Views of nurses on causes of absenteeism at selected regional public hospitals of Limpopo Province, South Africa: A qualitative study

Views of nurses on causes of absenteeism at selected regional public hospitals of Limpopo Province, South Africa: A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Views of nurses on causes of absenteeism at selected regional public hospitals of Limpopo Province, South Africa: A qualitative study Mamatsharaga Tshinyadzo, Ramavhoya Thifhelimbilu Irene, Mutshatshi Takalani Edith This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6071001/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Absenteeism is a major problem in many health institutions around the world and an issue that leads to poor service delivery. Globally, absenteeism of professional nurses is alarming, especially in hospitals where patients expect quality service. Absenteeism affects not only the quality of patient care, but also the efficiency of the healthcare institution and the productivity of professional nurses on duty. As such, this study explored and described the views of nurses on the causes of absenteeism at selected public hospitals in Limpopo province, South Africa. Methods: An explorative descriptive design was used to explore and describe the views of nurses on the causes of absenteeism in selected public hospitals in Limpopo Province, South Africa. A nonprobability convenience sampling technique was used for the selection of participants, and semi-structured interviews were conducted until data saturation was reached. Data were analysed using Tesch's open-coding method. Results: Management, social, nursing, and work-related factors were the four themes that emerged from the study. Lack of acknowledgement and recognition, unfair and unprofessional practices, burnout and stress, medical conditions and somatization, family challenges and responsibilities, financial challenges, high workload, and an unconducive environment were the subthemes that emerged from the current study. Conclusion : The findings showed that management, social, nurse, and work-related factors played a major role in nurse absenteeism. Consequently, hospital patient care and service delivery were poor. Professional nurses acknowledge and recognition was recommended. Implications: This study can contribute to improving patient care in the department, as absenteeism among nurses will be reduced. Absenteeism challenges nurse public hospital 1. Background Absenteeism is a major concern in many health institutions around the world and an issue that leads to poor service delivery 1 . According to Karimbil 2 , absenteeism is regarded as an act of being absent from work without permission; however, this study focused on lawful and unlawful absenteeism because both affect the operation of the health care institution. To run hospitals efficiently and effectively, daily attendance is expected to provide quality nursing care. Globally, absenteeism of professional nurses is alarming, especially in hospitals where patients anticipate quality service. Professional nurses are the backbones of health service delivery, as such, their absence from work has a negative impact on the productivity of those who remain on duty and affects patient care 3 . Several authors conducted studies on absenteeism, indicating various factors for professional nurses who absent themselves from work. As such, the Australian study revealed a shortage of nurses as a factor contributing to absenteeism 4 . Furthermore, according to Olenga 5 poor working conditions, such as unhealthy environments, long and difficult working hours, stressful work, job uncertainty, and lack of protection at work, contributed to absenteeism among nurses. The same was observed in South Africa, Limpopo province, where the researcher is working. Öncü et al. 6 discovered that some nurses absent themselves from duty due to personal issues. In the United States of America (USA), absenteeism is also a problematic issue, as it causes losses within the department. Furthermore, the same authors indicated that absenteeism of nurses led to a high cost to the employer, and as a result, estimated charges and low productivity cost more economic and operational damage to staff and the department. The results of a study conducted in Nigeria indicated that public hospitals are experiencing a high rate of absenteeism among nurses, resulting in poor patient care 7 . The researcher also observed the high number of absenteeism of professional nurses in the setting where this study was conducted (Limpopo province), where the total number of nurses recorded as absent in 2020–2021 was 783. The same was attested by Karimbi et al. 2 , where a large number of nurses were recorded absent from duty, leading to poor quality of patient care. This was further confirmed by Agwu et al. 5 , who discovered that shift work carried out by insufficient nurses jeopardises the health profession and the well-being of the patient. As such, nurses frequently tolerate stress and take time off work due to their heavy workload and frequent exposure to stressful situations 8 . Compassion fatigue, which refers to emotional depletion caused by a heavy workload, family-related concerns, unfavourable working conditions, lack of gratitude, and unethical managerial actions, is frequently used as a replacement for the effects of various stresses. One of these factors was identified as burnout, which is a state of bitterness and exhaustion caused by the ongoing pressure of work 9 . In South Africa, high absenteeism rates are a problematic issue and, as a result, interrupt patient care 9 . In addition to that, disruption in patient care, in South Africa, including Limpopo province, absenteeism exposes health care institutions to incur huge financial losses 10 . Olenga 2 discloses that the consistent absenteeism rate is marked as an area of concern in nursing practice, as it continues to negatively impact the health care service. The absenteeism challenges observed in the literature were also observed in the two hospitals where this study was conducted. Post-COVID-19, one would expect a sudden drop in the rate. However, the researcher has observed that from the absenteeism rate of 783, which was observed between 2020–2021, a slow decrease in absenteeism was observed between 2022–2024, where 673 professional nurses were absent from work, not including those who retired or resigned from the service. The increased rate of absenteeism in hospitals in Limpopo Province affects professional nurses and others who continue to remain on duty while their colleagues are absent, resulting in compromised patient care 10 . It was against this background that the researcher decided to conduct this study to explore and describe the views of nurses on the causes of absenteeism in selected public hospitals in Limpopo province, South Africa. 2. Research methods and design 2.1 Aim Explore and describe nurses' views on the causes of absenteeism in selected regional public hospitals in Limpopo province, South Africa. 2.2 Design According to Grove and Gray 11 , a research design is the best way for the researcher to select how to answer a research question regarding various considerations that comprise subject clusters, data collection technique, and intervention of the researcher. It gives the researcher a direction to implement a study in a way that is most likely to achieve the planned goal. In this study, a qualitative explorative descriptive design was used to explore and describe in-depth information on the views of nurses about the causes of absenteeism in selected public hospitals in Limpopo province, South Africa. The researcher collected and analysed the qualitative data and came up with the results. 2.3 Setting of the study Two regional hospitals in the Vhembe and Mopani districts in the province of Limpopo served as study sites. The researcher noticed a very high absenteeism rate in these two regional public hospitals compared to other hospitals in the area. There are 521 professional nurses in these two districts. Hospital A has 302 professional nurses, while Hospital B has 219 professional nurses. Most professional nurses have administrative and managerial responsibilities. They are all responsible for ensuring high-quality patient care and maintaining administrative tasks. There are approximately 10 to 15 professional nurses assigned to units such as medical, surgical and pediatrics, who ensure that the 60 to 70 patients admitted from the units receive high-quality care. There is a severe staffing deficit in public hospitals. As a result, 4–6 professional nurses are assigned to each shift, with 2–3 assigned to the day shift and again to the night shift, while the remaining nurses are on leave. This was aggravated by the abseentism rate, which was reported in a study by Manvela et al. 10 in the public hospitals of Limpopo province. 2.4 Population and sampling The participants in this study from both regional hospitals were professional nurses. A non-probability convenience sampling technique was used for the selection of the participants who participated in the study. The reason for using the convenience sampling method was that participants who were on duty during data collection were included in the study. The sample size could not be predetermined before data collection, as data was collected until saturation was reached at 24 participants. 2.4.1 Inclusion and exclusion criteria The study included all professional nurses from the two selected regional hospitals in Limpopo province who had at least one year of working experience and consented to participate. All professional nurses who were on leave, as well as those who did not choose not to sign the consent form, were excluded from the study. 2.5 Data collection Before data collection, participants were requested to sign the informed consent form before the beginning of the interview to ensure that they had agreed to participate in the interview. The venue for the interview was arranged in advance for the participants to feel free to be interviewed in private. The COVID-19 protocols and principles were followed, that is, social distancing, washing hands, and wearing masks. Data were collected using semi-structured face-to-face interviews using an interview guide developed by the researcher (Annexure A, attached as a supplementary file). Semi-structured face-to-face interviews were used because they offer a balance between structured and unstructured approaches, allowing researchers to explore topics in depth while maintaining focus on key themes and emergent ideas. Furthermore, the method allowed participants to relate their views related to absenteeism according to their understanding without being led or interrupted. It gave researchers the opportunity to ask follow-up questions based on the answers provided by the participants. The interview was conducted in English, since the participants were professional nurses, and lasted about 45 minutes with each participant. The central question asked was, 'Can you share with me the causes that contribute to absenteeism among nurses in this hospital?' The central question was followed by a probing question to obtain more detailed information based on the responses of the participants, and the probing stimulated information about the phenomenon. Audio tapes and field notes were taken to remind the researcher of non-verbal clues used by participants during the interview and to track all the collected information, which was followed by verbatim transcriptions of the recordings. Data was collected until saturation was reached, where no new information came from participants on the 22nd participant. However, 2 more were added to confirm saturation, where the 2 participants repeated the information already said by others. Data were collected for eight weeks. 3. Measures to ensure trustworthiness Trustworthiness was ensured by applying four principles of credibility, transferability, dependability, and conformability. With credibility, the results were the most significant criterion, with assurance of the study's certainty 12 , 13 . Furthermore, credibility was ensured by prolonged engagement and conducting unstructured individual interviews. Participants were allowed to describe their views on the causes of absenteeism until data saturation was reached. The triangulation of data collection methods was ensured by conducting one-to-one semi-structured interviews with participants until the data was saturated. The researcher captured field notes to a limited extent after each interview during the interview sessions. The interview session was recorded using a voice recorder. The researcher had enough time to interview within the time frame of 45 minutes. Themes and sub-themes that emerged from the results were confirmed with the independent coder. Transferability is the process by which qualitative research results are conveyed to other frameworks 14 . The researcher presented the findings of the study with a dense explanation of the research phenomenon. Furthermore, the researcher collected detailed data in the natural setting of regional public hospitals. The study findings were limited to selected regional hospitals. The researcher ensured transferability through a clear description of the qualitative research methodology used, which includes design, population, sampling method, data collection and data analysis. The selection of participants was carried out using convenience sampling. The interview was conducted using one-to-one semi-structured interviews and an interview guide. Dependability is the evaluation of the findings, interpretation, and recommendation of the study Korstjens et al. 14 . In this study, dependability was ensured by a solid description of the research methods, which increased the probability of repeating the study by another researcher. A detailed and complete methodology was achieved using triangulation of field notes data collection, using a voice recorder as approved by the research supervisor. Data were kept under lock and key for safekeeping. According to Mammbona et al. 15 conformability refers to the control of bias in qualitative projects. In this study, the conformability was ensured by involving an independent coder to confirm the reliability of the data analysed by the researcher. Triangulation was used to compare the coded results until the researcher and the independent coder reached consensus. The researcher used bracketing to identify and set aside preconceived thoughts and beliefs about the phenomenon under study. The researcher used an interview guide to achieve the objectives of the study. Audio-recorded data, written consent forms, field notes, and transcripts were kept as proof that the study was carried out by the researcher. 4. Data analysis Data were analysed using Tesch's open coding method, where themes and sub-themes were developed. After data collection, the researcher transcribed the recorded data, integrating the non-verbal cues captured in the field notes to give more meaning. The researcher read with understanding and captured the data the way it was said by the participant in the field, while collecting data as verbatim. Then, personally, the researcher analysed the data and identified themes and subthemes. Raw data was sent to be encoded by an independent coder. An agreement was reached about the themes and subthemes identified by the researcher and independent coder, and the final four themes and nine subthemes were concluded. 5. Ethical considerations Ethical clearance was obtained from Turfloop Research Ethics Committee (TREC) project number 558/2022: PG. Permission to conduct the study was obtained from the Provincial Department of Health (Limpopo Province) and the Chief Executive Officer (CEO) of the regional hospitals, the operational managers of the units, and the participants. After explaining the goals, objectives, benefits and risks, the participants were given time to complete the informed consent. Participation in the study was voluntary. According to Korstjens et al. 14 , there were no penalties or rewards for participating in the study as such, participants were allowed to withdraw from the study without punishment. The participants were given the assurance that the researcher would ensure anonymity by not referring to the participants by their names, but by addressing them using codes or numbers. Participants were assured that the collected data will not be disclosed to anyone except the researcher, the supervisors and the coder. The researcher gave the assurance that the collected data, recordings and transcripts will be stored in a private and well-secured place to ensure privacy. During data collection, privacy was ensured, which is referred to as the freedom of an individual to determine the time, extent, and general circumstances under which private information should not be shared or withheld from others 16 . The interviews were conducted in a private room free from noise and disturbances. People who did not participate in the study were not allowed to enter the interview area. 6. Results From the findings of the study, the researcher presented the demographic characteristics of the participants and the themes with their subthemes that emerged. 