The literature review: what are the factors contributing to nursing absenteeism and the effect on the health care system.Introduction According to Polit (2013:15), the literature review is a critical summary of existing knowledge on a topic of interest, often prepared in order for the research problem to be placed in context. It entails a systematic and clear approach to the identification, retrieval and bibliographical management of independent studies for the purpose of locating information on a topic, synthesizing conclusions, identifying areas for future studies, and developing guidelines for clinical practice. This literature review of nursing absenteeism viewed by Beck (2008: 30) defined absenteeism as a single day of missed work and as a failure of an employee to report to work, despite the reason. According to the Labor Relations Act (66 of 1995, as amended), absenteeism is an unauthorized leave by an individual who intends to return to work. The aim of this literature review is to identify factors with the greatest influence on turnover and absence of qualified professional Nurses. Furthermore, P Mudaly (2015:624) identified main factors that lead to the absenteeism of nurses in facilities, namely marital status, abuse of alcohol, poor working condition, paydays on 15th and 30th each month, age and gender of nurses, qualification, health status, family responsibility and transport problemQualifications Nurses who are in ownership of a bachelor’s degree or diploma seems to have lower rates of absenteeism as compare to nurses in short of basic professional nursing qualifications. The research study by Lewis and Tamblyn (1998: 19) give rise to findings that lower rates of absenteeism occur among professional nurses than the sub-professional nurse categories. This is due to the fact that professional nurses are having vital duties in their workplace and therefore they turn to attend their work as scheduled. Smith (2011: 1041) urges that professional nurses are more gratified with their work than sub-professional nurses since they anticipate superior opportunities for promotions. In a research study by Wills (1998:30), he urges that many nurses have feelings of being compelled to study for advanced diplomas and degrees in nursing to stay in the running for advancement. When they finish their studies discouragement sets in since their position does not change. Moreover, they then withdraw by either leaving the nursing profession or by absenting themselves from work. Armstrong-Stassen (1999:27) state that nurses with bachelor’s degrees share the same status with nurses who are having diplomas. Therefore, Nurses with degrees turns to lose their interest in their work and resort to absenteeism. Group cohesion In a research study by Breda (1997: 90) give rise to finding that lack of solidity among nurses can result in absenteeism in the workplace. Groups with greater solidarity have more impact over their members as compare to loosely controlled groups. Adams & Bond (2000:542) argues that cohesive group has a sensation of conjoint identity since the increase in group cohesiveness results in individual enjoyment and gratification. Wagner (1997: 283) views the lack of group cohesion in terms of individual variances within the work and states that a nurse withdraws from a social and interpersonal environment by being absent from work. Kalisch et al, (201: 938) stated that absenteeism of nurses might be due to the powerlessness of the nurse manager to encourage solidarity in the workplace. The above-mentioned viewpoints have indicated that group cohesion can contribute to a higher rate of absenteeism among nurses. Marital status of nurses In a research study by Deckman (1996: 173) found that absenteeism is high among married nurses and relatively lower among single nurses. Higgins., et al (1994: 144) has a different opinion and states that marital status is not related to the absenteeism of nurses. However, female nurses who have two or more dependants could be more absent from work than those with fewer dependents. Perna (2001: 552) points out that the approach of men towards their family responsibilities could play a part in men being absent from their work. Both married men and women have the same rate of absenteeism as they have the same responsibility toward their families. In the research study by Perna (2001: 552) state that an increase in spousal care results in higher self-confidence, fewer depressed moods and better quality of life, and this could lead to increased work presence among married nurses. The said authors also point out that single nurses who receive support from friends and their families experience a high quality of life and show lower absenteeism than nurses who have inadequate support. Family responsibility Maume (2006: 59) urges that in some families, multiple role expectations compete with an employee’s work time, and could lead to absenteeism in the workplace. Erickson, Nichols and Ritter (2000:266) they also state that family demands and family attitudes influence absenteeism among nurses. These factors mostly affect nurses who have younger children, under the age of six years, and those who experience difficulties raising their children. In the research study by Perna (2001: 552) outline the professional in competition with personal roles of nurses who are active both at the