一级护理费成本测算的方法与分析

我院自 1999年开始在医院管理中引入了全成本的概念 ,对一级护理费采用成本阶梯分摊法进行了初步测算。通过测算发现 ,每名护士每年实际工作时间为 2 2 0d ,每名一级护理病人每日劳动力成本为 12 0 .78～ 2 10 .2 6元 ,每日所需消耗品成本为 36 .4 9元。我们提出如下建议 :①提高护理费收费价格 ,使护理人员劳动价值得到体现。护理费收费标准每天应为15 0～ 2 5 0元。②对护理工作量大 ,消耗成本多的项目实行单独收费 ,如皮肤护理、床上擦浴等 ,每项成本在 15～ 2 0元。既可以保证病人的清洁舒适 ,又可以推动护理用品的开发。③应适当增加护理人员机动编制。即每 3名护士应设置 1名替班人员 ,有条件的医院设置护士人员流动库 ,以保证在岗护士的数量。同时 ,我们也认识到在护理管理中引用成本概念进行科学的统计和分析 ,才会为护理经济政策的制订提供依据 ,推动护理专业的发展     

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。     

综合性医院优质护理服务普通病房标准护理排班方式的构建

目的通过构建综合性医院优质护理服务普通病房标准护理排班方式,以提高优质护理服务质量,为护理人力资源管理提供依据。方法对综合性医院护理人员进行能级划分,测算各班次各级护士护理工作量,根据各级护士最适工作量,构建综合性医院优质护理服务普通病房标准护理排班方式。结果通过手术科室和非手术科室各班次各级护理人员标准最适工作量,计算出各班次各级护理人员的配置数量,实现优质护理服务普通病房标准护理排班方式的构建。结论构建优质护理服务普通病房标准护理排班方式,使护理人力资源科学合理配置和有效使用,为护理管理者提供科学的参考依据。     

医院改革中护理人力资源的合理配置与使用

护理人力资源的合理配置与使用是护理管理改革的一项重要内容。我院在此次改革中对各科室护理人员编制进行了科学合理地测算 ,制定了护理管理人员和专业技术人员的聘任标准和岗位职数 ,明确了护理岗位的内涵 ,对中专毕业护士实行合同聘任制 ,合理分流和考核转岗人员 ,科学排班 ,在医院业务量大幅度增加的情况下 ,在编护理人员数量未有明显增加 ,各项护理服务指标达到优良水平     

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。     

护理收费标准对分级护理质量的影响

目的：提高护理收费标准，达到护士劳动价值与价格的平衡，从而保证临床护士按需配备，保证分级护理质量。方法：依据分级护理收费标准，分级护理工作内容与所需时间及护理人员编制的计算，说明现有护理收费标准低于护士劳动价值。结果：收费标准与劳动价值不一致制约了护理人员编制，影响到护士的身心健康及护理队伍的稳定，造成护理收费的失控并影响到整个医疗收费结构，是影响分级护理质量的重要不利因素。结论：分级护理的收费标准应该与护士的劳动价值相一致，以劳动时间、劳动强度、护理级别为依据。     

医院护理人力资源配置中存在的问题及对策

通过分析目前我国护理人力资源配置的现状，发现存在的主要问题有：医院护理人力资源配置可参考的标准陈旧；医院护理人员数量不足；医院护理人员年龄结构过于年轻化；医院护理人员学历层次偏低；医院护理人员职称结构不合理，中高职称比例低；医院护理人员流失大等。对策：建议修订配置标准；适当增加医院临床护士数量；提高现有护理人力资源利用率；加强护士的在职培训和学校教育；规范护理技术职称的评审，保持护理队伍合理的技术职称结构。     

护理成本控制的探讨

随着医疗改革的不断深入,护理人员也在积极进行各项护理成本的分析与探讨,以达到成本控制及提高医疗护理质量的目标。护士占医院整个团队中的大多数,如果护理人员都能有正确的成本概念,提供经济有效的护理活动,对减少病人的看病费用、降低医院成本,提高医疗护理质量有一定作用。现将针对护理人员在临床工作中如何控制成本进行探讨。1基本概念1.1护理成本护理成本分直接护理成本和间接护理成本,直接护理成本是能够确认由本部门承担责任的成本,亦指护理人员执行护理过程所需要的成本。间接护理成本是指并非本部门发生的成本,而是为了某种管理…     

