【作者】 彭刚艺；

【导师】 李亚洁；

【作者基本信息】 南方医科大学 ， 护理学， 2009， 博士

【摘要】 卫生部在《中国护理事业发展规划纲要》中明确提出:要根据诊疗技术的发展和临床护理工作的需要,合理设置护理岗位,保证临床护理岗位的护士配备,科学统筹护士人力资源,扭转目前医院临床一线护士缺编的状况;要根据临床护理岗位的工作职责和技术水平要求,合理调整护士队伍结构。将护理岗位工作职责、技术要求与护士的分层次管理有机结合,充分发挥不同层次护士的作用。在我国,护理人力资源存在护士短缺、编制结构及配备不合理等方面相应问题。因此改革医院护理人力资源管理模式,可以最大限度利用现有的有限护理资源,提高护理资源的利用效率。第一部分:广东省三级医院护理人力资源分析目的:对广东省内三级医院护理人员相关信息进行调查研究,了解护理人力资源管理模型实施的基础。方法:采取现场问卷的形式,分别于2007年及2008年度对65家和69家三级医院进行调查。调查内容主要包括:护士数量、病房护士数量、病房护士与床位的比例、监护病房与床位的比例、合同护士的数量、有护理专业大专以上学历的比例、病人满意度等,用SAS 9.13统计软件录入及分析数据。结果:两年均调查的54家医院中病床数明显增加,2008年与2007年相比,病床平均使用率增加;合同护士比例占较大比重,并有增长趋势;护理人员学历在不断提高;调查对象的平均床护比均达到1:0.4。2008年调查结果,护士离职率＞10%的医院占4.34%,护士离职率介于5%-10%之间的医院占27.54%,护士离职率≤5%的医院占68.12%。结论:广东省三级医院依然存在护理人力资源不足的问题,护理人员总体学历水平存在较大差异,少数三级医院护理人员学历水平尚有较大的提升空间,调查医院中不同程度存在护士离职的现象,探讨高效的护理人力资源管理模式势在必行。第二部分:临床护理人力资源管理模型目前护理人力资源存在的问题:1、护理工作的内涵和复杂程度日益提高。2、临床护理工作模式仍然是以完成任务为中心,而不是“以病人为中心”。3、临床护士同质化管理加大了非临床趋势。4、护士排班方式反映临床护士人力资源利用的低效率。管理模型的基本构成:1.重新规划医院护理人力资源管理体系。2.建立新的病房护理人力资源管理政策模型。2.1细化医院病区护士人力资源配置数量、类别和结构。2.2建立临床护士分层级管理临床实践标准。2.3建立责任制护理的临床实践标准(政策标准)。2.4建立连续性排班的临床实践标准。2.5建立以层级管理为核心的护理工作核心工作制度及其运行模式。第三部分:临床护理人力资源管理模型实施状况分析目的:了解接受调查医院护理人力资源管理模式(包括护士分层级管理、连续性排班及责任制护理)实施情况。方法:采用“病房护理人力资源管理影响因素调查问卷”用随机抽样的方法对珠江医院(省级)、佛山市第一人民医院(市级)、东莞市人民医院和深圳市龙岗区人民医院入选科室的1125名护理人员进行护理人力资源管理影响因素调查和分析。结果:1125名被调查的护理人员的年龄构成以中青年为主,21-25岁以及26岁-30岁年龄段的护理人员比例最大,分别为29.16%和34.76%,46—50岁的护理人员仅占被调查人群的0.62%。男性仅占0.36%,学历以大专为主,职称分布以护士和护师为主,副主任护师以上仅占2.4%。护理工作年限在1-5年的护理人员最多,占总人数的38.67%,然后逐年减少,从事护理工作26年以上的仅占1.33%。护士分层级管理的临床实践调查中,98.49%被调查科室已经施行了护士的分层管理,97.51%被调查科室各护士的层级岗位相对固定,高级责任护士在护理工作中发挥重要作用;护士挂牌上岗,护士待遇(岗位津贴等)与岗位挂钩。93.42%的受调查科室中各班护理人员能形成老中青梯队。结论:新的临床护理人力资源管理模型使护士的职责更加明确,能充分调动护士的工作积极性,实现了护士人力资源科学管理和优化配置,为患者提供了无缝隙的护理。第四部分:临床护理人力资源管理模型的护士工作满意度评价目的:比较普通排班和连续性排班对护士满意度的影响,探讨连续性排班后护士工作满意度相关影响因素。方法:珠江医院共142名临床护士参与普通排班模式调查,396人参与连续性排班调查;1125人参与连续性排班调查,分别来自东莞市人民医院,佛山市第一人民医院,深圳龙岗区医院和珠江医院。采用自制调查及MMSS调查问卷,自制调查表主要包括年龄、性别、婚育状况、学历、工作年限等;MMSS表主要包括福利待遇、排班、家庭与工作平衡、与同事关系、社会或专业的交流、交往机会、专业发展机会、对工作支持及决策的机会和表扬及认可等8个方面31条目,每个条目要求按1～5打分。非常满意5分,中等满意4分,中立3分,中等不满意2分,非常不满意1分。结果:连续性排班后护士在工作总满意度、福利待遇、排班、家庭与工作平衡、与同事关系、社会或专业的交流、交往机会、专业发展机会、对工作支持及决策的机会和表扬及认可等方面满意度提高,与普通排班相比有显著差异。连续性排班后护士工作满意度与年龄、婚育状况、学历、级别、工作年限相关。结论:连续性排班优于普通排班,提高了护士工作满意度:连续性排班后,护士满意度与年龄、婚育状况、学历、级别、工作年限等因素相关。第五部分:管理模型的护理人员对患者安全文化的认识评价目的:研究对护理人员实施连续性排班后护理人员对患者安全的认识,以及连续性排班和传统排班护理对安全文化认识的差异比较。对象和方法:整群选取广东省四家不同地区不同等级医院不同科室的护理工作人员作为对象,以美国卫生保健研究与质量署设计的“医院患者安全文化调查表”作为测量工具,评估我国护理人员实施连续性排班后护理人员对患者安全文化的认识,其中在珠江医院中实施三次问卷调查,分别在实施连续性排班前、排班初期、排班后期。以多重回归分析统计方法方法进行结果分析。结果:在珠江医院回收实施连续性排班前有效问卷192份,实施APN排班初期有效问卷254。在四家医院实施连续性排班后期共回收有效问卷1125份。结果显示:实施连续性排班和传统排班对患者安全文化认识没有统计学差异(P＞0.05)。在实施连续性排班后,护理人员对患者安全同意率较高的是“组织学习与持续性改进”、“科室内团队合作”、“对错误的反馈与沟通”、“管理者促进安全的期望与行动”,同意率较低的是“人员配置”、“对错误的非惩罚性反应”、“事件报告频率”。职称是与患者安全文化总得分有统计学意义的影响因素。结论:实施连续性排班对护理人员的患者安全没有负面影响,对我国护理人员实施连续性排班后对患者安全有很好的认识。第六部分:管理模型的病人满意度评价目的:了解病区护理人力资源管理模型实施以后住院病人对医院医疗服务的满意度。方法:使用住院病人满意度量表(IPSQⅢA)对珠江医院、佛山市第一人民医院、东莞市人民医院、深圳龙岗区人民医院的825名病人进行调查,内容包括入院过程、护理、医疗环境与设施、知情权等。结果:住院病人对医院的总体满意度较高,住院病人对医生服务(83.78)和护理(82.04)评价最高,而对伙食供应(64.93)和花费(71.38)两个项目的满意度普遍不高。结论:医院护理人力资源管理的合理安排,对于提高护理服务质量和病人满意度有重要作用。更多还原

