A Study On Competency Based On The Professional Structure Of Clinic Nurse

Background:The scientific use of nursing human resources is of importance to health care institutions and also related to the quality of clinical care, the patient satisfaction and motivation. At present, there are two aspects of the problem for the allocation of nursing human resources. First of all, there are problems in the utilization of resources in the system. Nursing staff is high rank from the clinic and engaged in more than their low rank and rank the ability to practice work in some units. Therefore, it is difficult to guarantee the high level of quality of clinical nursing; some units make nursing personnel engaged in nursing staff working under a high rank due to the shortage of nursing staff,, so in a certain extent, this is of high quality waste of resources. The rank management and appointment of nursing staff to use most of the hospitals is the five title system of deputy director of the national Ministry of Health issued in 1981 in our country, director of the nurse practitioner, nurse and nurse, the main management division. this management mode must make nurse professional and technical personnel as the academic position and to a certain extent, it is mobilize the enthusiasm of nursing staff, but due to the lack of clinical evaluation and post competency standards, leading titles and practical ability of nursing staff is not consistent in the evaluation of professional titles.The second is the problem of occupying care resources outside the system. Due to the little of nurse career development opportunities and promotion way and escaping on night duty hard, there are part of the staff to non nursing professional jobs office, taking up a lot of nursing staff of the title. Because the management responsibility is not clear, some units let nurses to assume the duties of a large number of such as the maintenance of the order of ward, equipment maintenance, and other non nursing work, it costs nurse’s effort and hours of work. Thus, it is urgent and explores the scientific allocation and optimization of nursing human resources.It is very important of the rational allocation of nursing staff and scientific management to improve the implementation of post hospital care quality, clear division level nursing positions to play and help mobilize nurses enthusiasm, initiative, and improve quality of care, patient satisfaction and efficiency of management. More studies indicate that nurse staffing is closely related to the quality of care and hospital efficiency. The rational allocation of human resources is the key to quality of care and improving patient satisfaction. The hierarchical management helps to optimize the care of human resources. The United States, Britain, Singapore and other advanced practice nurses ability hierarchical system, the formation of different educational backgrounds, practicing certification, access system, strict limits on the roles and responsibilities of work and management system. In recent years, the use of the classification of nurses is also a lot to try and reform, but many rely on experience, and still remain in the exploration phase of exploration, scientific study and the lack of a unified system of standards. There are still many problems, such as the system which have not been formed and clinical positions and titles compatible mode. The job classification management layers in the proportion of people lack specific set standards, and the research in the field of nursing human resources in the country is blank. This research will be the study of hospitals in a hierarchical management of nurses to work out the proportion of clinical nursing job configuration management structure as well as titles based on staff at all levels in order to optimize the care of human resources, improve patients, hospitals and nurse satisfaction, provide the basis for hospital care, human resource allocation and administrative departments of health policy. Objective:The present study explores the definition of competence of clinical nursing position at all levels of the hierarchical management framework, a clear and detailed job responsibilities hierarchical management framework at all levels and the specific work items and estimates the clinical workload statistics counterparts at all levels and specific job duties entries, scientific computing allocation ratio of nursing staff at all levels, according to the technology, responsibility, risk, management, commitment to teaching, research and other elements, in order to develop a structure based on the traditional national titles, and titles system and clinical positions to adapt to hospitals hierarchical level management positions in clinical nursing mode. Methods:The study is divided into two parts: the first part is combined with an improved panel of experts’ talks Delphi method. 30 experts who are on the division of hospital clinical nursing level system of quantitative research, were collected by hand or using e-mail payment and questionnaires. Next letter asking roll forming after the end of each round consultation, organizing expert amendments, there will be a greater challenge or disagreement summary of the issues, organizational expert group meetings to discuss and uniform standards modified. Three questionnaires are used to describe the data by SPSS16.0 and EXCEL2007 to determine the level of clinical nursing management model based on job title structure and clear job responsibilities at all levels and the specific work items.The second phase of this study were observed mainly in the field measurements recorded direct nursing workload, combing with statistical questionnaires indirect nursing workload management framework to calculate the corresponding level nursing workload at all levels, so as to calculate the staff at all levels of ratio. Results:1. 