How Working While Sick Became the Norm – and Why That Should Change
Across boardrooms, hospital wards, classrooms, and home offices, a quiet epidemic is spreading — not of illness itself, but of working through it. Presenteeism, the practice of working while sick, has become so widespread that it now affects nearly 90% of the American workforce, despite many employers offering formal sick leave [1]. In Ireland, where statutory sick pay is slowly improving but still limited to five days per year as of 2024, the implications are equally alarming. Presenteeism, once seen as a harmless show of diligence, is now understood to be a key driver of burnout, illness, and economic loss. It is quietly undermining workplace productivity and health. It’s time leaders took it seriously.
The cost of presenteeism is not metaphorical. Recent research places the annual financial toll of presenteeism on US businesses at up to $150 billion — nearly ten times the cost of absenteeism [2]. Workers who show up ill are slower, less focused, and more error-prone, with their reduced performance often affecting team output. Far from being the reliable cogs in the machine they imagine themselves to be, sick employees become unintended saboteurs of efficiency.
These costs may be harder to quantify in an Irish context, but the parallels are evident. In a workplace culture that valorises toughness, where showing up has become shorthand for commitment, and where absence — no matter how justified — is perceived as weakness, presenteeism is not just tolerated. It is expected.
The Slacker Myth
Despite increased attention to workplace well-being, presenteeism remains alarmingly misunderstood. In popular discourse, absenteeism draws scrutiny: the empty desk, the out-of-office reply, the workload shuffled onto colleagues. But presenteeism is stealthier. It does not set off HR alerts or fill spreadsheets. It’s a quiet erosion of capability, carried out by employees who appear to be present but are not functioning at full capacity.
As Raquel Baldelomar, founder and CEO of marketing agency Quaintise, reports, a significant portion of the workforce doesn’t even use the sick leave they are entitled to. A 2016 survey found that only 16% of employees used all their paid sick days, while 32% didn’t use any [3]. The reasons range from wanting to save leave for a more serious illness to fears of appearing unreliable. Notably, 20% believed that not taking time off would help them advance in their careers. The logic is self-defeating: in striving to appear indispensable, these workers render themselves unproductive — and contagious.
This last point is critical. When sick employees come to work — whether physically or remotely — they endanger others. While working from home may reduce the risk of infection, it does not reduce the strain on the worker or the long-term organisational cost. The assumption that a remote setting makes it “safe” to work through illness is misguided. As noted by Erik Pham, the Founder of Health Canal, a health and wellness website that empowers people to lead healthier lives: “Presenteeism is still a risk” even in remote workplaces, especially given how digital surveillance and constant availability blur the lines between rest and productivity [4].
Structural, Not Personal
What makes presenteeism especially pernicious is how often it is treated as a personal failing. We tend to ask why individuals work while sick instead of asking what kind of system makes that behaviour rational. Monica L. Wang is an associate professor of community health sciences at Boston University School of Public Health and an adjunct associate professor of health policy and management at the Harvard T.H. Chan School of Public Health. Her research into presenteeism, published by Harvard Business Review, reframes the issue entirely. According to Wang, presenteeism is not about a lack of grit or self-awareness. It is a structural outcome of how work is designed, valued, and managed [5].
The causes, Wang argues, are systemic. Using a nationally representative sample of over 168 million American workers, her research identifies three core organisational drivers of presenteeism: inflexible job design, gendered occupational norms, and the imbalance between job demands and job resources.
Take the first of these: job flexibility. While we might assume that flexibility enables workers to rest when needed, the data suggests otherwise. In jobs with little flexibility (nursing, teaching, administration), women report high levels of presenteeism, often driven by fears around job security or letting their teams down. In highly flexible jobs (tech, finance, consulting), men report similarly high levels, driven instead by cultural expectations of constant availability. As Wang puts it, “some employees — particularly men — may feel pressure to remain constantly available, reinforcing cultural norms that equate being ‘always on’ with commitment” [6].
This leads into the second driver: occupational segregation. In female-dominated professions, rigid schedules, chronic understaffing, and limited autonomy create structural barriers to taking sick leave. In male-dominated sectors, an “availability culture” perpetuates the idea that only the most responsive and visible workers succeed. Both models discourage rest, just in different ways.
