Health Spain , Valladolid, Thursday, May 21 of 2015, 18:39

The human resources management model affects the stress of nursing staff

The doctoral thesis of the lecturer of the Faculty of Nursing of the University of Valladolid, Manuel Frutos, has analysed the management model of 14 Spanish hospitals to reflect the situation of 703 nurses and 505 technicians in auxiliary nursing care

Cristina G. Pedraz/DICYT In common with other professions involving the care and treatment of human beings, nursing produces high levels of occupational stress, which at times reaches the clinical stage known as the Burnout Syndrome. This pathology is characterised by an inner state of saturation in which sufferers feel physically, emotionally, and mentally exhausted. This results in a lack of energy and therefore a reduction in work capacity, a lack of motivation, mood swings, and physical symptoms such as locomotor problems (for instance muscular pains and aching joints) and other psychosomatic alterations (gastrointestinal problems, headaches, dizziness, etc.).

Occupational stress in nursing has attracted a multitude of research at an international level, although this has mainly concentrated on the type of work that nursing represents and the difficulties it generates, together with the individual characteristics of its workers.

The lecturer of the School of Nursing of the University of Valladolid, Manuel Frutos, has devoted his doctoral thesis to research in this field with a totally new approach: that of clinical management. His study confirms the hypothesis that the human resources management model directly affects the stress of nursing staff, absenteeism, and the Burnout Syndrome.


This doctoral thesis has been drawn up at the Department of Biomedical Science of the University of León and was defended last year. As Manuel Frutos explains, the idea to research occupational stress in nursing from the perspective of clinical management stemmed from his professional experience in this field.


“I worked in human resources management at a hospital for five years. When I took up the post I carried out a series of pilot studies to become familiar with the occupational stress of nursing staff and I detected great dissatisfaction and considerable occupational stress, which reached high levels of the Burnout Syndrome. I came to the conclusion that this was largely due to poor work organisation and therefore deficient human resources management, i.e. to defects inherent to the organisation itself”, he affirms. After changing to a more participative management model to encourage positive human relations, the reduction of the levels of occupational stress and burnout in the short- and medium-term were “surprising” and absenteeism dropped sharply.

On leaving management and entering academia Frutos decided to research these aspects. With this in mind he analysed the management models of 14 Spanish hospitals: the hospital complexes of Burgos, León, Palencia, and Soria, the Geriátrico of Palencia, the Complejo Hospitalario San Luis of Palencia, the Hospital Corachán of Barcelona, the Complejo Hospitalario of Orense, the Hospital de la Cruz Roja of Madrid, the Hospital Universitario Quirón of Madrid, the Hospital Universitario of Móstoles, the Hospital Nisa Pardo of Aravaca, the Hospital del Tajo of Aranjuez, and the Hospital General of Cataluña.

The information was gathered between 2010 and 2012 and the human resources management model of each hospital was allocated one of the three management levels proposed by the thesis. The first management level is the traditional vertical model in which management is carried out at the apex and there is practically no relationship with the base; this is an autocratic and very dependent model. The second management level is also vertical but favours horizontality: it encourages intermediate management and gives greater responsibility to employees; this system is more participative and humanised. The third management level is an open model, that of units of self-management and clinical management, in which the hospital gives full responsibility to the team of a Service or Unit and the professionals are free to define the responsibilities, the organisation, and the work objectives of the various components. This is a democratic human resources management model.

In total 703 nurses and 505 technicians in auxiliary nursing care took part in the study, of which 92’5 per cent were women and 7’5 per cent men.

“The initial hypothesis is confirmed by a wide margin. The average incidence of the Burnout Syndrome is 8’2 per cent and varies between very high levels of over 15 per cent to 4’3 - 6 per cent. The differences are great and in many cases they are almost exclusively due to how resources are managed. Being given greater responsibility and recognition, being treated with dignity, having support elements within the team, respecting the opinions of others, and being helped to plan professional activities, among others, have been detected as elements strongly linked to the Syndrome”, the researcher specifies.

Methodological contributions

Before carrying out the empirical work, Manuel Frutos analysed some 2,000 international studies published in the last 15 years on the subject. This revision allowed the selection of the most frequently used and validated methodological instruments for measuring the Burnout Syndrome. The most important of these is the Maslach Burnout Inventory (MBI), a questionnaire that measures three variables: emotional exhaustion, depersonalisation, and the level of personal achievement.

After analysing the instrument, the researcher proposed a series of modifications to the MBI with the objective of correcting a bias that may occur in the section of depersonalisation. Likewise the author provides in his research a Burnout Syndrome risk table, a novel instrument that he proposes in order to homogenise the definition of the prevalence and incidence of burnout.

As from the MBI, the doctoral thesis detected 27’3 per cent of professionals with a high level of emotional exhaustion, 27’1 per cent with high levels of depersonalisation, and 39’2 with low personal achievement levels; these values correspond to an average burnout level.

Proposals for improvement

Finally the researcher suggests a human resources management model that may be useful and efficient if it is implemented in hospitals together with a series of proposals for improvement. “We propose a professionalised human resources management model that favours competent leadership with training without being subject to continuous political changes, democratic and accessible, and which instead of criticising makes work easier, encouraging decision-making and group action and with the necessary number of professionals to provide a quality service. The fact is that according to the data analysed, the lack of human resources has important socio-economic consequences both concerning the professionals' health, the quality of the services and the expenses of the institutions, which must face the consequences of deficient resources (a waiting list, increased risk and complications, absenteeism, etc.). In short, the management model proposed does not involve increased costs but rather a management effort from committed leaders, who as well as economic resources also manage “people” and are sensitive to the reality and human context of health care.