ORIGINAL ARTICLE DOI: http://dx.doi.org/10.

1590/S1980-220X2017028903301

Productivity versus workloads in the nursing working environment*

A produtividade versus cargas de trabalho no ambiente laboral da enfermagem
La productividad versus cargas de trabajo en el marco laboral de la enfermería

Deciane Pintanela de Carvalho1, Laurelize Pereira Rocha1, Jamila Geri Tomaschewski-Barlem1, Edison Luiz Devos Barlem1,
Diana Cecagno2, Graziele de Lima Dalmolin3

How to cite this article:

Carvalho DP, Rocha LP, Tomaschewski-Barlem JG, Barlem ELD, Cecagno D, Dalmolin GL. Productivity versus workloads in the nursing working
environment. Rev Esc Enferm USP. 2017;51:e03301. DOI: http://dx.doi.org/10.1590/S1980-220X2017028903301

*
Extracted from the dissertation “Cargas ABSTRACT
de trabalho e perda de produtividade dos
trabalhadores de enfermagem: estudo em
Objective: To analyze the association between the productivity loss of nursing workers
um hospital universitário”, Programa de Pós- and workloads in a teaching hospital. Method: Descriptive study with a quantitative
Graduação em Enfermagem, Universidade approach, conducted with nursing workers. A structured data collection instrument and
Federal do Rio Grande, 2016. the Work Limitations Questionnaire were used. Data analysis was performed using
1
Universidade Federal de Rio Grande, Rio descriptive and analytical statistics, with the Kruskal Wallis test and the Spearman
Grande, Rio Grande do Sul, Brazil. rank correlation. Results: A total of 211 nursing workers participated in the study.
2
Universidade Federal de Pelotas, They had an average of 6.38% of lost productivity; 75% of nursing technicians showed
Pelotas, Rio Grande do Sul, Brazil. 9.57% of productivity loss, followed by nurses (8.75%) and nursing aides (8.50%). The
units presenting the highest productivity loss were surgical clinic (8.81%), and medical
3
Universidade Federal de Santa Maria,
Santa Maria, Rio Grande do Sul, Brazil. clinic (8.58%). The rate of productivity loss was significantly associated with chemical
loads (p=0.044) and with mechanical loads (p=0.041). Conclusion: Workers presented
productivity loss and work limitations associated with workloads, which shows they have
difficulty performing the activities in part of the work time.
DESCRIPTORS
Nursing, Team; Workload; Burnout, Professional; Presenteeism; Occupational Health.

Corresponding author:
Deciane Pintanela de Carvalho
Universidade Federal do Rio Grande
Rua General Osório, s/n
CEP 96200-190 – Rio Grande,
Rio Grande do Sul, Brazil Received: 07/19/2017
[email protected] Approved: 10/24/2017

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Productivity versus workloads in the nursing working environment

