Why Do Nurses Work While Sick? An Exploratory Study of Nurse Leaders' Cognitive Preferences Toward Presenteeism

Purpose: Nursing is a representative profession with a high prevalence of presenteeism, which is usually associated with negative outcomes. Therefore, it is important to explore the antecedent factors of nurse presenteeism behavior. This study aims to explore the impact and mechanism of head nurses' cognitive preference toward presenteeism on subordinate nurses' presenteeism (SNP), and the mediation effects of subordinate nurses' perception of head nurses' cognitive preference. Patient and Methods: A cross-sectional study was conducted from July to August 2022. A total of 256 head nurses and 1424 subordinate nurses were recruited from six hospitals located in Zhengzhou, Henan Province, China. The Nurse Presenteeism Questionnaire (NPQ) and Cognitive Preference Questionnaire were used to assess head nurses' cognitive preference toward presenteeism, SNP, and subordinate nurses' perception of head nurse's cognition of presenteeism. We conducted description, multilevel correlation, and multilevel structural equation models for the data analysis. Results: In the past 6 months, 93.4% of nurses experienced presenteeism. Within and between the team, head nurses' cognitive preference toward presenteeism is positively associated with SNP. The mediation effect of nurses' perception of head nurses' cognitive preference was also significant. Conclusion: Head nurses' cognitive preferences are essential predictors of subordinates' presenteeism. In this process, subordinates' subjective initiative plays a crucial role. Implications for Nursing Management: Hospital managers should focus on head nurses' values to formulate multiple interventions of presenteeism and strengthen communication between leaders and subordinates to promote transforming negative outcomes into positive outcomes.