Valorisation of cotton post-industrial textile waste into lactic acid: chemo-mechanical pretreatment, separate hydrolysis and fermentation using engineered yeast.

BACKGROUND: The textile industry has several negative impacts, mainly because it is based on a linear business model that depletes natural resources and produces excessive amounts of waste. Globally, about 75% of textile waste is disposed of in landfills and only 25% is reused or recycled, while less than 1% is recycled back into new garments. In this study, we explored the valorisation of cotton fabric waste from an apparel textile manufacturing company as valuable biomass to produce lactic acid, a versatile chemical building block. RESULTS: Post-industrial cotton patches were pre-treated with the aim of developing a methodology applicable to the industrial site involved. First, a mechanical shredding machine reduced the fabric into individual fibres of maximum 35 mm in length. Afterwards, an alkaline treatment was performed, using NaOH at different concentrations, including a 16% (w/v) NaOH enriched waste stream from the mercerisation of cotton fabrics. The combination of chemo-mechanical pre-treatment and enzymatic hydrolysis led to the maximum recovery yield of 90.46 ± 3.46%, corresponding to 74.96 ± 2.76 g/L of glucose released, which represents a novel valorisation of two different side products (NaOH enriched wastewater and cotton textile waste) of the textile industry. The Saccharomyces cerevisiae strain CEN.PK m850, engineered for redirecting the natural alcoholic fermentation towards a homolactic fermentation, was then used to valorise the glucose-enriched hydrolysate into lactic acid. Overall, the process produced 53.04 g/L ± 0.34 of L-lactic acid, with a yield of 82.7%, being the first example of second-generation biomass valorised with this yeast strain, to the best of our knowledge. Remarkably, the fermentation performances were comparable with the ones obtained in the control medium. CONCLUSION: This study validates the exploitation of cotton post-industrial waste as a possible feedstock for the production of commodity chemicals in microbial cell-based biorefineries. The presented strategy demonstrates the possibility of implementing a circular bioeconomy approach in manufacturing textile industries.

Determinants of Job Satisfaction among Nurses from Chilean Hospitals / Determinantes de satisfacción laboral entre enfermeras de hospitales chilenos / Determinantes da satisfação profissional entre enfermeiros de hospitais chilenos

To measure, at the national scope, the satisfaction of Chilean nurses working in hospitals, and establish personal and institutional determinants associated with satisfaction. Methods. Cross-sectional multicenter study, carried out in 40 public and private high-complexity hospitals in Chile. A self-administered survey was conducted with 1,632 clinical nurses from medical-surgical units. The variables of interest studied were: job satisfaction, personal determinants (sex, age, and postgraduate training), institutional organizational determinants (assignments and work environment, measured through the Practice Environment Scale of the Nursing Work Index), and institutional structural determinants. Data analysis applied hierarchical logistic regression models, with three blocks of determinants, following nested models design. Results. The study showed that 21% of the nurses is very satisfied with their job. Training opportunities and professional growth are Vol. 41 No 3, September ­ December 2023ISSNp: 0120-5307 • ISSNe: 2216-0280 Invest Educ Enferm. 2023; 41(3): e04Determinants of Job Satisfaction amongNurses from Chilean Hospitalsspecific work aspects with which there is a lower percentage of nurses satisfied (10% and 11.2%, respectively). Among the personal factors, male sex and age are associated positively with satisfaction (p<0.05). Among the institutional organizational factors, a good work environment was associated with greater satisfaction (p<0.001); the number of patients per nurse was associated marginally with satisfaction (p<0.05). The structural factors of hospitals were not associated with satisfaction. Conclusion. A low proportion of nurses working in the high-complexity hospitals studied are satisfied with their job. Planning of strategies must be prioritized, leading to improving the retention of nurses, reducing the number of patients per nurse, and promoting good work environments in hospitals

