Dotaciones, skillmix e indicadores laborales de enfermería en Hospitales Públicos chilenos

Abstract

a,b , alejandra galiano 3,a , María conSuelo cerón 1,a , eileen T. laKe 4,a,c , linda h. aiKen 4,a,c Nurse staffing, skill mix and job outcomes in Chilean public hospitals Background: International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality. Aim: To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile. Material and Methods: An observational, cross-sectional study of 1,855 registered nurses working in medical-surgical units in 37 public hospitals was conducted. Data collection followed the RN4CAST research protocol. Inferential analyses used logistic regression models. Results: The survey was answered by 1,395 registered nurses in 34 hospitals. The average staffing ratio was 14 patients-per-nurse, and the average skill mix was 31% registered nurses. Of all nurses, 35% reported burnout, 22% were dissatisfied, and 33% intended to leave. Being burned out increased by 9 and 6% the odds of being dissatisfied and the intent to leave, respectively (Odds ratio (OR) 1.09, p < 0.01 and 1.06, p < 0.01). Being dissatisfied increased by five times the odds of intent to leave (OR 5.19, p < 0.01). Conclusions: Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.

Hospital work environment, nurse staffing and missed care in Chile: A cross‐sectional observational study

“…This result is relevant from a managerial perspective, since there might be low‐cost strategies that may prove to be effective in improving the work environment and, consequently, reducing the prevalence of missed care. Even though hospitals in Chile should aim at improving staffing ratios (Aiken et al, 2021; Simonetti et al, 2020), nurse executives normally deal with very constrained hospital budgets and they may be more successful at getting resources to improve the work environment rather than increasing the fixed costs of a larger nursing workforce. The panel study conducted by Lake et al (2020) provides valuable evidence on the effectiveness of improving hospital work environments in reducing missed care.…”

“…First, regarding nurse staffing resources, recent Chilean data show problems of hospital understaffing. Average patient‐to‐nurse staffing ratios are significantly high as compared to those in North American and European countries (Aiken et al, 2014; Simonetti et al, 2020). The average patient assignment across hospitals is of 14 patients per nurse, ranging from 9 to 23, and patient assignments increase during night shifts (Simonetti et al, 2020).…”

“…Average patient‐to‐nurse staffing ratios are significantly high as compared to those in North American and European countries (Aiken et al, 2014; Simonetti et al, 2020). The average patient assignment across hospitals is of 14 patients per nurse, ranging from 9 to 23, and patient assignments increase during night shifts (Simonetti et al, 2020). It has been reported that hospitals, especially public hospitals, do not open all positions that will be needed to sufficiently staff their units; this cost‐containment measure mostly affects the nursing workforce (Vergara, 2015).…”

“…Second, the quality of hospital work environments reported in a previous study (Aiken et al, 2021) may also negatively contribute to the completion of patient care in those hospitals with worse assessments. Third, the low RN skillmix also warrants attention to the problem of missed care; in Chile, RNs comprise only a medium to small percentage of the total nursing personnel, with reported skillmix of 19% to 36% RNs (Aiken et al, 2021; Simonetti et al, 2020).…”

Technological innovation for workload allocation in nursing care management: an integrative review

“…The methodological proposals on how to calculate the nursing care requirements, nurse staffing, and skill mix, are based on local observations, which don't allow generalization. Low staffing levels negatively affect safety indicators and staff performance (Simonetti et al, 2020), but estimating the nursing workload, considering emergent care, for decision making, is still an unsolved challenge (Griffiths et al, 2020).…”