Dotación de enfermeras en los hospitales españoles: análisis comparativo

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Abstract

La escasez de enfermeras se está convirtiendo en un problema en la sostenibilidad de los niveles de calidad del sistema, afectando tanto a la seguridad de los pacientes como a la seguridad de la enfermería. Objetivo principal: Identificar y definir la dotación de enfermeras de hospitales españoles y especificar los aspectos a mejorar. Metodología: Recogida de información en bases de datos y análisis estadístico. Resultados principales: Existen diferencias importantes en la dotación de personal de enfermería, inclusive respecto de otros profesionales, que van en detrimento de la seguridad de los pacientes y de los propios profesionales de enfermería. Conclusión principal: no existen criterios uniformes en el conjunto del país para la provisión de recursos humanos sanitarios.

Translated abstract

The shortage of nurses is becoming a problem in the sustainability of the quality levels of the system, affecting both patient safety and the safety of nursing. Objective: Identify and define the nurse staffing Spanish hospitals and specify areas for improvement. Methods: Data adquisition in data bases and statistical analysis. Results: There are important differences in the staffing of nurses, including in relation with other professionals, it is in detriment of the safety of the patients and own nursing professionals. Conclusions: There isn't uniform criteria throughout the country for the provision of health human resources.

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Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

Churnrurtai Kanchanachitra, Magnus Lindelow, Timothy Johnston … (2011)

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Effects of hospital staffing and organizational climate on needlestick injuries to nurses.

P Clarke, Linda Aiken, Douglas Sloane (2002)

This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries.

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The impact of the nursing hours per patient day (NHPPD) staffing method on patient outcomes: a retrospective analysis of patient and staffing data.

Christine Duffield, Judith Finn, D Twigg … (2011)

In March 2002 the Australian Industrial Relations Commission ordered the introduction of a new staffing method - nursing hours per patient day (NHPPD) - for implementation in Western Australia public hospitals. This method used a "bottom up" approach to classify each hospital ward into one of seven categories using characteristics such as patient complexity, intervention levels, the presence of high dependency beds, the emergency/elective patient mix and patient turnover. Once classified, NHPPD were allocated for each ward. The objective of this study was to determine the impact of implementing the NHPPD staffing method on 14 nursing-sensitive outcomes: central nervous system complications, wound infections, pulmonary failure, urinary tract infection, pressure ulcer, pneumonia, deep vein thrombosis, ulcer/gastritis/upper gastrointestinal bleed, sepsis, physiologic/metabolic derangement, shock/cardiac arrest, mortality, failure to rescue and length of stay. The research design was an interrupted time series using retrospective analysis of patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over a 4-year period. All patient records (N=236,454) and nurse staffing records (N=150,925) from NHPPD wards were included. The study found significant decreases in the rates of nine nursing-sensitive outcomes when examining hospital-level data following implementation of NHPPD; mortality, central nervous system complications, pressure ulcers, deep vein thrombosis, sepsis, ulcer/gastritis/upper gastrointestinal bleed shock/cardiac arrest, pneumonia and average length of stay. At the ward level, significant decreases in the rates of five nursing-sensitive outcomes; mortality, shock/cardiac arrest, ulcer/gastritis/upper gastrointestinal bleed, length of stay and urinary tract infections occurred. The findings provide evidence to support the continuation of the NHPPD staffing method. They also add to evidence about the importance of nurse staffing to patient safety; evidence that must influence policy. This study is one of the first to empirically review a specific nurse staffing method, based on an individual assessment of each ward to determine staffing requirements, rather than a "one-size-fits-all" approach. Copyright © 2010 Elsevier Ltd. All rights reserved.