Abstract
Objective
To explore the mediating effect of work stress and the moderating effect of mindfulness between team presenteeism atmosphere and presenteeism among ICU nurses.
Methods
A cross-sectional survey was conducted among 224 ICU nurses from 8 hospitals in Chongqing, China. The Stanford presenteeism scale-6, team presenteeism atmosphere questionnaire, nurse work stressor scale, mindfulness attention awareness scale, and general information questionnaire were used to investigate.
Results
The score of ICU nurses presenteeism was 13.964 ± 5.695, the score of team presenteeism atmosphere was 16.857 ± 3.553, the score of work stress was 82.219 ± 20.734, and the score of mindfulness was 63.446 ± 11.884. Team presenteeism atmosphere and work stress were positively correlated with ICU nurses’ presenteeism (r = 0.361, r = 0.367, Ps < 0.001). Mindfulness was significantly negatively correlated with team presenteeism atmosphere, work stress, and presenteeism (r = -0.324, r = -0.383, r = -0.340, Ps < 0.001). Bootstrap analysis showed that team presenteeism atmosphere significantly positively predicted work stress and ICU nurses’ presenteeism (standardized β = 0.485, standardized β = 0.228, Ps < 0.001), and work stress significantly positively predicted presenteeism (standardized β = 0.245, P < 0.001). Work stress partially mediated between team presenteeism atmosphere and ICU nurses’ presenteeism, and the mediating effect accounted for 34.237% of the total effect size. Mindfulness significantly negatively moderated the relationship between work stress and presenteeism (ΔR2 = 0.019, P = 0.023).
Conclusion
Teamwork atmosphere, work stress, and mindfulness affect ICU nurses’ presenteeism. These findings suggest that ICU nurses’ presenteeism can be reduced by improving the teamwork atmosphere and nurses’ mindfulness level.
Trial registration
Not applicable.
Keywords: Intensive care unit, Nurses, Presenteeism, Work stress, Mindfulness, Mediation effect, Moderating effect
Introduction
Nurses are currently facing unprecedented challenges in their work, which stem not only from the heavy workload but also from their pursuit of higher levels of professional development and concerns about job stability. In this context, many nurses persist in working even when they are physically unwell, a phenomenon known as presenteeism [1, 2]. Meta-analysis results indicate that the global rate of presenteeism among nurses is 49.2%, higher than in other professions [3]. Intensive Care Unit (ICU), is one of the busiest and most stressful departments in the hospital, and ICU nurses experience more pronounced physical health impairments, emotional disorders, and resignation intentions [4, 5], making them a high-risk group for presenteeism. A survey conducted on 10,758 nurses from 46 hospitals in China found that ICU nurses had the most severe presenteeism issues [6]. The high rate of presenteeism among ICU nurses can not only raise turnover and burnout rates but also productivity loss [7]. Studies show that the labor productivity loss rate due to presenteeism among Chinese nurses within six months is 32.9%, and the unproductive time caused by presenteeism is 22 times that required for sick leave [8]. Moreover, it can cause productivity and economic losses to organizations and society [1].Studies indicate that the annual economic cost of nurse presenteeism behavior as much as $1,959 [9]. Crucially, presenteeism can compromise patient safety by causing distracted attention and slow reactions among unwell ICU nurses [10].
Researchers have developed several theoretical models to understand presenteeism. Based on Johns Gary’s “A dynamic model of presenteeism and absenteeism” [11], Hou W proposed “The Formation and Reaction Model of Presenteeism” in 2018 targeting nurses [12]. This model suggests that health events, organizational situational factors, and personal factors influence the occurrence of nurse presenteeism (Fig. 1). Health events, which refer to illness episodes, serve as a necessary condition for presenteeism, whereas contextual and individual factors play critical roles in shaping nurses’ decisions between presenteeism and absenteeism following a health event. Although a survey involving 1,023 healthcare workers confirmed that these three factors significantly affect presenteeism among medical staff, there is currently no empirical evidence examining the specific pathways through which contextual and individual factors contribute to the development of presenteeism among ICU nurses. This gap makes it challenging to identify precise intervention targets for ICU nurses’ presenteeism, thereby complicating the formulation of effective, targeted interventions [12].
Fig. 1.
The formation and reaction model of presenteeism
Regarding contextual factors, nurses take sick leave and the team’s attitude/atmosphere towards sick leave are key factors in organizational situational factors of the model, that is, nurse presenteeism is closely related to the team presenteeism atmosphere [13]. The complex leave application process and strict leadership may make nurses feel that enduring the adverse consequences of presenteeism is easier than choosing to take leave, leading to the occurrence of presenteeism. Moreover, a severe team presenteeism atmosphere may also damage team cooperation and communication, further increasing the work pressure on ICU nurses, thereby indirectly leading to the occurrence of presenteeism [6]. In Eastern cultures, collective obedience is particularly pronounced among ICU nurses, whose team-based work is highly influential. It can be inferred that the team’s presenteeism atmosphere can directly lead to the occurrence of ICU nurses’ presenteeism and indirectly lead to presenteeism by affecting the level of work pressure.
On the individual level, work stress is the most prominent characteristic among ICU nurses. High work pressure, stemming from caring for critically ill patients, can lead to physical discomfort, burnout, and anxiety, further driving presenteeism. However, the level of mindfulness is significantly negatively correlated with nurse presenteeism [14]. Beyond risk factors, protective factors also exist at the individual level. Research indicates that mindfulness is significantly negatively correlated with nurses’ presenteeism. Mindfulness, as a positive psychological state, enables individuals to better cope with stress and adversity. Studies have shown that enhancing nurses’ mindfulness can effectively reduce occupational burnout and boost personal achievement [15], while other research has demonstrated that increasing mindfulness among ICU nurses can reduce their work stress scores by 28.5% [16]. Thus, As a positive psychological state, it is negatively correlated with nurse presenteeism and can mitigate the effects of work pressure and job burnout, thus reducing the likelihood of presenteeism. It can be inferred that mindfulness can reduce the occurrence of presenteeism by weakening the effects of risk factors for nurse presenteeism.
To sum up, previous studies have indeed identified that team-level contextual factors and individual factors are associated with presenteeism among healthcare workers. However, there is still a lack of empirical studies that delve into how these factors exert their influence—specifically, the underlying mechanisms through which they affect presenteeism among ICU nurses. When exploring the mechanism of ICU nurse presenteeism, consider that the team’s presenteeism atmosphere can directly affect presenteeism and can also indirectly affect presenteeism by affecting the level of work pressure. However, mindfulness can weaken the positive connection between team presenteeism atmosphere, work pressure, and presenteeism. Our study hypothesizes that the team’s presenteeism atmosphere is the independent variable, with work pressure playing a mediating role and mindfulness playing a moderating role. Therefore, this study aims to investigate the current situation of presenteeism among ICU nurses, deeply explore the pathways through which the team’s presenteeism atmosphere affects ICU nurse presenteeism, find the key targets for intervention of ICU nurse presenteeism, and provide a basis for nursing managers to carry out subsequent targeted interventions.
Methods
Study design, participants, and data collection
This cross-sectional survey was implemented across eight grade III A hospitals located in Chongqing, China from April 1 2023 to April 8 2023. The Grade IIIA hospital is defined as a medical and preventive technology center with comprehensive capabilities in medical care, education, and scientific research, representing an advanced level of healthcare and aiming to provide the highest quality medical services in the region. Convenience sampling was used to recruit ICU nurses, with the inclusion criteria as follows: (1) registered ICU nurses currently employed, (2) at least one year of ICU work experience, (3) continued employment in the ICU during the study period and (4) voluntary participation in the study. The exclusion criteria encompassed nurses in further training, undergoing standardized training, or rotation, and those with significant physical or mental health conditions affecting work efficiency. Based on the empirical sampling method, the sample size is at least 20 times of the estimated parameter [17]. This study estimated five variables of SPS, team presenteeism, work stress, mindfulness, occupational exposure, and workplace violence, which would require a total of at least 100 ICU nurses, and 244 ICU nurses included in this study.
