| Background:In the reform of military logistics support, the nursing workforce in military hospitals has changed from a single composition of active-service nurses to a multiple composition of active-service, non-active-service and contract nurses. With the rapid development of military hospitals in the recent years, non-active-service nurses and contract nurses have been continuously increasing in proportion, which has eased the shorthandedness of nurses, improved the quality of nursing service and promoted the reform of military hospitals. As a general hospital in the army, its nursing staff is composed of three constituents:military, non-active-service and contract nurses. Compared with military and non-active-service nurses, the wage system for contract nurses needs to be perfected in order to make their wages a good indicator of their contribution. Neglected profession design, unstable job, low pay, inadequate treatment, and ill-planned training and use of contract nurses have caused them a series of problems, such as psychological pressure, insecurity, changeable mood, lack of initiative, strained interpersonal relationship, and so on. Results of studies show that, in the old mode of management, strained interpersonal relationship, anxiety, hostility and bigotry are obviously more common in contract nurses than in those on the regular list. This suggests that the differences in status and treatment make a considerable impact on the initiative of contract nurses, as well as on the stability of the whole nursing staff and the safety of clinical work.The theory of performance management was advanced in the 1970s and, with the practice and development of the theory of human resources management, has become the focus of its studies. Performance management is a process through which managers use certain methods and regulations to ensure the agreement between performance and strategic objectives and promote the realization of the target. For a large nursing staff, to integrate performance management into nursing management and make it an essential part of human resources management in the hospital is particularly important for arousing the enthusiasm of the nursing staff and improving nursing quality. With the rapid development of nursing and its important role in a hospital, the quality of nursing service directly influences the image of the hospital and satisfaction of patients. The improvement of nursing quality is closely related with efficient performance, and therefore, to promote the performance of nurses, a reasonable performance assessment system has to be established, which links the results of performance assessment with pay and brings about a favorable circle of performance-assessment-bonus.As for the present state of per-post pay of nurses, the base wage is low, the income relatively fixed, and the bonus loosely related to performance, which greatly affects the work enthusiasm of nurses. In 2008, under the direction of the Hospital Party Committee, the Nursing Department proposed and gradually implemented a new mode of performance management, with active-service nurses playing the leading role, non-active-service nurses as the backbone, and contract nurses managed by technical grades, appointed to posts according to corresponding technical grades and paid according to specific posts. In the early stage of the implementation, we conducted a survey in the Department of Obstetrics and Gynecology in view of its higher requirement of professional knowledge, longer training cycle, larger proportion of female members, and wider distribution of working places, such as delivery room, maternity ward, neonates room in the Obstetric Division, and obstetric clinic, gynecological clinic, ultrasound room, infant swimming room in the Outpatient Department.Objective:The new mode of performance management, with active-service nurses playing the leading role, non-active-service nurses as the backbone, and contract nurses appointed to specific posts according to their corresponding technical grades, may introduce a better incentive and competition among nurses. A steady echelon of outstanding nurses can be established by giving full play to their technical and management talent and rational planning of their professional career, which, in turn, may help optimize the grade-based nursing management, so that abilities may match up to posts and posts to pay, and the working enthusiasm of all nurses may be effectively aroused. By trial implementation of this mode of management in the Department of Obstetrics and Gynecology, we aimed to investigate the value of the technical grade-based wage system and its accompanying problems.Methods:According to the technical grade-based management, contract nurses were classified into four technical grades, from Grade 4, the highest, to Grade 1, the lowest. And the Grade-4 nurses were again categorized into senior 4, medium 4 and junior 4 based on their professional and technical qualifications. Grade-4 nurses constituted about 20% of the whole nursing staff, which was determined mainly by the technical requirements of nursing units, Grade-3 nurses about 20% also, and Grade-2 and Grade-1 nurses about 30%, respectively. Ten Grade-4 nurses were appointed in the Department of Obstetrics and Gynecology for its higher technical requirements, accounting for about 25% of the total number. The selection of Grade-4 nurses involved six procedures:mobilization, initial screening, specialist interview, examination results evaluation, publication of the