title: What degree of work overload is likely to cause increased sickness absenteeism among nurses? Evidence from the RAFAELA patient classification system.
abstract: OBJECTIVE
  This paper reports a study examining whether nurses' work overload is associated with increased sick leave and quantifying the loss of working days from work overload.
  
  
  BACKGROUND
  The RAFAELA patient classification system indicates nursing care intensity in relation to an optimum and is one of the few validated monitoring instruments of patient-associated workload among nurses. However, it is not clear whether work overload is a risk factor for increased sickness absenteeism, an important occupational problem in health care.
  
  
  METHODS
  An observational cohort study was carried out with 877 nurses, 31 wards and five Finnish hospitals. Patient-associated workload scores from the RAFAELA system were based on a 6-month monitoring period in 2004. Records of 12-month self certified (1-3 days) and medically certified (>3 days) periods of sick leave in the same year were obtained from employers' registers.
  
  
  RESULTS
  The mean workload was 9% (sd = 8%) above the optimum. There was a linear trend between increasing workload and increasing sick leave (P < or = 0.006). Among nurses with workload > or =30% above the optimum the rate of self certified periods of sick leave was 1.44 (95% CI 1.13-1.83) times higher than among those with an optimum workload. The corresponding rate ratio for medically certified sick leave was 1.49 (1.10-2.03). These excess rates of sickness absence resulted in 12 extra sick leave days per person-year.
  
  
  CONCLUSIONS
  Measuring nurses' workload may be an important part of strategic human resource management of nurses to reduce sick leave among nurses.
authors.affiliation: Vaasa Hospital District, Vaasa, Finland.
authors.forename: Auvo
authors.initials: A
authors.lastname: Rauhala
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Fagerström
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Anna-Kaisa
authors.initials: AK
authors.lastname: Rainio
authors.forename: Kati
authors.initials: K
authors.lastname: Ojaniemi
authors.forename: Juha
authors.initials: J
authors.lastname: Kinnunen
mesh_terms: D000041:Absenteeism; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010562:Personnel Staffing and Scheduling Information Systems; D018582:Sick Leave / Q000706:statistics & numerical data*; D016526:Workload