【Abstract】 Background:The Ministry of Health,"China’s development program for nursing," clearly put forward that the nursing care post should be properly arranged according to the development of medical diagnosis and treatment technology requirement of clinic nursing,so as to guarantee the nurses’ distribution of the clinical nursing post,and administrate the nurse human resource scientifically.Thereby,it can change the shortage of the first line clinic nurse.And the structure of nurses unit is reasonably regulated according to the work responsibility and the technical standard requirement of the clinical nursing post.The responsibility,the technical standard requirement and the layer-management of nurses should be integrated dynamically,so that the different level nurses fully play their role.Because there are so many problems in the nurse human resource of China,including shortage of nurse,improper establishment structure and arrangement of nurse etc.,the nursing care human resource management mode should be innovated to fully make the use of the existing nursing care resource, finally to improve use efficiency of nursing resourcePart one Investigation on nursing human resource in levelⅢhospital of GuangdongPurpose:To investigate nurses relative data in levelⅢhospital of Guangdong province,and to know the basis nursing human resource management model.Methods:We investigated 65 hospitals at 2006 and 69 hospitals at 2008 by means of spot field investigation,including the number of the nurse staff,the number of the nurse in wards,the ratio of nurses and hospital beds,the ratio of ICU wards and hospital beds,the number of Contract nurses,the proportion of nurses with college education diploma the patients’ satisfaction,and so on. Results:Hospital beds and bed occupancy rate increased greatly in 54 hospitals, There is a large proportion of contract nurses in every hospital and a increasing proportion of nurse with college education.Mean ratio of hospital beds and nurses is 1:0.4 There is varying degree resignation of nurses,in every hospitals.The hospitals of nurses resignation ratio more than 10%account for 4.34%of all investigated hospitals,the ones between 5%and 10%account for 27.54%,the ones not more than 5%account for 68.12%.Conclusions:There is a shortage of nursing human resource in levelⅢhospitals of Guangdong province.The nurses’ education background varies greatly.The professional educations need to be improved,and a nurse resignation is still exists in variable hospital.It is imperative to explore the efficient nursing human resource management model.Part two Study on policy model of human resource managementSome problems of the present nursing human resource management:1.The content and the complexity of nursing care are increasingly enhancing.2.The operating pattern of clinical nursing is not focus on the patients.But finishing the work tasks.3.The Management of clinical nurses is getting more non-clinical trend because of the homogenization of administration.4.The scheduling way of the nurses has shown the low efficiency of the clinical nurse human resource.Management principles of the policy model:1.Re-planning the Management system of clinical nursing care human resource.2.Establishing a new policy model to manage human resource of nursing care in wards2.1 Refining the quantity,the item and the structure of the human resource of ward nurses,in hospital2.2 Establishing the clinical practice standard of the clinical nurse human resource layer-management.2.3 Establishing the clinical practice standard(policy standard) of the primary nursing.2.4 Establishing the clinical practice standard of the continuous scheduling.2.5 Establishing the working system and operating pattern of nursing care which is focus on layer-management.Part three Analysis on practice state of human resource management model in clinical nursing.Purpose:To investigate the implementation of nursing human resource management model in hospital.