Presenteeism happens when employees come to work even when they are unwell or unfit, and this often leads to reduced productivity and potential long-term health issues. The main reasons for presenteeism in the workplace include worries such as time pressure, a fear of job loss, the nature of the workplace culture, or over-commitment by the employee. Understanding the reasons for presenteeism can help you reduce harmful presenteeism and better support employee well-being.
- Job strain – fear of backlog or missed deadlines
- Over-commitment – employees who can’t switch off
- Time pressure – looming deadlines or unrealistic workloads
- Colleague pressure – not wanting others to cover
- Manager pressure – fear of how absence is perceived
- Workplace culture – sickness seen as weakness
- Limited or strict sick leave policies – financial pressure or fear of repercussions
- Job insecurity – fear of redundancy or demotion
What is Presenteeism?
Presenteeism is more than simply working while unwell. It also includes situations where staff push through illness, injury, or mental health strain, which can lead to hidden health-related productivity loss rather than visible lost work days. In many organizations, occupational health services and reasonable workplace accommodations are key to reducing these risks.
It is usually divided into two types:
- Negative presenteeism – when employees are too sick to work effectively, which may worsen their condition or spread illness.
- Positive presenteeism – when, with the right occupational health support and reasonable workplace adjustments, employees with chronic or manageable conditions can stay at work safely.
What is the difference between presenteeism and absenteeism?
| Absenteeism | Presenteeism |
|---|---|
| Employee stays away from work due to illness or other reasons. | Employee comes to work despite being unwell or unfit. |
| Leads to lost workdays but is usually visible and measurable. | Leads to hidden productivity loss, often harder to detect. |
| Managed with clear sick leave policies and return-to-work processes. | Requires cultural change, flexible working, and supportive leadership. |
For more on the other side of this issue, see the main causes of absenteeism in the workplace.
What causes presenteeism at work?
The most common causes of presenteeism at work include job strain, time pressure, over-commitment, and workplace culture.
Below are 8 of the most common reasons:
1. Job strain
Job strain refers to when employees feel overwhelmed by workload or expectations, prompting them to work while sick.
For example, an employee might be worried that the workload will build up in their absence and that others will not be able to cover.
Likewise, they might be worried about tight deadlines or because their workload is too big.
2. Over-commitment to work
Over-commitment happens when employees feel unable to disconnect from work, even when unwell.
This is more common than you may think, and these people you might call workaholics.
A number of staff members fit into this category, especially in high-level jobs.
Over-commitment is also closely linked to stress, burnout, and declining mental health, which are major contributors to presenteeism.
3. Time pressure
Time pressure is a major driver of presenteeism, especially when deadlines are tight or workloads are excessive.
Rather than putting their own well-being first, some employees will put the work and job first, and this is another one of the common reasons for presenteeism in the workplace.
Tight deadlines and unrealistic workloads leave employees feeling like they can’t afford to take time off, even when unwell.
Improving time management across teams can ease this pressure and reduce presenteeism. Explore key benefits of time management in the workplace.
4. Concern for others or colleagues
Some employees come to work sick to avoid burdening their teammates.
They do not want their colleagues to suffer by having to cover for them.
While this is a very noble trait, it is not necessarily good for you as a company.
5. Pressure from colleagues and managers
Managerial or peer pressure can make employees fear judgment if they take sick leave.
Indeed, some managers can be far too demanding, and those they manage can sometimes live in fear of missing work and getting left behind.
Furthermore, they might worry about how their manager and colleagues might react on their return.
It is vital to train managers in dealing with employee sickness and absence consistently and supportively. See our Absence Management Training Materials for ready-to-use resources for manager training.
6. Work culture and ethics
In some companies, there’s an unspoken rule that taking time off — even when sick — is a sign of weakness or lack of dedication. These issues often stem from a lack of ethical leadership and supportive workplace values.
This reflects wider issues in how employee experience is managed and perceived within the company.
Also, some professions (such as in the areas of welfare, education, and health) may be more prone to presenteeism due to the nature of the job itself and the responsibility that the professional feels toward people in their care.
7. Limited paid sick leave and strict sick leave policies
Strict sick leave policies can discourage staff from taking time off when needed.
In the United States, this often relates to whether sick leave is paid or unpaid, while in the UK, it may involve how statutory sick pay is applied.
The US Department of Labor provides information on paid leave in the United States, which is useful background when reviewing your own company policies.
Whatever the policy, it should encourage employees to report illness honestly rather than making them fear repercussions for taking legitimate sick leave.
8. Job insecurity
If employees feel that they might lose their jobs, they might come to work even if they are sick.
By being there as decisions are made, they perhaps feel that they might be able to exert some kind of influence and have nothing to lose by keeping an eye on proceedings.
How can you encourage positive presenteeism and reduce absenteeism?
As an employer, you can encourage positive presenteeism and reduce harmful absence by ensuring you offer appropriate workplace accommodations, offer flexible work options, show a supportive management style, provide clear sick leave policies, and have in place good return-to-work support.
The slide below shows the positive and negative aspects of presenteeism and absenteeism to help you reduce the reasons for employee absenteeism.
PowerPoint slide from our Absence Management Materials
What is positive presenteeism, and how can you encourage it?
Positive presenteeism refers to employees working with health conditions when properly supported.
So presenteeism is not always a bad thing, because it can sometimes be a positive thing.
With positive presenteeism, we refer to situations in which somebody with a health condition, if given the right support, can be present at work and can actually benefit from being at work.
