Nursing team sizing in a reference unit for multidrug-resistant microorganisms: a mixed-methods study
DOI:
https://doi.org/10.12957/reuerj.2025.87665Keywords:
Nursing Staff, Hospital, Workload, Infection Control, Drug Resistance, MicrobialAbstract
Objective: to analyze the workload and staff sizing of a hospital inpatient unit that is a reference for the care of patients affected by multidrug-resistant microorganisms. Method: a mixed-methods, explanatory and sequential study, conducted in the aforementioned unit belonging to a hospital from southern Brazil. The quantitative data from the Patient Classification System scores between January 2022 and December 2023 were analyzed by means of descriptive statistical analysis and sizing parameters recommended by the regulatory body. The qualitative data were extracted from 13 interviews with the Nursing team, analyzed thematically and connected to the previous stage. Results: among 3,299 patient classifications, the Semi-intensive care stratum prevailed in both years (62.5% and 63.2%). The professionals reported high complexity levels in the clientele. The number of staff nurses was insufficient, but this differed from the workers' perception. Conclusion: there is high Nursing workload, explained by the patient profile and shortage of professionals.
References
1. Agência Nacional de Vigilância Sanitária (Br). Prevenção de infecções por microrganismos multirresistentes em serviços de saúde – Série Segurança do Paciente e Qualidade em Serviços de Saúde/Agência Nacional de Vigilância Sanitária. Brasília: Anvisa; 2021 [cited 2024 Jul 18]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/manual-prevencao-de-multirresistentes7.pdf.
2. Agência Nacional de Vigilância Sanitária (Br). Plano de Contingência Nacional para Infecções causadas por Microrganismos Multirresistentes em Serviços de Saúde – PLACON-RM. Brasília: Anvisa; 2021 [cited 2024 Jul 18]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/placon-nacional-mr-09-11-2021.pdf.
3. Castro AF, Rodrigues MCS. Audit of standardized precautionary and contact practices in the Intensive Care Unit. Rev esc enferm USP. 2019 [cited 2024 Jul 18]; 53:e03508. DOI: http://doi.org/10.1590/S1980-220X2018018603508.
4. Hessels AJ, Kelly AM, Chen L, Cohen B, Zachariah P, Larson EL. Impact of infectious exposures and outbreaks on nurse and infection preventionist workload. Am J Infect Control. 2019 [cited 2024 Jul 18]; 47(6):623-7. DOI: https://doi.org/10.1016/j.ajic.2019.02.007.
5. Macedo ABT, Junges M, Mello DB, Lovatto CG, Souza SBC. Multidrug-resistant germs carriers unit: elaboration of a patients care protocol. Rev. Enferm. Atual In Derme. 2019 [cited 2024 Jul 18]; 83(21):61-83. Available from: https://revistaenfermagematual.com.br/index.php/revista/article/view/286.
6. Macedo ABT, Antoniolli L, Dornelles TM, Hansel LA, Tavares JP, Souza SBC. Psychosocial stress and resilience: a study in nursing professionals. Rev. Enferm. UFSM. 2020 [cited 2025 Feb 26]; 10(25):e25. DOI: https://doi.org/10.5902/2179769235174.
7. Souza P, Cucolo DF, Perroca MG. Nursing workload: influence of indirect care interventions. Rev Esc Enferm USP. 2019 [cited 2024 Jul 18]; 53:e03440. DOI: https://doi.org/10.1590/S1980-220X2018006503440.
8. Barbosa IE, Fonseca AR, Andrade EN, Maklouf DC, Ribeiro MC, Rodrigues AJ, et al. Patient safety: main adverse events in the Intensive Therapy Unit. Rev. Eletrônica Acervo Saúde. 2021 [cited 2024 Sep 10]; 13(2):e6454. DOI: https://doi.org/10.25248/reas.e6454.2021.
9. Guardalupe JA, Brum ID, Canto DF, Telles KCM, Magalhães AMM, Oliveira JLC. Comparison of patient classification systems for dimensioning nursing staff. Rev Esc Enferm USP. 2023 [cited 2024 Jul 18] 28; 57:e20230047. DOI: https://doi.org/10.1590/1980-220X-REEUSP-2023-0047pt.
10. Conselho Federal de Enfermagem. Resolução COFEN 543/2017. Brasília: Conselho federal de enfermagem; 2017 [cited 2025 Feb 26]. Available from: https://www.cofen.gov.br/wp-content/uploads/2017/05/RESOLU%C3%87%C3%83O-COFEN-N%C2%BA-543-2017-completa.pdf.