(Nursing grade management,continue schedule and primary nursing)Methods:Using the Ward nursing human resources management factors questionnaire,researchers collected data from a sample involved 1125 patients taken at random from 4 hospitals to investigate and analysis the factors of Ward nursing human resources management.Results:Most of the 1125 nurses are young and middle-aged,29.16%of them are 21-25 years old,and 34.76%are 26-30 years,only 0.62%is 46-50 years old.The number of male account for 0.36%,most of them have specialized academic qualification and the professional title of Nurse Practitioner and Nurse-in-charge,but 2.4%are professor of nursing or associate professor of nursing.With the advance of work times,the number of nurses decreases.The work times between 1 and 5 take the most proportion,38.67 of all.Only 1.33%of nurses worked for 26 years or more. Nursing grade management has been applied in the 98.49%clinical department.Conclusion:New nursing human resource management model can promote enthusiasm of nurses because of more explicit the responsibilities.It is a important to achieve the scientific nursing human resources management,optimize the manpower configuration,and provide perfect seamless patient care.Part four:Assessment on nurses’ job satisfaction with human resource management model in clinical nursing.Objective:Compared nurses’ job satisfaction with ordinary scheduling to the continuity scheduling,discusses the related factors which influence job satisfaction after continuity scheduling.Methods:In Zhujiang hospital,142 nurses who working on ordinary scheduling and 396 nurses who working on continuous scheduling take part in survey;A total of 1125 nurses which respectively come from the People’s Hospital of Dongguan City,First People’s Hospital of Foshan,Hospital of Shenzhen Longgang District,Zhujiang Hospital working on continuous scheduling take part in survey.Self-made and MMSS questionnaire were adopted.Self-made questionnaire mainly contain age,gender, marriage,educational history,working lifetime et al.MMSS have eight factors,31 items.Eight factors are welfare treatment,scheduling,balance of family and work, colleague relationship,social or professional exchanges,interaction opportunities, professional development opportunities,and support and decision-making opportunities on work,praise and recognition.Items were rated using a 5-point scale ranging from 1(very dissatisfied) to 5(very satisfied).1 to 5 represent very dissatisfied,moderate dissatisfied,neutrality,moderate satisfied,very satisfied respectively.Results:After continuous scheduling,total satisfaction,welfare treatment,scheduling, balance of family and work,colleague relationship,social or professional exchanges, interaction opportunities,professional development opportunities,support and decision-making opportunities on work,praise and recognition were all increased.It’s significantly different with ordinary scheduling.After continuous scheduling,job satisfaction was related with age,marriage,educational history,grade,working lifetime.Conclusion:The