This study adheres to Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. The Research Committee approved the study at the Second Affiliated Hospital of Chongqing Medical University (Ke Lunshen No. (64) in 2024). Informed consent was obtained from all participants involved in this study. Prior to participation, all participants provided electronic informed consent. Data collection was administered exclusively through anonymous online questionnaires, accessible only after consent confirmation. Participants retained the right to withdraw at any time without penalty.
Measurement scales
General information questionnaire
Developed by the researcher, this questionnaire was used to collect general information of participants, such as age, gender, education level, and years of work experience in ICU.
Stanford presenteeism Scale-6
The Stanford Presenteeism Scale-6 (SPS-6), developed by Stanford University, was meticulously translated into Chinese by Zhao F et al. [18]. This scale was utilized to evaluate presenteeism among ICU nurses. It comprises six items, each scored on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree,” with higher scores indicating a more pronounced level of presenteeism. For the SPS-6, a score of ≥18 was defined as the threshold for high presenteeism. The SPS-6 demonstrated strong internal consistency in our study, with a Cronbach’s α coefficient of 0.916.
The team presenteeism atmosphere questionnaire
The Team Presenteeism Atmosphere Questionnaire developed by Hou W [12] was employed to evaluate the team-based presenteeism atmosphere among ICU nurses. This questionnaire comprises six items, each rated on a 5-point Likert scale from “completely disagree” to “agree”. Higher scores on this questionnaire reflect a stronger pronounced perception of presenteeism within the ICU nurse team. In this study, the internal consistency, as measured by Cronbach’s α coefficient, for the team presenteeism atmosphere was 0.721.
The nurse work stress source scale
The Nurse Work Stress Source Scale developed by Li X et al. [19] was used to evaluate the work-related stress experienced by ICU nurses. This scale encompasses 35 items distributed across five dimensions, each scored on a 4-point Likert scale ranging from “no stress” to “high stress.” A higher score on this scale signifies a higher level of work stress. In this study, the internal consistency of Cronbach’s α coefficient for the Nurse Work Stress Source Scale was 0.98.
The mindful attention awareness scale
The Mindful Attention Awareness Scale (MAAS), originally developed by Brown and Ryan and subsequently translated into Chinese by Chen S et al. [20], was used to evaluate the level of mindfulness among ICU nurses. The scale comprises 15 items, each rated on a 6-point Likert scale that extends from “almost always” to “almost never”. Higher scores on the MAAS are indicative of a higher level of mindfulness, improved mental-physical balance, and enhanced positive emotions. In this study, the internal consistency, as measured by Cronbach’s α coefficient, for the MAAS was 0.89, which is considered to represent good reliability.
Statistical analysis
SPSS 23.0 was used for the data processing and analysis. Categorical variables, including gender, education level, and presence of chronic diseases, were reported as frequencies and percentages. Continuous variables, such as years of work experience in the ICU, team presenteeism atmosphere, work stress, and mindfulness, were presented as means with standard deviations. All continuous variables were centered, and categorical variables were transformed into respective dummy variables for analysis. Normal probability plot (P-P plot) analyses indicated that the primary variables followed a normal distribution. Therefore, Pearson correlation analysis was conducted to examine the relationships among team presenteeism atmosphere, work stress, mindfulness, and presenteeism. Furthermore, PROCESS Macro Models 3.3 was used to construct multiple regression models to evaluate the mediating effect of work stress on the relationship between team presenteeism atmosphere and ICU nurses’ presenteeism, as well as the moderating effect of mindfulness. Statistical significance was set at an alpha level of 0.05. A bootstrap 95% confidence interval (CI) of the model was calculated to determine the significance of the mediating and moderating effects.