6.1. Demographic characteristics of the participants The participant's gender, age, highest level of education, and term of employment are among the collected data. Twenty-four professional nurses from two public hospitals in Limpopo Province, South Africa, participated in the study. Twenty-two of the participants were females and two were males. Twelve of the participants were between the ages of thirty and thirty-nine, followed by six who were between the ages of forty and forty-nine, and six more who were between the ages of fifty and fifty-nine. Of the professional nurses, three had a master’s degree, five had an honours degree, six had a bachelor’s degree, and ten had a diploma in nursing. The findings showed that the participants' years of work experience: five had ten –nineteen years of experience as a professional nurse, eleven had thirty-nine years, and eight had twenty–twenty-nine years. Table 1 Main theme: Nurses' views concerning causes of absenteeism THEMES SUB-THEMES 1.1 Management-related causes contributing to absenteeism -Lack of recognition and appreciation -Unfair and unprofessional management practices 1.2 Nurse-related causes contributing to absenteeism - Burnout and stress - Medical conditions versus Somatisation - Substance abuse 1.3 Social causes contributing to absenteeism - Family challenges and responsibilities - Financial challenges 1.4 Work-related causes contributing to absenteeism - High workload -Inconducive work environment (insufficient resources) The following themes merged during data collection: Management-related causes, nurse-related causes, social-related causes, and work-related causes contributed to absenteeism, as indicated in Table 1 above. 6.2. Management-related causes contributing to absenteeism This was the first theme which emerged from the study as indicated in Table 1 , above and its two sub-themes are presented below. Lack of recognition and appreciation Most participants reported that professional nurses miss shifts because their supervisors do not motivate them to keep up their hard work even if they have performed their duties well. Others have reported missing work due to poor management support caused by a staff shortage. 'Lack of support from the supervisor can cause absenteeism because if a nurse has done something good and has not given praise for what she has done, she becomes angry and does not come on duty' Participant 3. 'The lack of motivation by the management contributes greatly to absenteeism of nurses. If one is doing well and the manager is not even appreciating the good work, but always shouting if something is done wrongly, it’s not good 'Participant 11. Another participant reported that other nurses did not come to work without a reason for their absence, although sometimes they felt that the management did not support them. Because of that, they do not report on duty. 'Other professional nurses are just absent from duty because they do not receive support from management and feel like they are just struggling to be short-staffed without being appreciated for the good work they are doing' Participant 20. Unfair and unprofessional management practices Participants reported that there is a significant rate of absenteeism because certain supervisors have biases against other professional nurses, which causes them to miss work. Another participant said that instead of fostering a healthy work environment, certain supervisors treat them like slaves and frustrate them, which is why they ultimately miss work. This information was supported by the following quotations. “It's so boring to work in a unit where the manager takes sides without considering the hard work you are doing as a professional nurse. You can work hard, but if you do not fall under his favouritism group, it will be better for you to stay home because you will not be considered to be doing anything the right way. ' Participant 6. 'The manager is supposed to work with other employees as a person who occupies a managerial post. He should treat other employees fairly, not badly, because that is where nurses end up being absent. After all, he/ she will be acting as a superior to other people. A bad attitude of the manager influences more absenteeism, because a manager is not supposed to be feared, but to be respected by the subordinates. ' Participant 11. Another participant added and reported that although policies such as absenteeism and disciplinary measures are available in the unit, due to favouritism, they are not implemented for others. A person who did not report for duty will continue to work as if nothing happened. 'Policies are there, but they are just written and not implemented. Because if a person does not come to work, nothing will be done, he/she will continue to work even though he/she was absent for the past two days without producing a sick note or proof to show that that person was officially on that specific sick leave or annual leave. ' Participant 8. 6.3 Nurse-related causes contributing to absenteeism This was the second theme that emerged from the study, as indicated in Table 1 , from which three subthemes emerged as presented below. Burnout and Stress According to the participants, the lack of professional nurses was one of the causes of burnout. Others did not show up for duty due to the following factors: a conflict of values, an unfavourable work environment, interference between work and home life, inadequate compensation, and an overwhelming workload. This is supported by the following direct quotations. 'Burn out syndrome can cause absenteeism because if at work there are so many things not going well and the management does not take them into account, professional nurses will be absent because they will not be happy to be there as they could not be treated accordingly.' Participant 10. “Stressful situations can cause absenteeism. If one has stress, it can be at home or at work, and you cannot be productive at work. So, due to stressful situations nurses turn to be absent from work” Participant 14. Another participant concurred and indicated that he/she fails to cope with the burden of workload as such he/she is overworked, he cannot cope hence resulting in work absenteeism. Sometimes stress affects me in such a way that I end up absent from work because if work is too much for me to do in such a way that I cannot cope with work situations and even enjoy work due to fatigue and stress.' Participant 23. Medical Conditions versus Somatisation Participants reported that medical conditions are the main cause of absenteeism, so nurses will be absent from duty while trying to seek medical help. Participants went further and explained that some medical conditions make nurses not function well and hence a need to take care of themselves, which adds to the absenteeism rate. This is supported by the direct quotes that follow. 'Some of our colleagues turn to leave work due to medical conditions because there are many conditions that contribute to absenteeism among our colleagues here, so you find that you cannot work with a certain type of condition you need to take care of yourself' Participant 1. 'I think the medical condition contributes a lot because these days we may find nurses who are sick and who always go to the doctor for check-ups and those who are always admitted due to their medical conditions' Participant 4. A participant with a different version reported that, regardless of medical conditions, they stay home pretending or faking their illness caused by the workload burden and the shortage of staff. This was supported by the following quotations. 'We turn to work and when you go to bed at night you will be tired. And with this shortage of nurses and that burden we turn to get sick, but not real sickness (smiling), we fake sick that you can at least rest 'Participant 16. Substance abuse According to other participants, alcohol misuse was the reason why some of them did not report to duty, which happened especially after the end of the month, when they were paid. Other participants indicated that most of them cannot report to work in the morning after drinking alcohol. This is supported by the direct quotes that follow. “Sometimes you can also find something like alcohol abuse. There is this tendency that when you get paid, most of the time, when you look at the pattern, you can find that after pay day, this person is having a tendency not to come to work. They abuse alcohol in such a way, let's say if they drink on the weekend, Monday, Tuesday, they are not on duty because really, they cannot come, they will not come to work, a situation like that.' Participant 1. Another participant concurred and further stated that once a person has abused substances, he/she cannot wake up in the morning, as such, the person will not report for duty, adding to absenteeism. 'Others engage in alcohol consumption and when they consume alcohol, they do not wake up in the morning, while they have to come on duty the following day, it is not easy to wake up in the morning, and as a result they end up being absent from duty.' Participant 3. 'Alcohol causes a lot of absenteeism because you cannot wake up in the morning and come to work while you are still under the influence of alcohol, so you will be forced to be absent due to circumstances caused by alcohol, which we call babalasi. So, this babalasi forces you to go and take another drink, and then you feel stronger. ' Participant 5. 6.4 Social causes contributing to absenteeism The theme emerged as number three, as shown in Table 1 . It was supported by two subthemes, as explained below. Family challenges and responsibilities Participants reported that nurses did not report to work because they had additional obligations at home. Some participants mentioned that they care for their loved ones, which causes them to miss work. This is supported by the direct quotes that follow. 'Sometimes family problems cause absenteeism because most of us are adults here and we have family responsibilities. I cannot come to work if I know that my child is sick, I have to take care of that child and family issues like funerals or whatever, and as such I will have to take a family responsibility leave.” Participant 1. 'Family commitments are another contributing factor that may cause absenteeism, for example, let’s say a nurse has a relative or a child who is always sick, you may find the nurse not coming on duty regularly because she can be doing up and down movement doing family responsibilities at home' Participant 4. One participant reported that nurses might miss work due to marital problems that affect their relationships, thus resorting to absenteeism. “Another thing that contributes to absenteeism is the relationship problem. If things are not going well at home, one cannot work well. Like if there is always an argument with the husband or wife, one will be absent from work. ' Participant 14. Financial challenges Other participants reported that they miss work due to financial difficulties and that their salary is not enough to cover household expenses. The participants also reported that they become stressed and do not concentrate at work because they think other people predict that they do not have money and therefore stay at home. This is supported by the direct quotes that follow. “Some professional nurses are absent due to financial problems because most of them take out loans, and when they are at work, they feel stressed that they are working, but they are working for nothing. They cannot concentrate, that is why they stay at home so that they can be alone. Because when they are stressed like that, they just think that everyone can see that they are broke, so that no one can see their problems in their face 'Participant 6.' 'Due to the fact that many people have been stopped from coming to work from different companies, and you will find that as a nurse I am a bread winner at home because the person who helped me is no longer working and you can find that I am the one taking all the responsibilities and my salary does not meet those needs. So, it means that I will not be able to go to work because I will not have money for transportation, because there is no other income.' Participant 7. Another participant added that financial constraints lead nurses to borrow money from different financial institutions, which also contributes to absenteeism. 'Financial problems can result in absenteeism because one will be thinking about the debt that one is owing from the different institutions, and as such that person will end up absent from duty,' Participant 14. 6.5 Work-related causes contributing to absenteeism This was the fourth theme, as indicated in Table 1 , which emerged from the study with its two subthemes, as explained below. High workload Other participants said that despite their willingness to work, the lack of staff makes it difficult for them to put in more effort. Some reported that because they are afraid of being punished for treating the patient incorrectly due to workload, some even tend to miss their lunch times as such, they decided to stay home and avoid being charged. This is supported by the direct quotes below. 'The load of work is too much and it is beyond the limit. You cannot accommodate more patients than you are supposed to, due to a limited number of staff, and you don’t even go to lunch due to heavy workload and lack of staff. Sometimes you feel like you are not going to work because you are tired, because over the past two days you have overworked. So instead of coming here and being charged, it is better to sit at home because you will not be charged if you are at home. ' Participant 8. Another participant added that two professional nurses are mainly assigned to manage the activities of the unit, which include patient care, as a result, the following day, all of them might be absent due to work overload. 'A high workload can also cause absenteeism due to staff shortage, because a ward can be managed by two nurses instead of four absent from work. There is the possibility that the next day one or both of those who were at work may be absent due to fatigue because the waiting room will be too busy.' Participant 13. Another participant agreed and added that nurses are problem solvers and are responsible for any problem that arises in the unit that affects them emotionally. 'Every problem that arises, you are the one responsible and you get tired. You may be tired from the workload and emotionally tired. You have to solve problems, manage the room, and do the admin, it is so stressful. Due to overwork, you have no time for lunch, eat standing and don't have to leave the institution, you stay on the ward because you are the only professional nurse.' Participant 17. Inconducive work environment Participants reported being absent from work due to a shortage of medical treatment and supplies. Others mentioned that they sometimes miss work because of exhaustion of travelling to borrow equipment for activities such as medical treatment. This is supported by the direct quotes below. “Stressful situations caused by the shortage of working materials, pharmaceutical materials like medications. You cannot work in a unit where there is no treatment like paracetamol. And you know that paracetamol will make the patient feel better, but it is not there. So, it also stresses you as a nurse on how I am going to help the patient if there are no medications. It does not give me the stamina to wake up in the morning to go to work. So, this is one of the stressful situations that makes nurses not come to work. ' Participant 7. 