Realizar una medición de alcance nacional de la satisfacción de las enfermeras chilenas que trabajan en hospitales para establecer qué determinantes personales e institucionales están asociados a ella. Métodos. Estudio multicéntrico de corte transversal, realizado en 40 hospitales públicos y privados de alta complejidad en Chile. 1632 enfermeras clínicas de unidades médico-quirúrgicas diligenciaron una encuesta. Las variables de interés estudiadas fueron: satisfacción laboral, determinantes personales (sexo, edad y formación de postítulo), determinantes institucionales-organizacionales (dotaciones y ambiente laboral, medidos mediante el Practice Environment Scale of the Nursing Work Index) y determinantes institucionales estructurales. Para el análisis de los datos se aplicaron modelos de regresión logística jerárquica, con tres bloques de determinantes, con el diseño de modelos anidados. Resultados. El 21% de las enfermeras estaba muy satisfecha con su trabajo. Las oportunidades de formación y de crecimiento profesional son los aspectos específicos del trabajo con los que hay menor porcentaje de enfermeras satisfechas (10% y 11.2%, respectivamente). Entre los factores personales, el sexo masculino y la edad se asocian positivamente a la satisfacción (p<0.05). Entre los factores institucionales organizacionales, un ambiente laboral bueno se asoció a mayor satisfacción (p<0.001); el número de pacientes por enfermera se asoció marginalmente a la satisfacción (p<0.05). Los factores estructurales de los hospitales no se relacionaron a la satisfacción. Conclusión. Una baja proporción de enfermeras Invest Educ Enferm. 2023; 41(3): e04Marta Simonetti • Leyla Sáezque trabaja en los hospitales de alta complejidad estudiados están satisfechas con su trabajo. Debe priorizarse la planificación de estrategias conducentes a mejorar la retención de las enfermeras, reducir el número de pacientes por enfermera y fomentar los buenos ambientes de trabajo en los hospitales.

Realizar uma medição nacional da satisfação dos enfermeiros chilenos que trabalham em hospitais e estabelecer quais determinantes pessoais e institucionais estão associados à satisfação. Métodos. Estudo transversal multicêntrico, realizado em 40 hospitais públicos e privados de alta complexidade no Chile. 1632 enfermeiros clínicos de unidades médico-cirúrgicas responderam à pesquisa. As variáveis de interesse estudadas foram: satisfação no trabalho, determinantes pessoais (sexo, idade e formação de pós-graduação), determinantes institucionais organizacionais (pessoal e ambiente de trabalho, mensurados por meio da Escala de Ambiente de Prática do Índice de Trabalho em Enfermagem) e determinantes institucionais estruturais. Para análise dos dados foram aplicados modelos de regressão logística hierárquica, com três blocos de determinantes, seguindo desenho de modelos aninhados. Resultados. 21% dos enfermeiros estavam muito satisfeitos com o seu trabalho. As oportunidades de formação e crescimento profissional são os aspectos específicos da função com os quais existe menor percentagem de enfermeiros satisfeitos (10% e 11.2%, respectivamente). Entre os fatores pessoais, o sexo masculino e a idade estão positivamente associados à satisfação (p<0.05). Dentre os fatores institucionais organizacionais, um bom ambiente de trabalho esteve associado à maior satisfação (p<0.001); O número de pacientes por enfermeiro esteve marginalmente associado à satisfação (p<0.05). Os fatores estruturais hospitalares não estiveram relacionados à satisfação. Conclusão. Uma baixa proporção de enfermeiros que atuam nos hospitais de alta complexidade estudados estão satisfeitos com seu trabalho. Deve ser dada prioridade ao planeamento de estratégias para melhorar a retenção de enfermeiros, reduzir o número de pacientes por enfermeiro e promover bons ambientes de trabalho nos hospitais

Association between the nurse work environment and patient experience in Chilean hospitals: A multi-hospital cross-sectional study.

INTRODUCTION: International evidence shows that nurses' work environments affect patient outcomes, including their care experiences. In Chile, several factors negatively affect the work environment, but they have not been addressed in prior research. The aim of this study was to measure the quality of the nurse work environment in Chilean hospitals and its association with patient experience. DESIGN: A cross-sectional study of 40 adult general high-complexity hospitals across Chile. METHODS: Participants included bedside nurses (n = 1632) and patients (n = 2017) in medical or surgical wards, who responded to a survey. The work environment was measured through the Practice Environment Scale of the Nursing Work Index. Hospitals were categorized as having a good or poor work environment. A set of patient experience outcomes were measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Adjusted logistic regression models were used to test associations between the environment and patient experiences. RESULTS: For all outcomes, the percentage of patients satisfied was higher in hospitals with good as compared to poor work environments. In good environment hospitals patients had significantly higher odds of being satisfied with communication with nurses (OR 1.46, 95% CI: 1.10-1.94, p = 0.010), with pain control (OR 1.52, 95% CI: 1.14-2.02, p = 0.004), and with nurses' timely responses in helping them to go to the bathroom (OR 2.17, 95% CI: 1.49-3.16, p < 0.0001). CONCLUSIONS: Hospitals with good environments outperform hospitals with poor environments in most patient care experience indicators. Efforts to improve nurses' work environment hold promise for improving patient experiences in Chilean hospitals. CLINICAL RELEVANCE: Hospital administrators and nurse managers should value, especially in the context of financial constraints and understaffing, the implementation of strategies to improve the quality of nurses´ work environments so that they can provide patients with a better care experience.

