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Pressure to work while sick
Presenteeism or working while sick is the act or culture of employees continuing to work as a performative measure, despite having reduced productivity levels or negative consequences. Reduced productivity during presenteeism is often due to illness, injury, exhaustion, or other conditions, but presenteeism can also describe working while contagiously sick, which has the added risk of creating a workplace epidemic. Many different motives can lead to presenteeism. An employee may come to work because they simply need the money and cannot afford to take time off due to illness. Doctors may attend work while sick due to feelings of being irreplaceable. Additionally, one could go to work due to a love and devotion to the job; in this case, it could be considered an act of organizational citizenship and inspire admiration from colleagues. Jobs with large workloads are often associated with presenteeism. Certain occupations such as welfare and teaching may be more prone to presenteeism. Workaholics and people who base their self esteem on performance typically exhibit higher levels of presenteeism. While the contrasting subject of absenteeism has historically received extensive attention in the management sciences, presenteeism has only been studied recently. Aronsson, Gustafsson, and Dallner wrote that it means attending work even when one feels unhealthy. In a recent review of the literature, Johns highlighted the lack of agreement between the many definitions. The authors thought that this increase could have been due to decreases in the preexisting levels of presenteeism. However, they did not directly measure presenteeism. Commenting on such research behavior, Johns said in his review of the literature that researchers should not infer presenteeism from absenteeism data. Instead, the author noted that both constructs should be measured at the same time. Furthermore, Heponiemi et al. found that fixed term employees as opposed to permanent employees were less likely to report working while ill, and the work of Bockerman and Laukkanen supported this finding. Based on these inconclusive results, Johns noted that researchers had to reconsider the job insecurity hypothesis. In the private hospital, there was little pressure from management to exhibit presenteeism; however, a sense of family seemed to exist between the staff, and a strong loyalty to coworkers pushed employees to come to work while unhealthy. The public hospital had a distant management, but presenteeism was fostered by "loyalty to professional image, colleagues, and the institution as a whole." Further extending the examination of the medical field, McKevitt, Morgan, Dundas, and Holland studied hundreds of healthcare professionals and found that more than 80 percent of respondents had worked while ill. Individuals listed some of the reasons they had not taken sick days, and many cited the fact that they felt large pressure to work. In some cases, general practitioners did not want to burden their partners, and many felt a strong commitment to the job that prevented them from taking sick leave.

Jobs that have large workloads and many demands are often associated with higher levels of presenteeism. Caverely, Cunningham, and Macgregor studied Canadian firms and noted that presenteeism was often not the result of job insecurity. Instead individuals felt they had to come to work while ill or injured because they believed they had high workloads, many deadlines, and often very little backup support. Complementing this finding, McKevitt et al. also found that individuals feared their work would pile up if they did not go to their job. In the case of this study, the authors defined job demands as aspects of the job that require physical and/or psychological effort. Forced overtime, heavy workloads, and frenetic work paces give rise to debilitating repetitive stress injuries, on the job accidents, over exposure to toxic substances, and other dangerous work conditions. Some studies are beginning to show the costs of compulsory overwork. Reg Williams and Patricia Strasser, professors of nursing at the University of Michigan, estimated in the journal of the American Association of Occupational Health Nurses that the total cost of depression at work was as high as $44 billion. They pointed out that healthcare workers have focused much attention on the workplace risk factors for heart disease, cancer, obesity, and other illnesses, but little emphasis on the risk factors for depression, stress, negative changes in personal life, and difficulties in interpersonal relationships.

Those who exhibit workaholism tend to demonstrate higher levels of presenteeism. As defined by Schaufeli, Bakker, van der Heijden, and Prins, workaholics tend to work excessively and compulsively, and they are internally motivated to work to an excessive extent. In addition to their high levels of presenteeism, Schaufeli et al. discovered that workaholics also displayed the highest burnout and lowest happiness levels relative to other groups who were not defined as workaholics. Employees who demonstrate high levels of this construct have to prove their worth while on the job. Love et al. found that PBSE positively predicted presenteeism; however, the authors also discovered that the relationship between PBSE and presenteeism was strengthened when workers experienced high physical and psychological work demands. Those with poor diet and less emotional fulfillment also reported higher levels of presenteeism than those without these conditions. The researchers noted that individuals with diabetes tended to report higher levels of absenteeism as opposed to those without the condition. Individuals who partook in no physical activity were more prone to report higher levels of both absenteeism and presenteeism compared to those who took part in some physical activity.

One consequence of presenteeism is productivity loss, and scholars have attempted to estimate these productivity numbers. While examining productivity decrements, however, it is implied that losses are measured relative to not having a particular sickness or health issue. Furthermore, the authors concluded that of all the health related costs faced by employers, one fifth to three fifths of those expenses could be attributable to on the job productivity losses. Complementing that study, Schultz and Edington provided a detailed review of the effects of certain health conditions on productivity. These authors examined conditions such as allergies, arthritis, chronic pain, diabetes, and mental health disorders. The studies in the review showed, for example, that increases in pollen are associated with decreased performance. Moreover, Schultz and Edington noted that chronic pain had to be studied more thoroughly to better understand its effects on productivity. Furthermore, in their study of job demands and presenteeism, Demerouti et al. found that presenteeism resulted in increased exhaustion.

In the case of an infectious disease such as influenza, a culture of presenteeism will inevitably also lead to further infections throughout the workforce, compounding the ill effects and leading to a much wider problem. In a 2014 survey by Canada Life Insurance, over 80% of respondents stated that they had become ill as a result of an infection contracted in the workplace.

Scholars have often measured presenteeism in terms of how often an individual attends work while unhealthy. For instance, Aronsson et al. asked participants to what extent over the past year they had gone to work despite feeling they should have taken sick leave. Aside from measuring the frequency of presenteeism, scholars often look to measure the effects of poor health on job productivity. The Work Limitations Questionnaire (WLQ) is often used to perform this task. With 25 items, it examines the extent to which respondents can handle time, physical, mental interpersonal, and output demands. Additionally, The Stanford Presenteeism Scale seeks to determine the effects of health on productivity. It measures participants' abilities to concentrate and perform work despite having a primary health problem. Using six items, respondents determine the extent to which they agree with statements that describe how their health condition may or may not affect their work. The scale measures two factors that the authors labeled as completing work and avoiding distraction. Finally, another measure often used is the World Health Organization Health and Work Performance Questionnaire (HPQ). This self report measure acquires information about respondents' health conditions and has them provide perceptions of their job performance. The WLQ and HPQ have become the two most popular instruments;

Given the prominence and costs of presenteeism, scholars have suggested a variety of courses of action for employers. Companies should implement wellness programs for their employees aimed at increasing health and productivity. These organizations, however, must be aware that the effects of these programs may have an immediate impact on presenteeism as opposed to simply absenteeism. Firms must be cognizant of this fact when evaluating the effectiveness of their programs.

While progress has been made in regards to understanding presenteeism, many possible topics of inquiry still remain. In his literature review, Johns said that presenteeism had to be related to other constructs such as work attitudes and personality. Additionally, lessons from absenteeism could be applied to presenteeism. For instance, absenteeism can be defined as voluntary and involuntary, and scholars could consider applying such ideas to presenteeism. Lastly, the construct could be related to other elements of the work. Specifically, how does presenteeism relate to remote work? Is an individual who works from home while he or she is sick exhibiting presenteeism?