A significant percentage of Americans fear taking a sick day could cost them their job, their health or their financial security.

More than three-quarters of Americans said they have worked while sick in the past year, according to a survey of 1,000 working adults by Team Software. That survey also found that 45% of workers feel judged by coworkers when they take sick time and 15% of Gen Z workers said they were fired or pushed out of their job after taking sick leave. More than half of those surveyed said they can’t afford to take one week of unpaid sick leave without falling behind on their bills, and about one-quarter said they’d struggle to pay for groceries or bills after one or two unpaid days.

Perhaps because of these and other pressures, 57% of workers took less than two full sick days last year, the survey found. Survey respondents who feared taking time off due to illness were worried about falling behind on work or being perceived as unreliable.

Three in 10 workers said their employer has no formal sick leave policy. Others pointed to difficulty securing paid time off when a doctor’s note, lab results or telehealth visits are required. The report found more than 25% of Americans have used their own money to prove they are sick enough to stay home. Team Software said the burden falls disproportionately on younger workers, with 52% of Gen Z reporting such expenses compared with only 7% of baby boomers.

“Confidence in taking sick days rises with income — and, to a lesser extent, with gender. Nearly half (49%) of workers earning $150,000 or more believe taking time off has no impact on their chances of promotion, while 69% of those earning under $50,000 worry it could hurt their career,” the Team Software report said. “Gender plays a role, too. Forty percent of women say they often feel guilty about taking time off, compared to just 28% of men, a gap that reflects enduring pressures around workplace commitment, reliability and caregiving expectations.”

A separate survey of 1,000 employed U.S. workers by LiveCareer found similar sentiments. Nearly 60% of workers surveyed report feeling ‘PTO anxiety’ when it comes to taking time off from work, even though 45% indicated they are entitled to more than two weeks of paid time off per year. Nine percent of survey respondents said their employer actively discourages time off, the survey found.

About half of respondents said that while company policy supports paid time off, workloads make taking time off unrealistic. In addition, 20% indicated they are less likely to take time off from work if their manager doesn’t take vacation.

“Generous PTO policies don’t automatically translate into time away from work,” said the report. “When employees take far less time off than they’re given, it signals deeper cultural barriers that keep people from fully stepping away to recharge.”

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