selected, and signing of employment contracts.The responsibilities were defined for nurses of different technical grades. Grade-1 and Grade-2 nurses were chiefly charged with the general nursing responsibilities stipulated in the hospital, while Grade-3 and Grade-4 nurses, in addition to the above duties, were required to further improve their professional skills, participate in nursing researches and training. And Grade-4 nurses were further required to assist the head nurse in the management of the nursing unit, organize relevant training and researches within the unit, ensure the application of special nursing techniques, take part in training in advanced nursing techniques, and develop special training activities.The wage system was readjusted to different technical grades. Grade-1 and Grade-2 nurses were paid exclusively according to the set wage standards, while Grade-3 and Grade-4 nurses enjoyed additional grade-based technical subsidies, which was included in the cost accounting of a specific department.The mode of nursing unit management was reformed by setting up key nursing posts (key management posts and key technical posts) and adjusting key-post wages and bonus allocation to ensure post-based pay in nursing units.Finally, a questionnaire investigation was conducted among the contract nurses in the Department of Obstetrics and Gynecology.Results:1. After the implementation of the technical grade-based wage system, the mean work satisfaction score was increased from 3.2 to 3.7 points in the Department of Obstetrics and Gynecology against the full score of 5 points (t=3.062, P<0.05).2. After the initiation of the new mode of performance management, the mean satisfaction score of the patients was significantly elevated from 7.43 to 8.38 points against the full score of 10 points (t=-4.433, P<0.05).3. From the result:about 34.21% of them thought that what they benefited most from this wage system was "the broadened way of their professional development", about 23.68% considered it to be "increased salary ", and 13.16% were more concerned about the opportunities of being professionally promoted that the pay system might provide.4. Satisfaction of nurses with the technical grade-based wage system. Age is related to nurses' satisfaction with the technical grade-based wage system.The nurse: more than 36 years old has a high satisfaction,less than 25 years old and 26-35 years old has low satisfaction with the wage system.Conclusion:1. The technical grade-based wage system has offered a good professional development platform and broadened the way of professional development for contract nurses.The technical grade-based wage system has provided a base for the road of rational professional development of nurses, effectively coordinated the goal of personal development with that of the hospital, and established a win-win relationship between nurses and the hospital. The existing wage and promotion systems for contract nurses is imperfect in the special structure of military hospitals and, to a certain extent, have weakened the working enthusiasm of contract nurses. In the technical grade-based wage system, excellent nurses are entrusted with more important responsibilities and given corresponding subsidies, while other nurses can see their goals to be attained and the direction to be followed. Less than a year's practice in the Department of Obstetrics and Gynecology showed that 34.21% of the nurses thought that this system could broaden the way of their professional development.2. Accelerating all-round implementation of the technical grade-based wage system stage by stageThe structural reform of the army has caused a certain shortage of talented nurses, and the junior contract nurses make up a major proportion of the nursing staff. Generally, they are lack of nursing experience and their skills need to be further improved. Therefore, at the initial stage of the introduction of the technical grade-based wage system, only a few meet the requirements of Grade-3 and Grade-4 nurses, and even fewer are Grade-4 nurses, who account for only one-quarter of the required number. As a result, this wage system has achieved a very small benefit coverage. According to the plan, the all-round implementation of the technical grade-based wage system is divided into 3 stages and completed in 3 years. In the first stage, some contract nurses were already selected based on the requirements of different technical grades. With the gradual improvement of the juniors'skills and the exemplary role of the first batch of Grade-4 nurses, we shall complete the selection of all the nurses as required in the second and third stages. The results of investigation show that the staged implementation needs to be accelerated. Meanwhile, in the process of the implementation, the Nursing Department and head nurses should further publicize the system and hold more discussions, so that more junior nurses may have deeper insights into the significance of the system, and hence a greater impetus to better work.3. While stressing steady staged implementation of the technical grade-based wage system, we have to further publicize the related policy and speed up the process at a reasonable pace. The Nursing Department and head nurses need to conduct more discussions and investigations to enable more junior nurses to see the nature of the system, so that they may have a greater impetus to better performance and give full play to their intelligence and abilities.
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