护士分层责任制和床边工作制在基层医院的应用体会

目的:探讨护士分层责任制和床边工作制在县级医院的应用效果。方法:将24小时分成APN或AP小大两种排班模式进行连续性排班,在数个A班中,将护士按学历、职称、能力分成几个护理小组,应用多功能护理车,实行护士管床、管患者"责任制大包干"的护士床边工作制护理。结果:基础护理、各项治疗措施和病人健康教育落实到位,病人满意;护士能力互补工作压力减轻,自我价值得到体现,护士满意;护理质量实时监控,确保护理安全,护理质量明显提高,符合优质护理服务的要求。结论:护士分层责任制和床边工作制的应用,有效地利用了护理人力资源,能够真正实现责任制整体护理,有利于低年资护士的成长,护理质量及病人满意度得到明显提高,有效地推动创优质护理服务活动的顺利开展,值得在县级医院推广应用。     

护士排班方式与能级管理在MICU中的应用

有效合理使用人力资源,提高护士工作质量及患者满意度,将护士能级管理与APN排班相结合,应用于内科重症监护室（MICU）,探讨科学合理护理管理模式。     

护士排班方式与护理人力资源的合理利用

目的探讨护士的弹性排班,使护士的工作积极性、主动性增强,以提高护理工作质量和工作效益,提高患者的满意度.方法通过调整护士的排班及护士的工作量,提高患者满意度,充分调动护士对工作的积极性、能动性,使患者的利益最大化.结论在护理人力资源相对不足的情况下,通过合理利用人力资源,调动护理人员积极性,可以提高患者的满意度.     

APN排班模式在ICU实施效果的探讨

目的探讨ICU实施APN连续排班的效果。方法在实际工作中根据工作情况改变排班方法,实行APN连续性排班,依循护士个人能力安排工作任务,合理分配人力资源,落实分层次管理。实施过程中对患者、医生、护士发放各种调查表,对其结果进行比较分析。结果 APN排班能有效改善护理工作满意度,减轻护士工作压力。各项安全查对制度及操作流程能更规范认真有效落实,同时各级护士能更有效提高自身业务素质,提高工作效率。结论 APN连续排班能合理分配人力资源,减轻护士工作压力,缓解护理人员工作疲劳感,且在工作过程中更规范有效落实安全查对制度,提高患者、医生对护理工作的满意度。     

APN排班模式在ICU实施效果的探讨

目的探讨ICU实施APN连续排班的效果。方法在实际工作中根据工作情况改变排班方法,实行APN连续性排班,依循护士个人能力安排工作任务,合理分配人力资源,落实分层次管理。实施过程中对患者、医生、护士发放各种调查表,对其结果进行比较分析。结果 APN排班能有效改善护理工作满意度,减轻护士工作压力。各项安全查对制度及操作流程能更规范认真有效落实,同时各级护士能更有效提高自身业务素质,提高工作效率。结论 APN连续排班能合理分配人力资源,减轻护士工作压力,缓解护理人员工作疲劳感,且在工作过程中更规范有效落实安全查对制度,提高患者、医生对护理工作的满意度。     

区级医院护理人力资源现状分析与对策

目的　探讨区级医院如何合理使用护理人力资源 ,优化其护理岗位的设置。方法　针对区级医院护理人力资源管理现状分析 ,从护士数量、结构、配置、分工 (排班 )等 ,提出护理人力资源管理的思路与对策。结果　通过科学确定护理岗位及层级 ,提高了区级医院人力资源管理的科学性和决策正确性。结论　护士合理配置、有效使用、竞争机制、能力建设、成本效益是当前区级医院人力资源管理存在的主要问题和发展策略。     

以创优为目标,实施小组责任制护理

目的 探讨以创优为目标的小组责任制护理工作模式的应用效果.方法 根据现有的人力资源,将护士分为2个责任小组,每个小组2～3名护士,分管约10～12名住院病人,采用连续性排班+床边工作制等工作模式,对分管的病人全面负责.结果 护理服务主动及时,健康教育知晓率、病人满意程度都有了显著提高.结论 小组责任制护理工作模式能明显提高患者满意度及护理质量,能体现护士的职业价值,是一种先进的工作模式,值得深入广泛推广.     

