Logo of oenvmedOccupational and Environmental MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Occup Environ Med. 2003 Apr; 60(4): 271–278.
PMCID: PMC1740518

Work factors as predictors of sickness absence: a three month prospective study of nurses' aides


Aims: To identify the work factors that predict sickness absence in nurses' aides.

Methods: The sample comprised 5563 Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified sickness absence (>3 days), as assessed by self reports at follow up.

Results: Perceived lack of encouraging and supportive culture in the work unit (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.28 to 2.34), working in psychiatric and paediatric wards, having injured the neck in an accident, and health complaints were associated with higher risk of sickness absence, after adjustments for a series of physical, psychological, and organisational work factors, personal engagement in the work unit, demographic characteristics, and daily consumption of cigarettes. Having untraditional jobs (for nurses' aides) (OR 0.53; 95% CI 0.36 to 0.77), and engaging in aerobics or gym were associated with a lower risk of sickness absence.

Conclusions: The study suggests that the three month effects of work factors on rates of certified sickness absence are modest in nurses' aides. The most important work factor, in terms of predicting sickness absence, seems to be perceived lack of encouraging and supportive culture in the work unit.

Full Text

The Full Text of this article is available as a PDF (146K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Luz J, Green MS. Sickness absenteeism from work--a critical review of the literature. Public Health Rev. 1997;25(2):89–122. [PubMed]
  • Fuortes LJ, Shi Y, Zhang M, Zwerling C, Schootman M. Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey. J Occup Med. 1994 Sep;36(9):1022–1026. [PubMed]
  • Kristensen TS. Sickness absence and work strain among Danish slaughterhouse workers: an analysis of absence from work regarded as coping behaviour. Soc Sci Med. 1991;32(1):15–27. [PubMed]
  • Leppänen RA, Olkinuora MA. Psychological stress experienced by health care personnel. Scand J Work Environ Health. 1987 Feb;13(1):1–8. [PubMed]
  • North FM, Syme SL, Feeney A, Shipley M, Marmot M. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study. Am J Public Health. 1996 Mar;86(3):332–340. [PMC free article] [PubMed]
  • Stansfeld SA, Fuhrer R, Head J, Ferrie J, Shipley M. Work and psychiatric disorder in the Whitehall II Study. J Psychosom Res. 1997 Jul;43(1):73–81. [PubMed]
  • Stansfeld SA, Rael EG, Head J, Shipley M, Marmot M. Social support and psychiatric sickness absence: a prospective study of British civil servants. Psychol Med. 1997 Jan;27(1):35–48. [PubMed]
  • Spector PE, Jex SM. Relations of job characteristics from multiple data sources with employee affect, absence, turnover intentions, and health. J Appl Psychol. 1991 Feb;76(1):46–53. [PubMed]
  • Parkes KR. Locus of control as moderator: an explanation for additive versus interactive findings in the demand-discretion model of work stress? Br J Psychol. 1991 Aug;82(Pt 3):291–312. [PubMed]
  • Kivimäki M, Vahtera J, Thomson L, Griffiths A, Cox T, Pentti J. Psychosocial factors predicting employee sickness absence during economic decline. J Appl Psychol. 1997 Dec;82(6):858–872. [PubMed]
  • Vahtera J, Kivimäki M, Pentti J, Theorell T. Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees. J Epidemiol Community Health. 2000 Jul;54(7):484–493. [PMC free article] [PubMed]
  • Vahtera J, Kivimäki M, Uutela A, Pentti J. Hostility and ill health: role of psychosocial resources in two contexts of working life. J Psychosom Res. 2000 Jan;48(1):89–98. [PubMed]
  • Wickström GJ, Pentti J. Occupational factors affecting sick leave attributed to low-back pain. Scand J Work Environ Health. 1998 Apr;24(2):145–152. [PubMed]
  • Niedhammer I, Bugel I, Goldberg M, Leclerc A, Guéguen A. Psychosocial factors at work and sickness absence in the Gazel cohort: a prospective study. Occup Environ Med. 1998 Nov;55(11):735–741. [PMC free article] [PubMed]
