Job Stress and Presenteeism Among Nurses in Tertiary Level Hospitals, the Islamic Republic of Pakistan

  • Lachman Das Malhi Clinical Instructor, School of Nursing Mirpurkhas, Pakistan
  • ฐิติณัฏฐ์ อัคคะเดชอนันต์ Correspondent author, Assistant Professor, Faculty of Nursing, Chiang Mai University, Thailand
  • สมใจ ศิระกมล Assistant Professor, Faculty of Nursing, Chiang Mai University
Keywords: Job stress, presenteeism, nurse, tertiary care hospital, Pakistan


Presenteeism among nurses is the designation to attend work while sick, and is a vital issue for nurse administrators to focus.  This descriptive correlational study aimed to explore the level of job stress and presenteeism as perceived by nurses, and to explore the relationship between overall job stress and overall presenteeism among nurses in tertiary care hospitals, the Islamic Republic of Pakistan. The subjects were 282 nurses working in three tertiary care hospitals in the Islamic Republic of Pakistan. Data collection was carried out from February to March, 2016. The research instruments included the Expanded Nursing Stress Scale (ENSS) and the Stanford Presenteeism Scale-6 (SPS-6). The ENSS and the SPS-6 were confirmed for validity by the developers. The reliability coefficients of the ENSS and SPS-6 were 0.80. Descriptive statistics and Spearman’s rank-order correlation coefficient were used to analyze the data.

          The results of this study showed as follows:

  1. The mean score of overall job stress and the nine dimensions of job stress as perceived by nurses were at a moderate level.
  2. The mean score of overall presenteeism and the two dimensions of presenteeism included completing work and avoiding distraction as perceived by nurses were at a high level.
  3. There was no relationship between overall job stress and overall presenteeism among the nurses.

               The results of this study provide baseline information for hospital and nursing administrators in order to design strategies to reduce job stress and to manage presenteeism among nurses in tertiary care hospitals in the Islamic Republic of Pakistan.


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Anis-ul-Haq, M., & Sohail, T. (1997). Stress, social support, and burnout in nurses. Pakistan
Journal of Psychological Research. 12(3/4) 77-86.
Aronsson, G., & Gustafsson, K. (2005). ‘Sickness presenteeism: prevalence,
attendance-pressure factors and an outline of a model for research.’ Journal of Occupational and Environmental Medicine, 47(9), 958–966.
Bahalkani, H.A., Kumar, R., Lakho, A.R., Mahar, B., Mazhar, S.B., & Majeed, A.
(2011). Job satisfaction in nurses working in tertiary level health care settings of Islamabad, Pakistan. J Ayub Med Coll Abbottabad, 23(3) 130-133.
Benefits Canada. (2015). Employees more aware of workplace presenteeism than
employers. [Online] Retrieved from:
Brborovic, H., Brborovic, O., Brumen, V., Pavlekovic, G. & Mustajbegovic, J. (2014).
Are nurse presenteeism and patient safety culture associated: a cross-sectional study. Arh Hig Rada Toksikol, 65, 149-156. doi: 10.2478/10004-1254-65-2014-2462
Burns, N., & Grove, S.K. (2011). Understanding Nursing Research: Building an
Evidence- Based Practice. (5th.ed). USA: Saunders Elsevier Inc.
Burns & Grove, S.K. (2005). The practice of Nursing research: appraisal, synthesis
and generation of evidence. USA: Saunders, Elsevier Inc.
Clegg, A. (2001). Occupational stress in nursing: a review of literature. J Nurs Manag,
9(2) 101-106.
Demerouti, E., Blanc, P. M. L., Bakker, A.B., Schaufeli, W.B., Hox, J. (2009). Present
but sick: a three wave study on job demands, presenteeism and burnout. Career Development International, 14(1) 50 – 68.

