How Nurse Health Impacts Quality of Care

Purpose:
To describe the effect of RNs' presenteeism (working with health problems) on patient safety and quality of patient care, and the associated economic costs.

Background/Significance:
While research has been conducted on the importance of adequate numbers of RNs for quality of care, no research has addressed how the productivity of the workforce is related to the quality of care. As the workforce ages, health problems in nurses themselves may impact their productivity. This study examined the extent to which the health of registered nurses affected their productivity and self-reported nurse sensitive quality indicators.

Methods:
The study used a randomized, cross-sectional mailed survey of RNs employed in hospital settings in North Carolina. 2500 surveys were sent and 1171 returned/complete for analysis. Measures included individual characteristics, workplace characteristics, health problems (degree of pain and/or depression-PHQ-9), presenteeism (Work Productivity and Activity Impairment Questionnaire: General Health), quality of care, patient safety (number of medication errors and patient falls over the last month), and salary (hourly). Data were analyzed by descriptive statistics and regression models.

Results:
The prevalence of musculoskeletal pain was 71.1% and depression was 18.3%. The majority of respondents (61.6 %) reported a presenteeism score of at least 1 and 11% reported a score of 5 or higher. Pain and depression were significantly associated with presenteeism (p= .000). Presenteeism was significantly associated with patient falls (p = .004), the number of medication errors (p = .0001) and the quality of care score (p =.000). Baseline estimates demonstrate that the increased falls and medication errors caused by presenteeism are expected to cost $1,346 per nurse and just under $2 billion for the country. Upper bound estimates exceed $9,000 per RN and $13 billion for the U.S.

Conclusions and Implications for Practice:
Keeping RNs healthy clearly should be a priority for both nurse retention and for quality of care. Specific recommendations to support nurse health will be presented.