'Equipment is not enough and, as a result, makes us nurses feel discouraged to come to work, because after all, we go from one ward to another borrowing the equipment and end up tired of going up and down.' Participant 15. One added by indicating that the shortage of material resources stresses them, as sometimes the condition of the patient will become worse while they are still running around borrowing equipment in which the participants feel it discourages them, adding to absenteeism. 'Sometimes you are struggling to get the working materials such as syringes, medication, etc. to perform some duties, the patient's condition will deteriorate and sometimes he/she will pass on. Because of that, you may end up absconding from work the following day due to fatigue and work pressure. ' Participant 24. 7. Discussion 7.1 Management-related causes contributing to absenteeism The findings of this study revealed that management problems significantly increased the rate of absenteeism among nurses. One of the issues stated by the professional nurses was management's lack of recognition for their efforts. The professional nurses indicated that they wanted to be acknowledged and recognised because they thought it would inspire them to put more effort into their daily patient care. Based on the basic need for self-esteem, Maslow's hierarchy of needs theory, employees' needs for self-esteem should be considered while setting goals and making decisions 17 . However, nurses' efforts to provide high-quality patient care are rarely recognised by hospital management. Failure to recognise them could lead to poor service delivery and a higher absenteeism rate. Brunner et al. 2 corroborated the findings of the current study by showing a negative correlation between absenteeism and the failure of nursing management to acknowledge, value, and inspire nurses. As a result, nursing management must recognise professional nurses, for example, announcing a professional nurse for the month to reward excellent performance. Additionally, the study emphasised that professional nurses should also be consulted to make input before making changes, such as those involving policies, regulations and guidelines. To support the findings of the current study, Ada et al. 7 reported that professional nurses were concerned that their ideas were not taken into account during decision making, which led to resistance to implementing what was decided on; this had a negative impact on the management system. Additionally, Garca-Campayo 19 showed that absenteeism can be reduced by a strong organisation with strong leadership, clear communication, and positive reinforcement. Despite being valued or acknowledged as employees, the study findings revealed that there were unfair and unprofessional management practices where the majority of nurses struggled to maintain good working relationships with their managers. Professional nurses reported that they could not confide in their supervisors about certain personal problems, particularly those involving private matters. Additionally, if absent, absenteeism policies were implemented differently for those who did not report to work, and other professional nurses were not reprimanded. Magobolo et al. (9) corroborated this, stating that the main causes of absences were partisanship, the imposition of policies, agitation by staff members, and management's disregard for their opinions. 7.2 Nurse-related factors contributing to absenteeism The findings of the current study revealed that professional nurses often miss work due to stress and fatigue from their demanding jobs. As a result, when nurses experience stress and burnout, patients do not receive high-quality treatment. A similar study by Garca-Campayo 19 showed that stress and burnout syndrome are factors that lead to absenteeism. The same was discovered in a study conducted by Burmeiter et al. 2 and Ticharwa et al. 20 , who stated that excessive workload, conflict between work and home life, inadequate staffing, inadequate pay, and a poor work environment are the main causes of burnout. Stress, which includes work-related, emotional, and mental stressors, is associated with absenteeism. Stress has a detrimental effect on nurses' emotional and psychological well-being due to work-related issues, personal and family problems 20 , 21 , 22 . This led to a shortage of professional nurses, as identified from the findings of the current study, where only two professional nurses were assigned to a busy ward with multiple patients who needed help with daily activities. In turn, burnout, fatigue, and absenteeism were caused by a small number of professional nurses who cared for an unusually high volume of patients. According to the study findings, most professional nurses missed work due to health-related problems, and others feigned their illnesses, resulting in a shortage of staff in most units. For some professional nurses, particularly those in the older age group, medical conditions were the main reason for their absences. The shortage of staff due to absenteeism had a negative impact on patient care. This was also observed during COVID-19, where patients died in numbers due to workload, which was caused by the higher number of patients admitted with limited staff. According to Dyrbye et al. 23 professional nurses' absenteeism was associated with the low emotional state of a professional nurse as a result of illness, which results from family stress. Furthermore, the findings of the current study are consistent with those of Ticharwa et al. 20 who discovered that older nurses were more likely to miss work due to illness, while younger nurses were more likely to fake illness and be absent because they were less committed to the unit. The absence of professional nurses or the fabrication of diseases may be influenced by family health and conflict 1 , 22 , 24 . When providing patient care, the physical and mental well-being of professional nurses may be compromised, and they may fabricate reasons to avoid work that exacerbate their medical conditions 15 , 24 . The absenteeism and illness of professional nurses should be evaluated and addressed to assist in providing high-quality patient care 25 . The study findings revealed that addiction and alcohol misuse were additional problems that caused difficulties for professional nurses. The abuse of alcohol by professional nurses had a detrimental effect on job attendance and resulted in unexplained absenteeism. There is proof that professional nurses, particularly men, did not report to work because of drinking. This implies that the units will be understaffed, resulting in poor patient care. Many professional nurses are susceptible to substance misuse as a result, and the safety and security of patients and other staff members are compromised. To support the current findings, a study by Mulaudzi 26 revealed several factors that contribute to absenteeism, such as behavioural and environmental, social, physical, and psychological factors, as well as socioeconomic and genetic risk factors that are known to cause substance abuse. Another study by Van Jaarsveld 27 showed that it is possible to establish whether substance abuse levels cause the absence of professional nurses or whether low levels of consumption and absenteeism are predicted by job satisfaction. Furthermore, issues such as substance abuse, absenteeism, and low job satisfaction have a huge financial impact among professional nurses and the Department of Health at large. 7.3 Social factors contributing to absenteeism The results of the study demonstrate that professional nurses prioritise their families over their patients, resulting in their absence from work. Personal and family problems, illness, and other causes were associated with absenteeism. According to Maslow's hierarchy of needs, group cohesion is largely dependent on strong relationships, which constitute a fundamental necessity of social needs 17 . The findings of the current study revealed that nurses' social needs negatively impact their work roles and responsibilities because they miss work. Personal issues such as celebrations, attending events, and taking care of their family members were the cause of absenteeism among professional nurses. Financial difficulties were one of the factors that influenced nurse absenteeism 28 . The findings of the current study revealed that financial problems are yet another reason why professional nurses miss work. Most professional nurses said that they often skipped work to work part-time in private hospitals due to a lower salary. In addition, they indicated that they were so exhausted when they got home from private hospitals and ended up absent from work. Based on the fundamental demand for basic needs, Maslow's hierarchy of needs theory states that people are preoccupied with essentials such as clothing, food, drink, and shelter 17 . Most professional nurses are of childbearing age; therefore, their income is not sufficient to support their families. In support of the current study’s findings, a study by Suprapto et al. 29 revealed that most professional nurses missed work due to financial difficulties, such as debt pressure or the inability to do household tasks. It was acknowledged by professional nurses that their salaries did not correspond to their duties. Al-Sharif, Kassem, and Shokry 28 revealed that, among other things, financial problems cause distractions related to work such as absenteeism, increased staff turnover, and a decrease in the professional morale of nurses 29 . The study found that departmental performance is usually adversely affected by financial concerns. Absenteeism among professional nurses is affected by their inability to pay for transportation to work 30 , 31 . Demotivation caused by low pay and incentives has been found to be another source of financial difficulties for professional nurses 32 , 33 . Furthermore, the literature indicated that the department was criticised by professional nurses for not recognising them by offering incentives to reduce financial burdens, which was a major cause of absenteeism 35 , 36 , 37 . When nurses attempt to leave their jobs due to financial restrictions, absenteeism increases. 7.4 Work-related factors contributing to absenteeism The findings of the current study revealed that professional nurses in selected hospitals are overburdened by their heavy workloads, which frequently results in stress and exhaustion. Only two professional nurses, instead of at least four, were managing a larger number of patients. These findings were supported by various authors who found absenteeism to be related to a high patient ratio, subjective and unmanageable workload 38 , 39 , 40 . An excessive workload and a high patient-to-nurse ratio had an effect on nurses' emotional, psychological health as well as their musculoskeletal system, which resulted from heavy lifting and turning of patients 41 , 42 . Consequently, the increasing rate of professional nurses' absenteeism jeopardises their capacity to deliver exceptional patient care, raising the possibility of errors that could lead to negligence charges. This was also supported by several researchers, where professional nurses were facing disciplinary hearings and lawsuits because of negligence caused by their physical and emotional stress due to the increased workload 30 , 33 . The findings of the current study revealed that the majority of professional nurses reported being absent from duty due to unfavourable working conditions. These included dust, inadequate infrastructure, lack of equipment and materials, and other problems. They added that, in terms of safety and security requirements, a welcoming and comfortable workplace is optimal, in accordance with Maslow's hierarchy of needs theory 17 . Individuals prefer environments that are safe and secure 43 . Therefore, in order to improve high-quality patient care, professional nurses require a safe working environment that protects their physical and mental health and keeps them safe from injury. Brunner et al., 18 claim that environmental problems such as loud noises, dim lighting, crowded patients, and other problems that affect their physical working conditions cause professional nurses to be absent from work. García-Campayo 19 ; Kim et al. 44 indicated that nurses should work in a physically healthy environment. Furthermore, the same studies showed that workplace safety features, such as outdoor spaces and infrastructure, not only save maintenance costs, but also improve employee morale and professional nurses' productivity, which in turn lowers incident and absenteeism rates. The problem, which may be caused by poor working conditions or workplace health and safety, must be addressed by management. The study findings also showed that certain wards were experiencing a shortage of medical supplies and equipment. As a result, professional nurses were constantly moving around, borrowing resources and supplies, such as glucometers, from other units. The lack of material resources on the wards makes nurses less motivated to perform their nursing duties, leading to absenteeism. Nurses indicated that it was exhausting and time-consuming. Sharna 45 supported the findings of the current study, in which a shortage of resources and/or equipment leads to stress and absenteeism. 8. Conclusion The study findings demonstrate how managers fail to provide proactive assistance to their staff members, leaving professional nurses feeling vulnerable and abandoned. Managers did not acknowledge or encourage professional nurses, there was favouritism, and unit policies were not implemented for all. Professional nurses independently make all decisions regarding the patient's progress, while managers are perceived as merely sitting in offices, filling out paperwork, and neglecting to ensure that comprehensive patient care is provided. Medical conditions played a role in the absenteeism of nurses. Staff absenteeism was also caused by somatization, the practice of professional nurses pretending to be sick, and hence not showing up for work. Some professional nurses skip work due to drug or alcohol abuse or a lack of dedication and accountability. The results of the study made it clear that other professional nurses leave work due to personal, family and social obligations. Thus, they did not report for duty and did not provide the best possible quality care to their patients. The professional nurses were absent from work to recover from the stress of their personal problems and excessive workloads. Another major issue is financial stress, which is linked to poor income and causes many professional nurses to miss work, increasing the absenteeism rate. As such, the researcher recommended that managers should recognise all staff members, implement the unit's policies, refrain from favouritism, treat all staff equally, and promote teamwork. Additionally, managers should ensure that there is provision of resources, including allocation of staff and equipment to promote a conducive environment for staff members. Abbreviations CEO Chief Executive Officer TREC Turf loop Research Ethics Declarations 10. Study limitations The study was conducted only in two public hospitals due to a lack of funding; as such, the views of professional nurses who participated in this study cannot be generalised to other settings. One drawback was the unavailability of participants, as the few who were available during data collection were occupied with patients’ care; as such, the researcher had to visit the hospitals several times before data could be saturated. 11.1 Ethics approval and consent to participate Ethical clearance was obtained from the Turfloop Research Ethics Committee (TREC /5582022: PG) as the study involved humans. The study was pure non-experimental as such, and no human experiment or human samples were used in this research. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or research committee and with the Declaration of Helsinki of 1975, as revised in 2013. In this study, after explaining the objectives, benefits, and risks, participants received a consent form to sign before participating in the study. The researcher ensured that all participants signed an informed consent form before participating in the study. The participant was assured that participation in this study is voluntary and that the participant can withdraw from the study at any time without providing reasons. 11.2 Consent for publication Not applicable. 11.3 Clinical trial number Not applicable. 