手术室人力资源的有效利用

作者提出在市场经济条件下，要开发人力资源，加强内涵建设，必须树立资源＝交通管理的理念。介绍了通过培养优秀的手术专科护士，护高护理专业的高科技含量，建立知识化的管理人才梯队，制定责任制手术间、弹性排班，弹性排班，合理使用合同护士的一系列管理措施，在手术量大幅上升，而人员、台次比例未有明显增加的情况下，进行了人力资源的合理利用。     

探讨层级管理的APN护理排班模式在中西医结合病房运用效果

目的探讨层级管理的APN护理排班模式在中西医结合病房运用效果。方法应用层级管理,在原有护理人力基础上,改变人力结构,每个病区分两个小组,每组5-6名护士,实行APN排班,并比较新旧排班模式患者满意度,护理质量。结果实行APN排班模式,可以更有效地利用人力资源,保证护理质量,改革排班模式后各项护理质量均有提高,(P<0.05);护理投诉、缺陷明显下降,(P<0.05)患者对护士的满意度大幅度提高,由实施前的89%提高到95%.APN排班也得到了护士认可。结论运用APN排班模式,减少了交班次数,降低了交班对患者夜间睡眠的影响;同时新老护士搭配,加强了中午和晚班的薄弱环节,避免潜在的安全隐患,确保患者安全,提高护理质量,是一种有效的排班模式。     

变频工作制在医院管理实际工作中的应用

总结了变频工作制的3种模式,分析了变频工作制与弹性工作制、饱和工作制等人力资源管理模式之间的联系,阐述了变频工作制在医院的具体应用及在公共行政管理领域的应用,并提出了应用变频工作制需注意的问题。     

APN排班层级管理模式在肿瘤科实施的探讨

目的：改革护理管理模式。探讨APN排班在肿瘤科的应用效果。方法：肿瘤科人力资源不变的前提下,优化工作流程,修订护士工作职责,建立以护士长,护理组长,责任护士,助理护士为层级的管理梯队,实行APN连续性排班。结果：护士的交接班时间减少,因中间环节多而出现的护理缺陷减少,年轻护士的工作压力减少,护士的工作效率及护理满意度提高。结论：实施APN排班,充分利用人力资源,达到最佳的护理管理目标,利于护理人员的培养与梯队建设。顺应现代护理模式的发展,值得推广。     

APN排班结合护士意愿的实施方法及效果

目的探讨APN排班模式结合护士意愿的实施方法及效果,从而提高护士对护理管理的满意度。方法对传统排班方法进行改革,实行APN连续排班;同时,由以前的护士长安排班次模式改变为满足护士意愿进行排班。结果实行APN排班后,护士和患者的满意度均有提高（P〈0．05）;满足护士意愿进行排班在开始实行的不同时间段内护士满意度有差异（P〈0．05）。结论APN排班能适应新的护理模式的发展;同时满足护士意愿融入APN排班方法,能充分调动护士的工作热情,是本科迄今探索的最好排班模式。     

Chemotherapy appointment scheduling under uncertainty using mean-risk stochastic integer programming

Oncology clinics are often burdened with scheduling large volumes of cancer patients for chemotherapy treatments under limited resources such as the number of nurses and chairs. These cancer patients require a series of appointments over several weeks or months and the timing of these appointments is critical to the treatment’s effectiveness. Additionally, the appointment duration, the acuity levels of each appointment, and the availability of clinic nurses are uncertain. The timing constraints, stochastic parameters, rising treatment costs, and increased demand of outpatient oncology clinic services motivate the need for efficient appointment schedules and clinic operations. In this paper, we develop three mean-risk stochastic integer programming (SIP) models, referred to as SIP-CHEMO, for the problem of scheduling individual chemotherapy patient appointments and resources. These mean-risk models are presented and an algorithm is devised to improve computational speed. Computational results were conducted using a simulation model and results indicate that the risk-averse SIP-CHEMO model with the expected excess mean-risk measure can decrease patient waiting times and nurse overtime when compared to deterministic scheduling algorithms by 42 % and 27 %, respectively.     

医院中心导管室护士排班的实践探讨

随着医院导管室规模的扩大和诊疗患者的增加,护士的工作压力进一步加大,合理有效的排班机制是缓解护士的工作压力和提高工作效率的办法之一.文章以患者需求和医院人力资源情况为依据,总结了原有全夜班、弹性排班、APN排班等低信息化手工排班的缺点,建立了基于ILP模型的、具有强弱约束条件的护士排班方法,取得了良好的实践效果.     

外科护士夜班排班意愿调查研究

目的了解护士对夜班排班的意愿,为现行护士夜班排班制度的改革提供依据。方法采用研究者自行设计的护士夜班排班调查问卷对131名护士进行测评。结果 96.2%护士愿意按个人意愿排班,79.4%希望在一年内完成夜班总数量,工作年限>10年及年龄>35岁护士较其他低年龄及低年资护士更愿意参加白班,差异有统计学意义(p<0.05)。结论护理管理者应依据病区护理人力资源情况,遵照个人意愿排班。     

Quality and continuity of care in Dutch nurse clinics for people with rheumatic diseases.

