Un modelo de liderazgo para la retención de enfermeros/as profesionales

En el ámbito de Recursos Humanos es escaso el conocimiento sobre la implicancia de las características del fenómeno del Liderazgo en la retención del talento, en lo referido particularmente a la población de enfermeros/as profesionales. Este estudio empírico basado en un diseño no experimental de alcance descriptivo, tuvo por objetivo general evaluar si existe relación entre las estrategias de intervención enfocadas en el equipo de trabajo que desarrollan los Jefes de Unidad de Enfermería, y la retención del recurso humano de enfermería del Hospital Privado de Comunidad de la ciudad de Mar del Plata (Argentina), para generar una propuesta competitiva y sostenible de retención de Recursos Humanos basada en un modelo de liderazgo ajustado a las necesidades de los colaboradores. Abstract In the field of Human Resources, there is little knowledge about the implication of the characteristics of the Leadership phenomenon in the retention of talent, particularly in relation to the population of professional nurses. This empirical study based on a non-experimental design with a descriptive scope, had the general objective of evaluating whether there is a relationship between the intervention strategies focused on the work team developed by the Heads of Nursing Unit, and the retention of the nursing human resource of the Private Community Hospital of the city of Mar del Plata (Argentina), to generate a competitive and sustainable proposal for the retention of Human Resources based on a leadership model adjusted to the needs of employees.

The Environmental Factors Associated With Fatigue of Frontline Nurses in the Infection Disease Nursing Unit

The workload in the Infection Disease Nursing Unit (IDNU) is increasing dramatically due to COVID-19, and leads to the prevalence of fatigue among the frontline nurses, threatening their health, and safety. The built environment and design could fundamentally affect the fatigue of nurses for a long-term perspective. This article aims to extract the environmental factors of IDNU and explore nurses' perceptions of these factors on the work-related fatigue. It would produce evidences for mitigating the fatigue by environmental interferons. A cross-sectional design was employed by combination of focus group interview and written survey. Environmental factors of IDNU were collected from healthcare design experts (n = 8). Nurses (n = 64) with frontline COVID-19 experiences in IDNU were recruited to assess these factors individually. Four environmental factors were identified as: Nursing Distance (ND), Spatial Crowdness (SC), Natural Ventilation, and Light (NVL), and Spatial Privacy (SP). Among them, ND was considered as the most influential factor on the physical fatigue, while SP was on the psychological fatigue. Generally, these environmental factors were found to be more influential on the physical fatigue than the psychological fatigue. Technical titles were found to be associated with the nurses' perceptions of fatigue by these environmental factors. Nurse assistant and practical nurse were more likely to suffer from the physical fatigue by these factors than senior nurse. The result indicated that environmental factors of IDNU were associated with the nurses' fatigue, particularly on the physical aspect. Environmental interventions of design could be adopted to alleviate the fatigue by these factors such as reducing the ND and improving the spatial privacy. The accurate interventional measures should be applied to fit nurses' conditions due to their technical titles. More attention should be given to the low-ranking nurses, who account for the majority and are much vulnerable to the physical fatigue by environmental factors.

Conducting a Cluster RCT on Medication Safety in Nursing Units Overtaxed by the COVID-19 Pandemic

Medication errors continue to harm many hospitalized patients. In other high-risk industries, voluntary incident reporting is widely used to improve safety. Reporting is widely used in hospitals, but not as effectively. This AHRQ-funded cluster RCT will assess the effects of the SAFE Loop, which includes five enhancements in incident reporting implemented on hospital nursing units. Analyses will compare changes in nurses’ attitudes toward reporting, event reporting rates, report quality, and medication event rates between intervention and control arms. The COVID-19 pandemic has created both obstacles and opportunities. The intervention requires study staff to engage nursing unit directors, attend daily nursing “huddles”, and train overtaxed front-line nurses in a geographic area greatly impacted by COVID-19 surges. This created uncertainty around the best time to start the trial. Conversely, we have collected unique data on the implications of COVID-19 for medication safety while testing our instruments during the trial preparation phase.

The Continuous Learning Cycle: A Multi-phase Post-occupancy Evaluation (POE) of Decentralized Nursing Unit Design

Purpose: This study aims to demonstrate how multiphase postoccupancy evaluation (POE) research was integrated into multiple projects to develop a continuous learning cycle. Background: Despite the well-recognized importance of POE, few studies have reported how knowledge from POE is applied in new designs. Method: This study is developed as a multiphase POE that spanned 3 years and across three units. Phase I POE compared an existing unit (Unit A) in Hospital A and a new Unit B in Hospital B that has implemented innovative design features such as decentralized nurse stations. The idea was to understand the challenges of the existing facility in Hospital A and gather lessons learned from the new design in Unit B to inform the design of the Hospital A expansion (Unit C). After the new expansion was occupied, the Phase II POE was conducted using the same set of POE tools in both Unit C and Unit A. The POE applied the following methods: (1) patient room evaluations using the Center for Health Design standardized POE tools, (2) space syntax analysis of visibility, and (3) a pre- and postmove analysis of Press Ganey data. Results: The results demonstrated that by incorporating lessons learned from the Phase I POE, Unit C has further improvement on patient room design ratings, improved patient satisfaction, and better visibility among nurse work areas compared to Unit A and Unit B. Conclusions: The multiphase, multisite POE with standardized tools has demonstrated its value as an important tool for continuous design quality improvement.

