Presenteeism: Definition, Causes, Consequences

Working while sick can be unhealthy for employees, productivity and organizational culture.

Written by Jeff Rumage
Presenteeism: Definition, Causes, Consequences
Image: Shutterstock / Built In
Matthew Urwin | Sep 14, 2023

Organizational leaders have long been wary of employee absenteeism, but companies that place too much emphasis on attendance run the risk of an even greater productivity zapper: presenteeism. This workplace phenomenon, which occurs when employees show up to work sick, burned out or injured, is less visible than absenteeism, but some experts say it can be even more damaging to productivity, company culture and the health of a workforce.

What Is Presenteeism?

Presenteeism is a phenomenon where employees go to work but are not productive or fully functioning due to health or medical reasons.


What Is Presenteeism?

Presenteeism refers to employees reporting to work despite feeling sick or ill. This may be done out of dedication to their jobs, or because they feel pressure to show up even though they’re under the weather. Also in view are employees with mental health conditions, such as depression and ADHD, as well as chronic health conditions, which can impact their work performance. 

There is some scholarly debate about the scope of presenteeism. Ellen Ernst Kossek, a professor of management at Purdue University’s Mitchell E. Daniels, Jr. School of Business, for instance, argues that the phenomenon should take into account employees who show up to work unable to perform at a high level, regardless of their health. Generally, though, most experts agree that presenteeism refers primarily to showing up to work unhealthy, which manifests in a sharp drop in productivity.

Recommended ReadingHow to Spot Employee Stress Sooner


What Causes Presenteeism?

There are a variety of reasons why employees feel like they aren’t able to take off work, but they almost always stem from a workplace culture that emphasizes business demands over employee well-being.

In a 2004 ComPsych study that surveyed 627 professionals, 77 percent of respondents reported working while sick. A third of those employees said their presenteeism was due to their high workload, 26 percent voiced concerns of job security and 18 percent said they were saving days off to take care of their children.


1. Limited Sick Leave

Employees are far more likely to report to work sick if they don’t have paid sick leave. Paid sick leave is not a federal requirement, but more than a dozen states have required employers to provide this benefit in recent years.

Companies can discourage presenteeism by providing enough sick and vacation time, as well as by encouraging employees to actually use the PTO allotted to them. Some companies with unlimited PTO policies require employees to take a minimum of two or three weeks off per year.


2. High Workload

Employees can also feel obligated to “suck it up” and work sick because they feel like the business needs them. This sentiment may be prevalent in understaffed departments, among specialized workers who feel irreplaceable and within teams facing immediate deadlines.  

“When the pressure to perform at high levels, within tight deadlines, and/or with limited resources is too great, it creates an expectation that the work is more important than your health and well-being,” Jamy Conrad, senior director of people at TrustRadius, told Built In.

Find out who's hiring.
See all HR jobs at top tech companies & startups
View 435 Jobs

Mindy Honcoop, founder of fractional HR firm Agile in HR, said some tech companies that laid off employees are trying to do more with less, piling additional work responsibilities onto employees and discouraging them from taking time off work.

“There’s just no human way that you can do 200 people’s worth of work with 100 people,” Honcoop said. “So, how do we get really clear on what we should stop doing, and what are those three things that we are going to do? And then how are we dividing the work evenly among the people that we have?”

In addition to increased workloads, Honcoop said downsizing and reorganization can also be stressful for employees who are struggling to adapt to new roles or expanded responsibilities. Those feelings of stress, confusion and frustration can make it difficult for employees to be productive in their role.

“After six months there ends up being a performance issue, and what we realize is that the company had different expectations than when they hired the person, and they haven’t been clearly articulating the evolution of expectations and providing the right tools and resources to uplevel their skills along with those expectations,” Honcoop said. “That is so frustrating. It’s that level of frustration and that level of disconnection that can cause presenteeism.”


3. Layoffs Fuel Job Insecurity

Worries about job security, especially in a down economy or amid a wave of industry-wide layoffs, contribute to the problem of presenteeism.

Conrad said the current volatility in the tech industry, for instance, may cause tech professionals to think twice before calling out sick, wondering, “What will happen if I don’t go to work?”

