at reducing absenteeism (e.g., awards, benefits, promotions) can inadvertently encourage presenteeism. In such cases, workers may stay on the job as long as possible, potentially suffering greater health damage \u003csup\u003e(20)\u003c/sup\u003e. Additionally, workers interested in salary increases, bonuses, promotions, or maintaining their reputation may engage in \"competitive presenteeism\" as a way to \"make a presence\" in the organization \u003csup\u003e(21)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe health problems reported in this study are consistent with those found in other national \u003csup\u003e(9,12)\u003c/sup\u003e and international \u003csup\u003e(10,13)\u003c/sup\u003e studies, indicating a trend of health issues related to presenteeism among nursing professionals..\u003c/p\u003e \u003cp\u003eRegarding the treatment of reported health problems, most participants in both public and private sectors did not seek treatment. This is concerning, as remaining untreated can lead to further health deterioration, reduced work capacity, increased absenteeism, overburdening colleagues, and compromising the quality of nursing care and patient safety \u003csup\u003e(5,13)\u003c/sup\u003e. The higher percentage of untreated health issues in the public sector may reflect a lack of monitoring or insufficient monitoring of workers' health and patient care.\u003c/p\u003e \u003cp\u003eFor those who sought treatment, the majority underwent clinical treatment, with fewer seeking mental health or physiotherapeutic treatment, despite the high prevalence of musculoskeletal and mental/behavioral disorders. This highlights the need for early diagnosis of workers' health problems to better direct occupational health actions.\u003c/p\u003e \u003cp\u003eDue to the high prevalence of musculoskeletal and mental/behavioral disorders, the non-adherence to treatment, and the low demand for mental and physiotherapeutic treatment, private sector participants reported greater work limitations in all domains of the WLQ and, consequently, greater productivity losses among both nurses and nursing technicians compared to the public sector.\u003c/p\u003e \u003cp\u003eIn the private sector, the Intensive Care Unit and the Sterile Materials Center exhibited the greatest work limitations and productivity losses, while in the public sector, this was observed in the Surgical Center and the Sterile Materials Center. The high technological density and repetitive tasks in these sectors likely contribute to the increased workload, stress, and strain on nursing professionals compared to units handling low/medium complexity or technological density health services. These findings differ from other national studies \u003csup\u003e(17,21),\u003c/sup\u003e which found greater work limitations and productivity losses in open sectors that do not require intensive specialization. This indicates that Brazilian nursing workers are experiencing worsening health conditions and that presenteeism is on the rise.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn Brazil, the nursing field is characterized by multiple work bonds, low wages, long working hours, late retirement, and precarious working conditions. Despite these challenges, nursing professionals are more likely to work while sick (presenteeism) than to miss work (absenteeism). Therefore, it is crucial to study the characteristics of presenteeism in Brazilian nursing, investigate related factors, and quantify productivity losses at work.\u003c/p\u003e \u003cp\u003eThis study highlighted that nursing professionals' behaviors in response to illness vary depending on their work relationship. Public sector professionals are more prone to absenteeism, while private sector professionals exhibit higher rates of presenteeism. Factors contributing to this include the protectionism of the public service, working conditions, job flexibility, and precariousness, as well as an organizational culture that combats absenteeism but inadvertently encourages presenteeism.\u003c/p\u003e \u003cp\u003eAs a result, the greatest work limitations and productivity losses were observed among nursing workers in the private sector. Professionals working in high-complexity, closed sectors presented the highest rates of work limitations and productivity losses. These findings necessitate urgent attention from managers for diagnosis, planning, and implementation of actions to combat presenteeism through occupational health programs.