11.4 Availability of data and materials Supporting data for the findings of this research are available on request from MT, the principal investigator. 11.5 Competing interests None related to the publication of this study. 11.6 Funding The study was not funded; therefore, the researcher used her own resources to conduct the study. 11.7 Authors' contributions MT was the principal investigator who was also involved in the drafting of the current article. MTE and RTI were supervisors and were also involved in the finalisation of the current article. 11.8 Acknowledgements The authors acknowledge the University of Limpopo, Faculty of Health Sciences Research Ethics Committee, for giving permission for the researchers to conduct the study. References Løkke AK. Absenteeism in organizations. In Global encyclopedia of public administration, public policy, and governance, 2023 Apr 6 (pp. 6-11). Cham: Springer International Publishing. Karimbil MR. A study on employee absenteeism in today’s workplace. Journal of the Gujarat Research Society. 2019; 21(17):273-9 Klootwijk L, Zeyrek E, Njuguna F, Ket JC, Mostert S, Kaspers G. Absenteeism of Healthcare Workers in Primary Healthcare in Sub‐Saharan Africa: A Scoping Review. The International Journal of Health Planning and Management. 2025. Agwu P, Odii A, Orjiakor C, Ogbozor P, Mbachu C, Onwujekwe O. Implications of absenteeism of health workers on achieving universal health coverage in Nigeria: exploring lived experiences in primary healthcare. International Journal for Quality in Health Care. 2024 Jan 1;36(1):mzae015. Olenga BO. Factors contributing to absenteeism among nursing staff in a public hospital in Dammam, Saudi Arabia (Doctoral dissertation, University of Pretoria); 2024. Öncü E, Vayısoğlu SK, Karadağ G, Orak NŞ, Tosun AS, Yüksekol ÖD, Çatıker A, Yalçın GÇ. The relationship between unemployment anxiety, job satisfaction and migration attitude among the next generation of Turkish nurses: a cross-sectional study. International Journal of Nursing Studies. 2023 Dec 1;148:104603. Ada, MJ, Arop FO, Owan VJ, Agunwa JN. Teaching personnel management and attitude to work in secondary schools of Calabar Education Zone of Cross River State, Nigeria. A study of the management of learners’ absenteeism in school organizations in Nigeria. Research on Humanities and Social Sciences, volume 9, issue 18, p. 1 - 7 Posted: 2019. Okoli CT, Otachi JK, Seng S. Assessing opinions and barriers to providing evidence-based tobacco treatment among health care providers within an in-patient psychiatric facility. Journal of mental health. 2020 Nov 1. Magobolo GN, Dube BM. Factors influencing high absenteeism rate of student nurses in clinical areas at a nursing college in the Lejweleputswa District. Curationis. 2019 Jan 1; 42(1):1-6. Manvela B, Olumene D, Eyono PN, Utete R. Investigating the causes of absenteeism at the workplace: Evidence from the South African organisation; 2024. https://doi.org/10.5281/zenodo.11119027, accessed 15 April 2025. Grove SK, Gray JR, Bomer-Norton C. Study Guide for Understanding Nursing Research E-Book: Study Guide for Understanding Nursing Research E-Book. Elsevier Health Sciences; 2018 Sep 17. Connelly-Martínez CL, Idelevich EA, Sparbier K, Kuczius T, Kostrzewa M, Becker K. Development of a MALDI-TOF MS-based screening panel for accelerated differential detection of carbapenemases in Enterobacterales using the direct-on-target microdroplet growth assay. Scientific Reports. 2020 Mar 19; 10(1):4988. de Vos RJ, van der Vlist AC, Zwerver J, Meuffels DE, Smithuis F, van Ingen R, van der Giesen F, Visser E, Balemans A, Pols M, Veen N. Dutch multidisciplinary guideline on Achilles tendinopathy. British journal of sports medicine. 2021 Oct 1; 55(20):1125-34. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice. 2018 Jan 1; 24(1):120-4. Mammbona, AA, Mavhandu-Mudzusi AH. Enrolled nurses’ experiences of caring for patients living with HIV in a South African rural hospital. International Nursing Review 2019 Feb 13; 66, 139 – 146. Burns, N, Grove SK. Understanding nursing research: Building evidence-based practice. China: Elsevier. 2016 em> George,JB. The base for professional nursing practice. Nursing theories. 6th Ed . 2014 Feb 2; 636 Brunner B, Igic I, Keller AC Wieser S. Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work. The European Journal of Health Economics. 2019 Nov; 20(8):1165-80. García-Campayo J, Puebla-Guedea M, Herrera-Mercadal P, Daudén E. Burnout syndrome and demotivation among health care personnel. Managing stressful situations: The importance of teamwork. Actas Dermo-Sifiliográficas (English Edition). 2016 Jun 1; 107(5):400-6. Ticharwa M. Cope, V., Murray, M. Nurse Absenteeism: An analysis of trends and perceptions of nurse unit managers. Australia: Journal of Nursing Management, 2019. 27, 109-116. Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P. A nursing shortage–a prospect of global and local policies. International nursing review. 2019 Mar; 66(1):9-16. Tweheyo R, Wambede MN, Nyangoma A. Collaborative decision-making and sustainable food security: Rethinking the role of indigenous knowledge and farming practices in Uganda. Indonesian Journal of Social Science. 2019 Jan 1; 16(1). Dyrbye LN, Shanafelt TD, Johnson PO, Johnson LA, Satele D, West CP. A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC nursing. 2019 Dec; 18:1-8. Mukasa MN, Sensoy Bahar O, Ssewamala FM, KirkBride G, Kivumbi A, Namuwonge F, Damulira C. Examining the organizational factors that affect health workers' attendance: findings from southwestern Uganda. The International journal of health planning and management. 2019 Apr; 34(2):644-56. Carbonell P, Rodriguez-Escudero AI. The effect of transactive memory systems on job stress of new product development teams: Moderating effects of project complexity and technological turbulence. IEEE Transactions on Engineering Management. 2020 May 20;69(4):1432-46. Mulaudzi M, Dlamini BN, Coetzee J, Sikkema K, Gray G, Dietrich JJ. Perceptions of counsellors and youth-serving professionals about sexual and reproductive health services for adolescents in Soweto, South Africa. Reproductive health. 2018 Dec; 15:1-9. Van Jaarsveld JA. Substance consumption and workplace absenteeism: The moderating role of job satisfaction (Doctoral dissertation, North-West University). 2018 Khaled Abd El-Aziz Zaki A, Samir Abd El-Aziz Elsaiad H. Toxic Leadership and its Relation to Nurses' Absenteeism and Their Deviant Behaviors. Egyptian Journal of Health Care. 2021 Dec 1;12(4):1304-22. King AT, Gontarz J, Wei H. Employee engagement and absenteeism: A step towards improving patient care. In Nursing forum 2020 Jul (Vol. 55, No. 3, pp. 356-361). Alreshidi NM, Alaseeri RM, Garcia M. Factors influencing absenteeism among nursing staff in the primary health care centers in hail: a preliminary study for enhancing staff commitment. Health Science Journal. 2019; 13(3):1-7. Shah SA, Uddin I, Aziz F, Ahmad S, Al-Khasawneh MA, Sharaf M. Research Article An Enhanced Deep Neural Network for Predicting Workplace Absenteeism. An enhanced deep neural network for predicting workplace absenteeism. 2020 Hindawi Complex , 1-12. Khateeb FR. Absenteeism Among Nurses: A Bibliometric Analysis of the Past 25 Years of Research. Management and Labour Studies. 2024 Aug;49(3):527-54. Alharbi, FL, Almuzini, TB, Aljohani, AA, Aljohani, KA, Albowini, AR, Aljohani, ME, Althubyni, MM. Causes of absenteeism rate among staff nurses at Medina Maternity and Child Hospital. Medina, Saudi-Arabia: The Egyptian Journal of Hospital Medicine, 2018; 70 (10), 1784-1788. Duncombe DC. Factors influencing voluntary absenteeism among healthcare workers in the Bahamas. Nursing Economics. 2019 Mar 1; 37(2):92-109. Mothiba TM, Mbombi MO, Malema RN, Malatji M. The effects of absenteeism on nurses remaining on duty at a tertiary hospital of Limpopo province. Curationis. 2018 Jan 30; 41(1):1-5. Gemuhay, HM, Kalolo A, Mirisho, R, Chipwaza, B, Nyangena, E. Factors affecting performance in clinical practice among Preservice Diploma nursing students in northern Tanzania. Nursing Research and Practice, 2019. 3453085, 1- 9. Tumlinson, K, Gichane, MW, Curtis, SL, LeMasters, K. Understanding healthcare provider absenteeism in Kenya. A qualitative analysis. BMC Health Services Research, 2019. 19 (660), 1-8. (38) Vadgaonkar MD, Velhal G. A study of absenteeism of nurses in public hospitals. International Journal of Recent Scientific Research. 2018 Aug; 9(10E):29405-13. (39) Drennan VM, Ross F. Global nurse shortages—the facts, the impact and action for change. British medical bulletin. 2019 Jun 19; 130(1):25-37. (40) Martínez, CL, Moraga, SP, Paredes, CS, Vásquez, AS, Villarroel, CM. Occupational fatigue and work absenteeism in female assistant nurses of a high-complexity hospital, Chile. Ciência & Saúde Coletiva; 2020, 25(1): 243-249 Mbombi, MO, Mothiba, TM, Malema, RN, Malatji, M. The effects of absenteeism on nurses remaining on duty at a tertiary hospital of Limpopo Province. Curationis, 2018. 41 (1), doi: 10.4102/curationis. v41i1.1924 Van den Heede K, Cornelis J, Bouckaert N, Bruyneel L, Van de Voorde C, Sermeus W. Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria and Queensland: a discussion paper. Health Policy. 2020 Oct 1; 124(10):1064-73. Politis M, Rachiotis G, Mouchtouri VA, Hadjichristodoulou C. The Global Burden of Absenteeism Related to COVID-19 Vaccine Side Effects Among Healthcare Workers: A Systematic Review and Meta-Analysis. Vaccines. 2024 Oct 19;12(10):1196. Kim KJ, Yoo MS, Seo EJ. Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian nursing research. 2018 Jun 1; 12(2):121-6. Sharna SC, Maraseni T, Radanielson AM. A global systematic literature review on sustainable soil management practices (1994–2022). Soil Use and Management. 2022 Oct; 39(4):1267-88. Additional Declarations No competing interests reported. Supplementary Files ANNEXUREAINTERVIEWGUIDE.docx 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6071001","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449817906,"identity":"9895175e-3762-46b8-8dbc-f59a22a587cd","order_by":0,"name":"Mamatsharaga Tshinyadzo","email":"data:image/png;base64,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","orcid":"","institution":"University of Limpopo","correspondingAuthor":true,"prefix":"","firstName":"Mamatsharaga","middleName":"","lastName":"Tshinyadzo","suffix":""},{"id":449817907,"identity":"1a088457-df25-4f5e-af58-5ec386c0cf86","order_by":1,"name":"Ramavhoya Thifhelimbilu Irene","email":"","orcid":"","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"Ramavhoya","middleName":"Thifhelimbilu","lastName":"Irene","suffix":""},{"id":449817908,"identity":"6ea37086-10f0-41f3-9d29-59c76b0bcdbd","order_by":2,"name":"Mutshatshi Takalani Edith","email":"","orcid":"","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"Mutshatshi","middleName":"Takalani","lastName":"Edith","suffix":""}],"badges":[],"createdAt":"2025-02-20 10:23:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6071001/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6071001/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82490161,"identity":"4dae84a3-95f5-47cf-84c7-3b619caec823","added_by":"auto","created_at":"2025-05-12 06:32:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":918319,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6071001/v1/3557334b-f769-473e-9f98-080bd663a8dc.pdf"},{"id":81679099,"identity":"b6a41e4d-7ed7-49c3-96cc-c301c3146c24","added_by":"auto","created_at":"2025-04-30 08:35:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21380,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXUREAINTERVIEWGUIDE.docx","url":"https://assets-eu.researchsquare.com/files/rs-6071001/v1/2c3a92d20ab034eeaa42ae0f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Views of nurses on causes of absenteeism at selected regional public hospitals of Limpopo Province, South Africa: A qualitative study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAbsenteeism is a major concern in many health institutions around the world and an issue that leads to poor service delivery \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. According to Karimbil\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, absenteeism is regarded as an act of being absent from work without permission; however, this study focused on lawful and unlawful absenteeism because both affect the operation of the health care institution. To run hospitals efficiently and effectively, daily attendance is expected to provide quality nursing care. Globally, absenteeism of professional nurses is alarming, especially in hospitals where patients anticipate quality service. Professional nurses are the backbones of health service delivery, as such, their absence from work has a negative impact on the productivity of those who remain on duty and affects patient care\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Several authors conducted studies on absenteeism, indicating various factors for professional nurses who absent themselves from work. As such, the Australian study revealed a shortage of nurses as a factor contributing to absenteeism\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Furthermore, according to Olenga \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e poor working conditions, such as unhealthy environments, long and difficult working hours, stressful work, job uncertainty, and lack of protection at work, contributed to absenteeism among nurses. The same was observed in South Africa, Limpopo province, where the researcher is working.\u003c/p\u003e \u003cp\u003e\u0026Ouml;nc\u0026uuml; et al.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e discovered that some nurses absent themselves from duty due to personal issues. In the United States of America (USA), absenteeism is also a problematic issue, as it causes losses within the department. Furthermore, the same authors indicated that absenteeism of nurses led to a high cost to the employer, and as a result, estimated charges and low productivity cost more economic and operational damage to staff and the department.\u003c/p\u003e \u003cp\u003eThe results of a study conducted in Nigeria indicated that public hospitals are experiencing a high rate of absenteeism among nurses, resulting in poor patient care \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The researcher also observed the high number of absenteeism of professional nurses in the setting where this study was conducted (Limpopo province), where the total number of nurses recorded as absent in 2020\u0026ndash;2021 was 783. The same was attested by Karimbi et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, where a large number of nurses were recorded absent from duty, leading to poor quality of patient care. This was further confirmed by Agwu et al.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, who discovered that shift work carried out by insufficient nurses jeopardises the health profession and the well-being of the patient. As such, nurses frequently tolerate stress and take time off work due to their heavy workload and frequent exposure to stressful situations\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Compassion fatigue, which refers to emotional depletion caused by a heavy workload, family-related concerns, unfavourable working conditions, lack of gratitude, and unethical managerial actions, is frequently used as a replacement for the effects of various stresses. One of these factors was identified as burnout, which is a state of bitterness and exhaustion caused by the ongoing pressure of work \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn South Africa, high absenteeism rates are a problematic issue and, as a result, interrupt patient care\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In addition to that, disruption in patient care, in South Africa, including Limpopo province, absenteeism exposes health care institutions to incur huge financial losses \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Olenga \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e discloses that the consistent absenteeism rate is marked as an area of concern in nursing practice, as it continues to negatively impact the health care service. The absenteeism challenges observed in the literature were also observed in the two hospitals where this study was conducted. Post-COVID-19, one would expect a sudden drop in the rate. However, the researcher has observed that from the absenteeism rate of 783, which was observed between 2020\u0026ndash;2021, a slow decrease in absenteeism was observed between 2022\u0026ndash;2024, where 673 professional nurses were absent from work, not including those who retired or resigned from the service. The increased rate of absenteeism in hospitals in Limpopo Province affects professional nurses and others who continue to remain on duty while their colleagues are absent, resulting in compromised patient care\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. It was against this background that the researcher decided to conduct this study to explore and describe the views of nurses on the causes of absenteeism in selected public hospitals in Limpopo province, South Africa.