Study On The Classified Allocation Mode Of Nursing Human Resources In ICUs Within Large General Hospitals In Shanghai

Nursing human resources has been recognized as one of the most shortage resources in healthcare system.With the acuity of patient becomes more and more severe,and the technology of healthcare becomes more and more advanced,in order to utilize different levels of nursing human resources with a higher efficiency and rationally allocate the number of different levels of nurses,our study team tried to develop a nurses staffing mode on the basis of level structure formed firstly.We focused on the setting of ICUs in large hospitals in Shanghai,because of where is the place with a much higher intensity of healthcare resources.With this study,we want to reach the aims of higher levels of patients' safety,cost-effectively staff utilization as well as satisfied working status.Two parts of studies were included in this research.Part One The nurses level system in large hospitals in Shanghai.With 2-roundof Delphi method,semi-structured in-depth individual interview,and focused group discussion,the system of nursing staff's structure in Shanghai was developed,in which there were 4 groups,4 items of nursing staff's levels,6 items of recruitment criteria,45 items of job descriptions,and 127 work contents in different levels of nurses.The statistic results showed that nursing experts' opinions were focused and unanimous in the items which indicate that Delphi method was scientific and the result was proved to be valid (Ca=0.7613)。Part Two The staffing mode in different levels of nurses in ICUs of large hospitals in Shanghai.With the convenient sampling method and geographic balance consideration,our team had 7～11 days of clinical observations in 5 ICUs of 3 large hospitals in Shanghai.Firstly,with the multiple kinds of workload measurement tools,we collected all the necessary information related to nurses' workload in different levels.The main results we gained from the data were,the average times of direct nursing care working items,the frequencies of direct nursing care working items for each patient,the total indirect nursing care time,the total working hours per day in different levels of nurses, etc.And analysis between different settings and different levels of nurses,and the constitutional ratio of workload in different levels of nurses were calculated.Results showed that,the standard ideal working hours of Nursing Assistants,Registered A Nurses, Registered B Nurses,and Clinical Nurse Specialists was 8.326±0.280,6.668±0.238, 7.297±0.260,7.434±0.265 separately;the average daily workload of Nursing Assistants was the largest among different levels of nurses which constituted 47%of total workload, then Registered A Nurses(approximately 32%),Registered B Nurses(approximately 14%), Clinical Nurse Specialists(approximately 7%),and Expert Nurses(approximately 0%) followed.Secondly,with Analytic Hierarchy Process and Judgement of Same Speciality Experts methods,the weights of items in the nursing specific patient classification tool were set,based on which we collected 622 weight walues in those ICUs,and with K-means Cluster Analysis the patients trials were divided into 4 groups.Thirdly,after collecting the self-assessment scores on workload and the bed occupying time of patients, we got the subjective judgment of nursing workload and the transferring rate of ICU patients.Finally,we established the stratified nurses' staffing mode in ICUs of large hospitals in Shanghai,which was the multiple linear regression mode between the patient classification weight and daily workloads of different levels of nurses, Y=0.106+0.017X₁+0.006X₂+0.073X₄+0.093X₅(maximum),Y= 0.112+0.042X₁+0.022X₂-0.015X₃+0.077X₄+0.190X₅(minimum),and a group of linear regression equations between the patient classification weight and daily ideal numbers of different levels of nurses,Y=0.136+5.952N₁/T=0.190+4.872N₂/T=0.224+7.872N₃/T =0.220+16.080N₄/T(minimum),Y=0.132+6.432N₁/T=0.193+4.728N₂ /T= 0.226+7.584N₃/T=0.210+18.672N₄/T(maximum).The results of this study showed that,because of the traditional customs and the bias caused by managers' experience on nurses scheduling,the workload per nurse in ICU varied differently even under the same situation of nursing staff shortage.The classified allocation mode of nursing human resources in ICUs within large general hospitals in Shanghai from this study is not only adapted to the trend of clinical classified nursing staff in Shanghai,but also with the comprehensive combination of self-assessment of nursing workload,patients' need of nursing activities,the transferring rate of patients in ICU,we got a scientific nursing human resources allocation mode,which can provide scientific references for clinical nursing managers to allocate their own staffs,and also can be a guideline for the government and the public health sector to develop new policies on nursing human resources allocation.