Presenteeism and work-life conflict: A mixed methods study of Australian high acuity nurses

Author: Michelle Freeling

Freeling, Michelle, 2024 Presenteeism and work-life conflict: A mixed methods study of Australian high acuity nurses, Flinders University, College of Nursing and Health Sciences

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


Presenteeism refers to a situation where an employee attends work despite being unwell or experiencing personal issues, which affects their ability to perform their job effectively. This phenomenon is an ingrained aspect of modern work culture. Nurse presenteeism presents unique challenges due to the demanding nature of patient care, particularly in high acuity environments such as intensive care, perioperative and emergency room settings. Presenteeism impacts patient safety, nurse health and the healthcare system.

In this thesis, I conducted two studies that aimed to explore relationships between nurses’ work functioning, job-stress-related presenteeism, health-related quality of life, supervisor support and patient safety. In addition, as nurses’ experiences of nurse presenteeism, the impact on caring responsibilities, and how nurses cope with these issues were explored. A feminist pragmatism lens was used in this research. Data were collected from Australian nurses via a national cross-sectional survey, comprising a quantitative and qualitative component.

I found that nurse presenteeism, as measured by impairments in work functioning, led to increased job-stress-related presenteeism and decreased health-related quality of life. Nurses’ strong commitment to patient care, advanced health literacy and concerns about staffing shortages were identified as factors which may contribute to presenteeism. I also found that high acuity nurses are experiencing work-life conflict, which causes and is caused by presenteeism.

I present an integrative discussion, firstly discussing the percentage of nurses in this study who experienced presenteeism. The associations between job-stress-related nurse presenteeism, nurses’ work functioning, health-related quality, supervisor support, and patient safety, are highlighted. I discuss the impact of caring responsibilities on the experiences of presenteeism among nurses, and methods of coping with situations that lead to presenteeism. Also included are policy and leadership considerations relating to nurse presenteeism. Feminist theory, the Health Belief Model and the Presenteeism in Nursing Model are among the theoretical models discussed in relation to this research. An adapted version of the Presenteeism in Nursing Model is presented.

I include a broader discussion of the need for employers to recognise the challenges that nurses with caring responsibilities face, and of the larger structural issues in society. The meta-inference of this study is presented: high acuity nurses are experiencing work-life conflict, exacerbated by the COVID-19 pandemic, and by structural and organisational factors. This can both result in presenteeism and be the cause of presenteeism. Presenteeism decreases nurses’ health-related quality of life.

Overall, this research presents original knowledge regarding the complex issues of nurse presenteeism and work-life conflict. The research outcomes offer recommendations for healthcare organisations, policymakers and researchers which if implemented, may reduce nurse presenteeism and work-life conflict, overall promoting the wellbeing of the nursing workforce.

Keywords: nurse, presenteeism, work-life conflict, mixed methods, high acuity nursing, nursing workforce, feminist pragmatism, perioperative nurse, emergency department nurse, intensive care nurse, caring responsibilities

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Associate Professor Diane Chamberlain