Introduction
Presenteeism refers to the professional’s presence in the workplace despite their inability to function correctly. The reasons for inadequate compliance with professional duties may include an illness, work-related burnout, or overall demotivation to work. Thus, organizations experiencing high rates of staff presenteeism often exhibit poorer performance because of staff’s reduced work input. Presenteeism is prevalent in healthcare settings, with medical doctors and nurses inclined to exhibit such workplace behavior due to overload and chronic psychological pressure of the medical profession (Lui et al., 2018). The outcomes of presenteeism are detrimental for healthcare recipients, as it reduces medical teams’ effectiveness, worsens the quality of care, and causes a far-reaching deterioration in staff health.
Nurses working in the operating room are also susceptible to presenteeism, which is very dangerous for patients, as full alertness and involvement in the surgery process determine its outcomes. Therefore, the problem is a pressing one in the medical community, with various strategies developed to address the issue and improve healthcare quality across medical settings. This paper approaches nursing presenteeism from the self-determination theory perspective to see how the latter can inform better staff management and improve staff engagement.
Self-Determination Theory: Description
Self-determination theory (SDT) is a broad theory applied in many organizational settings. It is used to explain human motivation, personality development, and wellness across a continuum from control to autonomy (Ryan & Deci, 2018). The early SDT focused exclusively on individuals’ intrinsic motivation, but it gradually expanded to cover extrinsic motivation variables as well. At present, SDT research relates to life goals, relationship quality, people’s vitality, burnout, and well-being, among other topics (Ryan & Deci, 2019).
The functional approach of SDT is practical for many organizational settings. It clarifies how social and professional contexts should be organized to facilitate the motivation and satisfaction of participants instead of hindering them. SDT offers valuable insights into motivational regulation types and conditions that nurture them, thus informing the practical design of different social contexts, from families to workplaces. As Ryan and Deci (2018) indicated, SDT helps embrace the fundamentals of social and cultural nutrients indispensable in individuals’ healthy psychological and behavioral functioning. Therefore, the theory seems highly relevant to the discussed nursing problem, offering workable tools to enhance nurses’ motivation for meaningful work, dedicated service, and psychological health in the workplace.
Analysis of Self-Determination Theory
Explanations of the diversity of human behaviors and their justifications are at the heart of SDT. The theory sees human behavior as a function of the conscious and unconscious reasons and motives organizing it. Thus, the task of SDT is to analyze the developmental features and social conditions for a specific phenomenon and show how they undermine or promote human motivation and wellness (Ryan & Deci, 2018). In this way, SDT can inform the creation of effective social practices that would focus on high intrinsic and extrinsic motivation, sustained and meaningful staff commitment, and value-driven performance.
The outcomes of a positive change guided by SDT principles are affective commitment and employees’ intrinsic motivation in the workplace. Therefore, SDT can serve as a valuable perspective for dealing with nursing presenteeism in the operating room. However, it is vital to ensure that senior nurses attend to their subordinates’ basic psychological needs in the process of changing their workplace attitudes. These needs include autonomy, competence, and relatedness, which, once satisfied, promise higher levels of intrinsic motivation (Rigby & Ryan, 2018). With better commitment, the perceived value of their high-quality work, and higher intrinsic motivation, nurses in the OR are expected to deliver safer healthcare services to patients.
Theory Evaluation: Efficiency in Targeting Nursing Presenteeism
The SDT framework was already used in the examinations of presenteeism behaviors among healthcare staff. For example, Karanika-Murray and Biron (2019) approached presenteeism as a purposeful and adaptive behavior of nurses to balance health constraints and work demands. The researchers pointed out that the negative impact of presenteeism can be offset in organizations supportive of staff health needs and providing sufficient resources for aid adaptation. Lu and Cooper (2022) examined the presenteeism patterns among Taiwanese nurses and discovered that presenteeism behavior was shaped by work value orientations compensating for resource depletion in the demanding workplace. These insights explain why nurses prefer to attend work despite poor health and what meanings they associate with being present and trying to contribute.
However, to understand whether SDT is applicable in the management of nursing presenteeism in the OR, one should first uncover the causes of presenteeism behaviors. As Homrich et al. (2020) pointed out, presenteeism has several manifestations. They include working beyond the established hours to show commitment to the employer, attending work when ill, and poor performance of nursing duties during the formal shifts. Reasons for attending work when sick are the unwillingness to increase colleagues’ workload, financial problems, and avoidance of laziness labeling or dismissal. Researchers point out that beliefs about the healthy nature of working hard and a desire for evaluation as a strong and committed staff member also drive sick nurses to work (Shan et al., 2021). When applying SDT, one can see that the causes mentioned above are the psychological constructs derived from the social environment, guiding nurses’ intentional behaviors.
On-shift presenteeism is associated with job burnout, a low sense of personal accomplishment, and low job satisfaction. In this way, nurses get into the vicious cycle of facing increasing workload because of underperformance in regular hours, which in turn intensifies exhaustion and burnout. Many nurses sustaining these problems and continuing to attend their workplace as usual complain of sleep and mental health problems, low self-esteem, greater exposure to illnesses, and emotional issues (Mohammadi et al., 2021). SDT can adequately address this problem since it approaches the psychological well-being, commitment, and motivation of people in the workplace, offering workable strategies for improving the environment. Following the principles of SDT, a manager tasked with reducing absenteeism should focus on the social conditions in their employing organization to see how they hinder nursing motivation and wellness (Ryan & Deci, 2018). After that, a profound organizational change with a focus on the change of psychological mediators determining the workers’ presenteeism.
The harms of nursing presenteeism across healthcare settings are pronounced, with numerous stakeholders affected. The outcomes of high presenteeism rates are higher medical costs, lower productivity, higher rates of workplace accidents, and larger-scale financial losses to healthcare organizations (Homrich et al., 2020). The need to provide essential health care in a poor physical and psychological state often leads to grave medical mistakes, as nurses lack attention and concentration in such conditions. In addition, the cost of nurses’ disease rises as they attend work when being sick, as they do not dedicate enough attention to recovery and suffer from complications more often. All these organizational problems can also be effectively tackled with the help of SDT-informed changes.
The core principle of SDT is the importance of autonomy, competence, and relatedness for the person’s development and thriving in personal and professional domains. SDT researchers focus on the biological, social, and cultural conditions where humans can flourish. Rigby and Ryan (2018) acknowledged the potential of self-determination theory in organizations’ efforts to build a culture of high-quality motivation. Therefore, this theory is instrumental in the shift from passive or controlled compliance with the organization’s policies toward personal valuing and intrinsic interest in one’s professional duties.
Conclusion
As one can see from the presented evidence, the SDT is a helpful perspective for approaching nursing absenteeism in the operating rooms. The analysis of nurses’ rationale for continuing to work when sick or exhausted shows that such decisions are detrimental to patient outcomes and healthcare quality. Yet, they are determined by the institutional policies and social conditions in which nurses work, serving as psychological mediators of nurses’ motivational orientations. SBT claims that the desired behavioral outcomes can be easily achieved by appealing to people’s motives, goals, and expectations in the workplace. This effect is attainable with changes in the proximal features of social environments in which nurses operate. In practice, this can be a policy change toward a stronger focus on staff health and productivity instead of presence. Therefore, nurses can shift their psychological perceptions from rigid compliance with institutional norms to self-care and intrinsic commitment to high-quality care delivery.
References
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