programs of certification for the health institutions involve a
warranty of excellence not only in terms of professional satisfaction
but also in terms of quality of the health cares. At the moment,
an increasing number of researches that link the high rate of absenteeism
from work to the syndrome of "the burnout" among the Spanish nurses1,2
exist, being the hospital the predominant environment. Such a high
rate of absenteeism points to be a determinant answer faced with
the work dissatisfaction. This phenomenon, particularly the
work dissatisfaction in this professional area, is reproduced accurately
in the rest of the countries of the world as it can be EEUU, United
Kingdom, France, Italy or Portugal. Nevertheless the answer to this
dissatisfaction is very different as it is characterized by a high
index of staff turnovers among the health institutions, and a high
index of professional desertions that produces an alarming shortage
of human resources in those countries4.
Therefore it would be interesting to find out the possible
solutions that those countries have developed to face this problem.
Such solutions should at the same time be compatible with a policy
of excellence and total quality in the health services.
of the European countries have chosen to incorporate nurses coming
from developing countries such as The Philippines, Pakistan or India,
and from other occidental countries among which Spain is found.
This solution demands a double reconsideration. From one side,
an ethical dilemma appears when thinking about the consequences
of subtracting qualified human resources from countries where those
resources are the most needed ones for their own national development.
On the other side, we find Spain. Our country appears as an atypical
one in the European context. Even if in the year 2000 Spain
had 372 nurses per each one hundred thousand inhabitants while the
European average was 755, the policy practiced was to train professionals
for other countries to enjoy their services6.
On the other hand, EEUU, a place where the shortage of professionals
is not a new issue, faces the difficulty for attracting nurses coming
from other countries by developing formulas that make the profession
attractive. Among those, it must be underlined the effort made by
the managers to achieve the certification of "Magnetic Hospital"
by means of the program elaborated by the American Nurses Credentialing
what is that issue of the "Magnetic Hospital"? This question has
a difficult answer without mentioning its origin. Well, as early
as in the 70's the EE.UU suffered from a big shortage of nurses
that came to reach the 14% in some of its member states according
to a report elaborated by the Department of Health and Human Services
In the face of such a discouraging circumstance, the same
year of the report publication the American Academy of Nursery elaborated
a study on a nationwide basis whose aim was to analyze all the organizational
characteristics that made the nursing practice easy or difficult
in those hospitals where there was not vacancies without covering9.
That was the way the term "Magnetic Hospital " was born.
criteria followed to select the hospitals subjected to analysis
as good places to work, were three: a hospital with a low
rate of rotations towards other institutions and vacancies without
covering, a hospital introduced in a competitive market, and a hospital
fulfilling the condition of not being the only source of employment
for the nurses of the area10. The characteristics examined in these
hospitals were the personal and professional satisfaction, the status,
the role of the nurse in the quality of the care for the patient,
the ratio nurse-patient, the recruitment and maintenance of the
nurses, the relationship doctor-nurse, the decentralization of the
decision-making, the clinical leadership, the autonomy and responsibility
in the care for the patient, and the flexibility in the timetables,
research alluded, therefore, to environments favouring the practical
implementation of the knowledge and clinical experience of the nurses.
At first, as it was mentioned before, such qualities were related
to work satisfaction, being it also reflected in the rate of rotation
Afterwards and until now, the research line centred in the work
satisfaction started to shift towards the linking between organizational
features and clinical results, looking for the excellence in the
cares. It is not surprising that the conclusions of these surveys
pointed out rates of death up to a 4,6% lower13,
a lower rate of death 30 days after the admission, a higher patient
satisfaction about the nursery cares14,15,
and even a more secure environment in terms of work accidents16
in these hospitals. Everything exposed until now seems to indicate
that the philosopher's stone for the organization of the health
services has been found. An evidence of this is the fact that this
program of certification for the excellence in the quality of the
cares is able to supply empirical evidences of its effectiveness.