Determinants of Job Satisfaction among Nurses from Chilean Hospitals.

Objective: To measure, at the national scope, the satisfaction of Chilean nurses working in hospitals, and establish personal and institutional determinants associated with satisfaction. Methods: Cross-sectional multicenter study, carried out in 40 public and private high-complexity hospitals in Chile. A self-administered survey was conducted with 1,632 clinical nurses from medical-surgical units. The variables of interest studied were: job satisfaction, personal determinants (sex, age, and postgraduate training), institutional organizational determinants (assignments and work environment, measured through the Practice Environment Scale of the Nursing Work Index), and institutional structural determinants. Data analysis applied hierarchical logistic regression models, with three blocks of determinants, following nested models design. Results: The study showed that 21% of the nurses is very satisfied with their job. Training opportunities and professional growth are specific work aspects with which there is a lower percentage of nurses satisfied (10% and 11.2%, respectively). Among the personal factors, male sex and age are associated positively with satisfaction (p<0.05). Among the institutional organizational factors, a good work environment was associated with greater satisfaction (p<0.001); the number of patients per nurse was associated marginally with satisfaction (p<0.05). The structural factors of hospitals were not associated with satisfaction. Conclusion: A low proportion of nurses working in the high-complexity hospitals studied are satisfied with their job. Planning of strategies must be prioritized, leading to improving the retention of nurses, reducing the number of patients per nurse, and promoting good work environments in hospitals.

Hospital work environment, nurse staffing and missed care in Chile: A cross-sectional observational study.

AIMS AND OBJECTIVES: To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables. BACKGROUND: Missed nursing care is a common problem in different countries, but it has not been studied in Chile. DESIGN: Multihospital cross-sectional study (Supplementary file 1: STROBE guideline). METHODS: Study population of 45 adult high-complexity hospitals and 1853 registered nurses (RN) working on medical-surgical units. Primary data were collected through a nurse survey. Nurses reported, out of a list of nursing care activities, the ones left undone during their last shift. The main independent variables were the work environment, measured through the Practice Environment Scale of the Nursing Work Index, patient-to-nurse ratios and RN skillmix. Adjusted logistic regression analyses were used to test associations, accounting for clustering of nurses working in the same hospital. RESULTS: The hospital response rate was 88.9% and, for nurses, 88.1%. The mean patient-to-nurse ratio was 14.5 (range 6-23). The average skillmix was 31% RN. Eighty-six percent of nurses missed at least one activity. The activities most frequently missed included patient education, comforting patients and surveillance. The adjusted model showed a significant association between the work environment, staffing ratios and missed care. The RN skillmix was not associated. CONCLUSIONS: Missed care is highly prevalent problem in Chilean hospitals. Clinical activities were the least missed. It is necessary to improve work environments and reduce the number of patients per nurse to improve the safety and quality of care. RELEVANCE FOR CLINICAL PRACTICE: The study results are relevant since they provide new data to Chile. Better work environments and adequate human resources are modifiable factors that can be addressed from a managerial perspective, with low-cost strategies to effectively reduce missed care and improve safety and quality.

Environment, workload, and nurse burnout in public hospitals in Chile.

OBJECTIVE: To analyze, from an organizational perspective, the problem of nurse burnout in highly complex public hospitals in Chile. METHOD: Multicenter, observational, cross-sectional study. According to established inclusion criteria, the universe of hospitals and nurses was the object of work. Data collection was carried out through a nurse survey. Work environment was measured with the instrument Practice Environment Scale of the Nursing Work Index, staffing through the nurses' report on patient load, and burnout with the Maslach Burnout Inventory emotional exhaustion subscale. RESULTS: Thirty-four hospitals (92%) and 1,395 nurses (75.3%) participated in the study. The prevalence of burnout was 34.7%, being higher in Santiago than in other regions of the country (p = 0.001). The logistic regression analyses showed a significant association between work environment and burnout (OR 0.57, 95% CI 0.41-0.79, p = 0.001). No association was established between staffing, skill mix and burnout. CONCLUSION: A high percentage of nurses in Chile has burnout, which is significantly associated with the quality of the environment. The implementation of organizational strategies to improve work environments could reduce burnout and improve the quality of care.

Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study.

