Purpose: This study explores the issues around return to work after a period of absence through low back pain from the perspectives of both managers and nurses.

Background: Back pain is a major cause of sickness absence among nurses and is responsible for up to 3.5% of staff leaving the profession. Interventions to facilitate return to work therefore may prevent the loss of valuable members of staff to the workforce. Psychosocial factors are thought to influence this process, although there is limited research on the perceptions about work (blue flags) and objective work characteristics (black flags) relating specifically to the nursing profession.

Methods: A qualitative methodology was employed, using semi-structured, in-depth interviews. Six managers and six nurses from one NHS Trust were interviewed about their experiences of the return to work process. Using a grounded theory approach, data were conceptualised and categorised using an open coding technique. Themes were cross-checked with participants and an independent researcher analysed each interview to ensure reliability of emergent themes.

Results: Whilst absent from work, nurses expressed frustration about lack of workplace support, uncertainty about their physical limitations and potential consequences to their future employment. Perceptions about workplace pressures, finance, and boredom at home influenced their decisions to return to work. Managers primarily reported difficulties in balancing the needs of the nurse, other staff and service pressures. Considerable variations in practice and perceived levels of support were reported.

Conclusion: Nurses and managers worked towards return to work although their immediate priorities differed. Nurses focussed on blue flag issues whilst managers focussed on factors which could be described as black flags. Both managers and nurses agreed that occupational guidelines would aid the return process.