Regional variation in sick leave among nurses and health workers

Projections made at Statistics Norway indicate that there will be an increasing shortage of health care workers and nurses in the years up to 2035. The shortage of labor is exacerbated by the fact that two groups have high sickness absence. In this report, we take a closer look at the sickness absence of the two education groups, with particular focus on regional variations, and whether there are features of sickness absence that may indicate that these variations can primarily be attributed to regional conditions and to a lesser extent to characteristics of the individual.

The analysis is based on an empirical model for the sickness absence rate measured by sickness absence certified by a doctor. The approach means that when calculating the contributions from the regional areas, we can control for other factors that are of importance for sickness absence. Even after we have controlled for compositional effects related to age, shift work, where in the health care sector the person works and information (Norway / abroad) about place of education and place of birth, we find that there are regional variations in the sickness absence rate for nurses. The sickness absence rate is largest in the northern parts of the country according to our calculations for 2017, and the regional effects are statistically significant compared with the reference area Bergen. This finding is robust with respect to choice of observation year. However, we do not know whether the high sickness absence rate is due to special conditions in the workplaces in these areas or whether it is due to unobservable characteristics of the individuals.

When it comes to health care workers, it is even more important than for nurses to adjust for compositional effects when calculating the regional differences. For health care workers, the ranking of the regions based on the regional effects is sensitive with whether we look at adjusted or non-adjusted effects. After having controlled for compositional effects, the regional effects are reduced. The regional effects are relatively consistent over time.

We also find that the correlation between the regions with large effects for nurses and for health care workers respectively, is large. This finding may indicate that there is something with the organization of the work and / or working environment conditions in specific regions that contribute to high sickness absence.

Nurses who provide care services in institutions or in home services have a higher sickness absence rate than nurses who work in hospitals and in the municipal health service after it has been controlled for compositional effects. Similar findings also apply in part to female health care workers. However, this result does not necessarily mean that jobs in the care services leads to more sick leave, as there may also be effects related to the individual person (self-selection).

As expected, we find that gender and age are of great importance for sickness absence. We also find statistically significant effects of shift work, but the effects are relatively small.