BACKGROUND: Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile's new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals. METHODS: For this multilevel cross-sectional study, we used data from surveys of hospital nurses to measure staffing and work environments in public and private Chilean adult high-complexity hospitals, which were linked with patient satisfaction survey and discharge data from the national diagnosis-related groups database for inpatients. All adult patients on medical and surgical units whose conditions permitted and who had been hospitalised for more than 48 h were invited to participate in the patient experience survey until 50 responses were obtained in each hospital. We estimated associations between nurse staffing and work environment quality with inpatient 30-day mortality, 30-day readmission, length of stay (LOS), patient experience, and care quality using multilevel random-effects logistic regression models and zero-truncated negative binomial regression models, with clustering of patients within hospitals. FINDINGS: We collected and analysed surveys of 1652 hospital nurses from 40 hospitals (34 public and six private), satisfaction surveys of 2013 patients, and discharge data for 761 948 inpatients. Nurse staffing was significantly related to all outcomes, including mortality, after adjusting for patient characteristics, and the work environment was related to patient experience and nurses' quality assessments. Each patient added to nurses' workloads increased mortality (odds ratio 1·04, 95% CI 1·01-1·07, p<0·01), readmissions (1·02, 1·01-1·03, p<0·01), and LOS (incident rate ratio 1·04, 95% CI 1·01-1·06, p<0·05). Nurse workloads across hospitals varied from six to 24 patients per nurse. Patients in hospitals with 18 patients per nurse, compared with those in hospitals with eight patients per nurse, had 41% higher odds of dying, 20% higher odds of being readmitted, 41% higher odds of staying longer, and 68% lower odds of rating their hospital highly. We estimated that savings from reduced readmissions and shorter stays would exceed the costs of adding nurses by US$1·2 million and $5·4 million if the additional nurses resulted in average workloads of 12 or ten patients per nurse, respectively. INTERPRETATION: Improved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value. FUNDING: Sigma Theta Tau International, University of Pennsylvania Global Engagement Fund, University of Pennsylvania School of Nursing's Center for Health Outcomes, and Policy Research and Population Research Center. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Environment, workload, and nurse burnout in public hospitals in Chile / Ambiente, carga de trabalho e burnout em enfermeiras de hospitais públicos no Chile / Ambiente, carga laboral y burnout en enfermeras de hospitales públicos de Chile

ABSTRACT Objective: To analyze, from an organizational perspective, the problem of nurse burnout in highly complex public hospitals in Chile. Method: Multicenter, observational, cross-sectional study. According to established inclusion criteria, the universe of hospitals and nurses was the object of work. Data collection was carried out through a nurse survey. Work environment was measured with the instrument Practice Environment Scale of the Nursing Work Index, staffing through the nurses' report on patient load, and burnout with the Maslach Burnout Inventory emotional exhaustion subscale. Results: Thirty-four hospitals (92%) and 1,395 nurses (75.3%) participated in the study. The prevalence of burnout was 34.7%, being higher in Santiago than in other regions of the country (p = 0.001). The logistic regression analyses showed a significant association between work environment and burnout (OR 0.57, 95% CI 0.41-0.79, p = 0.001). No association was established between staffing, skill mix and burnout. Conclusion: A high percentage of nurses in Chile has burnout, which is significantly associated with the quality of the environment. The implementation of organizational strategies to improve work environments could reduce burnout and improve the quality of care.

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.

RESUMEN Objetivo: Analizar, bajo una perspectiva organizacional, el problema de burnout en enfermeras de hospitales públicos de alta complejidad de Chile. Método: Estudio multicéntrico, observacional, de corte transversal. Según criterios de inclusión establecidos, se trabajó con el universo de hospitales y enfermeras. Recolección de datos se realizó a través de encuesta a enfermeras. El ambiente laboral se midió con el instrumento Practice Environment Scale of the Nursing Work Index, las dotaciones a través del reporte de las enfermeras sobre carga de pacientes, y el burnout con la subescala de desgaste emocional del Maslach Burnout Inventory. Resultados: Participaron 34 hospitales (92%) y 1.395 enfermeras (75,3%). La prevalencia de burnout fue de 34,7%, siendo mayor en Santiago que en regiones (p = 0,001). Los análisis de regresión logística mostraron asociación significativa entre ambiente laboral y burnout (OR 0,57, 95% IC 0,41-0,79, p = 0,001). No se estableció asociación entre dotaciones, skillmix y burnout. Conclusión: Un alto porcentaje de enfermeras en Chile sufre burnout, asociado significativamente a la calidad del ambiente. La implementación de estrategias organizacionales que mejoren los ambientes de trabajo podría reducir el burnout y mejorar la calidad de atención.