OBJECTIVE: Recently a new form of nurse clinic for people with rheumatic diseases has been introduced into Dutch health care. This study gives insight into: (i) patients' perceptions about the quality and continuity of care given at these (transmural) nurse clinics; and (ii) specialized rheumatology nurses' and rheumatologists' perceptions about the quality and continuity of care in the clinics. DESIGN: Validated measurement tools (QUOTE and QCC) were used, before and after patients visited a clinic, to determine patient perceptions about the quality and continuity of care. Semi-structured interviews with professionals were used to gather information about their perceptions. SETTING: The study was carried out at five locations in The Netherlands where a home care organization and a general hospital collaborated closely and had joint responsibility for a transmural rheumatology nurse clinic. STUDY PARTICIPANTS: A total of 128 patients, six specialist rheumatology nurses and four rheumatologists. INTERVENTION: Transmural nurse clinics for people with rheumatic diseases. RESULTS: In general, patients were positive about the quality and continuity of care given at the clinics. Some continuity aspects, like the presence of a locum nurse and providing the locum with sufficient information could be improved. Professionals were positive about the information given at the clinics, which is additional to the information given by a rheumatologist. Professionals were less positive about some of the clinics' preconditions. CONCLUSION: In this study, a control group (e.g. patients who received standard rheumatologist care) was not available. However, in comparison with patients' experiences of standard medical care in other (comparable) research, patients' experiences in this study were very positive. It was concluded that Dutch transmural nurse clinics, to a large extent, meet patients' and professionals' expectations and were a positive development in the care of rheumatic patients.     

落实优质护理服务 促服务质量持续提升

指出虽然开展了“精美护理”,但仍存在质量标准更新不及时;护士人力配置不合理;责任分工不明确,基础护理不能满足需求;后勤支持不充分,绩效考核有待改进等问题。结合优质护理服务要求,从以下方面进行了改进：加强领导,健全护理质量评价标准;强化培训,转变服务理念;合理配置人力,确保临床护理需求;改革排班模式,按需施护;完善后勤支持,改进绩效考核方式等。     

军队医院护理人员排班研究

目的为探讨刍：队医院护理人力资源的利用现状，合理配置现有护理人力资源，使工作效率达到最大化。方法借助卫生经济学、卫生经济管理学及现代护理管理学的有关理论，采用了对部分医院临床科的军人护士和聘用护士进行问卷调查的方式。结果不同等级的医院、不同的科室工作量和工作效率并不完全相同，忙闲不均，各级护理人员在多数操作项目中没有层次差别，因而人力资源的能级浪费与不适宜服务并存。结论对护理人员的班次进行合理编排，形成最佳的能力结构和职称结构，真正实现以病人为中心的整体护理。     

A-N两班制排班模式在医院优质服务病区的应用效果

目的探讨A-N两班制排班模式在优质病区的运用,使有限的护理人力达到更优化的组合,来提高护理质量和护士排班的满意度。方法将创优病区普外科采用APN排班模式的阶段为对照组,采用改革后A-N两班制排班模式的阶段(即A代表上午班,上班时间8:00～16:30;N代表夜班,双人上班,上班时间16:30～次日08:00,其中22:00～次日02:00时间段可休息1人,02:00～06:00时间段可休息1人)为实验组,评价两组实施前后的护理质量、病人满意度、护士对排班的满意度等效果。结果实施A-N两班制排班模式后创优病区的护理质量、病人满意度、护士排班的满意度明显高于APN连续性排班模式病区(p<0.05,差异有统计学意义)。结论 A-N两班制排班模式能满足当下护士的需要,值得基层医院优质服务病区在排班方面借鉴。     

Acuity-based nurse assignment and patient scheduling in oncology clinics

The oncology clinics use different nursing care delivery models to provide chemotherapy treatment to cancer patients. Functional and primary care delivery models are the most commonly used methods in the clinics. In functional care delivery model, patients are scheduled for a chemotherapy appointment without considering availabilities of individual nurses, and nurses are assigned to patients according to patient acuities, nursing skill, and patient mix on a given day after the appointment schedule is determined. Patients might be treated by different nurses on different days of their treatment. In primary care delivery model, each patient is assigned to a primary nurse, and the patients are scheduled to be seen by the same nurse every time they come to the clinic for treatment. However, these clinics might experience high variability in daily nurse workload due to treatment protocols that should be followed strictly. In that case, part-time nurses can be utilized to share the excess workload of the primary nurses. The aim of this study is to develop optimization methods to reduce the time spent for nurse assignment and patient scheduling in oncology clinics that use different nursing care delivery models. For the functional delivery model, a multiobjective optimization model with the objectives of minimizing patient waiting times and nurse overtime is proposed to solve the nurse assignment problem. For the primary care delivery model, another multiobjective optimization model with the objectives of minimizing total overtime and total excess workload is proposed to solve the patient scheduling problem. Spreadsheet-based optimization tools are developed for easy implementation. Computational results show that the proposed models provide multiple nondominated solutions, which can be used to determine the optimal staffing levels.