workplace and at home. Deckman (1996: 173) states that nurses experience contradictory responsibilities, of running a household, taking care after family members and working shift systems, which makes a considerable degree of stress, leading to absenteeism. Basiese (2002: 19) mentioned that the Basic Conditions of Employment Act, 1997, as amended, stipulates that nurses should be allowed to take three paid working days per annum In practice, however, nurses sometimes manipulate these leave days for example, they attend every friend’s funeral. When they have no more leave days to their credit they may resort to absenteeism to enable them to take care of their family responsibilities. Maume (2006: 59) urges that Domestic conflicts, such as conflicts at home and violence, which can lead to injuries outside the workplace, also contribute to the absenteeism of nurses. Rowland (1997:526) specify that shocking experiences or abnormal pressure due to contradictory situations in the nurses’ personal lives could lead to absenteeism. They might take some time to return themselves to a state of psychological balance, before attending work again. Age and gender of nurses Nursing absenteeism can be related to age and gender, Age refers to the physical and chronological age of the individual P.Mudaly (2015:624). Gender is defined by the oxford advanced learner dictionary (2008) like the fact of being male or female. The discussion below highlights different views on the influence of age and gender on absenteeism from the article: Factors influencing nurse absenteeism in a general hospital in Durban, South Africa.Nursing is considered as embracing ageing, a mostly female workforce that often develops chronic medical problems as they become older. Young nurses’ employees usually reduce their sick leave than older nurses. On the other hand, older nurses are more prone to sickness absence than younger nurses due to health weakening and a prolonged period of recovery. However, Van der Walt (2001:49) confirms that nurses over the age of sixty have a lower rate of absenteeism than any other age group because older nurses have greater levels of commitment to their work than younger nurses. younger nurses report higher levels of stress that contribute to their absenteeism than nurses who are close to retirement. This occurs since they have not yet developed coping strategies to deal with stress in the workplace, younger nurses tend to adopt more negative work attitudes than their colleagues. Furthermore gender and absenteeism, female nurses displayed high rates of absenteeism compared with male nurses P.Mudaly (2015:624) female have more responsibilities and spend more time on household task than male. It is usually a mother who takes time off or becomes absent when a child is sick, and this time off is commonly seen as a form of sick leave.However, the research study by Van der Walt (1999:50) indicates that there are no significant differences between male and female nurse absenteeism rates. McHugh (2001:4) supports the latter by stating that there is a similar percentage of reported absenteeism rates for male and female nurses in health care organisations.Gupta (2000:200) agreed that female absenteeism rate is generally higher than males, but noted, that male’s absenteeism is higher between the age 18-25 years and low in the age 40-65years. However, most of the time young male nurses are exposed to the influence of alcohol, that is why and end up being absent at work rather than adult male nurses who have a lot of experience in the field in nursing and also, they have responsibilities such as family.Promotion opportunitiesIn a research study by Perna (2001: 587) discovered that the absence of promotion opportunities in the workplace might lead to frustration and absenteeism among nurses. Moreover, Borda, (1997:23) argues that absenteeism rates are lower in an organisation where promotion opportunities for nurses are reasonable as compare to the higher organisation where there are unfair promotions. Furthermore, Perna (2001:600) emphasis that promotion in the nursing profession depends on the qualification they possess before being promoted to the next level. This condition might lead to a lack of passion among nurses who do not meet the promotion standards. Qualified nurses with advanced experience in the field supposed to get recognition and promotions but they remain at the low level and underrated.Leadership style of nurse’s manager.Nurse managers use power to motivate their nursing staff, but the inappropriate use of power unpleasantly decreases self-confidence of nurses, which could lead to their absenteeism, Heidenthal (2004:100). He continues said leadership approach of the nurse manager plays a major role in causing stress, which leads to the absenteeism of nurses in the workplace. Heidenthal (2004:345) emphasises that an autocratic leadership approach leads to the absenteeism of nurses in the workplace, such as exercising power with intimidation over nurses who do not conform to the manager’s standard. Jooste (2010:556) argue that autocratic nurse’s managers often criticize subservient harshly in the workplace and subservient tended to be afraid to risk new projects because they could be punished for minor mistakes which may occur during the work activities and this lead to absenteeism.The lack of clear communication skills