Results
Demographic characteristics
A total of 244 questionnaires were distributed to ICU nurses, and 224 valid questionnaires were returned (a response rate of 91.803%). 224 ICU nurses included 185 females and 39 males, with ages ranging from 22 to 50 years, with a mean age of 30.36 ± 5.17 years. Participants’ years of experience in the ICU ranged from 1 to 27 years, averaging 6.48 ± 5.93 years. Their professional titles ranged from staff nurse to director of nursing, and their educational levels extended from associate degrees to postgraduate qualifications. Drawing from related research [21], an SPS score of 18 or higher was used as the threshold for high presenteeism. Among the participants, 79 ICU nurses (35.27%) were categorized as having high presenteeism, while 145 (64.73%) had low presenteeism. Chi-square test results indicated a significant difference in occupational exposure and workplace violence experienced within the past three months between the low and high presenteeism groups (P = 0.040, P = 0.019), with no significant differences in other variables. For the chi-square tests involving education, marital status, and professional title—which required multiple group comparisons—we applied the Bonferroni correction. The corrected results indicated no significant differences between groups. Independent samples t-test results indicated no significant differences in age and years of ICU work experience between the high and low presenteeism groups (age: F = 3.368, t = 0.817, P = 0.415; ICU work experience: F = 0.885, t = 0.985, P = 0.326). Specific demographic variables are presented in Table 1.
Table 1.
Demographic characteristics of ICU nurses (N = 224)
| Variables | Categories | Low presenteeism n(%) |
High presenteeism n(%) |
χ² | P |
|---|---|---|---|---|---|
| Gender | 1.432 | 0.231 | |||
| Male | 22 | 17 | |||
| Female | 123 | 62 | |||
| Experience of occupational exposure in the past three months | 4.139 | 0.042 | |||
| No | 143 | 74 | |||
| Yes | 2 | 5 | |||
| Experience of workplace violence in the past three months | 5.531 | 0.019 | |||
| No | 142 | 72 | |||
| Yes | 3 | 7 | |||
| Presence of chronic disease | 2.796 | 0.094 | |||
| No | 132 | 66 | |||
| Yes | 13 | 13 | |||
| Type of employment contract | 0.092 | 0.761 | |||
| Non- Establishment Position | 115 | 64 | |||
| Establishment Position | 30 | 15 | |||
| Academic qualification | 0.471 | 0.790 | |||
| Associate Degree | 19 | 13 | |||
| Bachelor’s Degree | 124 | 65 | |||
| Master’s Degree | 2 | 1 | |||
| Marital status | 0.727 | 0.695 | |||
| Single | 63 | 30 | |||
| Married | 78 | 46 | |||
| Divorced | 4 | 3 | |||
| Presence of an administrative position | 0.017 | 0.897 | |||
| No | 109 | 60 | |||
| Yes | 36 | 19 | |||
| Professional title | 2.176 | 0.537 | |||
| Registered Nurse | 33 | 22 | |||
| Senior Nurse | 74 | 33 | |||
| Nurse-in-charge | 31 | 21 | |||
| Associate Chief Physician/Chief Nurse | 7 | 3 |
Scores and correlations of variables
The findings from the Pearson correlation analysis revealed significant correlations between the total scores of presenteeism, team presenteeism atmosphere, work stress, and mindfulness among the 224 nurses (P < 0.01), as detailed in Table 2.
Table 2.
The score and correlation of variable of ICU nurses (N = 224)
| Varables | Mean ± SD | Presenteeism | Team presenteeism atmosphere | Work stress | Mindfulness |
|---|---|---|---|---|---|
| Presenteeism | 13.964 ± 5.695 | 1 | |||
| Team presenteeism atmosphere | 16.857 ± 3.553 | 0.361** | 1 | ||
| Work stress | 82.219 ± 20.734 | 0.367** | 0.508** | 1 | |
| Mindfulness | 63.446 ± 11.884 | -0.340** | -0.324** | -0.383** | 1 |
** P < 0.01
The independent samples t-test results indicated that ICU nurses with high presenteeism exhibited significantly higher scores in team presenteeism atmosphere and work stress, and significantly lower scores in mindfulness compared to their counterparts with low presenteeism.(Team presenteeism atmosphere: F = 4.525, t = 5.383, P < 0.001; Work stress: F = 0.020, t = 4.466, P < 0.001; Mindfulness: F = 2.79, t = 4.747, P < 0.001).