INTRODUCTION Data source

Productivity loss is related to problems in the perfor- For the sample calculation, the functional picture of the
mance of activities, such as difficulties in meeting dead- teaching hospital in the data collection period, consisting
lines, and concentration deficits, which prevent workers from of 355 nursing workers, was considered. The StatCalc of
thinking clearly, making them likely to make mistakes and the EpiInfo software, version 7, was used, with a 95% con-
unable to complete the physical demands of their work(1). fidence level, and a minimum sample of 184 participants.
This productivity loss may be inherent to presenteeism, char- Sample selection took place in a non-probabilistic way for
acterized by workers who, despite physical or mental prob- convenience. Thus, 211 nursing workers participated in this
lems related to work, continue to perform their activities, but study, namely 49 nurses, 85 nursing technicians, and 77
with reduced productivity and performance(2). nursing aides.
The nursing work process exposes workers to different The participants’ inclusion criterion was having worked
workloads, which cause physical and mental exhaustion, at least 3 months in the institution. The exclusion criteria
leading to productivity loss(3). Workloads act directly and were to work in administrative positions, and be on medical
indirectly on workers’ health(4) and are characterized as exter- leave, another leave of any nature, or on vacation at the time
nal and internal materiality loads. The former is identified by of data collection.
the physical, chemical, biological and mechanical loads, and
the latter by the physiological and psychic loads(5). Data collection
In nursing, changes in temperature and ionizing radia- Data collection was performed from July to August 2016,
tion are examples of physical loads; handling of chemicals covering the morning, afternoon and evening shifts, by a pre-
and medicines, in general, are chemical loads; exposure to viously trained data collection team. This team participated
patients’ body fluids, among others, are examples of bio- in two meetings held before the beginning of data collec-
logical loads(6); labor accidents and physical violence are tion. At the first meeting, the research theme, objectives,
mechanical loads; physiological loads include working in questionnaires, ethical aspects, and signing of the informed
the standing position, uncomfortable and inadequate pos- consent form were addressed.
tures, night work and manipulation of excessive weight(7); In a second moment, guidance was given on the approach
and, among psychic loads, lack of autonomy, abuse of power, of the workers, establishing schedules for data collection that
moral harassment, institutional pressure stand out(8). did not influence the routine of the studied sectors, avoid-
The constant exposure of workers to workloads can lead ing the schedules of duty change. Nursing workers were
to sickness, removal from the institution, and the decrease approached in the work sectors, and invited to participate
in capacity to perform activities(7). Another factor is presen- in the study. Following the clarification about the research
teeism, in which a great number of nursing team workers objective, the participants chose to fill in the form at that
can be present at work, even when presenting physical and moment, or to schedule the best date to return it.
mental limitations, which reduce their productivity(9). A structured data collection instrument was used, con-
The presence of workers in these conditions will lead sisting of questions related to the characteristics of the
to health loss. In addition, there is the possibility of the worker (gender, age, educational level); job characteristics
occurrence of errors, which impair the quality of care and (professional category, work sector, extra-hours per week,
the performance of work activities(10). The main limitations and work shift and period); and work process-related work-
related to nursing workers productivity loss are the physical loads (presence, type and Likert scale for checking the fre-
demands, which affect the nursing workers’ bodies, due to quency of loads, with levels always, often, sometimes, rarely,
physical efforts during the provision of care, and the mental and never).
demands comprising the difficulties workers have in per-
In addition, the Work Limitations Questionnaire
forming cognitive tasks, as well as working and interacting
(WLQ) was used, consisting of 25 items that assess the
with people(11).
frequency of difficulty or ability to perform work tasks,
Considering that workloads are responsible for nursing
distributed in four domains of limitation in the work:
workers’ illnesses, it is necessary to investigate the association
time management, physical demand, interpersonal mental
between work productivity loss and workloads, because these
demand, and production demand(12). This questionnaire was
directly influence workers’ health and the development of
validated, translated into Portuguese and culturally adapted
quality care. Therefore, the aim of this study was to analyze
to the Brazilian reality(13). The WLQ can only be used with
the association between productivity loss and workloads of
permission by the authors(12), and such permission required
nursing workers in a teaching hospital.
the signature of a Confidentiality Disclosure Agreement.
The WLQ consists of scales, which have a score ranging
METHOD
from zero (limited none of the time) to 100 (limited all of
the time), indicating the percentage of time workers had
Study type limitations at work. Finally, the WLQ index is calculated,
This is a descriptive study with a quantitative approach, determining the percentage of workers’ productivity loss
carried out with nursing workers in a teaching hospital in at work. The WLQ domains have their own score, and the
the south of the state of Rio Grande do Sul. average of the completed items is then calculated. The rule

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 Carvalho DP, Rocha LP, Tomaschewski-Barlem JG, Barlem ELD, Cecagno D, Dalmolin GL