Some employees may think that getting to the office early and staying late will increase their chances of dodging layoffs. One study found that, in times of downsizing and restructuring, male managers were prone to engage in “competitive presenteeism” by trying to stay longer in the office. (The study found that younger male employees were more likely to join this competitive atmosphere, while female employees resisted these pressures.)

During moments of organizational volatility, Honcoop said employees may sometimes feel like they are in “survival mode,” and they may not feel comfortable asking for feedback, sharing their stressors or asking for time off.

“Even if the manager is doing the best to try and ask them how they’re doing, the employee may not feel safe doing it,” Honcoop said.


4. Workplaces Value Physical Attendance

Just like any other environment, employees at work tend to take cues from the people around them. Longer-tenured employees may see their perfect attendance record as a badge of honor, which may send a signal to younger employees and new hires that working while sick is a social norm at a company.

Working while sick can be especially prevalent in companies and industries where “putting in facetime” or “being seen” carry undue importance.

In theory, the shift to remote work should have eliminated these kinds of social pressures, focusing on productivity instead of hours logged. Still, though, the culture of presenteeism is sometimes kept alive with the green light on email and workplace messaging platforms that show who is online and who is not. Employees may also feel pressured by productivity monitoring systems, which communicate distrust and create anxiety in employees.

Go DeeperWhat Is Work Culture? 11 Ways to Build a Positive Environment.


5. Remote Jobs Blur Work-Life Boundaries 

While remote work provides employees with extra time they would have spent commuting and has led to greater acceptance of flexible work schedules, it can just as easily be a culprit in rising presenteeism.

Indeed, several studies have shown that workers are more likely to work sick in remote environments. With blurred boundaries between work and home, employees may feel like they are always “on,” or they may downplay their illness because they are able to work from bed. 

“Employees have indicated that it is easier to work when ill and at home rather than in the office, and they are not seeing the value of taking ‘sick time’ as a result,” Conrad said.

“With blurred boundaries between work and home, employees may feel like they are always on.”

Remote employees might also be less likely to open up to their supervisor if they have never met in person, Honcoop said, which might make it more difficult for managers to address an employee’s questions about their role or any personal issues that might be affecting the employee’s job performance.

Overall, though, HR experts seem to agree that remote work is a net positive and that remote workers should force themselves to take time off when they need it. Kossek, who studies the benefits of flexible work environments, said companies that are requiring employees to come to the office should make the most of that time by engaging employees in collaborative work.

“Instead of requiring them to be in the office on, say, Monday, Wednesday and Friday, they need to align the work and the processes so that people are engaged as a team [on office days],” Kossek said.

Find out who's hiring.
See all HR jobs at top tech companies & startups
View 435 Jobs


Presenteeism vs. Absenteeism

Presenteeism is when employees are at work but aren’t actually all that productive. This is different from absenteeism, which is when employees chronically miss work without providing a reason. While absenteeism is a symptom of a disengaged employee, presenteeism can be caused by heavy workloads, job insecurity and workplace norms and may provide a more accurate view on how issues like chronic pain affect worker productivity.

In fact, research studies show presenteeism is far more prevalent than absenteeism. And researcher Gary Johns confirms presenteeism is a greater threat to productivity than absenteeism in an exhaustive review of academic research on the topic.   

“On the face of it, this suggests an iceberg effect in which the more visible portion of work loss (absenteeism) is dwarfed by that portion beneath the surface (presenteeism),” Johns wrote.


Consequences of Presenteeism

When employees come to work unhealthy — either physically or emotionally — it can hurt employee productivity, spread illnesses and exacerbate workplace negativity.


1. Lost Productivity

A major consequence of presenteeism is productivity losses, which makes sense: When an employee is sick, in pain or distracted, it is more difficult to get work done.

In a study from 2000, Bank One found that the productivity losses from presenteeism totaled $311.8 million, nearly triple the $116.2 million it spent on employees’ claims for medical treatment and pharmaceutical benefits. By comparison, absenteeism accounted for only $27 million in productivity losses.

Losses in productivity can vary depending on employees’ medical conditions and the prevalence of those conditions in the workforce.