In this way, at the present time they already exist 196 organizations
certified, one of which, recently incorporated, is located in the
This model of
magnetic hospital is being object of attentions in different disciplines
such as medicine of work, social health services, psychology, nursery
and management among others. Besides, this attention is not exclusive
of the EE.UU. On the contrary, it is gradually expanding worldwide.
A clear example would be the magnetic hospital located in the United
Kingdom. Nevertheless, the impact of this model has not only taken
on in the Anglo-Saxon world. It is also reflected already in a certain
number of Spanish publications: Aiken & Mullin17,
Havens et al19,
and even in PhD thesis like the one of Manzano García2.
is no doubt that the achievement of changes inside such a big and
complex system, as it is the National Health System, requires a
lot of work and effort coming from the health policies and the management
of the health services. It would demand the fulfilment of minimum
but radical changes assuming all the responsibility concerning them.
It would be necessary to bind the strategies of intervention basing
them on an organizational model that could guarantee the achievement
of a unique aim: the excellence. This guarantee of excellence is
marked by the best knowledge available nowadays, in its case a model
of magnetic hospital, being this equivalent to say a model of excellent
1. Atance Martínez
JC. Aspectos epidemiológicos del síndrome de Burnout
en personal sanitario. Revista Española de Salud Pública.
2. Manzano García G. Estrés
en personal de enfermería. Universidad de Deusto. 1997. Tesis
doctoral sin publicar.
3. Carrillo de Albornoz G. Análisis
comparativo del absentismo entre la asistencia especializada (hospitalaria)
y la asistencia primaria, para la misma área asistencial.
Enferm Integral. 1997. 41: 28-31.
4. World Health Organization.
Country profiles. 2001. www.who.org. [Visitada el 01-03-2003].
World Health Organization. Health For All Database. 2000. www.who.org.
[Visitada el 01-03-2003].
6. Consejo General de Enfermería.
El Consejo General de Enfermería impulsa una guía
europea para la contratación de enfermeras. 24 de noviembre
de 2000. www.ocenf.org [Visitada el 01-03-2003].
Center Credentialing Center. http://www.nursingworld.org/ancc/ index.htm.
[Visitada el 01-03-2003].
8. U. S. Department of Health and Human
Services. The recurrent shortage of registered nurses: A new look
at the issues. Rockville, MD: Author. 1981.
9. McClure M, Poulin
M, Sovie M, Wandelt M. Magnet Hospitals: Attraction Retention of
Professional Nurses. Kansas City: American Academy of Nursing. 1983.
Bucham J. Still attractive alter all these years? Magnet hospitals
in a changing health care environment. Journal of Advanced Nursing.
1999. 30(1): 100-108.
11. Lake ET. Development of the Practice
Environment Scale of the Nursing Work Index. Research in Nursing
& Health. 2002. 25: 176-188.
12. Kramer M, Hafner LP. Shared
values: impact on staff nurse job satisfaction and perceived productivity.
Nursing Research. 1989. 38(3): 172-177.
13. Aiken LH, Smith H,
Lake E. Lower Medicare mortality among a set of hospital known for
good nursing care. Medical Care. 1994. 32(8): 771-787.
LH, Sloane D, Lake ET, Sochalski J &Weber AL. Organization and
outcomes of inpatient AIDS care. Medical Care. 1999. 37(8): 760-772.
Aiken LH, Sloane D, Lake ET. Satisfaction with inpatient acquired
immunodeficiency syndrome care: A national comparison of dedicated
and scattered-bed units. Medical Care. 1997. 35(9): 948-962.
Aiken LH, Sloane D, Klocinski J. Hospital nurses risk of occupational
exposure to blood: Prospective, retrospective, and institutional
reports. American Journal of Public Health. 1997.87: 103-107.
Aiken LH, Mullin M. Hospitales con magnetismo: un modelo de organización
para mejorar los resultados de los pacientes. Enfermería
Clínica. 1995. 5(6): 259-62.
18. Marcos MM. Are hospitals
changing? Revista de Enfermería. 1997. 20(230): 59-61.
Havens DS, Labov TG, Faura T, Aiken LH. The clinical environment
of hospital nursing. Enfermería Clínica. 2002. 12(1):13-21.