Presenteeism, health-related productivity loss, burnout, quality of nursing care, and retention intention among nurses: a structural equation modeling study

Abstract

Background The interrelationships between presenteeism, health-related productivity loss, burnout, quality of nursing care, and retention intention remain insufficiently understood in nursing populations. Objective This study examined the associations between presenteeism, health-related productivity loss, burnout, quality of nursing care, and retention intention. Methods A cross-sectional survey was conducted involving 511 nurses. Composite scores from the Work Productivity and Activity Impairment (WPAI) questionnaire, the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), the Quality of Nursing Care Tool, and the Nurse Retention Intention Scale were analyzed using an observed-composite path structural equation modeling (SEM) approach. Indirect effects were estimated using 5,000 bootstrap resamples with percentile-based 95% confidence intervals. Results Presenteeism was positively associated with burnout (β = 0.262, p < 0.001) and negatively associated with the quality of nursing care (β = −0.250, p < 0.001) and retention intention (β = −0.334, p < 0.001). Burnout was negatively associated with the quality of nursing care (β = −0.177, p < 0.001) and retention intention (β = −0.179, p < 0.001). Bootstrap analyses indicated indirect associations between presenteeism and productivity loss and both outcomes through burnout. The model showed an acceptable but imperfect fit: χ2 (4) = 13.151, CFI = 0.959, TLI = 0.877, RMSEA = 0.067, and SRMR = 0.043. Conclusion Higher presenteeism was statistically associated with lower retention intention and poorer nursing care quality, both directly and indirectly, through burnout. Health-related productivity loss showed indirect associations with both outcomes through burnout.