42. Outbreak of SARS-CoV-2 in Hospitalized Hemodialysis Patients: an Epidemiologic and Genomic Investigation

Background Healthcare-associated transmission of SARS-CoV-2 is relatively rare and may be difficult to quantify. We performed an epidemiological investigation and SARS-CoV-2 genome sequencing to define the source and scope of a SARS-CoV-2 outbreak in a cluster of hospitalized patients Methods We conducted an outbreak investigation after identifying hospital-onset COVID-19 in patients receiving hemodialysis in January 2021. Electronic medical record review, staff interviews, review of employee schedule logs, and contact tracing were used to determine the outbreak timeline and identify exposed healthcare workers (HCW). SARS-CoV-2 genomes were sequenced from residual nasopharyngeal swab samples from 6 individuals in the outbreak investigation and compared to sequences from 14 patients in the same facility, 54 patients in nearby facilities, and 375 publicly available sequences from individuals in the state of Georgia. Results Eight patients with hospital-onset COVID-19 were identified (Cases 1-8); all were receiving hemodialysis and 5 were bedded in a single inpatient nursing unit. Among 53 potentially exposed HCW, 29 underwent testing and 5 were positive (Cases 9-13). The suspected index patient (Case 1) was found to have been coughing and inconsistently wearing a mask during a hemodialysis session on the same day that 6 of the 7 other patients and one HCW (Case 10) were in close proximity in the hemodialysis unit (Figure 1A). Further investigation revealed lack of use of curtain barriers in the hemodialysis bays, inconsistent use of personal protective equipment by HCW, and overcrowding of staff breakrooms. Among the 6 samples available for phylogenetic analysis, SARS-CoV-2 sequences from 5 (4 patients and 1 HCW, Case 9) were identical and at least 4 SNPs removed from the next closest sequence in this study, supporting a transmission cluster (Figure 1B). The sequence from the sixth sample (HCW Case 10) was phylogenetically distinct, indicating an independent source of infection. Figure 1 Exposure and onset of symptoms for the 6 cases in the outbreak with samples available for SARS-CoV-2 sequencing. Four patients with hospital-onset COVID-19 (Cases 1-4) were receiving hemodialysis and bedded in a single inpatient nursing unit, with two exposed healthcare workers (Cases 9-10). (A). Phylogenetic tree of SARS-CoV-2 genomes from individuals in this outbreak investigation (red), as well as 14 patients in the same facility and 54 patients in nearby facilities between 12/12/2020 and 1/13/2021 (blue). These were aligned with 375 publicly available sequences from individuals in the state of Georgia from the same time period using MAFFT. A maximum-likelihood phylogenetic tree was generated under a generalized time-reversible model with 1,000 bootstrap replicates using IQtree v2.0.3 and visualized and annotated using Interactive Tree of Life (iTOL) v4 (B). Conclusion Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission during a single hemodialysis session, based on clinical and genomic epidemiology. Use of appropriate PPE for both patients and HCW and other infection prevention measures are critical to prevent SARS-CoV-2 transmission. Disclosures All Authors: No reported disclosures

A new two-stage nurse scheduling approach based on occupational justice considering assurance attendance in works shifts by using Z-number method: A real case study

In this paper, a new binary integer programming mathematical model for scheduling nurses' problems in the emergency department of Kamkar Hospital in Qom province is developed. The manual arrangement of nurses by the head nurse and its time-consuming, occasional absences during the period and protests against injustices in the arrangement of nurses' work shifts were among the emergency department's challenges before implementing the model. Most relevant studies aimed to enhance nurses' satisfaction by creating a general balance considering occupational preferences. Thus, the present study pursued justice through considering preferences based on the results from periodical evaluations of each nurse's performance with the ultimate goal of improving nurses' satisfaction. Moreover, the lack of clarity in selecting shifts, which may cause irregular attendance, was improved using the Z-number method. After the run of the model, the rate of nurses' absences decreased by 40%, the rate of complaints about the performance of the nursing unit decreased by 50%. Also, nurses' satisfaction increased by 30% after the implementation of the model.

Examining Adverse Patient Outcomes in Nurses: The Role of Patient Acuity, Shift and Fatigue

This study identified key factors contributing to adverse patient outcomes (APOs) at a mid-western hospital. Understanding risk factors that contribute to increased nurse fatigue can provide solutions to reduce the impact that fatigue has on nurse performance and patient outcome. This study was comprised of two phases: 1) a database analysis of current data collected at a mid-western hospital, and 2) three focus groups to identify nurse perceptions pertaining to task demand and fatigue. The APOs analyzed in this study were medical administration errors (MAEs) and patient falls. A comparison of the data from both phases was then conducted to determine whether data reflected in the database correlated with nurse perceptions. This analysis documents significant results with respect to APOs in the following workload factors such as: hours worked, case mix index (CMI), shift, and nursing unit type.

Modelling workload to quality using system dynamics in manufacturing and healthcare

This paper presents an approach using System Dynamics (SD) to model long-run effects of given workload levels on employee health and quality of the system output. The models integrate scientific evidence on injury and burnout risk factors, error making probabilities, and presenteeism phenomena to create two SD models – one for a manufacturing assembly line and the other for a hospital nursing unit – that can help users explore the ergonomics-system performance relationship. The manufacturing model results show an increase in injury rates and a decrease in yield as the operators are exposed to higher spinal loads. The nursing model results show an increase in nurse burnout and medical errors as nursing workload is increased. This demonstration reveals the feasibility of SD modeling to help managers and engineers explore the long-run consequences of the human factors in their operations system design and inform policy decisions in terms of both human health and system performance outcomes.