\u003c/p\u003e"},{"header":"2. Research methods and design","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Aim\u003c/h2\u003e \u003cp\u003eExplore and describe nurses' views on the causes of absenteeism in selected regional public hospitals in Limpopo province, South Africa.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Design\u003c/h2\u003e \u003cp\u003eAccording to Grove and Gray\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, a research design is the best way for the researcher to select how to answer a research question regarding various considerations that comprise subject clusters, data collection technique, and intervention of the researcher. It gives the researcher a direction to implement a study in a way that is most likely to achieve the planned goal. In this study, a qualitative explorative descriptive design was used to explore and describe in-depth information on the views of nurses about the causes of absenteeism in selected public hospitals in Limpopo province, South Africa. The researcher collected and analysed the qualitative data and came up with the results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Setting of the study\u003c/h2\u003e \u003cp\u003eTwo regional hospitals in the Vhembe and Mopani districts in the province of Limpopo served as study sites. The researcher noticed a very high absenteeism rate in these two regional public hospitals compared to other hospitals in the area. There are 521 professional nurses in these two districts. Hospital A has 302 professional nurses, while Hospital B has 219 professional nurses. Most professional nurses have administrative and managerial responsibilities. They are all responsible for ensuring high-quality patient care and maintaining administrative tasks. There are approximately 10 to 15 professional nurses assigned to units such as medical, surgical and pediatrics, who ensure that the 60 to 70 patients admitted from the units receive high-quality care. There is a severe staffing deficit in public hospitals. As a result, 4\u0026ndash;6 professional nurses are assigned to each shift, with 2\u0026ndash;3 assigned to the day shift and again to the night shift, while the remaining nurses are on leave. This was aggravated by the abseentism rate, which was reported in a study by Manvela et al.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e in the public hospitals of Limpopo province.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Population and sampling\u003c/h2\u003e \u003cp\u003eThe participants in this study from both regional hospitals were professional nurses. A non-probability convenience sampling technique was used for the selection of the participants who participated in the study. The reason for using the convenience sampling method was that participants who were on duty during data collection were included in the study. The sample size could not be predetermined before data collection, as data was collected until saturation was reached at 24 participants.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe study included all professional nurses from the two selected regional hospitals in Limpopo province who had at least one year of working experience and consented to participate. All professional nurses who were on leave, as well as those who did not choose not to sign the consent form, were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data collection\u003c/h2\u003e \u003cp\u003e Before data collection, participants were requested to sign the informed consent form before the beginning of the interview to ensure that they had agreed to participate in the interview. The venue for the interview was arranged in advance for the participants to feel free to be interviewed in private. The COVID-19 protocols and principles were followed, that is, social distancing, washing hands, and wearing masks. Data were collected using semi-structured face-to-face interviews using an interview guide developed by the researcher (Annexure A, attached as a supplementary file). Semi-structured face-to-face interviews were used because they offer a balance between structured and unstructured approaches, allowing researchers to explore topics in depth while maintaining focus on key themes and emergent ideas. Furthermore, the method allowed participants to relate their views related to absenteeism according to their understanding without being led or interrupted. It gave researchers the opportunity to ask follow-up questions based on the answers provided by the participants. The interview was conducted in English, since the participants were professional nurses, and lasted about 45 minutes with each participant. The central question asked was, 'Can you share with me the causes that contribute to absenteeism among nurses in this hospital?' The central question was followed by a probing question to obtain more detailed information based on the responses of the participants, and the probing stimulated information about the phenomenon. Audio tapes and field notes were taken to remind the researcher of non-verbal clues used by participants during the interview and to track all the collected information, which was followed by verbatim transcriptions of the recordings. Data was collected until saturation was reached, where no new information came from participants on the 22nd participant. However, 2 more were added to confirm saturation, where the 2 participants repeated the information already said by others. Data were collected for eight weeks.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Measures to ensure trustworthiness","content":"\u003cp\u003eTrustworthiness was ensured by applying four principles of credibility, transferability, dependability, and conformability. With credibility, the results were the most significant criterion, with assurance of the study's certainty\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Furthermore, credibility was ensured by prolonged engagement and conducting unstructured individual interviews. Participants were allowed to describe their views on the causes of absenteeism until data saturation was reached.\u003c/p\u003e \u003cp\u003eThe triangulation of data collection methods was ensured by conducting one-to-one semi-structured interviews with participants until the data was saturated. The researcher captured field notes to a limited extent after each interview during the interview sessions. The interview session was recorded using a voice recorder. The researcher had enough time to interview within the time frame of 45 minutes. Themes and sub-themes that emerged from the results were confirmed with the independent coder. Transferability is the process by which qualitative research results are conveyed to other frameworks\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The researcher presented the findings of the study with a dense explanation of the research phenomenon. Furthermore, the researcher collected detailed data in the natural setting of regional public hospitals. The study findings were limited to selected regional hospitals. The researcher ensured transferability through a clear description of the qualitative research methodology used, which includes design, population, sampling method, data collection and data analysis. The selection of participants was carried out using convenience sampling. The interview was conducted using one-to-one semi-structured interviews and an interview guide. Dependability is the evaluation of the findings, interpretation, and recommendation of the study Korstjens et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In this study, dependability was ensured by a solid description of the research methods, which increased the probability of repeating the study by another researcher. A detailed and complete methodology was achieved using triangulation of field notes data collection, using a voice recorder as approved by the research supervisor. Data were kept under lock and key for safekeeping. According to Mammbona et al.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e conformability refers to the control of bias in qualitative projects. In this study, the conformability was ensured by involving an independent coder to confirm the reliability of the data analysed by the researcher. Triangulation was used to compare the coded results until the researcher and the independent coder reached consensus. The researcher used bracketing to identify and set aside preconceived thoughts and beliefs about the phenomenon under study. The researcher used an interview guide to achieve the objectives of the study. Audio-recorded data, written consent forms, field notes, and transcripts were kept as proof that the study was carried out by the researcher.\u003c/p\u003e"},{"header":"4. Data analysis","content":"\u003cp\u003eData were analysed using Tesch's open coding method, where themes and sub-themes were developed. After data collection, the researcher transcribed the recorded data, integrating the non-verbal cues captured in the field notes to give more meaning. The researcher read with understanding and captured the data the way it was said by the participant in the field, while collecting data as verbatim. Then, personally, the researcher analysed the data and identified themes and subthemes. Raw data was sent to be encoded by an independent coder. An agreement was reached about the themes and subthemes identified by the researcher and independent coder, and the final four themes and nine subthemes were concluded.\u003c/p\u003e"},{"header":"5. Ethical considerations","content":"\u003cp\u003e Ethical clearance was obtained from Turfloop Research Ethics Committee (TREC) project number 558/2022: PG. Permission to conduct the study was obtained from the Provincial Department of Health (Limpopo Province) and the Chief Executive Officer (CEO) of the regional hospitals, the operational managers of the units, and the participants. After explaining the goals, objectives, benefits and risks, the participants were given time to complete the informed consent. Participation in the study was voluntary. According to Korstjens et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, there were no penalties or rewards for participating in the study as such, participants were allowed to withdraw from the study without punishment. The participants were given the assurance that the researcher would ensure anonymity by not referring to the participants by their names, but by addressing them using codes or numbers. Participants were assured that the collected data will not be disclosed to anyone except the researcher, the supervisors and the coder. The researcher gave the assurance that the collected data, recordings and transcripts will be stored in a private and well-secured place to ensure privacy. During data collection, privacy was ensured, which is referred to as the freedom of an individual to determine the time, extent, and general circumstances under which private information should not be shared or withheld from others\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The interviews were conducted in a private room free from noise and disturbances. People who did not participate in the study were not allowed to enter the interview area.\u003c/p\u003e"},{"header":"6. Results","content":"\u003cp\u003eFrom the findings of the study, the researcher presented the demographic characteristics of the participants and the themes with their subthemes that emerged.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e6.1. Demographic characteristics of the participants\u003c/h2\u003e \u003cp\u003eThe participant's gender, age, highest level of education, and term of employment are among the collected data. Twenty-four professional nurses from two public hospitals in Limpopo Province, South Africa, participated in the study. Twenty-two of the participants were females and two were males. Twelve of the participants were between the ages of thirty and thirty-nine, followed by six who were between the ages of forty and forty-nine, and six more who were between the ages of fifty and fifty-nine. Of the professional nurses, three had a master\u0026rsquo;s degree, five had an honours degree, six had a bachelor\u0026rsquo;s degree, and ten had a diploma in nursing. The findings showed that the participants' years of work experience: five had ten \u0026ndash;nineteen years of experience as a professional nurse, eleven had thirty-nine years, and eight had twenty\u0026ndash;twenty-nine years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain theme: Nurses' views concerning causes of absenteeism\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTHEMES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSUB-THEMES\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1 Management-related causes contributing to absenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Lack of recognition and appreciation\u003c/p\u003e \u003cp\u003e-Unfair and unprofessional management practices\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2 Nurse-related causes contributing to absenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Burnout and stress\u003c/p\u003e \u003cp\u003e- Medical conditions versus Somatisation\u003c/p\u003e \u003cp\u003e- Substance abuse\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3 Social causes contributing to absenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Family challenges and responsibilities\u003c/p\u003e \u003cp\u003e- Financial challenges\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4 Work-related causes contributing to absenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- High workload\u003c/p\u003e \u003cp\u003e-Inconducive work environment (insufficient resources)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe following themes merged during data collection: Management-related causes, nurse-related causes, social-related causes, and work-related causes contributed to absenteeism, as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e6.2. Management-related causes contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThis was the first theme which emerged from the study as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, above and its two sub-themes are presented below.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eLack of recognition and appreciation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eMost participants reported that professional nurses miss shifts because their supervisors do not motivate them to keep up their hard work even if they have performed their duties well. Others have reported missing work due to poor management support caused by a staff shortage.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Lack of support from the supervisor can cause absenteeism because if a nurse has done something good and has not given praise for what she has done, she becomes angry and does not come on duty' Participant 3.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'The lack of motivation by the management contributes greatly to absenteeism of nurses. If one is doing well and the manager is not even appreciating the good work, but always shouting if something is done wrongly, it\u0026rsquo;s not good 'Participant 11.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant reported that other nurses did not come to work without a reason for their absence, although sometimes they felt that the management did not support them. Because of that, they do not report on duty.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Other professional nurses are just absent from duty because they do not receive support from management and feel like they are just struggling to be short-staffed without being appreciated for the good work they are doing' Participant 20.