We Missed You

We Missed You

OCTOBER 1985, VOL 42, NO 4 AORN JOURNAL We Missed You A PROGRAM TO CONTROL ABSENTEEISM Dorothy M. Lupascu, RN W hen planning for cost-effective st...

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OCTOBER 1985, VOL 42, NO 4




hen planning for cost-effective staffing patterns, supervisorsmust not overlook the economic implications of staff absenteeism and tardiness. Absence from work, whether due to excessive sickness, tardiness, or extended breaks and lunch periods, costs money and decreases productivity. The effective supervisor must not merely react to the problem with short-sighted solutions, such as hiring additional staff, pulling staff from other areas, or working short staffed: he/she must control the problem. This article describes the magnitude of the absenteeism problem in the OR and proposes a program to help control it.

The Problem


raditional sick leave policies may encourage employees to take sick leave unnecessarily.’ These policies may lead to a complacent attitude about absenteeism; employees are expected to be absent from time to time. Sometimes employees take paid sick days at will as extra vacation time. Recently I overheard an employee remark to a group of fellow employees, “I almost called in sick today.” He obviously was

Dorothy M. Lupascu, RN, EdD, ii the director of staff education/professional development at The Lutheran Hospital of Fort Wayne, Inc, I d She earned her doctorate at the International Graduate School in St Louis, and her master’s in education from Kent State Universig, Ohio. Her bachelor’sof nursing iifrom villa Maria College, and her diploma in nursing is from H m o t Hospital School of Nursing, both in Erie, Penn 538

not ill and had been considering taking the day off as an added benefit. Unfortunately, this attitude is often shared and condoned by supervisors and employees. Paid sick time is a benefit to assist workers when they are ill and cannot work. Supervisors who regard paid sick time as extra vacation due the employee are not promoting maximum productivity. The economic effects of absenteeism become significant in the OR considering the cost of building, equipping, and operating the surgical suites. In the OR, employees are highly trained specialists and usually limited in number. This increases the consequences of absenteeism and tardiness because when one employee is absent another usually works overtime. Employees who carry the load may become fatigued, and then, they also will be calling in ill. If this cycle continues, the problem becomes more difficult to remedy. One midwestem hospital employing 120 people had an annual cost of approximately $41,000 for sick leave payments.* Hospitals cannot afford this inefficiency. A 4% absentee rate is considered a serious problem because it means that for every 25 employees in the organization, one additional employee must be on the payroll to provide the necessary co~erage.~ If an organization employs 1,000 people and has an absenteeism rate of 4% an additional 40 people would be needed to cover for those missing. The following formula can be used to compute an absenteeism rate: number of days lost through absence x 100, divided by the average number of employees x

OCTOBER 1985. VOL 42. NO 4


Fig 1

Suggested Absenteeism Record

Hospital Department “WeMksed You” (name of person calling in) to say (name of employee absent or tardy)

called at (time)

on (date)

would be absent because of

took the call and recorded this message. (name of person taking call) “We Are Glad You Are Back” Since your work load could not be adequately done by another employee without significant cost to the hospital, we are glad you have returned: Doctor’s order to return to work yes no NA Confirmation of the above reason for absence: (Comments)

Are there any complications/limitations/lingeringeffects. Please explain. Employee’s signature Supervisor’s signature Date number of working days = the absenteeism rate.4 Using this formula for 30 employees, 22 working days and 30 absent days (all but three employees took one day off that month), the result would be the following: 27 loo = 2.700= 4% absenteeism rate. 30x22= 660 Absenteeism in the OR affects employees within the same job classification as well as patients,

surgeons, and other hospital staff. Delayed or cancelled surgery schedules may result from absent employees. This not only causes stress and anxiety for patients and their families, but it also affects the schedules of anesthesiologists, surgeons, and recovery room personnel who plan their day to allow for quality patient care preoperatively, intraoperatively,and postoperatively. Preoperative medication requirements have to be altered and 539


OCTOBER 1985, VOL 42, NO 4

Fig 2

Employee Attendance Record Name Birthdate

Year 19 --to 19 Anniversary Date -

additional physical and emotional care becomes necessary. For the surgeon, the delay may mean changes in ofice schedules, which affects even more patients. Each supervisor is responsible for setting and enforcing attendance standards. Components of an effective absenteeism control program include, but are not limittd to, a written policy, a recordkeeping system, motivational programs, and welldocumented counseling and disciplinary procedures?

The Program


n effective program starts with a written policy that defines absence and advises the employee how to call in ill. The policy


Position Vacation Time Due ~



_ D a_y s / H o u r s

should also address how absences will be documented and what requirements need to be met before the employee returns to work. Some hospitals require a written release from a physician when an employee has been ill for a certain period of time or has been hospitalized. Records. A comprehensive record-keeping system includes forms for recording absence calls, monthly calendars to indicate patterns of absenteeism, and a method for documentating sick time on the employee’s performance appraisal. A form establishes written documentation of sick calls received. Fig 1 records the original call and the follow-up meeting with .the supervisor when the employee returns to work. If an employee knows he will talk directly with his supervisor when he returns to work, he may not