11. Cofen. Parecer Normativo Nº 1/2024/COFEN. Brasília: Conselho Federal de Enfermagem; 2024 [cited 2025 Feb 26]. Available from: https://www.cofen.gov.br/wp-content/uploads/2024/03/Parecer-Normativo-1-2024.pdf.
12. Creswell JW, Creswell JD. Projeto de pesquisa métodos qualitativo, quantitativo e misto. 5ª ed. Porto Alegre: Penso; 2021.
13. Perroca, MG. The new version of a patient classification instrument: assessment of psychometric properties. J. Adv. Nurs. 2013 [cited 2025 Feb 26]; 69(8):1862-8. 2013 [cited 2024 Jul 18]. DOI: https://doi.org/10.1111/jan.12038.
14. Bardin, L. Análise de conteúdo. São Paulo: Edições; 2016.
15. Younas A, Pedersen M, Durante A. Characteristics of joint displays illustrating data integration in mixed-methods nursing studies. J Adv Nurs. 2020 [cited 2024 Jul 18]; 76(2):676-86. DOI: https://doi.org/10.1111/jan.14264.
16. Lima SBO, Oliveira JLC, Silva RB, Rosa JS, Ribeiro MRR. Quality tools applied to the emergency car checking: mixed methods research. Esc Anna Nery. 2021 [cited 2024 Jul 18]; 25(2):e20200274. DOI: https://doi.org/10.1590/2177-9465-EAN-2020-0274.
17. Silva LS, Passos HR, Oliveira JV, Amaral GG. Contextos de salud y trabajo de profesionales de enfermería en tiempos de pandemia por COVID-19. Enferm. Actual Costa Rica. 2023 [cited 2024 Jul 18]; (44):1-14. DOI: https://doi.org/10.15517/enferm.actual.cr.i44.49421.
18. Fernandes MA, Rocha DM, Ribeiro HKP, Sousa CCM. Riscos ocupacionais e intervenções que promovem segurança para a equipe de enfermagem oncológica. Rev bras saúde ocup. 2021 [cited 2024 Jul 18]; 46:e15. DOI: https://doi.org/10.1590/2317-6369000000319.
19. Andrade AO, Jesus SR, Mistro S. Hospitalizations in Brazil according to national health survey estimates, 2013 and 2019. Rev Saude Publica. 2023 [cited 2024 Jul 18]; 57:73. DOI: https://doi.org/10.11606/s1518-8787.2023057004395.
20. Hoseinzadeh E, Ebadi A, Ashktorab T, Sharif-Nia H. Nurses’ intention to care for patients with infectious disease: a content analysis study. BMC Nurs. 2023 [cited 2024 Jul 18]; 22:349. DOI: https://doi.org/10.1186/s12912-023-01538-9.
21. AbdELhay ES, Taha SM, El‑Sayed MM, Helaly SH, AbdELhay IS. Nurses retention: the impact of transformational leadership, career growth, work well-being, and work-life Balance. BMC Nursing. 2025 [cited 2025 Feb 26]; 24:148. DOI: https://doi.org/10.1186/s12912-025-02762-1.
22. Oliveira EB, Xavier T, Zeitoune RCG, Passos JP, Oliveira BR, Ferreira ARA. Precarious work at a surgical center: implications for the organization and for the health of nursing workers. Rev Bras Enferm. 2023 [cited 2024 Jul 18]; 76(2):e20220120. DOI: https://doi.org/10.1590/0034-7167-2022-0120.
23. Sawada S, Takemura Y, Isobe T, Koyanagi H, Kida R. Perceived impact of nurse turnover on the organization: a Delphi study on managers of nursing. J. Nurs. Manag. 2022 [cited 2024 Jul 18]; 30(7):3168–77. DOI: https://doi.org/10.1111/jonm.13738.
24. Bae SH. Noneconomic and economic impacts of nurse turnover in hospitals: a systematic review. Int Nurs Rev. 2022 [cited 2025 Feb 26]; 69:392–404. DOI: https://doi.org/10.1111/inr.12769.