Disease Management Association of America [DMAA]. (2009). Outcomes Guidelines
Report. Vol. 4. Washington, DC: DMAA: The Care Continuum Alliance, Inc.
Econtech. (2011). Update: Economic Modelling of the Cost of Presenteeism in Australia.
KPMG: Medibank Private.
Elstad, J.I., Vabo, M. (2008). Job stress, sickness absence and sickness presenteeism in
Nordic elderly care. Scand J Public Health, 36(5), 467-474.
French, S.E., Lenton, R., Walters, V., Eyles, J. (2000). An empirical evaluation of an
Expanded Nursing Stress Scale. Journal of Nursing Measurement, 8(2), 161-178.
Gray-Toft, P.A. & Anderson, J. (1981). The Nursing Stress Scale: Development of an
instrument. Journal of Behavioral Assessment, 3, 11–23.
Golbasi, Z., Kelleci, M. & Dogan, S. (2008). Relationships between coping strategies,
individual characteristics and job satisfaction in a sample of hospital nurses: Cross-sectional questionnaire survey. International Journal of Nursing Studies, 45,
Gul, R. (2008). The Image of Nursing from Nurses’ and Non-Nurses’ Perspective in
Pakistan. The Silence Voice, 1(2), 4-17.
Hafner, M., Stolk, C., Saunders, C., Krapels, J., & Baruch, B. (2015). Health, wellbeing
and productivity in the workplace: A Britain’s Healthiest Company Report. UK: RAND Corporation.
Hemp, P. (2004). Presenteeism: At work—But out of it. Harvard Business Review, 82, 49-58.
Jodas, D. A., Hadadd, M.C.L. (2009). Burnout syndrome in nursing workers of a
university hospital. Acta Paul Enferm, 22(2), 192-197.
Johns, G. (2010). Presenteeism in the workplace: A review and research agenda. J
Organiz Behav, 31, 519–542.
Khan, S.B., Hafizullah, M., Gul, A.M., et al. (2012). Frequency of coronary heart
disease risk factors among nurses. Journal of Postgraduate Medical Institute, 26(4), 377-385.
Khuwaja, H.M.A. (2013). Nursing Shortage in Pakistan – Human Resource
Management in Health Systems: JPMS International Medical Writing Context. Journal of Pioneering Medical Sciences Blog. [Online] Retrieved from

Koopman, C., Pelletier, K. R., Murray, J. F., Sharda, C. E., Berger, M. L., Turpin, R. S.,
et al. (2002). Stanford Presenteeism Scale: Health status and employee productivity. Journal of Epidemiology and Community Health, 44, 14–20.
Kumar, R., Ahmed, J., Shaikh, B.T., Hafeez, R., & Hafeez, A. (2013). Job satisfaction
among public health professionals working in public sector: a cross sectional study from Pakistan, Hum Resour Health, 11(2) 1-5. doi: 10.1186/1478-4491-11-2.
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal and Coping. New York, NY:
Springer Publication Co.
Leung-Chun, L. (2013). Job satisfaction and stress of nurses and their association with
turnover intention rate in Pamela Youde Nethersole Eastern Hospital Hong Kong. [Online] (Unpublished Thesis). Master of Public Health, The University of Hong Kong. Hong Kong. Retrieved from
Mandiracioglu, A., Bolukbas, O., Demirel, M., & Gumeli, F. (2015). Factors related to
presenteeism among employees of the private sector. International Journal of Occupational Safety and Ergonomics (JOSE), 21(1) 80–85.
Meghani, S.T., Sehar, S & Punjani, N.S. (2014). Comparison and analysis of health care
delivery system: Pakistan versus China. International Journal of Endorsing Health Science Research, 2(1), 46-50.
Moustaka, Åleni, Constantinidis, & Theodoros C. (2010). Sources and effects of work-
related stress in nursing. Health Science Journal, 4(4), p210.
National Management Consultants. (2006). Pre-Feasibility Study for Tertiary Hospital in Major
Cities of Pakistan. Employment and Research Section, Planning and Development Division, Government of Pakistan, Islamabad.

Pakistan Nursing Council (PNC) (1999). Job description of all categories of
Nursing Personnel’s. P.N.C. Islamabad.
Primo, G.M.G., Pine, T.M.M., & Sakurai, E. (2007). Absenteeism in health work:
related Factors. Rev Med Minas Gerais, 17(4) S260 –S268.
Schaufeli, W.B., & Bakker, A. B. (2004). Job demands, job sources, and their relationships
with burnout and engagement; A multi-sample study. Journal of Organizational Behavior, 25, 293-315.
Sutherland, V., & Cooper, C. (1990). Understanding Stress: A Psychological
Perspective for health professionals. London, UK: Chapman & Hall.
Umann, J., Guido, L.A. & Grazziano, E.S. (2012). Presenteeism in hospital nurses. Rev
Latino-Am Enfermagem, 20(1), 159-166.
Wan, H.C., Downey, L.A., & Stough, C. (2014). Understanding non-work
presenteeism: Relationships between emotional intelligence, boredom, procrastination and job stress. Personality and Individual Differences, 65, 86–90.
Yamane, T. (1973). Statistics: An introductory analysis. (3rd ed.). New York:
Harper & Row.
Yang, T., Shen, Yu-Ming., Zhu, M., Liu, Y., Deng, J., Chen, Q., & See, Lai-Chu. (2016). Effects of
Co-Worker and Supervisor Support on Job Stress and Presenteeism in an Aging Workforce: A Structural Equation Modelling Approach. Int J Environ Res Public Health, 13(1), 72. doi:10.3390/ijerph13010072