\u003c/p\u003e \u003cp\u003eThis study aims to provide data that can guide preventive, promotive, and restorative health actions for these workers through Occupational Health and Safety Programs. These programs could include initiatives such as ergonomics, mental health support, vaccinations, use of personal protective equipment, creation of a healthy work environment, occupational gymnastics, noise reduction, and adequate nutrition, among others.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study was limited to nursing professionals governed by the CLL. Therefore, additional studies are necessary to compare the characteristics of presenteeism between statutory servants (from federal, state/district, and municipal levels) and other public employees.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCLL: Consolidation of Labor Laws\u003c/p\u003e\n\u003cp\u003eMIT: Mental-Interpersonal Tasks\u003c/p\u003e\n\u003cp\u003ePhT: Physical Tasks\u003c/p\u003e\n\u003cp\u003eSDSQ: Sociodemographic and Health Questionnaire\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eSUS: Unified Health System\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTM: Time Management\u003c/p\u003e\n\u003cp\u003eULR: Unified Legal Regime\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWLQ: Work Limitations Questionnaire\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the research ethics standards established by the Brazilian National Health Council, which are based on the Declaration of Helsinki. All participants received written information about the project, had the opportunity to ask the researcher questions and signed the consent form. Everyone was treated anonymously. The study was approved by the Research Ethics Committee of the Federal University of the State of Rio de Janeiro, Brazil, under the Certificate of Submission for Ethical Appraisal number: 91296218.7.0000.5285.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eFunding solely for the publication of this manuscript was made possible (in part) through T37MD008647 from the National Institute on Minority Health and Health Disparities. The views expressed in this manuscript do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, business practices, or organizations imply endorsement by the U.S. Government.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eDB provided the conceptualization, investigation, methodology, writing of the original draft, \u0026nbsp;software/data collection, analysis, and visualization; NB, SS, and AA participated in conceptualization, investigation, and writing of the original draft; HS, NR, TS, ES, and TF participated in providing educational resources, helping with formal analysis and visualization of data and revision writing for final submission; JO participated in the revision and editing for the final submission. After reviewing the work, each author gave their approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; We sincerely appreciate the support and encouragement provided by the Minority Health and Health Disparities Research Training (MHRT) Program (T37 MD008647) coordinated by the School of Nursing and Health Studies of the University of Miami, due to the partnership with the GERIR Research Group of the School of Nursing of the Federal University of Bahia, Brazil.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMohammadi MM, Dehghan Nayeri N, Varaei S, Rasti A. Exploring the concept of presenteeism in nursing: A hybrid concept analysis. Int J Nurs Knowl. [Internet]. 2021 [cited 2023 Apr 29];32(3):166-176. Available from: https://doi: 10.1111/2047-3095.12308. \u003c/li\u003e\n\u003cli\u003eAwaad AE, El-Bestar S, El-Gilany AH, Al-Wehedy A, El-Hadidy SS. Presenteeism and associated factors among railway train drivers. F1000Research. 2022 [Internet]. [cited 2023 Apr 28];11:470. Available from: https://doi: 10.12688/f1000research.111999.2. PMID: 35811792; PMCID: PMC9237557. \u003c/li\u003e\n\u003cli\u003eAri Min, Minkyung Kang, Hye Chong Hong. Sickness Presenteeism in Shift and Non-Shift Nurses: Using the Fifth Korean Working Conditions Survey. Int J Environ Res Public Health. [Internet]. 2021. [cited 2023 Mar 17];18(6):3236. Available from: https://doi: 10.3390/ijerph18063236. PMID: 33800982; PMCID: PMC8004057.\u003c/li\u003e\n\u003cli\u003eBregenzer A, Jim\u0026eacute;nez P, Milfelner B. Appreciation at work and the effect on employees presenteeism. Work. [internet]. 