between the nurse manager and nurses plays a role in absenteeism in the workplace Bott (1999:31) mention that insufficient social interpersonal relations between managers and nurses hinder appropriate teamwork. Bennett (2002:6) states that the nurse manager’s lack of trust and respect towards nursing staff has a bad influence on the absenteeism of nurses. On the other hand, Jooste (2010:79) state that the reasons for the absenteeism of nurses as being the consequences of the discrimination of nurses, and of the nurse manager display favouritism to some nurses. Bennet (2002:6) state that the inability of the nurse manager to give inspiration and admiration for good work done leads to nurses feeling unacknowledged and useless. Fletcher (2001:53) concluded that negative comments from the nurse manager towards nurses, regarding their performance, discourage nurses from doing their best. He also recognised that shouting at nurses in a hectic working unit might inhibit nurses from focusing on patient care activity at a time. As a result, nurses become angry and decide to avoid the situation by being absent from work. Criticising staff results in a lack of interest and creates anger and aggression among nurses. The inability of nurse managers to give nurses feedback about their performance and the perceived inequity of performance evaluation could result in disappointment and absenteeism. Most nurses need to know about their strengths and weaknesses and are honestly grateful when supplied with the appropriate information about their progress. Heidenthal (2004:270) highlights that negative feedback might lead to bad arguments between the nurse manager and the nurse concerned, in that the nurse could eventually withdraw by being absent from work.Heidenthal (2004:363) state that after the nurse has received negative information about his or her performance, he or she might act to reduce the incongruity by being absent from work. This creates a situation in which nurses with excellent performance develop low morale, and this often affects their work attendance. Fletcher (2001:51) also add that the inability of the nurse manager to deal with nurses’ problems urgently and appropriately could contribute to staff dissatisfaction, leading to absenteeism in the workplace. Woods (1999:36) state that a lack of a cooperative management style in the workplace could result in a lack of commitment among nurses. Planning together and appreciating one another as important members of the team could prevent absenteeism caused by little morale.TransportAccording to Rhodes and Steers (2002) Transport is the main cause of nurse’s absenteeism for example nurses who travel from home to work or from work to home, using public transport has a higher rate of absenteeism than nurses who stay on hospital properties. Nurses using undependable transport might be disturbed by bad weather trying to reach their means of transport, or they may have to walk to their workplace and, rather, decide to be absent from work. Absenteeism is also seeming to be higher during late summer and mid-winter due to weather condition, for example, prolong extreme rain and snow is influence nurses to go to work. Most of the time this affect nurses who have four or more travel trips per day.Van der Walt (1999:50) states that a nurse using public transport often arrives at work by chance, and usually does not know whether transport will be available the next day. Rhodes and steers (2002) state that restricted financial resources hinder nurses’ access to public transport. This means that some of the nurses might also have financial problems in paying their transport charges. Therefore, financial limitations often impose absence from work. Effects of nurses absenteeism The high rate of absenteeism on duty rises workload to the remaining nurses, which lead to patient higher medico-legal hazards. This might put the patient’s life at danger especial with the minimum nursing care and possible risks of increased morbidity and mortality rate of the patients within the ward. Nurses remaining on duty are incapable to complete health care activities because of the shortage of staff. Hennessy (2009:354) state that nurses sometimes have a slight time to attend patients to provide them with individualised care. Mudaly and Indris at al (2009:678) state that nurses managers experience pressure when there is absenteeism in the unit and provide inadequate support to their assistants. Nurses absenteeism results in low staff morale. Nurses with low morale have substandard performance in the health care institutions, thus resulting in multiplied infectious diseases and disagreement among each other (Gaudin and Gregory. 2010: 234). Health care institutions might face less productivity as a result of poor performing nurses. They also have financial implication cost especial with regard to hiring replacement nurses and paying for a patient who sues the hospital for complications that happen due to poor nurses performance.Conclusion Absenteeism from work can be highly disruptive, whilst also potentially indicating a problematic working condition that affects the health care system or users which can lead to higher mortality, severe complications, increase the working load. This literature review is conducted using a different article published in South Africa and authors in other countries.