Shandong Province, A Tertiary Level Hospital Quality Care Demonstration Ward Nursing Workload Cost Estimation Studies

Objective:" Better nursing care than treatment", As an important part of health care services, nursing care plays an irreplaceable role in the development of medical and health. The purpose of this study is to provide the basis for the rational distribution of the hospital nursing staff and for the construction of clinical support systems by measuring the workload of nursing staff, to offer reference data for higher-level health administration and the pricing authorities by combining workload with the cost of care service, and thus to promote the sustainable improvement of care quality.Method:In this study,we choose ICU, pediatrics, obstetrics, cardiology, respiratory medicine, neurology, gastroenterology, orthopedic surgery, thoracic surgery, and urology department for the study of a total of 10 places in some third-grade class-A hospitals in Shandong Province from June 2011 to July 2011. According to the work habits and characteristics of the hospital nursing care, we classify the treatment and care programs into 65 items of direct nursing care and 40 items of indirect nursing care.22 investigators count the nursing workload by recording the care time that each patient actually received. All measurement data are entered EPIdata2.0 database and statistical analysis through SPSS software.Results:1. By analyzing the 10 clinical departments of the workload study data, we found that some nursing staff in day shift already were overburdened or near full capacity. The ratio of care to bed is much less effective than the ratio of nurse to patient to reflect the actual care work department.2. The direct care time is 64.97% of total nursing time in 10 clinical departments。There are statistically significant differences among the proportion of direct care time in all departments. Primary care, body temperature, pulse, respiration (referred to as TPR) measurements, liquid replacement, intravenous fluids and oral medication were the top five of direct care items for the time-consuming up. Placing the drug, preparation, checking, prescription processing/checking, drugs, goods, supplies received, print a variety of lists, and charging hospital fees were the top five of direct care items for the time-consuming. At the present stage, there were duplication of work, inefficient labor, and the phenomenon of nursing staff practicing non-nursing work in care work.3. The same care level of patients in different departments actually received different care time.4. The different qualifications and skill of nurses provided different meaning and quality of care services for patients.5. By analyzing the hospital costs and nursing charges, we found that the current nursing care fee covers fewer projects, and the part of the nursing care fees are only charged the materials cost. The survey of 350 patients with hospital costs indicated that care cost accounted for only 1.22% of hospital costs. By contrast, surgical cost is 9.06% and drug costs is 37.81%. There is a big gap between standard and actual charges, intensive care nursing 144 yuan/day vs 202.44 yuan/day, intensive care 96 yuan/day vs 142.61 yuan/day, levels of care 9 yuan/day vs 98.48 yuan/day two nursing 6 yuan/day vs 77.68 yuan/day, three nursing 3 yuan/day vs 67.03 yuan/day. Which resulted in a huge gap between care expenditures and the actual collection.6. By investigating 10 ward nurses per capita income 37261.36 yuan (before tax) in 2010 compared with per capita income of 37,440 yuan at the state-owned units in Jinan City in 2009, nursing staff income is relatively low. By comparing the income of 10 nursing wards, we found that nurses hard work, the critical condition of patients, and the risk coefficient of departments work were not proportional to the nursing staff income.Conclusion:1. According to ward nursing workload and labor intensity, the hospital should appropriately increase the number of nursing staff, reasonably allocate the nursing staff in different period of times and section offices, at the same time strengthen the clinical support system construction, enforce nursing staff performance assess, achieve the most optimal configuration of nursing workforce, and effectively control nursing manpower costs.2. In order to reflect the value of nursing work, relevant departments should appropriately increase the level of care fees, and heighten or supply some of the fees of special care item according to the characteristics of nursing care.3. To strengthen the full cooperation between the hospital and the community and to promote the development of community health services solve the "difficult" and "expensive" problem in seeing a doctor.