2022 [cited 2023 Mar 12];73(1):109-120. Available from: https:// doi: 10.3233/WOR-210766. \u003c/li\u003e\n\u003cli\u003eLuo Lu, Cary L Cooper. Sickness Presenteeism as a Link between Long Working Hours and Employees\u0026rsquo; Outcomes: Intrinsic and Extrinsic Motivators as Resources. J. Environ. Res. Public Health 2022[Internet]. [cited 2023 Mar 12], 19(4), 2179. Available from: https:// https://doi.org/10.3390/ijerph19042179.\u003c/li\u003e\n\u003cli\u003ePIE, ACC; FERNANDES, RCP; CARVALHO. FM; PORTO,LA. Presenteeism and associated factors in industry workers. Rev. bras. sa\u0026uacute;de ocup. 45 2020 [Internet]. 2020 [cited 2023 Apr 14]. Available from: https://doi.org/10.1590/2317-6369000003118 \u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). State of the world\u0026rsquo;s nursing 2020: investing in education, jobs and leadership[Internet]. 2020 [cited 2020 14 Apr]. Available from: https://www.who.int/publications-detail/nursing-report-2020 \u003c/li\u003e\n\u003cli\u003eAri Min, Minkyung Kang, Hye Chong Hong. Sickness Presenteeism in Shift and Non-Shift Nurses: Using the Fifth Korean Working Conditions Survey. Int J Environ Res Public Health. [Internet]. 2021. [cited 2023 Mar 17];18(6):3236. Available from: https://doi: 10.3390/ijerph18063236. PMID: 33800982; PMCID: PMC8004057. \u003c/li\u003e\n\u003cli\u003eCarvalho DP, Rocha LP, Brum AN, Brum RG, Bordignon SS, Barlem ELD, et al. Relationship between workloads and presenteeism among nursing workers. Rev Bras Enferm. [Internet]; 2021[cited 2023 Mar 18]; 74(6):e20210044. Available from: https://doi.org/10.1590/0034-7167-2021-0044\u003c/li\u003e\n\u003cli\u003eShdaifat EA. Presenteeism and productivity loss among nurses. Int J Occup Saf Ergon. [Internet]; 2022 [cited 2023 Mai 3]; 24:1-9. Available from: https://doi: 10.1080/10803548.2022.2108660. \u003c/li\u003e\n\u003cli\u003eSousa RM, Cenzi CM, Bortolini J, Terra FS, Valim MD. Common mental disorders, productivity and presenteeism in nursing workers. Rev Esc Enferm USP. [Internet] 2023 [cited 2023 jun 20 ];57:e20220296. Available from: https://doi.org/10.1590/1980-220X-REEUSP-2022-0296en.\u003c/li\u003e\n\u003cli\u003eTracera GMP, Santos KM, Nascimento FPB, Fonseca EC, Abreu AMM, Zeitoune RCG. Factors associated with presenteeism in outpatient nursing professionals. Rev Ga\u0026uacute;cha Enferm. [Internet]; 2022 [cited 2023 jun 20 ];43:e20210222. Available from: doi: https://doi.org/10.1590/1983- 1447.2022.20210222.\u003c/li\u003e\n\u003cli\u003eMosteiro-D\u0026iacute;az MP, Baldonedo-Mosteiro M, Borges E, Baptista P, Queir\u0026oacute;s C, S\u0026aacute;nchez-Zaballos M, Felli V, Abreu M, Silva F, Franco-Correia S. Presenteeism in nurses: comparative study of Spanish, Portuguese and Brazilian nurses. Int Nurs Rev. [Internet] 2020 [cited 2023 Mai 5 ]; 67(4):466-475. Available from: https://doi: 10.1111/inr.12615. Epub 2020 Aug 26. PMID: 32844446.\u003c/li\u003e\n\u003cli\u003eRainbow JG, Drake DA, Steege LM. Nurse Health, Work Environment, Presenteeism and Patient Safety. Western Journal of Nursing Research. [Internet] 2020; [cited 2023 Jun 5 ]; 42(5):332-339. Available from:doi:10.1177/0193945919863409.\u003c/li\u003e\n\u003cli\u003eMohammadi MM, Nayeri ND, Varaei S, Rasti A. The nurse without a nurse: the antecedents of presenteeism in nursing. BMC Nurs. [Internet] 2021; [cited 2023 Mai 20]; 20(1):143. Available from: https://doi:10.1186/s12912-021-00669-1. \u003c/li\u003e\n\u003cli\u003eOliveira SA, Campos JADB, Mar\u0026ocirc;co J, Marziale MHP, Rocha FLR. Psychometric properties of the Work Limitations Questionnaire applied to nursing workers. Rev. Latino-Am. Enfermagem. [Internet] 2021;29:e3466. [cited 2023 Apr 26 ]; Available in: http://dx.doi.org/10.1590/1518-8345.4771.3466.\u003c/li\u003e\n\u003cli\u003eLerner D, Amick III BC, Rogers WH, Malspeis S, Bungay K, Cynn D. The Work Limitations Questionnaire. Med Care [Internet]. 2001 [cited 2022 May 10];39(1):72\u0026ndash;85. Available from: hppt://doi.org/10.1097/00005650-200101000-00009.