Common method bias test
Harman’s single-factor test was conducted to examine common method bias across team presenteeism atmosphere, work stress, mindfulness, and presenteeism constructs. The analysis revealed 11 eigenvalues exceeding the value of 1 for the communal factors, with the most substantial factor explaining 34.163% of the variance. This percentage falls below the recommended threshold of 40%, suggesting that common method bias is not significantly influencing the results of this study.
The impact of team presenteeism atmosphere on presenteeism among ICU nurses: a moderated mediation model test
Mediation effect test of work stress
After adjusting for occupational exposure and workplace violence experienced in the past three months, the analysis designated the team presenteeism atmosphere as the independent variable, presenteeism as the dependent variable, and work stress as the mediator. The Process 3.3 plugin was used to examine the mediating influence of work stress. The results indicated that the team presenteeism atmosphere significantly and positively predicted work stress (standardized β = 0.485, P < 0.001), and also significantly and positively predicted presenteeism (standardized β = 0.228, P = 0.002). Concurrently, work stress significantly and positively predicted presenteeism (β = 0.245, P < 0.001). These findings suggest that work stress mediates the relationship between team presenteeism atmosphere and presenteeism, as depicted in Fig. 2, with the indirect effect constituting 34.237% of the total effect (indirect effect size/total effect size = 0.1187/0.3467*100%). A summary of the mediation effect test results is provided in Table 3.
Fig. 2.
The mediating role of work stress. Β is the Standardized regression coefficient; **P<0.01
Table 3.
Mediating effect of work stress (N = 224)
| Independent variable | Dependent variable | Standardized regression coefficient(95%CI) | SE | t | P |
|---|---|---|---|---|---|
| Work stress | Team presenteeism atmosphere | 0.485(0.369 ~ 0.601) | 0.059 | 8.222 | < 0.001 |
| Presenteeism | Work stress | 0.245(0.104 ~ 0.386) | 0.072 | 3.419 | < 0.001 |
| Team presenteeism atmosphere | 0.228(0.087 ~ 0.369) | 0.072 | 3.183 | 0.002 |
The moderating role of mindfulness in the relationship between team presenteeism atmosphere, work stress, and presenteeism
After adjusting for occupational exposure and workplace violence within the past three months, the study operationalized the team presenteeism atmosphere as the independent variable, presenteeism as the dependent variable, work stress as the mediating variable, and mindfulness as the moderating variable. The study aimed to assess the moderating effect of mindfulness. Specifically, it explored the moderating influence of mindfulness on the relationships between team presenteeism atmosphere and work stress, team presenteeism atmosphere and presenteeism, and work stress and presenteeism. The findings revealed that mindfulness significantly moderated the association between work stress and presenteeism (interaction term work stress−presenteeism = -0.136, P = 0.035), but not the associations between team presenteeism atmosphere and work stress (interaction term team presenteeism atmosphere−work stress = -0.059, P = 0.198) or between team presenteeism atmosphere and presenteeism (interaction term team presenteeism atmosphere−presenteeism = 0.022, P = 0.706). Consequently, a moderated mediation model was developed to scrutinize the moderating effect of mindfulness on the link between work stress and presenteeism. The analysis confirmed the partial mediating role of work stress and demonstrated that mindfulness significantly moderated the relationship between work stress and presenteeism (interaction term work stress−presenteeism = -0.123 (95%CI: -0.228~-0.017, ΔR2 = 0.019, P = 0.023), The moderation effect test results are depicted in Fig. 3.
Fig. 3.
The moderating role of mindfulness
Discussion
High prevalence of presenteeism among ICU nurses
This study surveyed 224 ICU nurses, revealing that 35.27% were experiencing a high level of presenteeism. Concurrently, a meta-analysis has shown that the global rate of high presenteeism among nurses is 49.2% [3], and a survey conducted by Chinese scholars Liu X et al. on 794 ICU nurses found that the rate of high presenteeism reached 55.4% [22]. The discrepancies in the results may be attributed to the varying cutoff values used to define high presenteeism. Liu X et al. used a threshold value of 16 [22], while this study employed the commonly accepted industry standard of 18. The adoption of a higher presenteeism threshold was associated with a lower observed rate of high presenteeism in this study. Heterogeneity in ICU nurses' reporting practices across cultural contexts [13] may contribute to the inconsistencies in the findings. Nevertheless, collectively, multiple studies have confirmed that ICU nurses are at a high risk for presenteeism.