2002 study of Lockheed Martin workers found that about 60 percent of employees had allergies, which reduced their productivity by 4.1 percent — a $1.8 million annual loss. Arthritis and chronic lower back pain were also prevalent, reducing productivity for 20 percent of its workforce. Depression, which affected 14 percent of employees, caused the greatest drop in productivity at 7.6 percent.


2. Spread of Sickness

Perhaps the most obvious consequence of presenteeism is the spread of communicable diseases. If the Covid-19 pandemic has taught us anything, it’s that we should stay home from the office if we are coughing, sneezing or exhibiting other flu-like symptoms. Going into the office would only make matters worse, potentially creating a workplace epidemic of sick employees who will either call in sick or slog unproductively through the workday.

Presenteeism can also be harmful for the health of individual employees. Untreated illnesses can turn into chronic conditions, cause more significant health episodes and prolong recovery periods.


3. Lower Morale

While most studies of presenteeism focus on the business angle of productivity loss, another factor to consider is that presenteeism may negatively affect workplace culture and employee morale.

Research has shown that burned-out workers who work while sick are likely to experience even greater feelings of emotional exhaustion. Some studies on the concept of “emotional contagion” have indicated that one coworker’s feelings of burnout can have a ripple effect, damaging the overall morale of the workplace.

Nobody wants to work in an environment where their coworkers are sick, stressed out and feeling like the company doesn’t care about them. Companies can set the tone of their workplace culture by promoting mental health services, health and wellness programs and encouraging the use of paid time off. Managers should also check in on their employees to make sure they feel like they have the resources they need to perform their job without feelings of stress, depression and burnout.

“Bottom line,” Conrad said, “when you run employees into the ground without regard to their well-being, it creates low morale, lower engagement, decreased quality of work, and higher turnover, all of which have significant financial impacts on the organization.”​


Reducing Presenteeism 

The best way to address presenteeism is to take a proactive approach. Embracing the following measures can jumpstart the process of developing a healthier workplace. 


1. Offer More Leave Benefits

A robust employee benefits package is an effective way to help prevent presenteeism. Paid sick days and unlimited PTO allow workers to take time off without worrying about lost wages. Companies may also want to enforce generous holiday breaks and recharge weeks for additional time away from work.   


2. Create a Wellness Program

To remove any workplace stigma surrounding mental health, companies can also establish their own wellness programs. This may include organizing free yoga lessons, reimbursing employees for gym memberships, offering free therapy sessions and partnering with mental health apps that make it easier for employees to access wellness services. 


3. Normalize and Model Taking Time Off

Even with the proper policies in place, employees may be hesitant to take time off if leaders don’t practice what they preach. Managers and company executives can strengthen the authority of wellness programs and benefits by taking advantage of these perks themselves. When company leaders take time off, mental health and wellness are seen as acceptable and the rest of the workforce will follow suit.  


4. Educate Employees on Presenteeism 

Taking time away from work may sound like the right thing to do, but it can still be difficult for employees to follow when they face looming deadlines, busy quarters and other scenarios that ramp up the pressure. Remind employees to take advantage of the company’s benefits and encourage them to establish a healthy work-life balance.     


5. Support Flexible Work Arrangements

When proper work-life boundaries are respected, remote and hybrid formats can be helpful for employees. Working from home allows employees with caretaking duties to be present in both their personal and professional lives. In addition, letting employees choose their own hours gives them the autonomy to structure their days as they see fit while still being productive.


Frequently Asked Questions

Presenteeism is when employees prioritize work over their own well-being, reporting for work when they’re sick, ill or injured. A variety of factors may compel employees to work through illness or pain, including understaffing, job insecurity and poor work-life balance.

While presenteeism is when employees show up to work despite being ill or injured, absenteeism is when employees chronically don’t show up to work when they’re expected to. Research also suggests that presenteeism leads to an even greater loss in productivity than absenteeism.

A drop in productivity is a common symptom of presenteeism, accompanied by other signs like frequent mistakes, skipped lunch breaks and feelings of apathy regarding one’s job.

Hiring Now
Origami Risk
Information Technology • Insurance • Professional Services • Software • Analytics