Ambiente, carga de trabalho e burnout em enfermeiras de hospitais públicos no Chile

Simonetti, Marta; Aqueveque, Ana María Vásquez; Alejandra Galiano, María

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2020-0521 copiar

Ambiente, carga de trabalho e burnout em enfermeiras de hospitais públicos no Chile

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Analisar, a partir de uma perspectiva organizacional, o problema de burnout em enfermeiras de hospitais públicos de alta complexidade no Chile.

Método:

Estudo multicêntrico, observacional e transversal. De acordo com os critérios de inclusão estabelecidos, trabalhou-se com o universo dos hospitais e enfermeiras. A coleta de dados foi realizada por meio de uma pesquisa com enfermeiras. O ambiente de trabalho foi medido com o instrumento Practice Environment Scale do Nursing Work Index, as equipes por meio do relatório das enfermeiras sobre carga de pacientes e burnout com a subescala de exaustão emocional do Inventário de Burnout de Maslach.

Resultados:

Participaram 34 hospitais (92%) e 1.395 enfermeiras (75,3%). A prevalência de burnout foi de 34,7%, sendo maior em Santiago do que nas regiões (p = 0,001). As análises de regressão logística apresentaram associação significativa entre ambiente de trabalho e burnout (OR 0,57, IC 95% 0,41–0,79, p = 0,001). Nenhuma associação foi estabelecida entre dotação de pessoal, combinação de tarefas (skill mix) e burnout.

Conclusão:

Uma alta porcentagem de enfermeiras no Chile sofre de burnout, significativamente associado à qualidade do ambiente. A implementação de estratégias organizacionais que melhorem os ambientes de trabalho podem reduzir o burnout e melhorar a qualidade do atendimento.

DESCRITORES
Esgotamento Psicológico; Estresse Ocupacional; Ambiente de Trabalho; Carga de Trabalho; Enfermagem

General characteristics of hospitals	Total n= 34	Santiago n= 10	Regions n= 24	p value
Size according to number of beds, $\bar{x}$ (DS)	409 (162)	507 (144)	368 (154)	0.021^* * p< 0.05
Work environment score, $\bar{x}$ (SD)	2.69 (0.18)	2.62 (0.20)	2.72 (0.16)	0.147
Poor work environment, n (%)	9 (26.5)	4 (40.0)	5 (20.8)
Average work environment, n (%)	16 (47.0)	4 (40.0)	12 (50.0)	0.621
Good work environment, n (%)	9 (26.5)	2 (20.0)	7 (29.2)
Patients per nurse, $\bar{x}$ (SD)	19.0 (6.3)	15.4 (4.5)	20.5 (6.4)	0.028^* * p< 0.05
Skill mix, %	29.5	30.6	29.0	0.340
Nurses characteristics	n= 1.395	n= 523	n= 872
Age, $\bar{x}$ (SD)	31.9 (7.4)	31.4 (6.6)	32.2 (7.9)	0.065
Female, n (%)	1.204 (86.7)	448 (86.0)	756 (87.2)	0.520
Years of work as a nurse, $\bar{x}$ (SD)	6.2 (6.9)	5.7 (5.8)	6.5 (7.4)	0.040^* * p< 0.05
Graduate certificate or master’s degree, n (%)	371 (26.9)	163 (31.8)	208 (24.1)	0.002^* * p< 0.05

Burnout	Total n= 1,395	Santiago n= 523	Regions n= 872	p value
Burnout score, $\bar{x}$ (DS)	22.7 (11.8)	24.3 (12.0)	21.7 (11.6)	0.0001^* * p < 0.05 † Nurses with a score > 27 on the MBI emotional exhaustion scale Note: (n= 1,395).
Nurses with burnout^† * p < 0.05 † Nurses with a score > 27 on the MBI emotional exhaustion scale Note: (n= 1,395). , n (%)	476 (34.7)	206 (40.0)	270 (31.5)	0.001^* * p < 0.05 † Nurses with a score > 27 on the MBI emotional exhaustion scale Note: (n= 1,395).

Emotional Burnout Scale	Total n= 1,395	Santiago n= 523	Regions n= 872	p value
Emotional Burnout Scale	n (%)	n (%)	n (%)	p value
I feel emotionally exhausted because of work	651 (46.7)	269 (51.4)	382 (43.8)	0.382
I feel exhausted at the end of the day	1.00 (72.0)	387 (74.0)	618 (70.9)	0.208
I feel fatigued when I wake up and have to face a new day at work	668 (47.9)	265 (50.7)	403 (46.2)	0.107
Working with people all day is a real effort for me	258 (1 8.5)	115 (22.0)	143 (16.4)	0.009^* * p< 0.05 Note: (n= 1395).
I’m stressed because of work	329 (23.6)	144 (27.5)	185 (21.2)	0.007^* * p< 0.05 Note: (n= 1395).
I feel frustrated in my work	203 (14.6)	92 (17.6)	111 (12.7)	0.013^* * p< 0.05 Note: (n= 1395).
I think I work too hard	624 (44.7)	263 (50.3)	361 (41.4)	0.001^* * p< 0.05 Note: (n= 1395).
Working directly with people causes me a lot of stress	225 (16.1)	98 (18.7)	127 (14.6)	0.040^* * p< 0.05 Note: (n= 1395).
I feel like I can’t take it anymore	138 (9.9)	61 (11.7)	77 (8.8)	0.086

Burnout	OR^† * p < 0.05 † OR = Odds Ratio ‡ CI = Confidence Interval The table presents logistic regression calculations, considering clustering of nurses per hospital, adjusted for the hospitals (location and size) and nurses (sex and age) characteristics.	CI^* * p < 0.05 † OR = Odds Ratio ‡ CI = Confidence Interval The table presents logistic regression calculations, considering clustering of nurses per hospital, adjusted for the hospitals (location and size) and nurses (sex and age) characteristics.	p value
	Unadjusted model
Work environment (ref. Poor environment)
Average versus poor	0.66	0.43–1.01	0.057
Good versus poor	0.53	0.36–0.77	0.001^* * p < 0.05 † OR = Odds Ratio ‡ CI = Confidence Interval The table presents logistic regression calculations, considering clustering of nurses per hospital, adjusted for the hospitals (location and size) and nurses (sex and age) characteristics.
Staffing (patients per nurse)	1.00	0.96–1.04	0.970
Skill mix	1.00	0.56–1.80	0.995
	Adjusted model
Work environment (ref. Poor environment)
Average versus poor	0.70	0.50–0.98	0.037^* * p < 0.05 † OR = Odds Ratio ‡ CI = Confidence Interval The table presents logistic regression calculations, considering clustering of nurses per hospital, adjusted for the hospitals (location and size) and nurses (sex and age) characteristics.
Good versus poor	0.57	0.41–0.79	0.001^* * p < 0.05 † OR = Odds Ratio ‡ CI = Confidence Interval The table presents logistic regression calculations, considering clustering of nurses per hospital, adjusted for the hospitals (location and size) and nurses (sex and age) characteristics.
Staffing (patients per nurse)	1.01	0.97–1.06	0.624
Skill mix	0.96	0.54–1.72	0.896

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Marta Simonetti, Monseñor Álvaro del Portillo, 13265, Las Condes, 7620001 – Santiago, Chile msimonetti@uandes.cl