The third driver — an imbalance between job demands and available resources — draws from the Job Demands-Resources (JD-R) model, a framework developed by organisational psychologists to understand workplace stress. It distinguishes between the pressures employees face, such as heavy workloads, emotional strain, and tight deadlines, and the support they’re given, like schedule flexibility, managerial backing, and autonomy. When demands consistently outweigh resources, presenteeism rises. But it rarely stops there. Burnout, absenteeism, and turnover often follow in its wake. [7]
The Illusion of Productivity
Presenteeism thrives because it masquerades as productivity. It is deceptively easy for a manager to believe that a sick employee, replying to emails or sitting in a meeting, is contributing. But productivity is not presence. In fact, Wang’s study finds that employees working while ill experience a reduction in individual productivity of up to one-third, a loss that can ripple across teams through delays, miscommunications, and errors [8].
Baldelomar makes the point more bluntly: “You are more likely to make mistakes” [9]. Medications, fatigue, stress, and diminished cognitive functioning all make errors more likely. These aren’t minor lapses; they are the kind that can delay major projects or risk safety in sectors like healthcare or construction.
And the impact is not limited to short-term inefficiency. Pham warns that employees who repeatedly engage in presenteeism are more likely to suffer from long-term health decline, stress-related illness, and future absenteeism [10]. This is the hidden cost: what looks like resilience today is often tomorrow’s disability claim.
From Culture to Contagion
Culture is one of the most overlooked vectors of presenteeism. Many workplaces claim to support health, but fail to communicate that taking time off is truly acceptable. In remote and hybrid environments especially, the lack of explicit norms around rest creates confusion. If a manager logs on while coughing, what message does that send? If the team continues to celebrate those who “power through,” who really feels safe taking time to recover?
Heather V. MacArthur, writing in Forbes, suggests reframing the question entirely: “Be interested in why [employees] felt so much pressure to show up.” Managers should not shame those who come in sick, but rather interrogate the structural forces that made staying home feel riskier [11].
Education is one part of the solution. Employees need to understand that presenteeism has real costs. But education is meaningless without structural change. Without redesigning the systems that make working while sick feel necessary — unrealistic deadlines, unfilled vacancies, ambiguous expectations — any policy encouraging sick leave remains performative.
What Effective Leaders do Differently
If presenteeism is structural, then leaders hold the tools to dismantle it. Wang outlines a strategic approach based on the JD-R model that offers a concrete path forward. First, organisations must conduct diagnostics: mapping where job demands exceed resources across role categories. This can be done through pulse surveys, focus groups, or heat maps to identify departments most at risk [12].
Second, train managers to spot early warning signs: the employee sending emails at midnight, joining meetings while visibly unwell, or hesitating to take leave. Intervention might include redistributing workloads, adjusting deadlines, or offering temporary flexibility. Wang cites a study of over 7,000 UK firms in which mental health training for line managers significantly reduced presenteeism across the board [13].
Third, build ongoing feedback mechanisms. Continuous surveys, open forums, and transparent actions build trust and responsiveness. Microsoft’s pandemic-era “daily pulse” system, where employee feedback was collected and acted upon weekly, is a case in point. This responsiveness doesn’t just prevent burnout, it cultivates a culture of care [14].
Moving Forward
The lesson is clear. Presenteeism is not just a health issue. It’s a management issue. A design issue. A cultural issue. And the cost is paid in productivity, morale, and ultimately, talent.
In the midst of hybrid upheaval, staffing strain, and mounting mental health pressures, Irish employers would do well to recognise that confronting presenteeism isn’t a matter of kindness, it’s a matter of long-term viability. The myth that working while sick is a mark of commitment must be retired. Instead, leaders must reframe rest as resilience, and recovery as productivity.
We all get sick. The question is no longer whether sick employees will try to work. The question is: will your organisation allow them not to?
Sources
[1] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[2] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[3] https://www.forbes.com/sites/raquelbaldelomar/2016/08/31/three-reasons-to-stop-coming-to-work-sick/
[5] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[6] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[7] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[8] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[9] https://www.forbes.com/sites/raquelbaldelomar/2016/08/31/three-reasons-to-stop-coming-to-work-sick/
[12] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[13] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
[14] https://hbr.org/2025/06/research-why-employees-work-while-sick-and-how-leaders-can-stop-it
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