Culture of presenteeism: emergent perspectives from an NHS-workforce convenience sample

Abstract Background The United Kingdom’s National Health Service (NHS) has been under strain for more than a decade, which has been exacerbated by the 2019 coronavirus disease (COVID-19) pandemic. According to NHS staff, this is felt especially during the winter (also called ‘winter pressure’), when both absenteeism and presenteeism rates are high in the healthcare workforce. Aims To understand the culture of presenteeism amongst NHS staff, focusing specifically on how presenteeism both persisted and changed during the COVID-19 pandemic and during periods of annual winter pressure. Methods Data for this study were derived from 20 in-depth interviews conducted with NHS staff, drawn from a convenience sample of primary- and secondary-care services. Interviews were guided by a semi-structured interview protocol. Results This study contributes to an understanding of presenteeism by describing the ways in which the practice both changed and, in some ways, stayed the same during COVID-19 self-isolation regulations, with remote work arrangements enabling some healthcare workers to continue working even when unwell. Despite this, isolation guidelines threw into stark relief NHS workers’ deeply held beliefs about duty, service, and commitment to the wider healthcare system, while exposing their experiences and perceptions of profound systemic challenges and a lack of wider support to carry out their work. Conclusions The emergent findings from this study suggest that the culture of presenteeism is linked to wider NHS staff’s identification with the institutional goals of the NHS, resulting in their motivation to continue working, even if remotely; yet, the consequences are not fully understood. The spike in the number of patients coming to clinic during the winter months exposes the United Kingdom’s National Health Service’s (NHS) reliance on staff coming into work whilst unwell. This culture of presenteeism persisted during the 2019 coronavirus disease pandemic. While remote work arrangements enabled NHS staff to continue working, their motivation to work whilst ill is driven by duty, service and commitment.