Abstract:
Background: Absenteeism and turnover among healthcare workers have a significant
impact on overall healthcare system performance. The literature captures variables from
different levels of measurement and analysis as being associated with attendance behavior
among nurses. Yet, it remains unclear how variables from different contextual levels
interact to impact nurses’ attendance behaviors.
Objectives: The purpose of this review is to develop an integrative multilevel framework
that optimizes our understanding of absenteeism and turnover among nurses in hospital
settings.
Methods: We therefore systematically examine English-only studies retrieved from two
major databases, PubMed and CINAHL Plus and published between January, 2007 and
January, 2013 (inclusive).
Findings: Our review led to the identification of 7619 articles out of which 41 matched the
inclusion criteria. The analysis yielded a total of 91 antecedent variables and 12 outcome
variables for turnover, and 29 antecedent variables and 9 outcome variables for
absenteeism. The various manifested variables were analyzed using content analysis and
grouped into 11 categories, and further into five main factors: Job, Organization,
Individual, National and inTerpersonal (JOINT). Thus, we propose the JOINT multilevel
conceptual model for investigating absenteeism and turnover among nurses.
Conclusions: The JOINT model can be adapted by researchers for fitting their hypothesized
multilevel relationships. It can also be used by nursing managers as a lens for holistically
managing nurses’ attendance behaviors.