30 expert nursing care have a detailed review and positive evaluation for each item, and their positive coefficient Cj is 100%, indicating that care experts for consultation questionnaire in this study show a very high degree of importance. After three rounds of consultation and expert panel discussions, letter uniform standards and centralized observations, nurses’ framework at all levels, sharing the competence, job responsibilities and work items were above 4.5, indicating a high degree of recognized experts and the questionnaire content validity better. Established clinical nursing job title level structure-based management framework, and determine the qualifications and other conditions of work and specific job responsibilities entry levels.2. The care nursing personnel at all levels in elementary and intermediate nurse is very close to 25% by the field time measurement combined with the data from questionnaire survey and calculate. The proportion of responsibility of team leader and senior nurse allocation are reached 15%, but the allocation of nursing personnel is only 5%. The results is consistent with clinical status quo and the ratio of most of the specialist care unit, but the proportion of senior nurse anesthesia care unit and burn care unit are highest. This is may be that patients of the former were complicated, frequent rescue and emergency patients more and using breathing machine, the latter is complex wound dressing, and these items are in the distribution of more advanced nurse level.In the nurses allocation ratio in ordinary clinical departments at all levels, the highest proportion of the primary responsibility of nurses is about 30%, the following are intermediate responsibilities of nurses and assistant nurses with each with 15 percent, while senior specialist nurses and nursing specialists compared with only two 10%. The results also verify the current clinical care which is still a lot of therapy and overall patient-centered care based, and difficult-tech specialist care development remains relatively weak. The ratio of caregiver allocation is only 4%. Due to the general ward, lot of life care is still done by family members or nursing staff. The nursing staff allocation ratio of each ward can be seen in different specialties, there are some differences between the ratio of staff at all levels related to the department received seed treatment, disease progression and prognosis, treatment, bed turnover and so on.3. There is not significant difference between the two kinds of method which are the senior experts and working hours measuring different level nurses percentage to calculate the proportion of the overall basic consistent, but the assistant nurse, primary nurse and intermediate nurse triple income proportion with working hours are slightly greater than the subjective evaluation method. The proportion of intermediate duty nurses at all levels is slightly higher than the other, indicating the clinical nursing work, nursing, basic nursing technology, doctor’s advice, treatment and overall still occupy a larger proportion, and held by senior nurse and senior specialist nurse technology development is still relatively weak. The nurse allocation proportion of subjective rating method is higher, showing that clinical nursing management on patients with clean and taking care of life value degree is higher, compling with the quality of nursing service in the "soliding foundation nursing" and with the ministry of health in 1997 promulgated the 《general hospital accreditation standards》 in "nursing personnel and nurse ratio is 3:1”. The senior nurse, senior specialist nurses and nursing experts allocation of Subjective evaluation method were higher than time measuring method of income allocation ratio, which reflected the nursing managers to advocate the concept of multidisciplinary comprehensive, develop the nurse and to improve the professional and academic status of nursing science, according with the goal of “cultivating clinical specialist nurse” in the “nursing career development plan in 2011-2015” Conclusion:1. The current study establishes the qualifications and conditions of the nursing staff at all levels of the hierarchical framework and caregivers. This study will be divided into five eight clinical nurses: 0- the caregiver, I-the grade assistant nurse, II-the grade primary responsibility of nurses, III-a- the mid-level responsibility of nurses, III-b-the grade team leader responsibilities, IV-a-the Senior responsibility nurse or specialist nurse, IV-b- the level senior specialist nurses, V-the class care experts. The present study have more clearly defined career development and advancement direction, broadening their career prospects. Meanwhile, we define the levels of nursing qualifications and conditions, adding clinical practice settings and levels of management, clinical care nurses ability to match levels, in order to fully use the expertise and resources and positional unity.2. The present study make out a clear management structure in the post-level job responsibilities and job content at all levels of nursing staff. The study identified at all levels of specific criteria and scope of work of the nursing staff, and made different levels of nurses being a relatively clear distinction in the clinical work projects to help improve the core self-evaluation of nurses, job satisfaction, investment, reduce burnout and turnover rates, improve patient satisfaction, quality of care and services. The advanced training can also serve as a basis for nursing ability, ease of nurses gradually according to their specialty choice which is more conducive to professional self-development, improving their enthusiasm for learning subjective in order to conducive to the professional nursing development direction.3. The present study also established the ratio of clinical nursing job allocation level management structures at all levels. This standard provides for the basic of hierarchical management of clinical nursing and advanced scientific, so that in addition to promotion from the management approach, the increase in the direction of the various professional development and specialist care of nurse in line with overseas to develop specialist nurse trend and with international standards to improve the nurse’s professional worth and career satisfaction and be able to promote the nursing profession forward4. The differences between two methods of the nursing staff allocation indicate the current situation of clinical nursing work, to decision makers providing work direction and references for the next step. Subjective evaluation method mainly reflects the nursing managers to nursing career development and the concept of talent management, which conform to the requirements of the national policy and international development direction, but the time measuring method reflects the actual situation of the current clinical work. The differences of two methods in income allocation ratio also showing our country currently in layered nurses is still lack of unified standards on the use and management, to solve the nursing managers.