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Background:  In China, sickness presenteeism, job burnout, and fatigue are common among nurses during the COVID-19 pandemic. We propose the prevalence of sickness presenteeism can adversely affect nurses' physical and mental health, negatively impact their work productivity and quality, and pose a threat to patients' safety. Therefore, this study examines the mechanism of productivity loss caused by sickness presenteeism, fatigue, and job burnout.    Objectives:  To investigate the serial-multiple mediating effect of job burnout and fatigue in the relationship between sickness presenteeism and productivity loss among nurses.    Methods:  A multicenter cross-sectional survey was undertaken by administering an online questionnaire from December 2020 to May 2021. Stratified cluster sampling was used to include 3,491 nurses from 14 hospitals in Shandong Province, China. Variables were measured using the Sickness Presenteeism Questionnaire, Stanford Presenteeism Scale, Chalder Fatigue Scale, and Maslach Burnout Inventory. Data analyses were carried out using descriptive statistics, one-way analysis of variance, independent-samples  t -test, Pearson correlation analysis, hierarchical regression, and bootstrapping method.    Results:  From the 3,491 nurses who volunteered in this online survey, only 2,968 valid questionnaires were returned. Sickness presenteeism exhibited a prevalence of 70.6% during the COVID-19 pandemic. The average score of health-related productivity loss was 15.05 ± 4.52, fatigue was 8.48 ± 3.40, and job burnout was 39.14 ± 19.64. Sickness presenteeism was positively associated with fatigue and job burnout while job burnout was positively associated with nurse fatigue. Sickness presenteeism, fatigue, and job burnout were also positively correlated with health-related productivity loss. Statistically significant paths via the single mediation of fatigue and job burnout were established. A statistically significant serial-multiple mediating effect of fatigue and job burnout on the association between sickness presenteeism and productivity loss accounted for 35.12% of the total effect size.    Conclusions:  There was a high incidence of sickness presenteeism and job burnout among Chinese nurses. High-frequency sickness presenteeism may result in increased productivity loss through the two mediating effects of fatigue and job burnout. Sickness presenteeism may increase fatigue, promote job burnout, and result in increased productivity loss among Chinese nurses during the COVID-19 pandemic.

frontiers in public health

Serial-Multiple Mediation of Job Burnout and Fatigue in the Relationship Between Sickness Presenteeism and Productivity Loss in Nurses: A Multicenter Cross-Sectional Study