The problem with presenteeism in the NHS, and why it can’t be ignored

The subject of presenteesim within the NHS is perhaps something that’s been overlooked in recent months; with all NHS staff working tirelessly to protect the public, it’s now become common place to hear stories of doctors, nurses and locums working far beyond their regular hours – all in the name of keeping us all safe.

However, this remarkable sense of duty – whilst truly admirable – is perhaps highlighting just how much pressure our NHS heroes are enduring. In December 2020, the public service union UNISON highlighted that the combination of regular winter pressures and the ongoing Coronavirus pandemic are causing NHS staff to burn out under the current workloads. In addition, they also urged all NHS trusts to explore every option to avoid simply making healthcare workers do further shifts – which included calling on the thousands of former NHS staff who already came forward to offer their services during the first Covid-19 wave.

Whilst we are seeing the effects of the 2021 lockdown bringing cases down and vaccination rates climbing, NHS hospitals and medical facilities are still fighting an ongoing war on two fronts: that of Covid-19, and the continuation of normal operations and elective care services. Even with the unprecedented vaccine roll out, the pressures on the NHS are not going to be alleviated any time soon. This means that NHS staff will continue to be heavily relied upon, and this could be hiding a potentially damaging culture of presenteeism

Why is Presenteeism so damaging?

With NHS trusts under pressure to meet their patient care targets and deliver exceptional levels of patient care, they need to have active, positive and productive workforces to support them doing just that. Of course, all NHS staff strive to do just that; often going above and beyond the call of duty in the aid of delivering that crucial patient care – taking on extra shifts, staying later most days, or arriving earlier to ensure smooth handovers.

The problem is, is that whilst devoting more time to the cause is certainly helping the NHS with its’ workloads, if left unchecked, it can start to negatively affect a person’s work-life balance. It is perhaps our health workers’ amazing sense of duty and willingness to help others that can lead to presenteeism, and whilst it often starts with the best of intentions, it can –if left unchecked – contribute towards lower productivity, lower levels of morale and lack of staff engagement.

The importance of switching off

In any organisation, those issues could be problematic; but in the NHS, a workforce suffering from presenteeism can lead to far more serious problems; including:

• Increased likelihood of work-based mistakes that can impact patient care
• Physical and mental exhaustion
• Increased mental stress
• Workplace sickness epidemics
• Longer illness recover times

The fact of the matter is that presenteeism isn’t a recent phenomenon brought on by recent events; it’s something that the NHS and frontline staff have always been prone to. For example, in 2018 the Royal College of Nursing (RCN) stated that NHS nurses were experiencing ‘unprecedented’ stress levels and resulting ill health owing to overwork and staff cuts. A total of 82% of the nurses responding to an RCN questionnaire said they attended work while ill – and more than half of the respondents cited work-related stress as being among the causes of their illnesses.

Given those statistics, and the fact that both doctors and nurses are critical assets to every single NHS trusts,  it’s clear that the problem of presenteeism has the potential to get a lot worse over the coming weeks and months. Whilst always having a full roster of substantive NHS staff may seem beneficial on paper, it may actually be hiding a problem in plain sight – so, it’s critical that NHS staff support both each other and themselves to maintain all-important positive wellbeing and avoid falling into the trap of presenteeism.

Recognising the warning signs

There are some key indications which staff managers can look out for if they think that presenteeism is beginning to affect members of their staff; these include:

• Making more mistakes than usual – Making mistakes is of course human; but if normally conscientious members of staff begin making basic errors, it could be a sign of mental exhaustion.
• Producing work of a low standard – this could include making consistent mistakes on patient charting or reports.
• Low productivity – if their duties are beginning to take longer than usual, it may because they have become physically and mentally stressed and need a rest.
• Lack of care about results – this could include a lack of empathy with patients, to becoming completely cut off from their wellbeing entirely.
• Arriving late or leaving early – this could be an indication of their sleeping patterns having been negatively impacted by their workloads
• Missing lunch breaks or working longer hours – Consistently missing break times or working beyond normal hours can have a cumulatively negative effect on a person’s wellbeing
• Working whilst sick – Cornanvirus symptoms-aside, if someone is clearly unwell, they should take time off to recuperate and protect others from illness, too.
• Looking tired or exhausted – If this is becoming the norm rather than the exception, the member of staff may be more tired than they are letting on.

Our healthcare workers have truly shown what amazing individuals they are over the past year, and for that reason, we owe it to them to know the warning signs of unbalanced work and home life – and provide all the support they may need.