Should You Stay Home?

Issue 7 and Volume 11.

Dr. Nicola Davies discusses the phenomenon of presenteeism, a topic gaining much academic interest at the recent British Psychological Society’s Division of Occupational Psychology Conference.

Only fairly recently has the problem of presenteeism, as opposed to absenteeism, become a focus of academic research. It is often taken for granted that a loyal employee who comes to work regardless of physical illness or emotional problems is to be praised. However, research has shown that people who come to work when they really should be recovering at home can potentially have a negative impact on the workplace.

Cost Vs. Benefit

Gary Johns, author of “Presenteeism in the workplace: A review and research agenda,” says, “Organizational policies concerning pay, sick pay, attendance control, downsizing, and permanency of employment have all been suggested to foster presenteeism.” Nowhere is this more dangerous than in occupations where the lives of others are dependent on the decisions an employee makes, often under the pressure of time constraints and in dangerous situations; this would put firefighters at the top of the list along with lifesavers and search and rescue teams.

In the United States, Dr. Walter Stewart of AdvancePCS Center for Work and Health in Hunt Valley, Maryland, showed that the costs of lost productivity because of presenteeism could be up to three times the cost of absence-related productivity loss. In the case of firefighting, presenteeism can lead to slower response rates, irrational decisions, and even physical complications such as shakiness or fatigue-all of which could have fatal results.

Risking Your Life and the Lives of Others

Coming into work when not fully recovered from an illness can pose multiple problems including a lack of concentration, a tendency to make erroneous judgments, an inability to correctly assess personal fitness levels, and slower response time in dangerous situations. Dr. Dan Dodd, director of the Exercise Physiology Laboratory at Illinois State University and a certified strength and conditioning specialist (NCSA), is particularly concerned about reduction in reaction time because of presenteeism: “Response time is paramount in firefighting and is critical to the job. The effect that presenteeism can have on response time can be significant, but it can largely come down to the extent to which the illness/stressor is affecting that specific individual.”

This is something that needs to be communicated between the firefighter and fellow crew members so they are aware of any diminished capabilities that may be present. “However, I would also argue,” says Dodd, “that the extent of presenteeism can also come down to the level of preparation at the station, mentality on approach to a call, and of course the physical and mental readiness on location. Just like any situation (presenteeism or not), underprepared firefighters may increase risk for themselves or others.”

Being Physically Below Par

In firefighting, physical and mental strength are vitally important. If a firefighter returns to work too soon after a respiratory infection, for example, his reaction to temperature levels and respiratory distress in a live-fire situation could be problematic. Dodd explains, “It is difficult to establish what specific reaction would occur as each individual has varying responses to the stimuli. However, my research looking at physiological effects such as heart rate, blood pressure, and body temperature, as well as psychological changes (anxiety, respiratory distress, and thermal sensation) in firefighters during on-duty tasks showed that all firefighters exhibited significant increases immediately prior to and during the task.”

Dodd’s research also indicates that those with inherent high levels of trait anxiety (i.e., related to personality) show more significant physical and psychological changes after a stressful event. This supports other published research showing that high levels of trait anxiety, as opposed to situational anxiety, have greater physiological and psychological responses to stressful stimuli, particularly in high adrenaline tasks such as firefighting where elevated heart rate and respiration are often observed in response to the job.

Management is Vital

A good team leader knows his team well and should be able to pick up cases of presenteeism. Responses from a presentee firefighter would be similar in nature to those of a fatigued firefighter. A deconditioned individual (in this case, through illness) would have exacerbated responses to the stimuli, particularly in active tasks (search and rescue, labor-intensive tasks).

In addition, according to Dodd, “The response would be highly correlated to the intensity. Would this affect job performance? Possibly, but it would also depend on how the individual is managed or manages himself. Managing time on task, practicing breathing control, and including periods of rest during each call would be ways that individuals could perform the job without possible repercussions.”

Response to Stress a Key Factor

While presenteeism is mainly an issue for those working when they aren’t fully recovered from an illness, emotional distress (i.e., returning to work after a bereavement or relationship crisis) could also affect performance. “Personal responses to similar stressors can be very different,” explains Dodd. “It is hard to pinpoint exactly how a firefighter has been affected. One firefighter may be more motivated, show more concentration and commitment to the tasks at hand vs. another who may have completely the opposite response.” He adds, “It would largely depend on the level to which the stressor impacts the individual.”

An assessment of anxiety levels can go a long way in establishing whether an individual is in fact able to carry out demanding firefighting duties when he reports for duty after an absence. If anxiety levels are too high, this could lead to poor decision making, and then it is the team leader who is responsible for redeploying a presentee firefighter to a task without risk to the self or others or at least making sure that the individual has someone as backup who is aware of his presenteeism and is ready to assist if necessary.

A Multidimensional Approach to Training

So, how can we negate the effects of presenteeism among firefighters? Dodd says, “First, I believe that further action toward improved fitness levels and the incorporation of a multidimensional approach to training that includes attention to muscular strength, power, and endurance, in conjunction with cardiorespiratory improvement, is paramount. Improvement in fitness and maintenance of higher levels of fitness may provide a buffering effect to any response that may occur because of presenteeism.” In other words, by addressing the key areas to performing on-duty tasks with relative ease, it may provide better adjustment to the tasks, quicker recovery, and overall better efficiency, even if under some duress.

“The other addition I feel may assist is to provide sessions dealing with presenteeism and the impact it may have,” continues Dodd. More specifically, he recommends sessions to include nutritional guidance, meditation or respiratory control to mediate anxiety and distress during on-duty tasks, and recovery opportunities (sleep, rest periods, nutrition, hydration, and medication if needed).

“I feel it is important to address not only on-duty time but also off-duty time,” he says. “Overall, it may be impossible to negate presenteeism, but that may not necessarily be the goal, as much as it is to minimize the effect to maintain a low risk to oneself and others.”

Permission to Recover

Firefighters need to be sufficiently prepared both mentally and physically to cope with live-fire, anxiety-provoking situations. In addition, team leaders to know their team well enough to assess whether an individual is feeling below par and take supportive action, either by sending the team member for an occupational assessment, checking anxiety levels, or reorganizing duties so that a presentee firefighter isn’t put into a live-fire situation requiring peak health.

More importantly, firefighters and team leaders need to be educated about presenteeism and its risk to self and others. Ultimately, permission needs to be given for full recovery from illness and emotional stress.