of a minimum number of responses in each domain is con- A p-value <0.05 was adopted as statistical significance in
sidered, which allows the other calculations to determine all analyses(14).
the limitation(12).
Ethical aspects
Data analysis This study is part of the macroproject “Work process
Data were entered and organized using the double typ- and nursing worker’s health”, approved by a health research
ing technique for data quality control, and then submitted ethics committee, under no. 54/2016, and observed the rec-
to statistical analysis using the Statistical Package for the ommendations of Resolution 446/12 of the National Health
Social Sciences (SPSS) software, version 21. After database Council, on research involving human subjects. All partici-
entry, the calculations were performed to determine the pants signed an informed consent form.
values corresponding to the indices of productivity loss. In
the domains, values according to participants’ answers were RESULTS
assigned; because two of them did not fill the WLQ scales Of the 211 participants, 188 (89.1%) were female, and
with the minimum number of responses required for WLQ 23 (10.9%) were male, their median age was 41 years, with
analysis, two questionnaires were excluded. a minimum age of 23 years and a maximum of 68 years.
Qualitative variables were described by means of abso- Regarding working time in nursing care, nursing workers
lute and relative frequencies; for the quantitative variables, a had a minimum of 1 year and 1 month, and a maximum of
descriptive analysis was performed through mean, standard 38 years and 2 months, with an average of 15 years and 3
deviation, median, interquartile range, maximum and mini- months, 92 (43.6%) workers worked extra-hours every week.
mum values. In the analytical analysis, the normality of the Regarding productivity loss, according to Table 1, nurs-
numerical data was tested by means of the Kolmogorov- ing workers had a mean of 6.38% productivity loss, of which
Smirnov Test, and it was noted that the data did not show 75% had up to 8.89% of productivity loss. In addition, 75%
a normal distribution; therefore, non-parametric tests were of the workers presented a 50% limitation in the physical
used to analyze the results. The Kruskal Wallis test was demand area, which shows that, in part of the time, the
used for variables with more than one category, and also workers had difficulty performing activities that required
the Spearman’s rank correlation coefficient, which checks the repetition of movements during work, as well as con-
the strength of a linear relationship between two variables. tinuously remaining in the same position.

Table 1 – Distribution of nursing workers according to the values achieved in items of the WLQ – Rio Grande do Sul, Brazil, 2016.

WLQ* Domains N Mean Sd† Q1‡ Med§ Q3||

WLQ* index 209 6.38 5.16 2.65 4.69 8.89

Time management 209 26.83 25.52 6.25 15 40

Physical demand 209 32.46 23.74 12.50 29.17 50

Mental-interpersonal demand 209 20.49 22.71 3.13 13.89 27.95

Output demand 209 22.02 24.23 5 15 30

Work Limitations Questionnaire; †Standard deviation; ‡1st Quartile; §Median; ||3rd Quartile.
*

Note: n= 209

Table 2 shows the average productivity loss of nursing unit presented an index of 11.86%. This can be justified by
workers by professional categories and by work sectors. It the fact that these units have a high demand for care, with
was observed that the average productivity loss among the hospitalization for adult patients in pre- and post-opera-
professional categories presented little variation; however, tive situations in the surgical unit, and hospitalization for
75% of the nursing technicians had a 9.57% productivity adult patients with physical impairment, in situations of
loss at work, followed by an 8.75% loss by the nurses, and chronic diseases, infectious diseases, and palliative care in
an 8.50% by nursing aides. This means that these work- the clinical unit.
ers had difficulty performing work tasks, such as handling Seventy-five percent of the workers had a lower rate of
equipment, concentrating on work, completing activities, productivity loss in the surgical center units (4.90%), and
and exchanging information with co-workers and patients. in the neonatal intensive care unit (5.55%). These results
Considering the work sectors, it was observed that 75% can be related to the fact that the sectors are configured as
of workers in the clinical surgical unit presented a produc- a closed workplace, with limited access to the public and
tivity loss index of 14.94%, and the workers of the medical greater circulation of professionals.

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Productivity versus workloads in the nursing working environment

Table 2 – Distribution of nursing workers per professional category and work sector, according to the WLQ Index – Rio Grande do
Sul, Brazil, 2016.
WLQ Index
Variables n
Min. Max. Mean Sd† Q1‡ Med§ Q3||
Professional category
Nurses 49 0.80 21.70 6.20 4.53 2.95 4.50 8.75
Nursing technicians 84 0 23.51 6.56 5.12 2.65 4.88 9.57
Nursing aides 76 0 22.59 6.30 5.62 2.27 4.36 8.50
Work sector
Surgical clinic unit 21 1.16 17.84 8.81 5.67 3.89 7.65 14.94
Medical clinic unit 21 1.49 15.89 8.58 4.05 4.99 8.69 11.86
Trauma unit 11 1.72 21.70 7.98 6.68 2.28 7.08 9.11
Pediatrics 14 1.79 23.51 7.82 7.16 2.64 5.03 10.91
Emergency service 24 0 22.22 7.06 6.25 2.40 5.48 10.57
Maternity 16 0 20.40 5.47 5.49 1.89 3.53 7.61
Obstetrics 13 0.90 14.53 5.46 4.76 1.76 3.60 8.41
General intensive care unit 12 0 13.12 5.13 3.79 2.34 4.50 8.16
Neonatal intensive care unit 37 0.24 18.71 4.81 4 2.49 3.81 5.55
Material and sterilization center 6 0.90 10.90 4.24 3.60 1.46 3.43 6.57
Operating room 19 0.18 13.31 3.71 3.07 2.11 2.81 4.90
†
Standard deviation; ‡1st Quartile; § Median; ||3rd Quartile.
Note: n = 209.