OCTOBER 1985, VOL 42, NO 4


Some hospitals have had success with motivation programs such as attendance lotteries, wellness pay, cash rewards. misuse sick leave benefits. A call should be required for each day of illness unless it is long term (usually more than four consecutive work days). The second portion of the form in Fig 1“We are glad you are back‘-verifies the reason for absence. Documentation should also include a way to identify patterns such as calling in ill before or after a weekend, holiday, or a regularly scheduled day off (Fig 2). If such a pattern becomes apparent the effective supervisor begins counseling sessions. Motivation, Some hospitals have had success with motivation programs such as attendance lotteries, wellness pay, and cash rewards for good attendance. However, the most effective and least costly motivation comes from the supervisor. If the supervisor can enhance job satisfaction, the employee is less likely to call in sick unnecessarily. Supervisors can contribute to job satisfaction by recognizing good performance and documenting it in their personnel file. Encouraging esprit de corps with team projects also helps. Flexible work schedules, such as the 10-hour day/four-day work week, may be motivational for some. Counseling and dkcipline. Every supervisor will eventually need to counsel an employee for absenteeism or tardiness. This is no easy task. Sometimes it appears easier to allow such behavior to continue rather than counsel the employee. Ignoring the problem, however, could cause a proliferation of the problem and a more difficult counseling situation. If the supervisor strives for open and honest communication in everyday workings, then counseling will be based on a preestablished mutual trusting relationship. Counseling is never easy, but focusing on the problem behavior and using only welldocumented facts will make it less difficult for both the supervisor and the employee. A counseling session that focuses on personality and hearsay is unfair, illegal, and could be cause for successful grievance proceedings. 544

Because employee and supervisor might experience negative emotions during a counseling session, the supervisor must remember to remain calm and not argue with the employee. The employee might be defensive and use denial, projection, or rationalization to excuse his behavior; the supervisor might feel guilty and see himself as the cause of someone else’s grief. If the problem behavior is dealt with objectively, such emotions may be lessened. When motivation and counseling efforts do not correct the problem, effective and fair administration of discipline is appropriate. Although a negative motivator, discipline causes the employee to either change his behavior or be subject to termination. Progressive disciplinary measures should be started with administrative approval and should always follow the institution’s employee policies. Documentation of the discipline should include: a list of days absent in the past year, a reference to all counseling sessions, future steps to be taken, a statement of what will be considered satisfactory attendance, a written warning, and a date for a follow-up meeting. Every disciplinary action has legal implications. The employee has a right against unjust termination; the employer has a right to correct employees’ problem behaviors. To avoid unnecessary grievance procedures, the supervisor must follow policy, treat everyone equally, and respect employees’ privacy. In 1977, the Privacy Protection Study Commission recommended a policy that provides employees access to records relating to their qualifications for employment, promotion, pay raises, or records resulting in discipline and discharge? Knowing that an employee has the right to read any written notes placed in his file should make the supervisor more aware of the


need to be objective in documenting behaviors. If any part of the documentation is proven inaccurate, the supervisor’s credibility is in question. This lack of credibility could then cause the supervisor to lose in a grievance procedure. Another federal law, the Uniform Guidelines for Employee Selection, which applies to employee salary or promotion decisions, states that if a raise or promotion has been denied for factors unrelated to performance, the supervisor could be charged with unlawful dis~rimination.~ Therefore, absenteeism should be correlated as a performance problem; it would be more difficult to dispute discipline for performance problems than with attendance problems. 0 Notes 1. R E Kopelman, G 0 Schweller IV, J J Silver Jr,

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“Parkinson’s law and absenteeism: A program to rein in sick leave costs,” Personnel Adminfitrator 26 (May 1981) 57-63. 2. B H Harvey, “Two alternatives to traditional sick leave programs,” Personnel Journal 62 (May 1983) 374-378. 3. S E Oberman, G P Rainer, “Effective control of absenteeism,” Health Care Supervzior (April 1983) 1730. 4. U S Department of Labor,Suggestionsfor control of turnover and absenteeism, 1972,20. 5. R J Bula, “Keeping all staff present and accounted for,” Nursing Management 15 (September 1984) 38A38H. 6. R J Wells, “Guidelines for effective and defensible performance appraisal systems,” Personnel Journal 6 1 (October 1982) 78 1. 7. J G Goodale, M W Mouser, “Developing and auditing a merit pay system,” Personnel Journal 60 (May 1981) 391.

Physicians Have Public Image Problems At a recent meeting of the American Medical Association delegates, the physicians learned that their public image was getting worse instead of better. A random telephone survey of 1,500 adults and 1,000 physicians showed that while the adults did not question the physicians’ knowledge, they were dissatisfied with physicians’ fees, interest in patients, and explanations. In 1984, 27% of the public thought physicians’ fees were reasonable compared to 42% in 1982. The percentage of people who thought physicians took a genuine interest in their patients dropped from 68% in 1982 to 62% in 1984. There was an 11% drop in the number of people who thought physicians explained things well to their patients from 1982 to 1984. The respondents were more complimentary to their personal physicians though. The survey also showed increasing public support for professional liability system reform. The reform measure with the greatest support was limiting the amount of money that could be awarded to a plaintiff who sued a physician for malpractice. This was needed because plaintiffs are “just looking for an easy way to make money,” according to 44% of the adult respond546

ents, and juries award too much money to plaintiffs, according to 41% of the respondents. Survey findings were reported in the July 5 American Medical News.

Sclera Perforation with Laser Reported The first report of complete perforation of the sclera in a living human eye with the use of a laser alone is described in the June issue of Archives of Ophthalmology. The neodymium-YAG laser was used by Wayne F. March, MD, and colleagues from the University of Oklahoma College of Medicine, Oklahoma City, to test the safety of a one-step filtering procedure in an eye undergoing enucleation to remove a malignant tumor. The procedure may prove effective in relieving intraocular eye pressure caused by glaucoma. “Although this study was too short-term to make any long-range predictions, the creation of a permanent filtering fstula seems more probable than with previous nonperforating procedures,” said the researchers.