Dotaciones, skillmix e indicadores laborales de enfermería en Hospitales Públicos chilenos

Background: International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality. Aim: To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile. Material and Methods: An observational, cross-sectional study of 1,855 registered nurses working in medical-surgical units in 37 public hospitals was conducted. Data collection followed the RN4CAST research protocol. Inferential analyses used logistic regression models. Results: The survey was answered by 1,395 registered nurses in 34 hospitals. The average staffing ratio was 14 patients-per-nurse, and the average skill mix was 31% registered nurses. Of all nurses, 35% reported burnout, 22% were dissatisfied, and 33% intended to leave. Being burned out increased by 9 and 6% the odds of being dissatisfied and the intent to leave, respectively (Odds ratio (OR) 1.09, p < 0.01 and 1.06, p < 0.01). Being dissatisfied increased by five times the odds of intent to leave (OR 5.19, p < 0.01). Conclusions: Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.

Development, implementation and evaluation of an evidence-based practice model in a new hospital in Chile.

AIMS: To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results. BACKGROUND: Evidence-based practice is key to professional nursing for improving health care safety and quality. METHODS: First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated. RESULTS: The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p = .038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p < .01). CONCLUSION: Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.

[Nurse staffing, skill mix and job outcomes in Chilean public hospitals]. / Dotaciones, skillmix e indicadores laborales de enfermería en Hospitales Públicos chilenos.

BACKGROUND: International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality. AIM: To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile. MATERIAL AND METHODS: An observational, cross-sectional study of 1,855 registered nurses working in medical-surgical units in 37 public hospitals was conducted. Data collection followed the RN4CAST research protocol. Inferential analyses used logistic regression models. RESULTS: The survey was answered by 1,395 registered nurses in 34 hospitals. The average staffing ratio was 14 patients-per-nurse, and the average skill mix was 31% registered nurses. Of all nurses, 35% reported burnout, 22% were dissatisfied, and 33% intended to leave. Being burned out increased by 9 and 6% the odds of being dissatisfied and the intent to leave, respectively (Odds ratio (OR) 1.09, p < 0.01 and 1.06, p < 0.01). Being dissatisfied increased by five times the odds of intent to leave (OR 5.19, p < 0.01). CONCLUSIONS: Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.

Nursing in Chilean Hospitals: A Research Agenda to Inform Health Policies and Improve Patient Outcomes.

INTRODUCTION: The ongoing challenge for Chilean hospitals of meeting population health needs merits attention to the health care workforce. No studies have explored how nursing might contribute to addressing this challenge. International research shows that organizational characteristics of the nursing workforce and practice environment are associated with patient outcomes. Chile lacks actionable evidence that applies to its context of care. METHOD: First, a review of international literature was developed to synthesize evidence on the association between organizational characteristics of the nursing workforce and patient outcomes. Second, a review of literature and other nonacademic sources was performed to describe the context of care and data pertaining to nurses in Chilean hospitals. Third, a research agenda for efficient utilization of the hospital nursing workforce in Chile was proposed. RESULTS: International evidence shows that low patient-to-nurse ratios, high skill mix, and good practice environments are associated with better patient outcomes. Chilean hospitals have financial constraints that greatly influence the context of nursing practice and the scarce data about nursing organization call for greater attention. CONCLUSION: The establishment and implementation of a research agenda is needed to build local evidence regarding effective organization of nurses to inform policies and to improve patient outcomes in Chile.

Categorización de servicios de enfermería: propuesta para asegurar una atención de calidad en tiempos de escasez de enfermeras / Nursing services classification: proposal to ensure quality care in times of nursing shortages

Numerosos estudios han comunicado sobre la crisis mundial de escasez de enfermeras. Chile no se encuentra ajeno a este fenómeno. Ante esta contingencia se propone adoptar el modelo de división del trabajo propuesto por Benoit-Smullyan, generando el situs de enfermería, la categorización de servicios sustentada en criterios de delegación/encargo a las demás ocupaciones del situs y proyectar la Gestión del Cuidado como centro de producción de acciones de enfermería. El desarrollo del situs de enfermería, la categorización de servicios y la delegación/encargo son consideradas herramientas efectivas que evitan la sustitución de funciones, aumentan la producción de acciones de enfermería seguras, de calidad e inspiradas en los valores de la profesión.

Numerous studies have reported on the shortage of nurses global crisis. Chile is not beyond this phenomenon. In view of this situation, we propose the adoption of the model of division of work described by Benoit-Smullyan, generating the nursing situs, the categorization of services based on certain delegation/commissioning criteria to the other occupations within the situs, and to foster Nursing Care Management as the center of nursing actions' production. The development of the nursing situs, the categorization of services and the delegation/commissioning are considered effective tools to prevent the substitution of functions and to enhance the production of safe, quality nursing work, inspired in the values of the profession.