Regarding the WLQ domains, according to Table 3, p=0.034), and the productivity loss index (x2=29.34; gl=15;
it was observed that the professional category of nurs- p=0.015), which highlights that the work sector influences
ing workers presented a statistically significant difference the difficulty of workers in meeting the work demand, mov-
with a limitation in the physical demand domain (x2=6.62; ing through different locations, and complying with the
gl=2; p=0.036), evidencing that the workers presented unit’s schedule and routine.
some physical difficulty, such as leaning and stretching to In the Spearman’s rank correlation test, the variable work
develop their activities. However, the work shift did not time did not show statistical significance with productivity
present statistical significance with productivity loss, and loss and limitations to work. Weekly extra-hours and WLQ
limitation to work. domains showed a significant statistical correlation (0.039)
The variable work sector presented a significant differ- with the limitation in the physical demand domain, iden-
ence from the limitation in the time management domain tifying that the workers had difficulties in following the
(x2=28.28; gl=15; p=0.020), the physical demand (x2=32.14; work routines, such as moving to provide care to patients,
gl= 15; p=0.006 ), the output demand (x2=26.40; gl=15; gl=2; standing, or carrying objects.

Table 3 – Distribution of p-value of the characteristics of the work process regarding WLQ domains – Rio Grande do Sul, Brazil, 2016.
Mental-interpersonal
WLQ* Index Time management Physical demand Output demand
Variable demand
p p p p p
Professional category .632 .969 .036† .697 .638
Work shift .287 .111 .491 .800 .502
Work sector .015† .020† .006† .231 .034†
Work Limitations Questionnaire; †p<0.05.
*

Note: n = 209

In Table 4, there was a significant association between limitation in the time management domain (x2=10.38;
chemical load and productivity loss at work (x2=9.81; gl=4; gl=4; p=0.034) was also observed, which explains the diffi-
p=0.044), as well as between chemical load and mental-in- culty workers have to perform all the activities during the
terpersonal demand limitation (x2=10.41; gl=4; p=0.034). work period.
This aspect is related to debilitation caused by chemical Mechanical load had a statistically significant association
loads, such as irritability, which can reduce concentration with productivity loss (x2=9.97; gl=4; p=0.041), and with the
at work and hamper interpersonal relationships. limitation in the time management domain (x2=11.46; gl=4;
A significant association between physical load and p=0.010). This association is due to the dynamics and nurs-
limitation in the physical demand domain (x2=9.80; gl=4; ing work overload, which allow the occurrence of accidents,
p=0.044), psychic load and time management limita- generating difficulty to develop activities without breaks or
tion (x2=6.62; gl=4; p=0.022), and physiological load and rest, as well as to maintain a work routine.

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 Carvalho DP, Rocha LP, Tomaschewski-Barlem JG, Barlem ELD, Cecagno D, Dalmolin GL

Table 4 – Distribution of p-value of WLQ domains according to the workloads in the work environment of the nursing workers – Rio
Grande do Sul, Brazil, 2016.
Workloads
Chemical load Physical load Psychic load Physiological load Mechanical load Biological load
WLQ Domains*
(n=205) (n=209) (n=208) (n=206) (n=204) (n=208)
p† p† p† p† p† p†
WLQ index .044‡ .139 .178 .064 .041‡ .253
Time management .124 .134 .022‡ .034‡ .010‡ .339
Physical demand .845 .044‡ .965 .192 .252 .902
Mental-interpersonal demand .034‡ .540 .175 .106 .281 .244
Output demand .123 .171 .150 .135 .219 .296
Work Limitations Questionnaire; †Kruskal Wallis test; ‡p<0.05.
*

Note: n = 209.

