Impacto del tamaño del ámbito de control de las jefas de unidad en los comportamientos laborales de las enfermeras / Impact of charge nurses’ span of control on the work attitudes of nurses

Fundamento: Conocer el número de enfermeras a cargode las jefas de unidades de Enfermería de los hospitalespúblicos generales aragoneses y analizar cómo afecta alos comportamientos organizacionales de la enfermera ya la calidad de las relaciones que se establecen con lajefa de unidad. Método: Estudio descriptivo transversal realizado ennueve hospitales públicos. Se evaluó mediante cuestionarios validados los comportamientos laborales de lasenfermeras y la calidad de las relaciones de la enfermeracon la jefa de unidad y de esta con la enfermera y consu inmediato superior. Se analizó si existía relación entreestas variables y el número de enfermeras por unidad. Resultados: La muestra se compuso de 2541 enfermeras y192 jefas de unidad. La media del ámbito de control fue de29 enfermeras (DE = 22,4). Se obtuvieron puntaciones menores al aumentar el ámbito de control en: empoderamiento (p<0,001), satisfacción (p = 0,027), apoyo organizacionalpercibido (p<0,001) y calidad de las relaciones entre lasenfermeras y las jefas de unidad (p<0,001) y de la jefa deunidad con su inmediato superior (p<0,001). No se observaron asociaciones significativas respecto a la intenciónde rotación, los comportamientos cívicos organizacionales y el compromiso organizacional. Conclusiones: El tamaño del ámbito de control se relaciona con la percepción de los comportamientos organizacionales de las enfermeras, así como con la calidad delas relaciones interpersonales que establecen con la jefade unidad, indicando la necesidad ajustar el ámbito decontrol por unidad con el objetivo mejorar la calidad dela gestión de las unidades de Enfermería.(AU)

Background: To determine the number of nurses whoare supervised by a charge nurse in the Nursing Unitsof Aragonese general public hospitals and to analyzehow this affects the organizational behaviors of nursesand the quality of the relationships established with thecharge nurses. Methods: Cross-sectional study carried out in nine publichospitals. Validated questionnaires were used to assessthe working behavior of nurses and the quality of theirrelationships with charge nurses, and the charge nurse’srelationship with their immediate superior and nursingstaff. We analyzed whether there was an association between these variables and the number of nurses per unit. Results: The study included 2,541 nurses and 192 super-visors. The mean span of control was 29 (SD = 22.4). Statistically significant differences were observed with re-spect to empowerment (p<0.001), satisfaction (p = 0.027),perceived organizational support (p<0.001) and thequality of the nurse’s relationships with the supervisor(p<0.001) and the supervisor with her immediate superior (p<0.001), obtaining lower scores as the span of con-trol increased. No significant associations were observedwith respect to turnover intention, organizational citizenship behavior and organizational commitment. Conclusions: The span of control is related to the perception of nurses’ organizational behaviors and with thequality of interpersonal relationships with the chargenurse, indicating a need to adjust the span of of controlper unit in order to improve the quality of the management of the units.(AU)

[Impact of charge nurses' span of control on the work attitudes of nurses].

BACKGROUND: To determine the number of nurses who are supervised by a charge nurse in the Nursing Units of Aragonese general public hospitals and to analyze how this affects the organizational behaviors of nurses and the quality of the relationships established with the charge nurses. METHODS: Cross-sectional study carried out in nine public hospitals. Validated questionnaires were used to assess the working behavior of nurses and the quality of their relationships with charge nurses, and the charge nurse's relationship with their immediate superior and nursing staff. We analyzed whether there was an association between these variables and the number of nurses per unit. RESULTS: The study included 2,541 nurses and 192 supervisors. The mean span of control was 29 (SD=22.4). Statistically significant differences were observed with respect to empowerment (p<0.001), satisfaction (p=0.027), perceived organizational support (p<0.001) and the quality of the nurse's relationships with the supervisor (p<0.001) and the supervisor with her immediate superior (p<0.001), obtaining lower scores as the span of control increased. No significant associations were observed with respect to turnover intention, organizational citizenship behavior and organizational commitment. CONCLUSIONS: The span of control is related to the perception of nurses' organizational behaviors and with the quality of interpersonal relationships with the charge nurse, indicating a need to adjust the span of of control per unit in order to improve the quality of the management of the units.

Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel / Incidence of postoperative adverse events in a tertiary hospital

Objetivos. Determinar la proporción de reintervenciones, mortalidad, incidencia, gravedad y grado de evitabilidad de eventos adversos posquirúrgicos (EAP) en un hospital de tercer nivel. Métodos. Revisión retrospectiva de una muestra aleatoria de 350 cirugías realizadas en 2009 en pacientes mayores de 14 años. Para identificar los EAP, determinar su gravedad y establecer su grado de evitabilidad se utilizaron clasificaciones preestablecidas. Resultados. Se detectaron 113 EAP en 61 pacientes, el 17,4% de los 350 pacientes estudiados. El 4,3% de los pacientes fue reintervenido y la mortalidad a los 30 días fue del 2,6%. Los EAP más frecuentes fueron: infección de herida quirúrgica (15,0%), hematoma o hemorragia de herida (9,7%) y anemia por sangrado (8,8%). Los factores asociados a los pacientes que adquirieron un EAP fueron el uso anestesia general, grado ASA≥3, estancia media, edad media y servicios con cirugía de mayor repercusión sistémica. Cerca del 70% de los EAP estaban recogidos en el informe de alta. El 72,6% de EAP fueron de gravedad leve, el 11,5% de gravedad moderada y el 15,9% muy graves. Un 39,9% de EAP tenían una probabilidad alta de haberse evitado. No se encontró relación entre la evitabilidad y la gravedad de los EAP. Conclusiones. La alta proporción de pacientes intervenidos con EAP, las reintervenciones consecuentes y la mortalidad en el postoperatorio inmediato señalan la importancia de implantar acciones para reducir la magnitud y el impacto de los eventos adversos, teniendo en cuenta que más del 40% de los EAP podría ser evitado(AU)

Objectives. To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. Methods. Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. Results. Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. Conclusions. The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided(AU)

[Incidence of postoperative adverse events in a tertiary hospital]. / Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel.

OBJECTIVES: To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. METHODS: Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. RESULTS: Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. CONCLUSIONS: The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided.