美、英、日护理人力配置基准比较及其对我国的启示

世界各国护理人力配置基准中,以美英为代表的是根据不同护理班次,从护理实际需求出发,结合不同级别护士的专业技术组合能力,根据实际护理工作量和工作时间来配置护理人员的方法;另一种是以日本为代表,从护理供给角度出发,规定24小时内护士对患者比例的平均标准,根据床位数量和相对的护理工作量来配置护理人力的方法。不同角度的“基准”是由于各国不同的护士雇佣方式、护理班次和薪金支付方式,同时受到各国护士专科化的程度和使用机制的影响,其后果是护理人力状况在各国间存在较大差异。中国对护理人力配置也有明确的规定,但由于缺乏具体的管理措施,在实际中没有得到很好的执行,影响了护理质量和护理专业健康、有序的发展。借鉴国外经验和我国医疗保险实际,明确我国护理人力配置的原则,并坚持科学地测算和有效的监督管理,才可以确保合理的人力配置得到有效的实施。     

国际护士会对护士安全配置的策略

护士人力短缺是全球的一个热点问题,在中国这一问题尤为严峻。据2004年卫生部对全国400多家医院调查,我国病房护士与床位比平均为1:0.33,还未达到卫生部1978年制定的1:0.4的标准。根据WHO1998～2002年的统计,我国香港地区、日本、泰国、德国以及英国等国家的医护比都超过1:4,我国2001年只有1:0.613。从护士和人口比来看,世界上除印度、土耳其、泰国等国家以外,许多国家每千人口的护士数都在3名以上,部分国家高达25～40名,亚洲国家平均为1:2.019,我国只有1名。2005年卫生部下发了《中国护理事业发展规划纲要(2005～2010年)》,明确提出了护士配置的具体要求。在我国护理人力资源管理中,既有数量上的不足,也有使用上的不合理;既有体制上的问题,也有分配、激励机制上的问题。研究和借鉴先进国家和地区的经验,分析我国的现状和存在的问题,对于探索我国护理人力资源的合理配置是十分必要的。2006年,国际护士会提出了“护士的安全配置对拯救生命至关重要”;日本将护理人力配置与医疗收费标准挂钩,即不同护士人力配置的医院实施不同收费标准;香港十分注重人力策划的科学性,根据对护士的需求制定护士人力指标。我国内地的护理管理人员也进行了这方面的探索,上海市卫生局设立了课题基金,专门研究上海市护理人力资源配置与人才需求;江苏省卫生厅也在此方面进行了调查与研究;福建省立医院承担的福建省医学创新课题,对护理人员的合理使用进行了研究和评价。在本专栏中,各位读者将分享这些经验和成果。     

安徽省临床护理人力资源配置现状的调查研究

目的了解安徽省护理人力资源现状,探讨以实际护理工作量为依据的护士人力配置标准。方法采用问卷调查和观察法先后对全省的109所医院和其中60所医院的400个临床病区进行调查。结果①护士缺编严重;②需要配置护士数与实际配置差距大;③医院级别越高,规模越大,床位使用率越高,护士缺编比例越大;④聘用制护士离岗率高,护理队伍不稳定;⑤高学历、高职称人员比例偏少;⑥临床护理质量令人担忧。结论科学合理的配置护士人力、提高护士素质是护理人力资源管理的重要内容。各级医院应根据实际护理工作量,合理配置,科学管理,改变目前护士缺编现状,确保临床护理安全。     

护士人力资源配置改变对住院患者医疗护理质量影响的Meta分析

目的评价护士人力资源配置改变对住院患者影响的效果。方法计算机检索中外8个著名医学文献数据库,纳入常规护士人力资源配置对比常规人力资源配置基础上,改变配置模式护理住院患者的随机对照试验,提取有效数据并采用RevMan5．0软件对结果进行Meta分析。结果共纳入11个随机对照试验。Meta分析结果显示,与常规护士人力资源配置相比,在常规护士配置基础上改变护士人力配置的方法可以降低患者死亡率,缩短平均住院时间,减少住院费用。结论在常规护士配置基础上改变护士配置方式能够提高患者的部分医疗护理质量。建议护理管理者在配置护士人力时,在考虑以上指标的同时,应选择适合的护士配置模式,最大化地满足患者的护理需求,提高医院的医疗护理质量。     

对我院护理工作量的3次调查及分析

目的　探讨近几年护理工作量变化对护士人力配置的影响。方法　分别在1995年、2000年、2002年12月份对病房护理 工作量进行调查,并将结果进行对比分析。结果　在直接护理时数逐渐增多的同时,间接护理时数也在相应增多。不仅相同 护理级别的病人在不同科室的直接护理时数不同,而且同一科室在不同时间的平均护理时数也不相同。结论　单一的人力 配置标准已不再适合社会和医疗发展的需要,应结合各医院的实际情况选择最合理的护士人力配置方案。     

基于卫生经济学及RBRVS的护理服务项目定价模型研究

[目的]构建科学、合理的护理服务项目定价模型,推动我国医疗服务价格改革,促进护理学科的发展。[方法]在运用卫生经济学和RBRVS原理的基础上,根据服务项目确定实际所需人数及操作时间,从而保证直接成本与辅助成本尽可能接近真实情况,同时增加衡量地区、医院之间不同的差异系数,以不同级别护士进行静脉输液为例构建护理服务项目定价模型。[结果]构建的护理服务项目定价模型测算的收费项目包括服务项目所消耗的护士标准劳动成本和所需要的标准辅助成本,符合实际情况,能更科学地体现我国现行护理服务项目收费标准,体现护士人力成本,使价格与价值相一致。[结论]构建的护理服务项目定价模型能对护士劳务价值进行测量,能充分体现护理服务项目成本。     

急诊ICU一级护理服务项目单项成本研究

目的:探讨急诊ICU一级护理病人10项基础护理单项成本核算,为合理调整医疗护理收费项目提供可靠依据,推进医院护理成本核算的科学化管理。方法:根据1998年《深圳市医疗收费标准》中的一级护理服务标准,应用项目阶梯成本分摊法对10项基础护理服务进行测算,对比现行的一级护理收费标准。结果:一级护理10项基础护理项目总成本为127.93元,其中人力成本53.55元,占总成本的41.85%;材料成本38.66元,占总成本的30.21%,现行的一级护理收费标准10元/天,仅是实际成本的7.8%。结论:医院护理服务价格严重偏离护理成本,建议相关部门重视护理项目合理收费,使护士劳动价值得到应有的补偿,体现护士的劳动价值。     

2007年中华护理学会各专科护理学术交流会议征文内容

经中华护理学会学术工作委员会和各专业委员会研究决定,将于2007年举办各专科护理学术交流暨专题讲座会议。欢迎各医院广大护理界同仁积极撰写论文,踊跃投稿。现将各专科会议征文内容通知如下。2007年“中国护理事业发展”论坛当今全球护士缺乏已是不争的事实。由于护理人力的不足,导致护理工作不到位,影响了医疗安全、护理质量和患者的利益。国际护士会将2006年国际护士节的主题定为“保证安全的护士配置,保障患者的生命安全”(Safe Staffing Saves Lives),呼吁全球重视护理人力配置及护士的社会价值和需要。合理的人力资源配置是确保护…     

济南市市级医院护理人力配置现状及改革对策

目的 :了解济南市市级医院护理人力配置现状 ,探讨医院人力配置标准。方法 :预设调查表和问卷 ,抽样调查济南市 6家医院人员编制现状。结果 :6家医院职工平均 6 0 7人 ,卫生技术人员占 78 41%。卫生技术人员中医生占 33 79% ,护士占 44 17%。床位与职工比为 1∶2 2 2 ,床位与护士比为 1∶0 7,医生与护士比为 1∶1 3,床位与病区护士之比为 1∶0 4。病区从事临床护理工作的护士占 5 1% ,49%的注册护士不在临床护理岗位。结论 :医院实际护士总编低于 1978年的部编医院人力配置标准 ,护士内部分布结构不尽合理 ,建议在人事管理制度改革中加以完善。     

护理成本核算与护理价格的调查

目的 论述护理价格与护理成本相偏离所引起的危害,阐明构建适合中国国情的护理成本核算体系的必要性.方法 通过比较<江苏省医疗服务定价目录>、<上海市医疗服务收费标准>、<深圳市医疗服务收费标准>和2001年卫生部<全国医疗服务价格项目规范(试行)>,并结合中国护理成本现状进行分析.结果 现有护理收费标准偏低.护理收费漏项多.结论 现行护理服务价格,不能体现护理价值,影响了护理服务质量和护士的社会地位,阻碍了护理事业的发展,需建立完善的护理成本核算体系.     