For example, somebody who suffers from a chronic health condition, such as diabetes, can attend work if given support, such as being able to take breaks to monitor their blood sugar level or to have a snack.
The ADA may require employers to make suitable workplace adjustments for an employee with a disability. What is appropriate will depend on the individual situation and the job, and might include changes to working hours, equipment, or break arrangements.
Employers should consider each request individually, including whether the proposed adjustment would create significant difficulty or expense for the organization.
Options such as flexible working or hybrid working can also help staff manage health conditions while remaining productive.
In any case, though, it is good practice to support an employee if, with small and inexpensive adjustments, they can still come to work.
In some cases, you will need to consult with a health professional or with your occupational health services team to assess possible adjustments and employee fitness to work.
This type of presenteeism needs to be encouraged.
This diagram also shows how absenteeism and presenteeism relate. Positive absenteeism refers to legitimate absence — either planned or unplanned — such as staying home when genuinely ill.
We want employees to stay away from work when they have a legitimate reason to do so, if they are unwell, if they are too sick to come to work (no matter what type of adjustments you might offer), and/or if they have diseases that can be transmitted to their colleagues.
Positive absenteeism is also to be encouraged.
Let’s now look at the negatives.
What is negative presenteeism, and how can you reduce it?
Negative presenteeism is when an employee is too ill to be at work.
You want to reduce this type of presenteeism by assessing the situation (with the help of health professionals).
So, if the employee can still work with adequate support, you provide support and move towards positive presenteeism.
On the other hand, if there is no way that the employee should be at work, you need to encourage them to be off (and move towards positive absenteeism).
What is negative absenteeism?
Finally, let’s look at negative absenteeism.
Negative absenteeism can include illegitimate absence or long-term absence, where an employee could return with the right support.
So, you want to reduce the number of people who feel they are unable to work but would like to come back by putting in place adjustments or structured return-to-work programs that support reintegration and move them from negative absenteeism to positive presenteeism.
As for those who engage in illegitimate absenteeism, ideally, you would want to eliminate this type of behavior, either by improving your workplace culture or by using disciplinary procedures as a last resort if you have done everything you can and the absenteeism is just down to the individual.
These cases will hopefully be rare, but they do happen.
When is it appropriate for an employee to work while sick?
Deciding whether an employee should work when sick depends on the illness type, symptoms, and workplace adjustments.
(Another slide from the training materials we provide)
| Illness Type | When Should They Stay Home? |
|---|---|
| Common cold | If the symptoms are mild and there’s little face-to-face interaction, working remotely can be fine. Otherwise, rest should be encouraged to avoid spreading illness. |
| Flu | Flu often causes tiredness and a fever. Employees are best off staying at home until they’ve fully recovered. This also helps avoid infecting others. |
| Migraine | Working may be possible with adjustments such as reduced screen time or dim lighting. If symptoms are severe, a rest day at home is normally advisable. |
| Mental health stress | If the employee is stressed or experiencing burnout, the employee should be encouraged to take a break. Furthermore, supportive adjustments are likely to be needed. |
Note: This table is intended as a general workplace guide. If there is any doubt about symptoms or fitness to work, employees should consult a qualified medical professional or occupational health advisor.
1. Illness Manifestation
The first thing you need to consider is the illness manifestation.
Illness manifestation refers to whether the illness is episodic, acute, or chronic.
An episodic illness is something that comes and goes periodically, such as an allergy or a migraine.
In this case, the decision will depend on the severity of the symptoms and how these are managed (for instance, with medications that might cause side effects such as drowsiness).
The manager and the employee can discuss and agree if any accommodations are needed, such as working from home to avoid driving or avoiding computer screens during a migraine attack, etc.
An acute illness includes conditions that appear suddenly and with noticeable symptoms, and these can include communicable diseases, such as the flu.
A decision will depend on the type of job, whether the disease is infectious, if rest is needed to avoid a worsening of the condition, etc.
A chronic illness refers to long-term conditions such as diabetes, arthritis, heart disease, etc.
Unless symptoms are flaring up, usually people with these conditions can work, provided they are given support such as more breaks, time off for medical appointments, and lighter duties if needed.
2. Nature of the Illness
Another factor to consider is the nature of the illness.
This refers to whether the illness is physical or psychological.
People with mental health issues and distress tend not to discuss their symptoms and to avoid taking time off until they are badly affected.
So, managers need to keep an eye out for signs of distress and evaluate each situation on a case-by-case basis.
3. Task and Role
The third thing you need to consider is the tasks and the role of the job.
An office worker with a broken leg can still perform their duties, while a parking enforcement officer (who needs to stand around and walk a lot) with a sprained ankle will struggle.
Lastly, you need to consider other variables that vary from case to case and cannot be generalized. For example, you might want to consider transport availability or what types of facilities are available in the workplace.
What are the most common questions about presenteeism training?
Can presenteeism be reduced with manager training?
Yes. Manager training equips supervisors to recognize signs of presenteeism early and respond appropriately. It is about training your managers to encourage healthier attendance behaviors while supporting employee well-being.
How does this presenteeism training connect with absence management training?
Presenteeism and absenteeism are two sides of the same issue. Our Absence Management Training Materials complement this type of course by giving managers a complete toolkit to reduce both hidden productivity loss and unnecessary lost workdays.
Need Absence Management Training Materials?
Presenteeism and absenteeism are two sides of the same challenge. Save time with our complete Absence Management Training Materials, designed for HR professionals and facilitators.