ICU nurses’ presenteeism is closely related to individual and team factors
This study demonstrates a significant and positive correlation between the team presenteeism atmosphere and individual tendencies towards presenteeism, with ICU nurses who report high levels of presenteeism also perceiving a more pronounced team presenteeism atmosphere. Given the inherently collaborative nature of nursing work, when nurses encounter physical discomfort, they weigh not only their capacity to sustain work efforts but also the potential consequences of their absence on team dynamics and peer perceptions [23, 24]. Furthermore, this study reveals a significant association between work stress and presenteeism, with ICU nurses experiencing high presenteeism also reporting higher levels of work stress. This finding is consistent with previous research [25, 26]. A survey of 442 Korean nurses by Baek found that work stress as a key factor influencing nurse presenteeism [25]. Similarly, research conducted by Li G demonstrates that work stress can significantly and positively predict presenteeism. ICU nurses grapple with substantial clinical workloads daily and must also manage a variety of non-clinical tasks, contributing to considerable work stress [4]. Prolonged exposure to elevated work stress can precipitate a spectrum of physical and psychological health issues for ICU nurses, including anxiety, insomnia, and job burnout, all of which can precipitate presenteeism [21]. Lastly, this study indicates a significant and negative correlation between presenteeism and mindfulness. A survey of 580 medical staff in 9 hospitals in Shanxi Province, China similarly found a significant negative correlation between mindfulness and presenteeism [27]. ICU nurses with higher levels of mindfulness are better equipped to mitigate work stress and enjoy greater job satisfaction, thereby preventing the occurrence of presenteeism [28].
Work stress transmits the promoting effect of team presenteeism atmosphere on presenteeism among ICU nurses
This study reveals the direct impact of the team presenteeism atmosphere on ICU nurse presenteeism and affirms that presenteeism can indirectly influence individual levels of presenteeism by elevating the perception of work stress among ICU nurses. A positive organizational atmosphere can significantly enhance nurse job satisfaction and help reduce their work stress [29, 30]. Conversely, a pervasive team presenteeism atmosphere can escalate internal competition, diminish the quality of human care within the team, impede nurses’ adjustment to work demands, and culminate in heightened work stress [31]. Prolonged exposure to high work stress levels can result in job burnout and physical illness among ICU nurses, resulting in diminished work efficiency and increased incidences of presenteeism [21]. Li N et al., after surveying 342 nurses from 12 general hospitals in China, found that work stress mediates the relationship between team atmosphere and work alienation, thereby establishing that the organizational atmosphere can indirectly influence individual work performance through work stress [14]. Moreover, the team presenteeism atmosphere can directly affect presenteeism. A team atmosphere that condones presenteeism may encourage nurses to engage in presenteeism behaviors. A qualitative study has indicated that when teams hold the belief that taking leave will precipitate a staff shortage and exacerbate the workload of their peers, some nurses may forgo leave due to feelings of guilt or fear of imposing an additional burden on colleagues, which in turn, results in presenteeism [10]. Chinese studies have also found that a complex leave procedure can discourage nurses from taking leave, thus fostering presenteeism [32]. It is apparent that the team atmosphere can not only indirectly shape presenteeism by influencing work stress but can also have a direct impact on presenteeism, exerting a substantial influence on the prevalence of presenteeism among ICU nurses.