设立优质护理病房的卫生经济学评价

目的分析设立优质护理病房所增加的护士人力成本与患者每日分摊费用,进行卫生经济学评价分析研究。方法根据病区床位使用数量,按优质护理服务护士护理患者人数,设立优质护理病房。合理排班,计算护士人力,得出床护比,与原床护比进行比较,得出增加的护士人力成本,除以患者数量,得出每日患者分摊增加的护士人力成本费用。结果在床位使用率100%的情况下,病区床位数为32、40、48、56、64、72、80、88和96张时,患者每日分摊费用较原来分别增加18.27、13.29、9.97、2.85、-2.49、11.81、3.32、2.42和4.43元。结论随着病区床位数量增加,患者每日分摊费用总体呈下降趋势。在床位数为64张时,保持原收费不变,医院节省49 137.66元。床位56张和88张时,患者每日分摊费用增加不多,患者能够接受。因而床位数成一定规模时,可以弥补优质护理病房设立增加的护士成本,节约社会资源。     

护理收费对开展优质护理服务示范工程的影响

[目的]通过优质护理服务示范病区的推广,完善和提高护理服务收费项目与标准.[方法]根据河南省物价收费标准及卫生部关于住院病人基础护理服务项目及基础护理服务工作规范的要求,完成护理工作所需时间及护理人员的编制计算,说明现有的护理收费项目缺失,收费标准不合理.[结果]收费标准不合理影响了护士的身心健康及护理队伍的稳定,从而制约护理人员的编制,造成护理收费失控,护理服务质量不高,护士对工作的积极性不高.[结论]护理收费标准应该充分体现护士的劳动价值,适应市场经济的发展,应以护理级别、劳动时间和劳动强度为依据.     

State and Local APN Salary Data: The Best Evidence for Negotiations

Compensation commensurate with responsibilities is an element of overall job satisfaction and influences satisfaction with and commitment to work. State and local salary data can be useful when negotiating compensation. This Washington State survey of advanced practice nurses (APNs) found salary differences according to factors such as geographic locations, gender, years of practice, education, and practice setting. Men earned almost $6000 a year more than women, and advanced practice nurses in the hospitalist role earned the highest average salary. Nearly a quarter of APNs were dissatisfied with their salary and 5% were very dissatisfied.     

Nursing attitudes to the care of elderly patients at risk of continuing hospital care

This study assesses changes in nurses' attitudes to the process of decision-making regarding the care of elderly patients identified as being at risk of continuing (long-term) hospital care It was undertaken during the course of an evaluation of an intervention programme which involved a new approach to decision-making concerning the long-term care of dependent elderly patients Complementary components of the intervention programme were (a) an early discharge planning service, and (b) an extended home care programme The programme involved close liaison of specially trained community health nurses with staff members of the general medical wards of a large general hospital At the onset of the evaluation, it was perceived by management that the staff of the general medical wards favoured continuing hospital care for very dependent elderly patients rather than community care It was hypothesized that the intervention programme would result in a change in ward staffs' attitudes concerning the feasibility of home-based care and how decisions about care should be made To test this, attitude changes of community health nurses and ward nurses were assessed over the period of implementation of the programme Following the introduction of the programme, the study found that some of the ward nurses' attitudes became closer to those of community health nurses There was a shift in ward nurses' attitudes away from a professional approach to decisions about the care and placement of very dependent elderly patients to a 'patient choice' approach Nurses felt more strongly that they had an important role in patient care Implications of the research are considered in relation to the process of discharge planning     

山西省长治地区护士对糖尿病足知识的认知情况调查分析

目的 调查分析山西省长治地区护士对糖尿病足知识的认知情况.方法 采用自行设计的调查评价表对由便利抽样所得的100名二级医院护士的糖尿病足知识进行调查与评价.结果 护理人员对糖尿病足知识的认识水平较低,参加继续教育的护理人员糖尿病足知识的掌握水平明显高于没有参加者.结论 山西省长治地区护理工作者对糖尿病足知识的认知度较低,需要引起护理管理者的重视,组织相应的继续教育及专科培训为糖尿病足的预防工作奠定良好的理论基础;护理工作者应该学习阅读文献,掌握最新知识,树立预防重于治疗的意识;在健康教育过程中应该扮演积极主动的角色.     