  • Heaney CA, Clemans J. Occupational stress, physician-excused absences, and absences not excused by a physician. Am J Health Promot. 1995 Nov-Dec;10(2):117–124. [PubMed]
  • Häkkänen M, Viikari-Juntura E, Martikainen R. Job experience, work load, and risk of musculoskeletal disorders. Occup Environ Med. 2001 Feb;58(2):129–135. [PMC free article] [PubMed]
  • Kleiven M, Bøggild H, Jeppesen HJ. Shift work and sick leave. Scand J Work Environ Health. 1998;24 (Suppl 3):128–133. [PubMed]
  • Nuwayhid IA, Stewart W, Johnson JV. Work activities and the onset of first-time low back pain among New York City fire fighters. Am J Epidemiol. 1993 Mar 1;137(5):539–548. [PubMed]
  • Krause N, Ragland DR, Fisher JM, Syme SL. Psychosocial job factors, physical workload, and incidence of work-related spinal injury: a 5-year prospective study of urban transit operators. Spine (Phila Pa 1976) 1998 Dec 1;23(23):2507–2516. [PubMed]
  • Voss M, Floderus B, Diderichsen F. Physical, psychosocial, and organisational factors relative to sickness absence: a study based on Sweden Post. Occup Environ Med. 2001 Mar;58(3):178–184. [PMC free article] [PubMed]
  • Theorell T, Harms-Ringdahl K, Ahlberg-Hultén G, Westin B. Psychosocial job factors and symptoms from the locomotor system--a multicausal analysis. Scand J Rehabil Med. 1991;23(3):165–173. [PubMed]
  • Tellnes G, Bruusgaard D, Sandvik L. Occupational factors in sickness certification. Scand J Prim Health Care. 1990 Mar;8(1):37–44. [PubMed]
  • Leigh JP. Employee and job attributes as predictors of absenteeism in a national sample of workers: the importance of health and dangerous working conditions. Soc Sci Med. 1991;33(2):127–137. [PubMed]
  • Hensing G, Alexanderson K, Akerlind I, Bjurulf P. Sick-leave due to minor psychiatric morbidity: role of sex integration. Soc Psychiatry Psychiatr Epidemiol. 1995 Jan;30(1):39–43. [PubMed]
  • Müller CF, Monrad T, Biering-Sørensen F, Darre E, Deis A, Kryger P. The influence of previous low back trouble, general health, and working conditions on future sick-listing because of low back trouble. A 15-year follow-up study of risk indicators for self-reported sick-listing caused by low back trouble. Spine (Phila Pa 1976) 1999 Aug 1;24(15):1562–1570. [PubMed]
  • Bourbonnais R, Vinet A, Vézina M, Gingras S. Certified sick leave as a non-specific morbidity indicator: a case-referent study among nurses. Br J Ind Med. 1992 Oct;49(10):673–678. [PMC free article] [PubMed]
  • Bourbonnais R, Vinet A, Meyer F, Goldberg M. Certified sick leave and work load. A case referent study among nurses. J Occup Med. 1992 Jan;34(1):69–74. [PubMed]
  • Gauci Borda R, Norman IJ. Factors influencing turnover and absence of nurses: a research review. Int J Nurs Stud. 1997 Dec;34(6):385–394. [PubMed]
  • Parker PA, Kulik JA. Burnout, self- and supervisor-rated job performance, and absenteeism among nurses. J Behav Med. 1995 Dec;18(6):581–599. [PubMed]
  • Clarke S, Hussey DG. Sickness absence amongst nursing staff at two hospitals. J Soc Occup Med. 1979 Oct;29(4):126–130. [PubMed]
  • Larese F, Fiorito A. Musculoskeletal disorders in hospital nurses: a comparison between two hospitals. Ergonomics. 1994 Jul;37(7):1205–1211. [PubMed]
  • Smedley J, Egger P, Cooper C, Coggon D. Prospective cohort study of predictors of incident low back pain in nurses. BMJ. 1997 Apr 26;314(7089):1225–1228. [PMC free article] [PubMed]
  • Lagerström M, Hansson T, Hagberg M. Work-related low-back problems in nursing. Scand J Work Environ Health. 1998 Dec;24(6):449–464. [PubMed]
  • Bourbonnais R, Mondor M. Job strain and sickness absence among nurses in the province of Québec. Am J Ind Med. 2001 Feb;39(2):194–202. [PubMed]
  • Estryn-Behar M, Kaminski M, Peigne E, Maillard MF, Pelletier A, Berthier C, Delaporte MF, Paoli MC, Leroux JM. Strenuous working conditions and musculo-skeletal disorders among female hospital workers. Int Arch Occup Environ Health. 1990;62(1):47–57. [PubMed]
  • Kivimäki M, Elovainio M, Vahtera J. Workplace bullying and sickness absence in hospital staff. Occup Environ Med. 2000 Oct;57(10):656–660. [PMC free article] [PubMed]
