我国中、东部二级医院护理工作支持现状的调查

Current status investigation of nursing support system in the central and eastern of China among the second grade hospitals

目的探讨我国中、东部地区的二级医院在人力配置、后勤支持以及护理管理范畴方面对护理工作的支持状况。方法采用自行设计的调查问卷，于2013年4月采用便利抽样方法抽取全国13个省市的63所二级医院的护理管理者进行调查，调查内容包括一般资料、医院的一般情况、护理队伍建设情况、医院后勤保障体系、护理部职能等。结果63所二级医院已100％开展责任制整体护理工作，82．54％的医院处在护士岗位管理“启动、准备、取得成效”阶段。在护理队伍建设方面，二级医院平均床护比为1：0．54，39．68％的医院大专以上学历护士比例小于50％，58．73％的医院护师及以下职称护士比例大于60％，73．02％的医院中工作3年以下护士比例大于25％，69．84％的医院未配置护理员。在医院后勤保障方面，50％以上医院已开展专人下收下送消毒物品、配送办公物品、取送检验标本、护送患者检查、维护病房秩序和清洁，但只有12．7％的医院有专人配置静脉液体。护理管理范畴方面，做到开展质量控制、院内培训、院内调配护士人力的医院达到90％以上，能参与护士招募与护士长任免的医院61．90％，能实现奖金与绩效分配的医院占41．27％。结论中、东部二级医院已广泛推行责任制整体护理，并逐步推进护士岗位管理。护理人力配置初步改善，但与国家十二五规划要求存在一定差距，队伍结构存在年轻化、低职称、低学历特点；后勤保障配备与护理管理体制需进一步完善。二级医院应立足自身特点，进一步加强对护理工作的支持，推动护理改革进程。

Objective To explore the support status in nursing work among the second grade hospitals from such perspectives as the allocation of nursing human resources, logistics support system and nursing management model in the central and eastern regions of China. Methods Totally 63 second grade hospitals in 13 provinces were investigated by a self-designed questionnaire including the general information, general hospital circumstances, construction of nurse team, hospital logistic support, nursing function, etc. Results Among 63 second grade hospitals, all of them had adopted responsibility nursing system, and 82.54% hospitals were going to the stage of ＂start, prepare, acquire achievement＂ for nurse position management. For nurse allocation, bed/nurse ratio was 1 ： （0.54 ：t：0. 17） in average, and 39.68% of hospital own less than 50% of nursing graduated from junior college or beyond, 58.73% of hospital having more then 60% of nurses occupying Charge Nurse occupational title or below, 73.2% of hospital having more than 25% of nurses less than 3 years work experience, and 69.84 of hospital having no personal care assistant. Logistics support system ： only 30.2% hospitals had care works and 12.7% hospitals had full-time staff to configuration intravenous fluid. In the logistic support system, more than 50% hospitals already arrange specially-assigned person for collecting and sending sterilize items, specimen, sending patients for examination, maintaining ward order and clean, but just 12. 7% hospital had specially-assigned person for IV liquid configuration. At the aspect of nursing management, there were over 90% hospital carrying out quality control management, in service, nurses resource adjustment within hospital, 61.9% hospital involving nursing recruitment and nurse manager appointed and dismissed, 41.27% hospital distributing money award by job performance. Conclusions The hospitals in the central and eastern regions of China have widely practiced quality care service and gradually implement nurse position management. In the support system for care work, the allocation of human resources have improved. However, the team structure still shows the young age, low job title and educational level, still having gap withnational one two five planning. In addition, logistics support system needs to be improved and the vertical management doesn＇t carry out well. Second grade hospitals would strengthen the support for care work based on their own features so that it can promote the process of nursing reform.