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eUnfair and unprofessional management practices\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants reported that there is a significant rate of absenteeism because certain supervisors have biases against other professional nurses, which causes them to miss work. Another participant said that instead of fostering a healthy work environment, certain supervisors treat them like slaves and frustrate them, which is why they ultimately miss work. This information was supported by the following quotations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It's so boring to work in a unit where the manager takes sides without considering the hard work you are doing as a professional nurse. You can work hard, but if you do not fall under his favouritism group, it will be better for you to stay home because you will not be considered to be doing anything the right way. ' Participant 6.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'The manager is supposed to work with other employees as a person who occupies a managerial post. He should treat other employees fairly, not badly, because that is where nurses end up being absent. After all, he/ she will be acting as a superior to other people. A bad attitude of the manager influences more absenteeism, because a manager is not supposed to be feared, but to be respected by the subordinates. ' Participant 11.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant added and reported that although policies such as absenteeism and disciplinary measures are available in the unit, due to favouritism, they are not implemented for others. A person who did not report for duty will continue to work as if nothing happened.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Policies are there, but they are just written and not implemented. Because if a person does not come to work, nothing will be done, he/she will continue to work even though he/she was absent for the past two days without producing a sick note or proof to show that that person was officially on that specific sick leave or annual leave. ' Participant 8.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e6.3 Nurse-related causes contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThis was the second theme that emerged from the study, as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, from which three subthemes emerged as presented below.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eBurnout and Stress\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAccording to the participants, the lack of professional nurses was one of the causes of burnout. Others did not show up for duty due to the following factors: a conflict of values, an unfavourable work environment, interference between work and home life, inadequate compensation, and an overwhelming workload. This is supported by the following direct quotations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Burn out syndrome can cause absenteeism because if at work there are so many things not going well and the management does not take them into account, professional nurses will be absent because they will not be happy to be there as they could not be treated accordingly.' Participant 10.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Stressful situations can cause absenteeism. If one has stress, it can be at home or at work, and you cannot be productive at work. So, due to stressful situations nurses turn to be absent from work\u0026rdquo; Participant 14.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant concurred and indicated that he/she fails to cope with the burden of workload as such he/she is overworked, he cannot cope hence resulting in work absenteeism.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSometimes stress affects me in such a way that I end up absent from work because if work is too much for me to do in such a way that I cannot cope with work situations and even enjoy work due to fatigue and stress.' Participant 23.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMedical Conditions versus Somatisation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants reported that medical conditions are the main cause of absenteeism, so nurses will be absent from duty while trying to seek medical help. Participants went further and explained that some medical conditions make nurses not function well and hence a need to take care of themselves, which adds to the absenteeism rate. This is supported by the direct quotes that follow.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Some of our colleagues turn to leave work due to medical conditions because there are many conditions that contribute to absenteeism among our colleagues here, so you find that you cannot work with a certain type of condition you need to take care of yourself' Participant 1.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'I think the medical condition contributes a lot because these days we may find nurses who are sick and who always go to the doctor for check-ups and those who are always admitted due to their medical conditions' Participant 4.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA participant with a different version reported that, regardless of medical conditions, they stay home pretending or faking their illness caused by the workload burden and the shortage of staff. This was supported by the following quotations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'We turn to work and when you go to bed at night you will be tired. And with this shortage of nurses and that burden we turn to get sick, but not real sickness (smiling), we fake sick that you can at least rest 'Participant 16.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSubstance abuse\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAccording to other participants, alcohol misuse was the reason why some of them did not report to duty, which happened especially after the end of the month, when they were paid. Other participants indicated that most of them cannot report to work in the morning after drinking alcohol. This is supported by the direct quotes that follow.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes you can also find something like alcohol abuse. There is this tendency that when you get paid, most of the time, when you look at the pattern, you can find that after pay day, this person is having a tendency not to come to work. They abuse alcohol in such a way, let's say if they drink on the weekend, Monday, Tuesday, they are not on duty because really, they cannot come, they will not come to work, a situation like that.' Participant 1.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant concurred and further stated that once a person has abused substances, he/she cannot wake up in the morning, as such, the person will not report for duty, adding to absenteeism.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Others engage in alcohol consumption and when they consume alcohol, they do not wake up in the morning, while they have to come on duty the following day, it is not easy to wake up in the morning, and as a result they end up being absent from duty.' Participant 3.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'Alcohol causes a lot of absenteeism because you cannot wake up in the morning and come to work while you are still under the influence of alcohol, so you will be forced to be absent due to circumstances caused by alcohol, which we call babalasi. So, this babalasi forces you to go and take another drink, and then you feel stronger. ' Participant 5.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e6.4 Social causes contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThe theme emerged as number three, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. It was supported by two subthemes, as explained below.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFamily challenges and responsibilities\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants reported that nurses did not report to work because they had additional obligations at home. Some participants mentioned that they care for their loved ones, which causes them to miss work. This is supported by the direct quotes that follow.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Sometimes family problems cause absenteeism because most of us are adults here and we have family responsibilities. I cannot come to work if I know that my child is sick, I have to take care of that child and family issues like funerals or whatever, and as such I will have to take a family responsibility leave.\u0026rdquo; Participant 1.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'Family commitments are another contributing factor that may cause absenteeism, for example, let\u0026rsquo;s say a nurse has a relative or a child who is always sick, you may find the nurse not coming on duty regularly because she can be doing up and down movement doing family responsibilities at home' Participant 4.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne participant reported that nurses might miss work due to marital problems that affect their relationships, thus resorting to absenteeism.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Another thing that contributes to absenteeism is the relationship problem. If things are not going well at home, one cannot work well. Like if there is always an argument with the husband or wife, one will be absent from work. ' Participant 14.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFinancial challenges\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOther participants reported that they miss work due to financial difficulties and that their salary is not enough to cover household expenses. The participants also reported that they become stressed and do not concentrate at work because they think other people predict that they do not have money and therefore stay at home. This is supported by the direct quotes that follow.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some professional nurses are absent due to financial problems because most of them take out loans, and when they are at work, they feel stressed that they are working, but they are working for nothing. They cannot concentrate, that is why they stay at home so that they can be alone. Because when they are stressed like that, they just think that everyone can see that they are broke, so that no one can see their problems in their face 'Participant 6.'\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'Due to the fact that many people have been stopped from coming to work from different companies, and you will find that as a nurse I am a bread winner at home because the person who helped me is no longer working and you can find that I am the one taking all the responsibilities and my salary does not meet those needs. So, it means that I will not be able to go to work because I will not have money for transportation, because there is no other income.' Participant 7.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant added that financial constraints lead nurses to borrow money from different financial institutions, which also contributes to absenteeism.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Financial problems can result in absenteeism because one will be thinking about the debt that one is owing from the different institutions, and as such that person will end up absent from duty,' Participant 14.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e6.5 Work-related causes contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThis was the fourth theme, as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which emerged from the study with its two subthemes, as explained below.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHigh workload\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOther participants said that despite their willingness to work, the lack of staff makes it difficult for them to put in more effort. Some reported that because they are afraid of being punished for treating the patient incorrectly due to workload, some even tend to miss their lunch times as such, they decided to stay home and avoid being charged. This is supported by the direct quotes below.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'The load of work is too much and it is beyond the limit. You cannot accommodate more patients than you are supposed to, due to a limited number of staff, and you don\u0026rsquo;t even go to lunch due to heavy workload and lack of staff. Sometimes you feel like you are not going to work because you are tired, because over the past two days you have overworked. So instead of coming here and being charged, it is better to sit at home because you will not be charged if you are at home. ' Participant 8.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant added that two professional nurses are mainly assigned to manage the activities of the unit, which include patient care, as a result, the following day, all of them might be absent due to work overload.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'A high workload can also cause absenteeism due to staff shortage, because a ward can be managed by two nurses instead of four absent from work. There is the possibility that the next day one or both of those who were at work may be absent due to fatigue because the waiting room will be too busy.' Participant 13.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant agreed and added that nurses are problem solvers and are responsible for any problem that arises in the unit that affects them emotionally.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Every problem that arises, you are the one responsible and you get tired. You may be tired from the workload and emotionally tired. You have to solve problems, manage the room, and do the admin, it is so stressful. Due to overwork, you have no time for lunch, eat standing and don't have to leave the institution, you stay on the ward because you are the only professional nurse.' Participant 17.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInconducive work environment\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants reported being absent from work due to a shortage of medical treatment and supplies. Others mentioned that they sometimes miss work because of exhaustion of travelling to borrow equipment for activities such as medical treatment. This is supported by the direct quotes below.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Stressful situations caused by the shortage of working materials, pharmaceutical materials like medications. You cannot work in a unit where there is no treatment like paracetamol. And you know that paracetamol will make the patient feel better, but it is not there. So, it also stresses you as a nurse on how I am going to help the patient if there are no medications. It does not give me the stamina to wake up in the morning to go to work. So, this is one of the stressful situations that makes nurses not come to work. ' Participant 7.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e'Equipment is not enough and, as a result, makes us nurses feel discouraged to come to work, because after all, we go from one ward to another borrowing the equipment and end up tired of going up and down.' Participant 15.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne added by indicating that the shortage of material resources stresses them, as sometimes the condition of the patient will become worse while they are still running around borrowing equipment in which the participants feel it discourages them, adding to absenteeism.\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Sometimes you are struggling to get the working materials such as syringes, medication, etc. to perform some duties, the patient's condition will deteriorate and sometimes he/she will pass on. Because of that, you may end up absconding from work the following day due to fatigue and work pressure. ' Participant 24.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"7. Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e7.1 Management-related causes contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThe findings of this study revealed that management problems significantly increased the rate of absenteeism among nurses. One of the issues stated by the professional nurses was management's lack of recognition for their efforts. The professional nurses indicated that they wanted to be acknowledged and recognised because they thought it would inspire them to put more effort into their daily patient care. Based on the basic need for self-esteem, Maslow's hierarchy of needs theory, employees' needs for self-esteem should be considered while setting goals and making decisions\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. However, nurses' efforts to provide high-quality patient care are rarely recognised by hospital management. Failure to recognise them could lead to poor service delivery and a higher absenteeism rate. Brunner et al. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e corroborated the findings of the current study by showing a negative correlation between absenteeism and the failure of nursing management to acknowledge, value, and inspire nurses. As a result, nursing management must recognise professional nurses, for example, announcing a professional nurse for the month to reward excellent performance. Additionally, the study emphasised that professional nurses should also be consulted to make input before making changes, such as those involving policies, regulations and guidelines. To support the findings of the current study, Ada et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e reported that professional nurses were concerned that their ideas were not taken into account during decision making, which led to resistance to implementing what was decided on; this had a negative impact on the management system. Additionally, Garca-Campayo\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e showed that absenteeism can be reduced by a strong organisation with strong leadership, clear communication, and positive reinforcement.\u003c/p\u003e \u003cp\u003eDespite being valued or acknowledged as employees, the study findings revealed that there were unfair and unprofessional management practices where the majority of nurses struggled to maintain good working relationships with their managers. Professional nurses reported that they could not confide in their supervisors about certain personal problems, particularly those involving private matters. Additionally, if absent, absenteeism policies were implemented differently for those who did not report to work, and other professional nurses were not reprimanded. Magobolo et al. \u003csup\u003e(9)\u003c/sup\u003e corroborated this, stating that the main causes of absences were partisanship, the imposition of policies, agitation by staff members, and management's disregard for their opinions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e7.2 Nurse-related factors contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThe findings of the current study revealed that professional nurses often miss work due to stress and fatigue from their demanding jobs. As a result, when nurses experience stress and burnout, patients do not receive high-quality treatment. A similar study by Garca-Campayo\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e showed that stress and burnout syndrome are factors that lead to absenteeism. The same was discovered in a study conducted by Burmeiter et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e and Ticharwa et al.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003c/sup\u003e who stated that excessive workload, conflict between work and home life, inadequate staffing, inadequate pay, and a poor work environment are the main causes of burnout. Stress, which includes work-related, emotional, and mental stressors, is associated with absenteeism. Stress has a detrimental effect on nurses' emotional and psychological well-being due to work-related issues, personal and family problems \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. This led to a shortage of professional nurses, as identified from the findings of the current study, where only two professional nurses were assigned to a busy ward with multiple patients who needed help with daily activities. In turn, burnout, fatigue, and absenteeism were caused by a small number of professional nurses who cared for an unusually high volume of patients.\u003c/p\u003e \u003cp\u003eAccording to the study findings, most professional nurses missed work due to health-related problems, and others feigned their illnesses, resulting in a shortage of staff in most units. For some professional nurses, particularly those in the older age group, medical conditions were the main reason for their absences. The shortage of staff due to absenteeism had a negative impact on patient care. This was also observed during COVID-19, where patients died in numbers due to workload, which was caused by the higher number of patients admitted with limited staff. According to Dyrbye et al. \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e professional nurses' absenteeism was associated with the low emotional state of a professional nurse as a result of illness, which results from family stress. Furthermore, the findings of the current study are consistent with those of Ticharwa et al. \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e who discovered that older nurses were more likely to miss work due to illness, while younger nurses were more likely to fake illness and be absent because they were less committed to the unit. The absence of professional nurses or the fabrication of diseases may be influenced by family health and conflict\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. When providing patient care, the physical and mental well-being of professional nurses may be compromised, and they may fabricate reasons to avoid work that exacerbate their medical conditions\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. The absenteeism and illness of professional nurses should be evaluated and addressed to assist in providing high-quality patient care \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe study findings revealed that addiction and alcohol misuse were additional problems that caused difficulties for professional nurses. The abuse of alcohol by professional nurses had a detrimental effect on job attendance and resulted in unexplained absenteeism. There is proof that professional nurses, particularly men, did not report to work because of drinking. This implies that the units will be understaffed, resulting in poor patient care. Many professional nurses are susceptible to substance misuse as a result, and the safety and security of patients and other staff members are compromised. To support the current findings, a study by Mulaudzi\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e revealed several factors that contribute to absenteeism, such as behavioural and environmental, social, physical, and psychological factors, as well as socioeconomic and genetic risk factors that are known to cause substance abuse. Another study by Van Jaarsveld\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e showed that it is possible to establish whether substance abuse levels cause the absence of professional nurses or whether low levels of consumption and absenteeism are predicted by job satisfaction. Furthermore, issues such as substance abuse, absenteeism, and low job satisfaction have a huge financial impact among professional nurses and the Department of Health at large.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e7.3 Social factors contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThe results of the study demonstrate that professional nurses prioritise their families over their patients, resulting in their absence from work. Personal and family problems, illness, and other causes were associated with absenteeism. According to Maslow's hierarchy of needs, group cohesion is largely dependent on strong relationships, which constitute a fundamental necessity of social needs\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The findings of the current study revealed that nurses' social needs negatively impact their work roles and responsibilities because they miss work. Personal issues such as celebrations, attending events, and taking care of their family members were the cause of absenteeism among professional nurses.\u003c/p\u003e \u003cp\u003eFinancial difficulties were one of the factors that influenced nurse absenteeism\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. The findings of the current study revealed that financial problems are yet another reason why professional nurses miss work. Most professional nurses said that they often skipped work to work part-time in private hospitals due to a lower salary. In addition, they indicated that they were so exhausted when they got home from private hospitals and ended up absent from work. Based on the fundamental demand for basic needs, Maslow's hierarchy of needs theory states that people are preoccupied with essentials such as clothing, food, drink, and shelter\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Most professional nurses are of childbearing age; therefore, their income is not sufficient to support their families. In support of the current study\u0026rsquo;s findings, a study by Suprapto et al.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e revealed that most professional nurses missed work due to financial difficulties, such as debt pressure or the inability to do household tasks. It was acknowledged by professional nurses that their salaries did not correspond to their duties. Al-Sharif, Kassem, and Shokry\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e revealed that, among other things, financial problems cause distractions related to work such as absenteeism, increased staff turnover, and a decrease in the professional morale of nurses\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The study found that departmental performance is usually adversely affected by financial concerns.\u003c/p\u003e \u003cp\u003eAbsenteeism among professional nurses is affected by their inability to pay for transportation to work\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Demotivation caused by low pay and incentives has been found to be another source of financial difficulties for professional nurses\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Furthermore, the literature indicated that the department was criticised by professional nurses for not recognising them by offering incentives to reduce financial burdens, which was a major cause of absenteeism\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. When nurses attempt to leave their jobs due to financial restrictions, absenteeism increases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e7.4 Work-related factors contributing to absenteeism\u003c/h2\u003e \u003cp\u003eThe findings of the current study revealed that professional nurses in selected hospitals are overburdened by their heavy workloads, which frequently results in stress and exhaustion. Only two professional nurses, instead of at least four, were managing a larger number of patients. These findings were supported by various authors who found absenteeism to be related to a high patient ratio, subjective and unmanageable workload\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. An excessive workload and a high patient-to-nurse ratio had an effect on nurses' emotional, psychological health as well as their musculoskeletal system, which resulted from heavy lifting and turning of patients \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConsequently, the increasing rate of professional nurses' absenteeism jeopardises their capacity to deliver exceptional patient care, raising the possibility of errors that could lead to negligence charges. This was also supported by several researchers, where professional nurses were facing disciplinary hearings and lawsuits because of negligence caused by their physical and emotional stress due to the increased workload \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe findings of the current study revealed that the majority of professional nurses reported being absent from duty due to unfavourable working conditions. These included dust, inadequate infrastructure, lack of equipment and materials, and other problems. They added that, in terms of safety and security requirements, a welcoming and comfortable workplace is optimal, in accordance with Maslow's hierarchy of needs theory\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Individuals prefer environments that are safe and secure\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Therefore, in order to improve high-quality patient care, professional nurses require a safe working environment that protects their physical and mental health and keeps them safe from injury. Brunner et al., \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e claim that environmental problems such as loud noises, dim lighting, crowded patients, and other problems that affect their physical working conditions cause professional nurses to be absent from work. Garc\u0026iacute;a-Campayo\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e; Kim et al. \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e indicated that nurses should work in a physically healthy environment. Furthermore, the same studies showed that workplace safety features, such as outdoor spaces and infrastructure, not only save maintenance costs, but also improve employee morale and professional nurses' productivity, which in turn lowers incident and absenteeism rates. The problem, which may be caused by poor working conditions or workplace health and safety, must be addressed by management.\u003c/p\u003e \u003cp\u003eThe study findings also showed that certain wards were experiencing a shortage of medical supplies and equipment. As a result, professional nurses were constantly moving around, borrowing resources and supplies, such as glucometers, from other units. The lack of material resources on the wards makes nurses less motivated to perform their nursing duties, leading to absenteeism. Nurses indicated that it was exhausting and time-consuming. Sharna\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e supported the findings of the current study, in which a shortage of resources and/or equipment leads to stress and absenteeism.\u003c/p\u003e \u003c/div\u003e"},{"header":"8. Conclusion","content":"\u003cp\u003eThe study findings demonstrate how managers fail to provide proactive assistance to their staff members, leaving professional nurses feeling vulnerable and abandoned. Managers did not acknowledge or encourage professional nurses, there was favouritism, and unit policies were not implemented for all. Professional nurses independently make all decisions regarding the patient's progress, while managers are perceived as merely sitting in offices, filling out paperwork, and neglecting to ensure that comprehensive patient care is provided. Medical conditions played a role in the absenteeism of nurses. Staff absenteeism was also caused by somatization, the practice of professional nurses pretending to be sick, and hence not showing up for work. Some professional nurses skip work due to drug or alcohol abuse or a lack of dedication and accountability.\u003c/p\u003e \u003cp\u003eThe results of the study made it clear that other professional nurses leave work due to personal, family and social obligations. Thus, they did not report for duty and did not provide the best possible quality care to their patients. The professional nurses were absent from work to recover from the stress of their personal problems and excessive workloads. Another major issue is financial stress, which is linked to poor income and causes many professional nurses to miss work, increasing the absenteeism rate. As such, the researcher recommended that managers should recognise all staff members, implement the unit's policies, refrain from favouritism, treat all staff equally, and promote teamwork. Additionally, managers should ensure that there is provision of resources, including allocation of staff and equipment to promote a conducive environment for staff members.