张家口市三甲医院急诊科医护人力资源配置现状及离职意愿调查

Status of medical human resource allocation and turnover intention of medical staff in emergency department of top three hospitals in Zhangjiakou City

目的了解张家口市三甲医院急诊科医护人力资源配置现状和医护人员离职意愿,为后期该市急诊科人力资源配置优化提供意见。方法通过查阅张家口市两家三甲医院统计年报和医护人员基本信息调查表,收集2017—2019年医院急诊科运营情况和医护人员人力资源配置现状相关资料,调查3年间急诊工作量、医护人员配置、急诊医护基本情况,并对医护人员的离职意愿进行多因素logistic回归分析。结果2017—2019年2家三甲医院急诊科日均急诊量呈现逐年增加趋势(P<0.05)。3年间,固定医生、护士占比均有所增加,但差异尚无统计学意义(P>0.05);急诊科医生临床工作年限基本超过3年,临床培训间隔基本低于2年;急诊科护士临床工作年限有随着时间推移呈下降趋势(P<0.05)。张家口市三甲医院急诊科抢救区床医比基本达标,但依然存在床位配置过少问题。本科、硕士学历医生占比超过80%,本科、大专学历护士(师)占比则超过90%,医护人员呈现年轻化趋势,但中、高级职称医护人员占比不超过40%,超过70%医护人员工作年限不足5年。急诊科医护人员年龄、性别、职称、学历、工作年限在3年间差异未见统计学意义(P>0.05)。2017—2019年三甲医院急诊科医护流动率分别为31.08%、40.66%以及39.81%,2019年有离职意愿的占24.07%(26/108)。logistic回归分析结果显示,工作压力越大,心理症状越严重,急诊科医护人员离职的可能性也越大(OR=1.533、1.874,P<0.05)。结论张家口市三甲医院急诊科医护人员配置存在不足,医护人员职称、学历比例欠合理,工作经验相对不足,人员稳定性欠佳。需要进一步改善急诊科医护人员人力资源配置,减少医护人员工作压力,以满足急诊科发展需要。

Objective To understand the status of human resource allocation of medical staff in emergency department of top(3A)hospitals in Zhangjiakou City and their leaving willingness,so as to provide suggestions for optimizing medical human resource allocation in this city.Methods Referring to the annual statistical reports of 2 top(3A)hospitals in Zhangjiakou,the data related to emergency department operation and medical human resource allocation during 2017 to 2019 was collected.The questionnaires were used to survey leaving willingness of medical staff and possible affecting factors.The emergency workload,medical human resource allocation and basic situation of emergency medical care in these 3 years were analyzed.Multivariate logistic regression analysis was performed to screen the factors influencing leaving willingness.Results The daily average workloads of emergency department in these 2 top three hospitals from 2017 to 2019 showed an increasing trend(P<0.05).The proportions of both doctors and nurses with permanent employment increased also in these 3 years.Most emergency doctors worked in their position for more than 3 years,but had clinical training for less than 2 years.The working time of clinical nurses showed a decreasing gradually year by year(P<0.05).The ration of bed-to-doctor in emergency department was basically met the governmental requirements,but there still existed a shortage of medical beds.Though more than 80%of medical doctors had bachelor’s degree or higher and 90%senior nurses had bachelor’s degree and/or college education,the proportion of medical staff with intermediate and/or senior titles was lower than 40%,and 70%of the medical staff worked for less 5 years.There was no statistically significant difference of medical staff’s age,gender,title,educational level,and working time during these 3 years(P>0.05).From 2017 to 2019,the proportion of resigned staff in emergency department was 31.08%,40.66%and 39.81%,respectively.Among current employed medical staff,24.07%(26/108)had the intention to leave.The results of logistic regression analysis showed that the leaving willingness possibility of medical staff in emergency department were affected by higher work stress and the severer psychological symptoms(OR=1.533,1.874,P<0.05).Conclusions There was insufficient allocation of medical staff,shortage of senior of professionals,insufficient work experience and poor personnel stability in emergency department of top(3A)hospitals in Zhangjiakou City.It is necessary to further improve medical human resource allocation in emergency departments.