Presenteeism in the Nursing Work Environment

Abstract

PRESENTEEISM IN THE NURSING WORK ENVIRONMENT Background. Job stress related presenteeism, being physically present at work while cognitive energy is diverted by workplace stressors, poses a significant threat to nurse well-being, retention, and patient safety in acute care settings.Purpose: To develop a nurse-centered explanation of how the medical–surgical work environment produces cognitive disruption and contributes to job stress related presenteeism. Methods. Grounded theory methodology was employed to conduct interviews with 15 registered nurses working in acute care medical–surgical units in Wisconsin. Results. Findings produced a grounded theory of work stress related cognitive disruption as a fluid, recursive process sustained by four mutually reinforcing workplace dynamics: multidirectional demand, interruption–reprioritization, interactional workload disruption (cognitive triage), and collective compensatory labor. Survey responses aligned with nurses’ reports of distraction, mental exhaustion, delayed task initiation, and reliance on coworkers. Discussion. The findings indicate that job stress related presenteeism stems from systemic cognitive issues rather than individual challenges. Disruption and compensatory work appear to be embedded in routine unit workflow, suggesting that efforts focused only on individual resilience are unlikely to be sufficient to meaningfully reduce presenteeism. Conclusions. Organizations may reduce job stress related presenteeism by lowering cognitive load, managing interruptions, matching staffing demand, and recognizing compensatory work to build a resilient nursing workforce.