DISCUSSION with 174 nurses from four small hospitals located in the
region of Piedmont, Italy, identified a statistically significant
Nursing workers presented a mean productivity loss
relationship between work time and loss of productivity,
of 6.38%, evidencing that part of the teaching hospital’s
contradicting the results found in this study.
workers provide care with some limitations; in addition, up
There was a correlation between weekly extra-hours and
to 75% of the workers showed 8.89% of productivity loss.
limitation on the domain physical demand. This result may
Other studies(11,15) also showed similar but lower values, with
a mean of 5.5% of productivity loss, with nurses working in be related to the fact that the profession requires capac-
the nephrology unit, of whom 75% presented a productivity ity of movement, flexibility, and physical resistance. Due
loss index of up to 4.84%; nurses providing care to critical to these needs, workers who exceed the weekly workload
and potentially critical patients had an average productivity can be physically debilitated, which is confirmed in Korean
loss of 3.31%. workers who showed a relation between excessive workload
It should be emphasized that the greatest limitations and productivity loss at work(14).
of the workers in this study are related to time limitation In the association between workloads and productiv-
to perform activities from physical demands, followed by ity loss, and WLQ domains, it was observed that chem-
the limitation of time management, output demand, and ical loads had significant associations with productivity
mental-interpersonal demand. Similar results were found loss index and with limitation in the mental-interpersonal
in a WLQ analysis with 129 nurses, showing a limitation of domain. Chemical loads can generate pruritus, discomfort,
26.33% of time to perform activities from physical demand, and irritability in workers, and visible skin rashes may be
followed by 11.34% of the mental-interpersonal demand, embarrassing factors, influencing interpersonal relationships.
9.1% of time management, and 8.8% of output demand(11). Such loads are common in the nursing work due to drug
The professional category of nursing technicians pre- manipulation(6). There is evidence that nursing workers may
sented a higher productivity loss index; however, the values present cutaneous reactions when reconstituting antibiotics,
did not differ considerably from the values of nurses and with pruritus and rashes as symptoms(17).
nursing aides. These results are similar to the findings of Physical workloads had a significant association with the
nurses working in northern Italy, who were identified as domain of physical limitation. This workload is character-
the most active workers, presenting physical and mental ized by exposure of workers to ionizing and non-ionizing
exhaustion, and consequently productivity loss at work(16). radiations, temperature differences, noise, among others(5).
Regarding work sectors, it was evidenced that the highest The noise perceived in the nursing work environment is due
index of productivity loss was in the clinical surgical unit, to patient monitoring devices and infusion pumps, which
followed by the medical unit. The sites that presented the can cause discomfort to workers, to the point of impact-
least productivity loss were the operating room and the neo- ing productivity and capacity to work(18). Irritability during
natal intensive care unit. The occurrence of a higher index work is an impairment resulting from this load(6), which
of productivity loss in open units, and a lower index in the can cause tension and decrease workers’ physical and men-
closed units is confirmed due to the physical and functional tal willingness.
structure, and because it presents less vigilance in work per- Limitation in the time management domain is related to
formance, and proximity to the other workers, which differs the difficulty workers have to comply with schedules and to
them from closed units(10). perform the tasks within the expected time(12). In this study,
Work shifts and WLQ domains were not significantly there was a significant association of the time management
associated, which was confirmed in a study with nurses at domain with the psychic loads present in the nursing work
another teaching hospital, highlighting that work shifts do environment, which can be identified by excessive work
not affect the evaluation of productivity loss(10). Work time demands. This condition is confirmed among nurses in basic
also had no statistically significant correlation with loss of care units in Maracanaú, Brazil, who, due to the excess of
productivity and limitation for work. However, a study(16) daily care activities, presented difficulties in carrying out

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Productivity versus workloads in the nursing working environment