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCEO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChief Executive Officer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTREC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTurf loop Research Ethics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e10. Study limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted only in two public hospitals due to a lack of funding; as such, the views of professional nurses who participated in this study cannot be generalised to other settings. One drawback was the unavailability of participants, as the few who were available during data collection were occupied with patients\u0026rsquo; care; as such, the researcher had to visit the hospitals several times before data could be saturated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.1 Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Turfloop Research Ethics Committee (TREC /5582022: PG) as the study involved humans. The study was pure non-experimental as such, and no human experiment or human samples were used in this research. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or research committee and with the Declaration of Helsinki of 1975, as revised in 2013.\u0026nbsp;In this study, after explaining the objectives, benefits, and risks, participants received a consent form to sign before participating in the study. The researcher ensured that all participants signed an informed consent form before participating in the study. The participant was assured that participation in this study is voluntary and that the participant can withdraw from the study at any time without providing reasons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.2 Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.3 Clinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.4 Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupporting data for the findings of this research are available on request from MT, the principal investigator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.5 Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone related to the publication of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.6 Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was not funded; therefore, the researcher used her own resources to conduct the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.7 Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMT was the principal investigator who was also involved in the drafting of the current article. \u0026nbsp;MTE and RTI were supervisors and were also involved in the finalisation of the current article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.8 Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the University of Limpopo, Faculty of Health Sciences Research Ethics Committee, for giving permission for the researchers to conduct the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLøkke AK. Absenteeism in organizations. In Global encyclopedia of public administration, public policy, and governance, 2023 Apr 6 (pp. 6-11). Cham: Springer International Publishing.\u003c/li\u003e\n \u003cli\u003eKarimbil MR. A study on employee absenteeism in today’s workplace. Journal of the Gujarat Research Society. 2019; 21(17):273-9\u003c/li\u003e\n \u003cli\u003eKlootwijk L, Zeyrek E, Njuguna F, Ket JC, Mostert S, Kaspers G. Absenteeism of Healthcare Workers in Primary Healthcare in Sub‐Saharan Africa: A Scoping Review. The International Journal of Health Planning and Management. 2025.\u003c/li\u003e\n \u003cli\u003eAgwu P, Odii A, Orjiakor C, Ogbozor P, Mbachu C, Onwujekwe O. Implications of absenteeism of health workers on achieving universal health coverage in Nigeria: exploring lived experiences in primary healthcare. International Journal for Quality in Health Care. 2024 Jan 1;36(1):mzae015.\u003c/li\u003e\n \u003cli\u003eOlenga BO. \u003cem\u003eFactors contributing to absenteeism among nursing staff in a public hospital in Dammam, Saudi Arabia \u003c/em\u003e (Doctoral dissertation, University of Pretoria); 2024.\u003c/li\u003e\n \u003cli\u003eÖncü E, Vayısoğlu SK, Karadağ G, Orak NŞ, Tosun AS, Yüksekol ÖD, Çatıker A, Yalçın GÇ. The relationship between unemployment anxiety, job satisfaction and migration attitude among the next generation of Turkish nurses: a cross-sectional study. International Journal of Nursing Studies. 2023 Dec 1;148:104603.\u003c/li\u003e\n \u003cli\u003eAda, MJ, Arop FO, Owan VJ, Agunwa JN. Teaching personnel management and attitude to work in secondary schools of Calabar Education Zone of Cross River State, Nigeria.\u003cem\u003e A study of the management of learners’ absenteeism in school organizations in Nigeria.\u003c/em\u003e Research on Humanities and Social Sciences, volume 9, issue 18, p. 1 - 7 Posted: 2019.\u003c/li\u003e\n \u003cli\u003eOkoli CT, Otachi JK, Seng S. Assessing opinions and barriers to providing evidence-based tobacco treatment among health care providers within an in-patient psychiatric facility. Journal of mental health. 2020 Nov 1.\u003c/li\u003e\n \u003cli\u003eMagobolo GN, Dube BM. Factors influencing high absenteeism rate of student nurses in clinical areas at a nursing college in the Lejweleputswa District. Curationis. 2019 Jan 1; 42(1):1-6.\u003c/li\u003e\n \u003cli\u003eManvela B, Olumene D, Eyono PN, Utete R. Investigating the causes of absenteeism at the workplace: Evidence from the South African organisation; 2024. https://doi.org/10.5281/zenodo.11119027, accessed 15 April 2025.\u003c/li\u003e\n \u003cli\u003eGrove SK, Gray JR, Bomer-Norton C. Study Guide for Understanding Nursing Research E-Book: Study Guide for Understanding Nursing Research E-Book. Elsevier Health Sciences; 2018 Sep 17.\u003c/li\u003e\n \u003cli\u003eConnelly-Martínez CL, Idelevich EA, Sparbier K, Kuczius T, Kostrzewa M, Becker K. Development of a MALDI-TOF MS-based screening panel for accelerated differential detection of carbapenemases in Enterobacterales using the direct-on-target microdroplet growth assay. Scientific Reports. 2020 Mar 19; 10(1):4988.\u003c/li\u003e\n \u003cli\u003ede Vos RJ, van der Vlist AC, Zwerver J, Meuffels DE, Smithuis F, van Ingen R, van der Giesen F, Visser E, Balemans A, Pols M, Veen N. Dutch multidisciplinary guideline on Achilles tendinopathy. British journal of sports medicine. 2021 Oct 1; 55(20):1125-34.\u003c/li\u003e\n \u003cli\u003eKorstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice. 2018 Jan 1; 24(1):120-4.\u003c/li\u003e\n \u003cli\u003eMammbona, AA, Mavhandu-Mudzusi AH. Enrolled nurses’ experiences of caring for patients living with HIV in a South African rural hospital. International Nursing Review 2019 Feb 13; 66, 139 – 146.\u003c/li\u003e\n \u003cli\u003eBurns, N, Grove SK. \u003cem\u003eUnderstanding nursing research: Building evidence-based practice.\u003c/em\u003e China: Elsevier. 2016\u003c/li\u003e\n \u003cli\u003eem\u0026gt; George,JB. The base for professional nursing practice.\u003cem\u003e Nursing theories.\u003c/em\u003e \u003cem\u003e6th Ed\u003c/em\u003e. 2014 Feb 2; 636\u003c/li\u003e\n \u003cli\u003eBrunner B, Igic I, Keller AC Wieser S. Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work. The European Journal of Health Economics. 2019 Nov; 20(8):1165-80.\u003c/li\u003e\n \u003cli\u003eGarcía-Campayo J, Puebla-Guedea M, Herrera-Mercadal P, Daudén E. Burnout syndrome and demotivation among health care personnel. Managing stressful situations: The importance of teamwork. Actas Dermo-Sifiliográficas (English Edition). 2016 Jun 1; 107(5):400-6.\u003c/li\u003e\n \u003cli\u003eTicharwa M. Cope, V., Murray, M. Nurse Absenteeism: An analysis of trends and perceptions of nurse unit managers. \u003cem\u003eAustralia: Journal of Nursing Management, \u003c/em\u003e2019. \u003cem\u003e27,\u003c/em\u003e 109-116.\u003c/li\u003e\n \u003cli\u003eMarć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P. A nursing shortage–a prospect of global and local policies. International nursing review. 2019 Mar; 66(1):9-16.\u003c/li\u003e\n \u003cli\u003eTweheyo R, Wambede MN, Nyangoma A. Collaborative decision-making and sustainable food security: Rethinking the role of indigenous knowledge and farming practices in Uganda. Indonesian Journal of Social Science. 2019 Jan 1; 16(1).\u003c/li\u003e\n \u003cli\u003eDyrbye LN, Shanafelt TD, Johnson PO, Johnson LA, Satele D, West CP. A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC nursing. 2019 Dec; 18:1-8.\u003c/li\u003e\n \u003cli\u003eMukasa MN, Sensoy Bahar O, Ssewamala FM, KirkBride G, Kivumbi A, Namuwonge F, Damulira C. Examining the organizational factors that affect health workers' attendance: findings from southwestern Uganda. The International journal of health planning and management. 2019 Apr; 34(2):644-56.\u003c/li\u003e\n \u003cli\u003eCarbonell P, Rodriguez-Escudero AI. The effect of transactive memory systems on job stress of new product development teams: Moderating effects of project complexity and technological turbulence. IEEE Transactions on Engineering Management. 2020 May 20;69(4):1432-46.\u003c/li\u003e\n \u003cli\u003eMulaudzi M, Dlamini BN, Coetzee J, Sikkema K, Gray G, Dietrich JJ. Perceptions of counsellors and youth-serving professionals about sexual and reproductive health services for adolescents in Soweto, South Africa. Reproductive health. 2018 Dec; 15:1-9.\u003c/li\u003e\n \u003cli\u003eVan Jaarsveld JA. Substance consumption and workplace absenteeism: The moderating role of job satisfaction (Doctoral dissertation, North-West University). 2018\u003c/li\u003e\n \u003cli\u003eKhaled Abd El-Aziz Zaki A, Samir Abd El-Aziz Elsaiad H. Toxic Leadership and its Relation to Nurses' Absenteeism and Their Deviant Behaviors. Egyptian Journal of Health Care. 2021 Dec 1;12(4):1304-22.\u003c/li\u003e\n \u003cli\u003eKing AT, Gontarz J, Wei H. Employee engagement and absenteeism: A step towards improving patient care. In Nursing forum 2020 Jul (Vol. 55, No. 3, pp. 356-361).\u003c/li\u003e\n \u003cli\u003eAlreshidi NM, Alaseeri RM, Garcia M. Factors influencing absenteeism among nursing staff in the primary health care centers in hail: a preliminary study for enhancing staff commitment. Health Science Journal. 2019; 13(3):1-7.\u003c/li\u003e\n \u003cli\u003eShah SA, Uddin I, Aziz F, Ahmad S, Al-Khasawneh MA, Sharaf M. Research Article An Enhanced Deep Neural Network for Predicting Workplace Absenteeism. An enhanced deep neural network for predicting workplace absenteeism. 2020 \u003cem\u003eHindawi Complex\u003c/em\u003e, 1-12.\u003c/li\u003e\n \u003cli\u003eKhateeb FR. Absenteeism Among Nurses: A Bibliometric Analysis of the Past 25 Years of Research. Management and Labour Studies. 2024 Aug;49(3):527-54.\u003c/li\u003e\n \u003cli\u003eAlharbi, FL, Almuzini, TB, Aljohani, AA, Aljohani, KA, Albowini, AR, Aljohani, ME, Althubyni, MM. Causes of absenteeism rate among staff nurses at Medina Maternity and Child Hospital. \u003cem\u003eMedina, Saudi-Arabia: The Egyptian Journal of Hospital Medicine, \u003c/em\u003e2018;\u003cem\u003e 70\u003c/em\u003e(10), 1784-1788.\u003c/li\u003e\n \u003cli\u003eDuncombe DC. Factors influencing voluntary absenteeism among healthcare workers in the Bahamas. Nursing Economics. 2019 Mar 1; 37(2):92-109.\u003c/li\u003e\n \u003cli\u003eMothiba TM, Mbombi MO, Malema RN, Malatji M. The effects of absenteeism on nurses remaining on duty at a tertiary hospital of Limpopo province. Curationis. 2018 Jan 30; 41(1):1-5.\u003c/li\u003e\n \u003cli\u003eGemuhay, HM, Kalolo A, Mirisho, R, Chipwaza, B, Nyangena, E. Factors affecting performance in clinical practice among Preservice Diploma nursing students in northern Tanzania. \u003cem\u003eNursing Research and Practice, \u003c/em\u003e2019. \u003cem\u003e3453085,\u003c/em\u003e 1- 9.\u003c/li\u003e\n \u003cli\u003eTumlinson, K, Gichane, MW, Curtis, SL, LeMasters, K. Understanding healthcare provider absenteeism in Kenya. A qualitative analysis. \u003cem\u003eBMC Health Services Research, \u003c/em\u003e2019. \u003cem\u003e19\u003c/em\u003e(660), 1-8.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e(38)\u003c/em\u003e Vadgaonkar MD, Velhal G. A study of absenteeism of nurses in public hospitals. International Journal of Recent Scientific Research. 2018 Aug; 9(10E):29405-13.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e(39)\u003c/em\u003e Drennan VM, Ross F. Global nurse shortages—the facts, the impact and action for change. British medical bulletin. 2019 Jun 19; 130(1):25-37.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e(40)\u003c/em\u003e \u003cem\u003eMartínez, CL, Moraga, SP, Paredes, CS, Vásquez, AS, Villarroel, CM. Occupational fatigue and work absenteeism in female assistant nurses of a high-complexity hospital, Chile. Ciência \u0026amp; Saúde Coletiva; 2020, 25(1): 243-249\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eMbombi, MO, Mothiba, TM, Malema, RN, Malatji, M. The effects of absenteeism on nurses remaining on duty at a tertiary hospital of Limpopo Province. \u003cem\u003eCurationis, \u003c/em\u003e2018. \u003cem\u003e41\u003c/em\u003e(1), doi: 10.4102/curationis. v41i1.1924 \u003c/li\u003e\n \u003cli\u003eVan den Heede K, Cornelis J, Bouckaert N, Bruyneel L, Van de Voorde C, Sermeus W. Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria and Queensland: a discussion paper. Health Policy. 2020 Oct 1; 124(10):1064-73.\u003c/li\u003e\n \u003cli\u003ePolitis M, Rachiotis G, Mouchtouri VA, Hadjichristodoulou C. The Global Burden of Absenteeism Related to COVID-19 Vaccine Side Effects Among Healthcare Workers: A Systematic Review and Meta-Analysis. Vaccines. 2024 Oct 19;12(10):1196.\u003c/li\u003e\n \u003cli\u003eKim KJ, Yoo MS, Seo EJ. Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian nursing research. 2018 Jun 1; 12(2):121-6.\u003c/li\u003e\n \u003cli\u003eSharna SC, Maraseni T, Radanielson AM. A global systematic literature review on sustainable soil management practices (1994–2022). Soil Use and Management. 2022 Oct; 39(4):1267-88.\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":"Absenteeism, challenges, nurse, public hospital","lastPublishedDoi":"10.21203/rs.3.rs-6071001/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6071001/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAbsenteeism is a major problem in many health institutions around the world and an issue that leads to poor service delivery. Globally, absenteeism of professional nurses is alarming, especially in hospitals where patients expect quality service. Absenteeism affects not only the quality of patient care, but also the efficiency of the healthcare institution and the productivity of professional nurses on duty.\u003cstrong\u003e \u003c/strong\u003eAs such, this study explored and described the views of nurses on the causes of absenteeism at selected public hospitals in Limpopo province, South Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An explorative descriptive design was used to explore and describe the views of nurses on the causes of absenteeism in selected public hospitals in Limpopo Province, South Africa. A nonprobability convenience sampling technique was used for the selection of participants, and semi-structured interviews were conducted until data saturation was reached. Data were analysed using Tesch's open-coding method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Management, social, nursing, and work-related factors were the four themes that emerged from the study. Lack of acknowledgement and recognition, unfair and unprofessional practices, burnout and stress, medical conditions and somatization, family challenges and responsibilities, financial challenges, high workload, and an unconducive environment were the subthemes that emerged from the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The findings showed that management, social, nurse, and work-related factors played a major role in nurse absenteeism. Consequently, hospital patient care and service delivery were poor. Professional nurses acknowledge and recognition was recommended.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications:\u003c/strong\u003e This study can contribute to improving patient care in the department, as absenteeism among nurses will be reduced.\u003c/p\u003e","manuscriptTitle":"Views of nurses on causes of absenteeism at selected regional public hospitals of Limpopo Province, South Africa: A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-30 08:35:40","doi":"10.21203/rs.3.rs-6071001/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":"c4881003-711e-45e0-9f49-0298717324c2","owner":[],"postedDate":"April 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T06:24:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-30 08:35:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6071001","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6071001","identity":"rs-6071001","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}