护理人员编制与病人安全

多年来,以护理人员短缺为基本特征护理人员编制问题一直困扰着一些世界发达国家,并且已经成为一个危及病人安全的严重问题。2006年,我国卫生部通过新闻发布会坦承中国护理人员短缺的事实。同年,国际护士会发表了专题报告“保证安全的护理人员编制,保护病人的生命安全”,并作为护士节之主题。在此种背景之下,将主要探讨护理人员编制对病人安全的影响。     

Improvement Plan of Nurse Staffing Standards in Korea

PurposeThis study compares the expected nurse-to-patient ratio, penalties for violating these regulations, and the laws enacted in the medical and nursing fields in Korea and advanced countries like Germany, Australia, the United States, and Japan.MethodsThis study deployed an integrative review method and used search terms such as “nursing law,” “nurse ratio,” “nurse,” “nurse staffing,” “health,” and “staffing” to find articles published in English, Korean, German, or Japanese through Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, the Westlaw (International Materials-Jurisdiction) site, US government and state sites (federal parliament, National Conference of State Legislatures), and Google Scholar.ResultsCompared with medical laws in other advanced countries, Korean laws are quite crude and its nurse-to-patient ratio does not reflect patients' status. Korea also lacks strict penalties for nurse staffing ratio violations.ConclusionKorea requires a strong regulatory apparatus for nurse staffing in health-care organizations to improve the quality of its health-care services and patient safety.     

Sexual Assault Nurse Examiner/Forensic Nurse Hospital-based Staffing Solution: A Business Plan Development and Evaluation

Nationally and internationally, providing competent and sustainable sexual assault nurse examiner/forensic nurse coverage has been a shared challenge. This project, “Sexual Assault Nurse Examiner/Forensic Nurse Hospital-based Staffing Solution: A Business Plan Development and Evaluation,” provides an example for assessment, construction, implementation, and evaluation of a business plan for a sustainable sexual assault nurse examiner/forensic nurse staffing solution. By using preexisting float pool positions and converting them to sexual assault nurse examiner emergency nurses, coverage for sexual assault nurse examiner examinations in a 16-hospital health system was established, which decreased sexual assault nurse examiner turnover related to burnout while increasing the sustainability of sexual assault nurse examiner nurses who provided quality care to patients who had experienced a sexual assault, domestic or intimate partner violence, elder or child abuse or neglect, assault, strangulation, or human trafficking. Implementation of the business plan resulted in a 179% increase in completed sexual assault nurse examiner examinations and a 242% increase in all types of completed forensic examinations from 2015 to 2019 as 7 new community hospitals were added to the health system. A sum of more than $20 000 allocated for training new sexual assault nurse examiners/forensic nurses was saved per year by using a sexual assault nurse examiner emergency nurse. By creating a supportive structure that fosters and sustains sexual assault nurse examiners/forensic nurses, both medical and mental health concerns can be addressed through trauma-informed care techniques that will affect lifelong health and healing as well as engagement in the criminal justice process for patients who have experienced sexual assault, abuse, neglect, and violence.     

Nurse staffing and patient safety

Safe, effective and ethical nurse staffing requires that there is a sufficient number and appropriate use and mix of competent nurses available to care for patients. Because of its close connections with patient safety, nurse staffing has become an important concern for governments, health-care providers and the public. This article provides highlights from the Canadian Health Services Research Foundation research report Evaluation of Patient Safety and Nurse Staffing (2005), which focused on the connections between nurse staffing and patient safety. The report findings were discussed at a roundtable of decision-makers and experts, and these deliberations and the literature evidence were used to create the final synthesis. The authors present one of the key recommendations for nurse staffing that arose from the synthesis.     

AWHONN Members’ Recommendations on What to Include in Updated Standards for Professional Registered Nurse Staffing for Perinatal Units

ObjectiveTo solicit advice from members of the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) on what to include in an update of nurse staffing standards.DesignOnline, single-question survey with thematic analysis of responses.SettingElectronic survey link sent via e-mail.ParticipantsAWHONN members who shared their e-mail with the association and who responded to the survey (n = 1,813).MeasuresParticipants were asked to answer this single question: “The AWHONN (2010) Guidelines for Professional Registered Nurse Staffing for Perinatal Units are being updated. During their initial development, feedback from nearly 900 AWHONN members was extremely helpful in providing specific details for the nurse staffing guidelines. We’d really like to hear from you again. Please give the writing team your input. What should AWHONN consider when updating the AWHONN nurse staffing guidelines?”ResultsThe e-mail was successfully delivered to 20,463 members; 8,050 opened the e-mail, and 3,050 opened the link to the survey. There were 1,892 responses. After removing duplicate and blank responses, 1,813 responses were available for analysis. They represented all hospital practice settings for maternity and newborn care and included nurses from small-volume and rural hospitals. Primary concerns of respondents centered on two aspects of patient acuity—the increasing complexity of clinical cases and the need to link nurse staffing standards to patient acuity. Other themes included maintaining current nurse-to-patient ratios, needing help with implementation in the context of economic challenges, and changing wording from “guidelines” to “standards” to promote widespread adoption.ConclusionIn a single-question survey, AWHONN members offered rich, detailed recommendations that were used in the updating of the AWHONN nurse staffing standards.     

Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality

AIM: This paper is a report of a study to assess the impact of nurse absenteeism on the quality of patient care. BACKGROUND: Nurse absenteeism is a growing management concern. It can contribute to understaffed units, staffing instability, and other factors that could have a negative impact on patient care. The impacts of absenteeism on the quality of nursing care have rarely been studied. METHOD: Retrospective monthly data from incident reports and staffing records in six inpatient units for 2004 were analysed. Dependent variables were the numbers of restraints, alternatives to restraints, incident reports, deaths, and length of stay. Explanatory variables were nurse absenteeism hours, patient days per nursing staff, and interaction between these variables. Controls were patient acuity and unit characteristics. Fixed effects regressions were analysed as regular or negative binomial models. FINDINGS: Neither high Registered Nurse absenteeism nor high patient load was related to restraint use when taken separately. However, high Registered Nurse absenteeism was related to restraint use when patient load was high. Registered Nurse absenteeism was related to a lower use of alternatives to restraints. Incident reports were increased by high patient load, but not absenteeism, or absenteeism given patient load. When both patient load and absenteeism were high, deaths were higher also. CONCLUSION: Absenteeism alone may not be a strong factor in lowering quality, but the combination of high Registered Nurse absenteeism and high patient load could be a factor. Staffing and absenteeism may be part of a vicious cycle in which low staffing contributes to unit absenteeism, which contributes to low staffing, and so on.     

A framework for nurse staffing in long-term care facilities

Nurse staffing is complex and requires the nurse administrator to consider multiple factors. The Framework for Nurse Staffing in Long-term Care (LTC) Facilities provides a comprehensive perspective of those factors and their interrelatedness. The purpose of the framework is to provide nurse administrators and managers with ways to analyze and evaluate nurse staffing in their own facilities and develop solutions and approaches that are specific to their needs and circumstances. The framework also can serve as the basis for developing and testing research questions that will guide nurse administrators in making informed decisions to determine, allocate, and deliver the resources necessary to provide quality care for residents.     

Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses,The Critical Care Networks National Nurse Leads,Royal College of Nursing Critical Care and In‐flight Forum

Background: Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units. These standards have evolved from previous works and are endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N) and the Royal College of Nursing Critical Care and In‐flight Forum. Aim: The aim of this paper is to provide an overview of the much more detailed document ‘Standards for Nurse Staffing in Critical Care’, which can be found on the BACCN web site at www.baccn.org.uk . The full paper has extensively reviewed the evidence, whereas this short paper provides essential detail and the 12 standard statements. Methods: Representation was sort from each of the critical care associations. The authors extensively reviewed the literature using the terms: (1) critical care nursing, (2) nursing, (3) nurse staffing, (4) skill mix, (5) adverse events, (6) health care assistants and critical care, (7) length of stay, (8) critical care, (9) intensive care, (10) technology, (11) infection control. Outcomes: Comprehensive review of the evidence has culminated in 12 standard statements endorsed by BACCN, CC3N and the Royal College of Nursing Critical Care and In‐flight Forum. The standards act as a reference for nursing staff, managers and commissioners associated with critical care to provide and support safe patient care. Conclusion: The review of the evidence has shown that the contribution of nursing can be difficult to measure and consequently support nurse staffing ratios. However, there is a growing body of evidence which associates higher number of registered nursing staff to patient ratio relates to improved safety and better outcomes for patients. The challenge for nurses is to produce accurate and meaningful outcome measures for nursing and collect data that accurately reflect the input of nursing on patient outcomes and safety.     

Safe Staffing for the Post Anesthesia Care Unit: Weighing the Evidence and Identifying the Gaps

Postanesthesia nursing care and standards are continually evolving. ASPAN has the professional responsibility to develop standards of nursing practice to promote a safe environment of care. Currently, ASPAN's recommended staffing ratios are based on the best available evidence: expert opinion and consensus. Our Society believes that these nurse-to-patient ratios have served to provide safe, quality patient care. In 2006, the ASPAN Safe Staffing Strategic Work Team was charged with conducting a national PACU Safe Staffing Evidence-Based Practice (EBP) project. The purpose of this EBP staffing project was to search the scientific staffing evidence in an attempt to validate ASPAN's staffing ratios. This expert panel critically weighed the nursing evidence on staffing ratios, workload intensity, patient acuity, nursing-sensitive outcomes, and nursing-sensitive indicators, including appropriate critical care studies because of the scarce number of postanesthesia studies. The outcome of this dynamic initiative revealed the need to develop nursing-sensitive perianesthesia indicators that can provide patient outcomes used to assess the effectiveness of staffing ratios. Finally, research gaps were identified and the next steps in the generation of knowledge needed to build safe staffing evidence were identified in ASPAN's Strategic Research Staffing Plan.