Effort-reward imbalance and absenteeism among nursing personnel in Brasil

The Effort-Reward Imbalance (ERI) model is known to have predictive power for adverse health outcomes including absenteeism rates. This study describes the associations between ERI and absenteeism, verifying whether the type of contractual employment has influence on this association among nursing personnel. A cross-sectional study with nursing personnel (1288 women and 198 men) at three public hospitals in Rio de Janeiro, Brazil was performed. The definition of absenteeism rate was based on the question How many whole days have you been off work because of a health problem (disease or health care or for examination) during the past year (12 months)? The answer was dichotomized (not at all/one or more days). Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI95%) were calculated (p=0.05). About 37% of the sample was absent from work for at least one day in the last 12 months (women=38.7% and man=27.8%). Among workers classified in the high-ERI group, those with permanent jobs reported more absences compared to those with precarious jobs. This result holds true for both genders, but the difference was more evident among men. For women, the odds for being classified in the absent group among high-ERI workers was about two times, as compared to workers with low ERI, after adjusting for age, type of contractual employment, occupation and BMI (OR=1.91; IC95%=1.34-2.72); a higher adjusted odds ratio was observed for men (OR=2.64; IC95%= 0.97-7.23). A borderline interaction was observed between the psychosocial stress at work and the type of contractual employment only among men (p=0.093). The psychosocial stress seems to be more relevant for absenteeism among men, particularly those with permanent jobs. Unequal opportunities at work can explain differences concerning the type of employment as regards absenteeism rates. Results can subsidize intervention strategies considering the specificities of nursing profession at hospitals.