  • Pines A, Skulkeo K, Pollak E, Peritz E, Steif J. Rates of sickness absenteeism among employees of a modern hospital: the role of demographic and occupational factors. Br J Ind Med. 1985 May;42(5):326–335. [PMC free article] [PubMed]
  • Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996 Jan;1(1):27–41. [PubMed]
  • Smedley J, Egger P, Cooper C, Coggon D. Manual handling activities and risk of low back pain in nurses. Occup Environ Med. 1995 Mar;52(3):160–163. [PMC free article] [PubMed]
  • Partinen M, Gislason T. Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res. 1995 Jun;4(S1):150–155. [PubMed]
  • Tambs K, Moum T. How well can a few questionnaire items indicate anxiety and depression? Acta Psychiatr Scand. 1993 May;87(5):364–367. [PubMed]
  • Kraus JF, Gardner L, Collins J, Sorock G, Volinn E. Design factors in epidemiologic cohort studies of work-related low back injury or pain. Am J Ind Med. 1997 Aug;32(2):153–163. [PubMed]
  • Severens JL, Mulder J, Laheij RJ, Verbeek AL. Precision and accuracy in measuring absence from work as a basis for calculating productivity costs in The Netherlands. Soc Sci Med. 2000 Jul;51(2):243–249. [PubMed]
  • Fredriksson K, Toomingas A, Torgén M, Thorbjörnsson CB, Kilbom A. Validity and reliability of self-reported retrospectively collected data on sick leave related to musculoskeletal diseases. Scand J Work Environ Health. 1998 Oct;24(5):425–431. [PubMed]
  • Burdorf A, Post W, Bruggeling T. Reliability of a questionnaire on sickness absence with specific attention to absence due to back pain and respiratory complaints. Occup Environ Med. 1996 Jan;53(1):58–62. [PMC free article] [PubMed]
  • Burdorf A. Reducing random measurement error in assessing postural load on the back in epidemiologic surveys. Scand J Work Environ Health. 1995 Feb;21(1):15–23. [PubMed]
  • Viikari-Juntura E, Rauas S, Martikainen R, Kuosma E, Riihimäki H, Takala EP, Saarenmaa K. Validity of self-reported physical work load in epidemiologic studies on musculoskeletal disorders. Scand J Work Environ Health. 1996 Aug;22(4):251–259. [PubMed]
  • Eriksen W. The role of social support in the pathogenesis of coronary heart disease. A literature review. Fam Pract. 1994 Jun;11(2):201–209. [PubMed]
  • Linnemann CC, Jr, Ramundo N, Perlstein PH, Minton SD, Englender GS. Use of pertussis vaccine in an epidemic involving hospital staff. Lancet. 1975 Sep 20;2(7934):540–543. [PubMed]
  • Kuppermann M, Lubeck DP, Mazonson PD, Patrick DL, Stewart AL, Buesching DP, Fifer SK. Sleep problems and their correlates in a working population. J Gen Intern Med. 1995 Jan;10(1):25–32. [PubMed]
  • Eriksen W, Natvig B, Bruusgaard D. Sleep problems: a predictor of long-term work disability? A four-year prospective study. Scand J Public Health. 2001 Mar;29(1):23–31. [PubMed]
  • Bjerkedal T, Wergeland E. Uførepensjonering av kvinner i ulike yrker på grunn av muskel- og skjelettsykdommer. Tidsskr Nor Laegeforen. 1995 Nov 20;115(28):3522–3527. [PubMed]
  • Jónsson H, Jr, Cesarini K, Sahlstedt B, Rauschning W. Findings and outcome in whiplash-type neck distortions. Spine (Phila Pa 1976) 1994 Dec 15;19(24):2733–2743. [PubMed]
  • Bush R, Wooden M. Smoking and absence from work: Australian evidence. Soc Sci Med. 1995 Aug;41(3):437–446. [PubMed]
  • Bertera RL. The effects of behavioral risks on absenteeism and health-care costs in the workplace. J Occup Med. 1991 Nov;33(11):1119–1124. [PubMed]
  • Vahtera J, Kivimäki M, Koskenvuo M, Pentti J. Hostility and registered sickness absences: a prospective study of municipal employees. Psychol Med. 1997 May;27(3):693–701. [PubMed]
  • Muto T, Sakurai H. Relation between exercise and absenteeism due to illness and injury in manufacturing companies in Japan. J Occup Med. 1993 Oct;35(10):995–999. [PubMed]
  • Marmot MG, North F, Feeney A, Head J. Alcohol consumption and sickness absence: from the Whitehall II study. Addiction. 1993 Mar;88(3):369–382. [PubMed]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Group


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    NCBI Bookshelf books that cite the current articles.
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...