continuous scheduling is superior to ordinary scheduling,and improved job satisfaction of nurses.Job satisfaction of continuous scheduling was related to factors as age,marriage,educational history,grade,working lifetime.Part five:Assessment on nurses’ recognition in patient safety culture of human resource management model in clinical nursing.Purpose:To investigate the recognition of patient safety in nurses after the implementation of APN shift arrangement and to make a comparison between APN and traditional shift arrangement in the patients’ knowledge of safety culture.Objective:and methods:A cluster sampling was applied to select nurses of Guangdong province from four different departments of hospitals in different areas, To assess the recognition of patient safety in nurses after the implementation of APN shift arrangement,it was measured with "Hospital Survey on Patient Safety Culture" which designed by American Healthy Care Study and Quality Administration.Of this total,three rounds of questionnaires were performed in Zhujiang Hospital including before,initial stage and late stage of APN shift arrangement.Multivariate regression analysis is applied to the statistics of the results.Results:The total valid questionnaires are 192,which regained from Zhujiang Hospital before the implementation of APN shift arrangement,while 254 in the initial stage.The number that comes from the late stage in four hospitals is 1125.The Statistics analysis showed that there was no statistical significance between APN and traditional shift arrangement in the patients’ knowledge of safety culture.(P＞0.05) After the implementation of APN shift arrangement,the higher consent rate among nurses were in "Organizational learning-Continuous improvement"、"Teamwork within units"、"Feedback & communication about error"、"Supervisor/manager expectations & actions promoting safety",while the lower consent rate were in "Personnel Configuration","No punitive response to error","Frequency of events reported".The professional title can be a statistical significant factor influencing the total score of patients’ safety culture.Conclusion:The implementation of APN shift arrangement seemed to have no negative effect on patient safety and would improve the safety recognition among nurses in China.Part six:Assessment on patients’ satisfaction of human resource management model in clinical nursingObjective:To explore the inpatients’ satisfaction with the medical service in the hospitals,and administrate the nursing care human resources by the new policy model in ward.Methods:The questionnaire of inpatients’ satisfaction with the medical service (IPSQⅢA),including the procedure of admission to hospital,nursing care,hospital environment and facilities,the right to know etc.,is finished by 825 inpatients in Zhujiang Hospital,the First People’s hospital of Foshan,the People’s hospital of Doguan city and Hospital of Shenzhen Longgang District.Results:In the study of the 4 hospitals,most inpatients are satisfied with the medical services and have highest level of satisfaction with doctor service(83.78) and nursing care(82.04).But most of them have lowest level of satisfaction with the food supply (64.93) and the cost(71.38).Conclusion:Reasonable nursing human resources management is very important to improve nursing care quality and patient satisfaction in hospital.更多还原