Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Outcomes and Policy Research

Research Advisor

Shelley I. White-Means, PhD


Cyril Chang, PhD Dick R. Gourley, PharmD Muriel C. Rice, RN, PhD Mona N. Wicks, RN, PhD


diverse workforce, health workforce, nurses, pharmacists, presenteeism, productivity


The complex phenomenon of presenteeism is an undesirable health outcome that occurs when employees remain present on-the-job with lowered work productivity caused by personal health conditions. The cost burden of presenteeism in healthcare professionals has been under-explored and the cost burden of presenteeism across racial and ethnic minority employees has been un-explored. Aims of this research were to describe presenteeism and its cost burden among nurses and pharmacists and to determine distinctness of differences across racial/ethnic groups within these professions. In exploring presenteeism, the focus was on recognizing it, characterizing it, and measuring it. In monetizing presenteeism, its costs burden from the perspective of the employer was determined at the broader workforce level.

This analytical study entailed an on-line survey of a cross-sectional, convenience sample of 226 nurses and pharmacist stratified by race and ethnicity (23% minorities and 77% non-minorities). Wellness-at-Work, a patient reported outcomes (PRO) tool that adopted presenteeism scales from two well established presenteeism surveys were administered. Contingency tables using Chi-square tests established association or differences by profession or race. Ordinal logistic regression modeled 12 predictors of presenteeism and the human capital approach determined cost burden.

Over half, 52.65%, of the sample (226) reported experiencing presenteeism -- 47.06% nurses and 52.94% pharmacists. Mean rate of reported presenteeism was 13.2%. Presenteeism was the driver of annual lost productivity valued at $12,700 per nurse or pharmacist, a workforce value of $2.6 million loss. The likelihood of presenteeism increased 22.4% if professionals suffered physical health symptoms, increased 22.5% if they suffered mental health conditions, decreased 34% if their physical and mental health conditions were never treated by pharmacotherapy, and decreased 29% if their mental or physical health conditions were previously treated by pharmacotherapy (but not currently treated). Both professions had significant self-reported mental health conditions and physical health symptoms. Physical health symptoms significantly associated with presenteeism were: feeling tired or no energy; back or neck pain; pain in arms, legs, joints; watery eyes, runny nose or stuffy head; trouble sleeping; headaches; muscle soreness; cough or sore throat; fever, chills, or other cold/flu; constipation, loose bowels, or diarrhea; and nausea, gas, or indigestion. Depression and anxiety were more prevalent conditions than the common cold or flu symptoms in these knowledge-based professions and mental health conditions were a significant predictor of presenteeism.

Rates of presenteeism between racial and ethnic non-minority and minority groups and rates between nurses and pharmacists were not found to be significantly different (p=.5774 and p=0.4282 respectively). Of note is that rates of presenteeism for racial ethnic minorities were slightly lower than non-minorities, but not statistically significantly so. The imperative for individual health care employers was to address workforce cost burden by being the catalyst for developing creative practice models and changing health policies.