美国麻省总医院的管理与启示

磁性医院是指在护士严重短缺的状况下，医院仍然能像磁铁一样吸引专业护士加入，降低护士离职率，拥有高素质的护理队伍，提供优质护理服务，取得最好临床效果的医院。笔者从磁性医院不可或缺的8个构成要素等方面，对美国麻省总医院进行介绍，并对我国护理的现状进行思考，提出自己的建议：合理配置并利用护理人力资源，重视护士工作满意度，尝试在我国创建护患双方均满意的评选标准，并将其纳入等级医院评审标准中。     

Nurse migration and its implications for Philippine hospitals

BACKGROUND: 'Push' and 'pull' factors motivate Filipino registered nurses (RNs) to leave for employment in foreign countries making the Philippines the leading source country for nurses overseas. OBJECTIVE: To assess the current RN-staffing situation in Philippine hospitals. DESIGN: A self-administered survey was mailed to a sample of 200 Philippine hospital chiefs of nurses. RESULTS: According to respondents, the majority of RNs in their hospitals (73%) were aged 40 years and younger and female (85%); government hospital RNs earned higher wages than private hospital RNs; and on average, RN vacancy rates and RN turnover rates were lower in government hospitals than private hospitals. All respondents reported no difficulty recruiting RNs with less than 12 months of work experience. However, recruitment of more experienced RNs was somewhat or very difficult for private hospitals compared with government hospitals. Higher salaries, better benefits and good career opportunities were identified as most effective incentives for both recruitment and retention. CONCLUSIONS: RN staffing in government hospitals is more favourable than in private hospitals as measured by employment tenure, vacancy rates, turnover rates and ability to recruit and retain more experienced RNs. On average, respondents reported over half (59%) of total RN turnover was the result of nurse migration overseas.     

Social interaction between nurses and female patients in the course oforganization of a Nursing Development Unit

Following Friedson's work in the early 1970s, discussion about nursing's status as a profession took place. As a result the nursing development unit movement started in Great Britain in the early 1980ies. The goal of nursing development units is committed to both the development of nurses and nursing practice. The programme was supported by a grant of 3.2 million pound sterling from the British Department of Health. The last decade has witnessed a proliferation of these units. There a now over 300 (Draper, 1996). In Germany this programme of nursing development units is still rather unknown. The author believes that it should be discussed also in Germany as an effective instrument for the development of nursing as both an academic and a practice discipline. The central focus was to draw attention to the social interactions between nurses and patients within an NDU. Another question was whether nursing development units fundamentally represent an effective way to improve the standard of patient care by promoting excellence in nursing. In conclusion the level of patient oriented care and the quality of social interactions between nurses and patients has increased. However, examples for backward steps in the development of the unit the author visited were also found. The study shows that there were both conditions which inhibited and which gave support nurses' development and their practice.     

做好护理继续教育促进实践能力与创新精神的结合

目的 通过在职培训,拓展护士的能力,开发创造力,全面提高护士的综合素质.方法对在职护士采用适应性教育、补缺型教育、深化型教育模式,实现对专业技术人员的知识补充,达到人才质量的全面提高和学科建设的发展.结果对不同时期的护士采用分层次、灵活多样、有的放矢的系统教育形式,使900余名不同年制的护士拓展和完善了知识结构,增强了创新意识,提高了综合能力,适应科学进步和学科发展的需要.结论通过培训获得了全面知识的拓展,开发了潜力,达到了实践能力与创新精神的结合.     

浅析护理服务低价格的现状及应采取的措施

具体分析了护理服务低价格的现状及对医疗事业发展的影响。提出了运用价值规律、调节医院劳务市场 ,制定护理服务价格时必须召集护理专家参加 ,调整医疗费用的结构 ,提供优质、优价的特需护理服务 ,建立科学的成本核算方法等五个方面使护理工作的价值得到真正体现的措施。     

我院聘用护士管理体系的建立

目的:建立规范、科学的聘用护士管理体系。方法:明确聘用人员的组织管理体系,出台相关政策,建立聘用护士管理档案,编制专门的管理软件。结论:依法用工事在必行,医院要承担适当的用人成本,激励机制是调动聘用护士积极性的有效方法。     

Comparison of risk management in Taiwan and the USA

AIM: The purpose of this paper is to compare and contrast the systems of risk management between a hospital in the USA and a hospital in Taiwan. BACKGROUND: By comparing both systems, nurses and managers will have a better understanding of risk management improvements and be in a better position to protect their patients and themselves. EVALUATION: Two interviews were conducted and literature were collected and reviewed by the author to support the argument. The gathered information was analysed to demonstrate the strengths and weaknesses of both hospital systems. KEY ISSUES: Although risk management is not difficult to understand, nurses and managers usually pay insufficient attention to it. CONCLUSION: Health care providers should work as a team to complete risk assessment and management in their workplaces. There are weaknesses to be improved and strengths to be continued and addressed in Taiwan and in the USA.