25. Moraes RM, Nishiyama JA, Báo AC, Costa FM, Aldabe LN, Oliveira JL. Sizing of nursing staff in clinical, surgical and pediatric hospitalization units. Texto Amp Contexto Enferm. 2021 [cited 10 Sep 2024]; 30:e20200377. DOI: https://doi.org/10.1590/1980-265x-tce-2020-0377.
26. Lasater KB, Sloane DM, McHugh MD, Porat‐Dahlerbruch J, Aiken LH. Changes in proportion of bachelor's nurses associated with improvements in patient outcomes. Res Nurs Health. 2021 [cited 2024 Jul 18]; 44(5):787-95. DOI: https://doi.org/10.1002/nur.22163.
27. Conselho Federal de Enfermagem. Resolução Cofen Nº 736 de 7 de janeiro de 2024. Brasília: Conselho Federal de Enfermagem; 2024 [cited 10 Sep 2024]. Available from: https://www.cofen.gov.br/resolucao-cofen-no-736-de-17-de-janeiro-de-2024/.
28. Brasil. Lei n° 7.498, de 25 de junho de 1986. Dispõe sobre a regulamentação do exercício da enfermagem, e dá outras providências. Brasília: Congresso Nacional; 1986 [cited 2024 Jul 18]. Available from: https://www.planalto.gov.br/ccivil_03/leis/l7498.htm.
29. Modolo, FH, Pessoas GB, Zanela GC, Borges SS, Krause RCF. Auditoria como ferramenta de gestão do SUS: o papel do enfermeiro auditor no serviço de hemoterapia. Hematol Transfus Cell Ther. 2023 [cited 2024 Jul 18]; 45:S858-9. DOI: https://doi.org/10.1016/j.htct.2023.09.1546.
30. Gomes ET, Assunção MCT, Lins EM, Püschel VAA. Nursing in mechanical prevention of venous thromboembolism in surgical patients. Rev esc enferm USP. 2021 [cited 2024 Jul 18]; 55:e03738. DOI: https://doi.org/10.1590/S1980-220X2020002703738.
31. Győri Á, Ádám S. Profession-specific working conditions, burnout, engagement, and turnover intention: the case of Hungarian social workers. Front Sociol. 2024 [cited 2025 Feb 26]; 9:e1487367. DOI: https://doi.org/10.3389/fsoc.2024.1487367.
32. Oro J, Matos E. Possibilities and limits of organization of nursing work in the comprehensive care model in a hospital institution. Texto contexto enferm. 2013 [cited 2024 Jul 18]; 22(2):500–8. DOI: https://doi.org/10.1590/S0104-07072013000200028.
33. Bracarense CF, Costa NS, Raponi MBG, Goulart BF, Chaves LDP, Simões ALA. Organizational climate and nurses’ turnover intention: a mixed method study. Rev Bras Enferm. 2022 [cited 2025 Feb 26]; 75(4):e20210792. DOI: https://doi.org/10.1590/0034-7167-2021-0792.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Júlia Nogueira Treib, João Lucas Campos de Oliveira, Ana Maria Müller de Magalhães, Nicole Hertzog Rodrigues, Jéssica Azevedo Guardalupe, Eduardo Lopes Pereira, Patrícia Godoy Fanton
This work is licensed under a Creative Commons Attribution 4.0 International License.
When publishing in Revista Enfermagem UERJ, the authors declare that the work is their exclusive authorship and therefore assume full responsibility for its content.
Authors retain copyright to their article and agree to license their work using a Creative Commons Attribution International Public License (CC BY), thereby accepting the terms and conditions of this license (https://creativecommons.org/licenses/by/4.0/legalcode.en), which allows material created by the author to be distributed, copied and displayed by third parties. The original work must be cited and present a link to the article available on the website of the journal in which it was published.
The Copyright of the articles published in Revista Enfermagem UERJ belongs to their respective author(s), with the rights of first publication assigned to Revista Enfermagem UERJ, with the work simultaneously licensed under a Creative Commons License CC BY, which allows sharing of work with recognition of authorship and initial publication in this journal.
The authors grant Revista Enfermagem UERJ the right of first publication, to identify themselves as the original publisher of the work and grant the magazine a license of non-exclusive rights to use the work in the following ways:
- Sell and/or distribute the work in printed copies and/or electronic format;
- Distribute parts and/or the work as a whole with the aim of promoting the magazine through the internet and other digital and printed media;
- Record and playback work in any format, including digital media.
In line with the journal's policies, each published article will be assigned a Creative Commons Attribution (CC BY) license.