\u003c/li\u003e\n\u003cli\u003eSo\u0026aacute;rez, Patr\u0026iacute;cia Coelho de, Kowalski, Clarissa Campos Guaragna,Ferraz, Marcos Bosi,Ciconelli, Rozana Mesquita (2007) Translation into Brazilian Portuguese and validation of a productivity evaluation questionnaire. Rev Panam Salud Publica. [Internet] 2007; 22(1). [cited 2022 Nov 20] Available in: http://www.scielosp. org/scielo.php?script=sci_arttext\u0026amp;pid=S1020-49892007000600 003\u003c/li\u003e\n\u003cli\u003eBaldonedo-Mosteiro M, S\u0026aacute;nchez-Zaballos M, Rodr\u0026iacute;guez-D\u0026iacute;az FJ, Herrero J, Mosteiro‐D\u0026iacute;az MP. Adaptation and validation of the Stanford Presenteeism Scale-6 in healthcare professionals. Int Nurs Rev. [Internet] 2020;[cited 2023 Jun 20]67(1):109-17. Available from: https://doi.org/10.1111/inr.12544\u0026raquo; https://doi.org/10.1111/inr. 12544\u003c/li\u003e\n\u003cli\u003eKinman G, Clements AJ. Presenteeism-the case for action. Occup Med (Lond). [Internet]2023; [cited 2023 May 18];73(4):181-182. Available from: https://doi: 10.1093/occmed/kqad033. PMID: 37202209.\u003c/li\u003e\n\u003cli\u003eLaranjeira C, Pereira F, Querido A, Bieri M, Verloo H. Contributing Factors of Presenteeism among Portuguese and Swiss Nurses: A Qualitative Study Using Focus Groups. Int J Environ Res Public Health. [Internet] 2022; [cited 2023 May 21];19(14):8844. Available from:https://10.3390/ijerph19148844. PMID: 35886694; PMCID: PMC9316472.\u003c/li\u003e\n\u003cli\u003eSiqueira V de B, Rocha A de SL, Schwingel PA, Carvalho FM. Prevalence of Presenteeism in Agricultural Workers: Systematic Review. Workplace Health \u0026amp; Safety. 2023;0(0). doi:10.1177/21650799231154281.\u003c/li\u003e\n\u003cli\u003eGrimani, A., Aboagye, E. \u0026amp; Kwak, L. The effectiveness of workplace nutrition and physical activity interventions in improving productivity, work performance and workability: a systematic review. BMC Public Health 19, 1676 (2019). https://doi.org/10.1186/s12889-019-8033-1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Presenteeism, Absenteeism, Nursing, Occupational Health, Health Services, Organizational Efficiency","lastPublishedDoi":"10.21203/rs.3.rs-4739078/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4739078/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo characterize presenteeism and productivity losses among nursing professionals in public and private health services.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003e A cross-sectional study was conducted with 123 participants from a public hospital and 159 from a private hospital in Manaus, Brazil. The Sociodemographic Health Questionnaire was utilized to assess presenteeism, while the Work Limitations Questionnaire measured productivity losses. Data were analyzed using non-parametric methods.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHealth-related work loss and presenteeism were reported by 50.41% of public sector professionals and 39.62% of private sector professionals. Despite this, presenteeism was more prevalent in the private sector (93.65%) compared to the public sector. Common health issues included musculoskeletal (26.49%), mental/behavioral (19.21%), respiratory (17.22%), neurological (16.56%), and gastrointestinal (5.96%) conditions. Additionally, 54.24% of private sector professionals and 44.23% of public sector professionals did not seek treatment. The private sector exhibited greater limitations in receiving care due to time management (40.34%), mental-interpersonal tasks (49.95%), production tasks (52.54%), and physical tasks (61.30%), resulting in higher productivity losses among nurses (13.46%) and nursing technicians (15.82%). High-complexity sectors demonstrated the greatest productivity losses.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study identified significant differences in the characteristics of presenteeism and productivity losses between nursing professionals in the public and private health sectors. These results point to the need to improve management and occupational safety and regulatory measures to solve workers' health problems and mitigate presenteeism and productivity losses in the public and private health sectors.\u003c/p\u003e","manuscriptTitle":"Examining presenteeism and productivity losses among nursing workers: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 11:30:14","doi":"10.21203/rs.3.rs-4739078/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d32ed6b5-e8c5-417b-9e7f-c6e6198da104","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-20T05:25:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-26 11:30:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4739078","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4739078","identity":"rs-4739078","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}