tasks involving planning, coordination, and organization Another limitation was the study development in a single
of care(19). workplace, which does not allow the generalization of the
Another significant association with the limitation in results among the nursing workers.
the time management domain was the physiological loads, The results found contribute to the scientific knowledge,
which may be related to the workers’ limitations that pre- allowing a discussion about the issues of productivity loss
vent them from performing the activities in the period of and workloads. This fact allows the search for strategies to
time they previously performed them, consequently reducing change behaviors and attitudes on the part of nursing work-
their productivity. These loads are identified through the per- ers, managers, professors, and students linked to the institu-
formance of activities in the standing position, inadequate tions, with the purpose of changing the work reality, because
positions, manipulation and weight transport, and may be situations that require interventions have been identified.
responsible for work-related musculoskeletal diseases(7,20).
A study(21) with 296 Portuguese nurses identified musculo- CONCLUSION
skeletal diseases in 46.1% of the participants as those that The study led to the conclusion that the nursing workers
showed the greatest relationship with presenteeism, evi- at the studied teaching hospital showed workload-associated
denced by productivity loss. productivity loss, and limitations to work that are stronger
Time management and mechanical load domains also than those presented in the literature, demonstrating that
showed a significant association, as well as mechanical loads these workers have difficulty performing the activities in
and productivity loss. These workloads can be represented by part of the time. Productivity loss may be related to nursing
work accidents with sharp materials and physical violence(7). workers illnesses and impairment due to the workloads in
Work accidents cause physical and psychological damage to the work environment.
workers, who seek to carry out nursing care more cautiously, Thus, the results have identified, through productivity
as a way to prevent accidents from occurring again(22); this loss, a negative impact of workloads on workers’ health that,
may require more time for the development of tasks, leading consequently, impact patient care. Based on this association
to a decrease in productivity and performance of activities. between productivity loss and workloads, the need for new
The study’s cross-sectional design can be considered a studies that contribute to the investigation about the rela-
limitation, as it does not allow the establishment of causal tionship between productivity and work-related accidents,
relationships, even in statistically significant associations. impairments, and nursing work-related diseases is reinforced.

RESUMO
Objetivo: Analisar a associação entre a perda de produtividade dos trabalhadores da enfermagem e as cargas de trabalho em um
Hospital Universitário. Método: Estudo descritivo com abordagem quantitativa, realizado com trabalhadores de enfermagem. Utilizou-
se de um instrumento de coleta de dados estruturado e o Work Limitations Questionnaire. A análise de dados ocorreu por meio de
estatística descritiva e analítica, com os testes Kruskal Wallis e correlação de Rho de Spearmam. Resultados: Participaram do estudo
211 trabalhadores da enfermagem. Os trabalhadores apresentaram média de 6,38% de produtividade perdida, 75% dos técnicos de
enfermagem possuíram 9,57% de perda de produtividade, seguido dos enfermeiros (8,75%) e auxiliares de enfermagem (8,50%).
As Unidades que apresentaram maior produtividade perdida foram Clínica Cirúrgica (8,81%) e Clínica Médica (8,58%). O índice
de perda de produtividade apresentou associação significativa com as cargas químicas (p=0,044) e com as cargas mecânicas (p=0,041).
Conclusão: Os trabalhadores apresentaram perda de produtividade e limitações para o trabalho associadas às cargas de trabalho, o que
demonstra que possuem dificuldade para a realização das atividades em parte do tempo de trabalho.
DESCRITORES
Equipe de Enfermagem; Carga de Trabalho; Esgotamento Profissional; Presenteísmo; Saúde do Trabalhador.
RESUMEN
Objetivo: Analizar la asociación entre la pérdida de productividad de los trabajadores de la enfermería y las cargas de trabajo en un
Hospital Universitario. Método: Estudio descriptivo con abordaje cuantitativo, llevado a cabo con trabajadores de enfermería. Se utilizó
un instrumento de recolección de datos estructurado y el Work Limitations Questionnaire. El análisis de datos ocurrió por medio de
estadística descriptiva y analítica, con las pruebas Kruskal Wallis y correlación de Rho de Spearmam. Resultados: Participaron en el
estudio 211 trabajadores de la enfermería. Los trabajadores presentaron promedio del 6,38% de productividad perdida, el 75% de los
técnicos de enfermería tuvieron el 9,57% de pérdida de productividad, seguido de los enfermeros (el 8,75%) y auxiliares de enfermería
(el 8,50%). Las Unidades que presentaron mayor productividad perdida fueron Clínica Quirúrgica (8,81%) y Clínica Médica (8,58%).
El índice de pérdida de productividad presentó asociación significativa con las cargas químicas (p=0,044) y con las cargas mecánicas
(p=0,041). Conclusión: Los trabajadores presentaron pérdida de productividad y limitaciones para el trabajo asociadas con las cargas de
trabajo, lo que demuestra que tienen dificultad para la realización de las actividades en parte del tiempo laboral.
DESCRIPTORES
Grupo de Enfermería; Carga de Trabajo; Agotamiento Profesional; Presentismo; Salud Laboral.

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 Carvalho DP, Rocha LP, Tomaschewski-Barlem JG, Barlem ELD, Cecagno D, Dalmolin GL

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