The negative moderating effect of mindfulness on the relationship between work stress and presenteeism
This study indicates that mindfulness has an inhibitory effect on the positive relationship between work stress and presenteeism. Related research also confirms that mindfulness is significantly associated with the prevalence of presenteeism among nurses. The mechanism of mindfulness on the relationship between work stress and presenteeism is related to its role in alleviating the negative effects of work stress [27]. Specifically, ICU nurses with higher levels of mindfulness can more actively self-regulate when facing stress and setbacks, dealing with the negative impacts of work stress and reducing the incidence of presenteeism [33]. Evidence shows that mindfulness can alleviate work stress, reduce professional burnout, and decrease levels of anxiety and depression among nurses [34]. Furthermore, research also confirms that mindfulness can moderate the negative impact of work stress on job satisfaction among nurses [27], thereby aiding in the prevention of presenteeism amidst high-stress work environments [35].
Innovation and contribution of the study
This study makes several important contributions to the existing literature on presenteeism among ICU nurses. First, while previous research has identified associations between team-level contextual factors and individual characteristics with presenteeism, few studies have empirically explored the underlying mechanisms that explain how these factors contribute to presenteeism behavior, especially in high-stress environments such like the ICU. By introducing work stress as a mediator, our study provides empirical evidence that helps to unpack the complex process through which team presenteeism atmosphere influences nurse behavior. Second, this study is among the first to examine the moderating role of mindfulness in the relationship between work stress and presenteeism. Our findings suggest that mindfulness can buffer the adverse effects of stress, thereby serving as a potential protective factor in the presenteeism pathway. This moderated mediation model advances theoretical understanding and offers a more nuanced explanation of presenteeism formation. Finally, by focusing on ICU nurses, a population at high risk of burnout and presenteeism, our study addresses an important and underexplored group. The identification of both mediating and moderating mechanisms provides practical implications for intervention development—highlighting the potential benefits of organizational climate improvements and mindfulness-based interventions in reducing presenteeism and promoting staff well-being in critical care settings.
Conclusions
This study reveals that ICU nurses exhibit a high prevalence of presenteeism, a condition that may precipitate increased turnover rates and decreased quality of nursing services provided by ICU nurses, thereby threatening patient safety [36]. Therefore, ICU nurse managers need to pay adequate attention to the phenomenon of presenteeism among ICU nurses and take measures to mitigate its occurrence. However, there is a paucity of literature on interventions for presenteeism specifically targeting ICU nurses in China. This study shows that mindfulness can ameliorate the adverse impact of work stress on presenteeism among ICU nurses, and this finding is echoed by international scholars who have verified that mindfulness-based interventions can significantly reduce presenteeism [37]. Therefore, future research should explore the potential of mindfulness intervention strategies to alleviate presenteeism among ICU nurses. Additionally, given that this study is cross-sectional and previous research has indicated that the prevalence of presenteeism may fluctuate with tenure in the workforce [38], future studies should extend their focus to examine the longitudinal dynamics of presenteeism among ICU nurses.
Acknowledgements
We would like to thank all the participants who contributed to this study and contributed to the data collection.
Abbreviations
- ICU
Intensive care unit
- SPS-6
The Stanford Presenteeism Scale-6
- MAAS
The Mindful Attention Awareness Scale
Author contributions
All authors participated in the conceptualization and design of the study. L.X: Investigation, Data curation, Formal analysis, Writing – Original Draft. W.X.M: Quality control, Revised manuscript. Z.C.L and Z.J.Z Investigated participants. L.T and Y.R.Q: Data analysis. All authors read and approved the final version of this manuscript.
Funding
This work was supported by The Medical Scientific Research Project of Nanan District, Chongqing(Joint project of Chongqing Health Commission and Science and Technology Bureau)(No.2023-01).
Data availability
All data generated or analyzed during the study are available from the corresponding author [Xiaomei Wang] on request.
Declarations
Ethics approval and consent to participate
All procedures performed in studies involving human participants were by the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. The Research Committee approved the study at the second affiliated hospital of Chongqing Medical University (Ke Lunshen No. (64) in 2024). Informed consent was obtained from all subjects involved in this study. All participants will receive confirmation of informed consent before completing the questionnaire, and they can only fill out the questionnaire after agreeing to participate in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data generated or analyzed during the study are available from the corresponding author [Xiaomei Wang] on request.