| Objective:to determine the effectiveness of management of nurse ladder in maternal wards; to establish the standards of the competency levels of different ladder nurses and job responsibilities of different levels of nurses. To implement and evaluate the clinical ladder program.Methods:In the first stage, we preliminarily determine the nurse ladder framework in maternal wards, standards of the competency levels and job responsibilities of different ladder nurses based on literature review and the reality of our hospital. After two rounds of expert consultation and discussion, the final consensus was reached. In the second stage, management of nurse ladder in maternal wards was implemented and evaluated. All nurses in maternal wards at our hospital were included in our study. There were no significant difference on nurses’age, education level between different wards. The following items such as job satisfaction of patients, doctors and nurses, the implementation of breast feeding, etc were compared before and after the program of clinical nurse ladder.Results:the nurse ladder framework in maternal wards, the nurses were divided into four ladders:Nl, N2, N3, and N4. The standards of the nurse competency is composed of7dimensions, namely, clinical nursing ability, dianosis and monitor nursing problem, education and coach the patient and low ladder nurses, evaluate and control treatment and nursing intervention, quality management, leadership and meet a contingency. Different levels of nurses have different ability description and the corresponding requirements in each dimension.The score of job satisfaction of nurses was2.82±0.527å'Œ2.97±0.526(t=-1.693, P>0.05) before and after the program of clinical nurse ladder. Nursing job satisfaction were improved in all dimensions except "coworkers" and"extrinsic",The three dimensions of’praise and recognition" and"control and responsibility"," balance of family and job" were significantly improved. Prior to the implementation, only" coworkers" and " praise and recognition" achieved satisfactory degree, after the implementation, in addition to the above two dimensions," control and responsibility" has achieved the satisfactory degree.Satisfaciton of patients on the nursing was6.21±0.728and6.38±0.460(t=-2.205, P<0.05) before and after the implementation. Satisfaction of doctors on nursing before and after the implementation was also evaluated and was found not significant (6.38±0.641and6.49±0.530, t=-0.911, P>0.05), but"co-operation with the nurses " and "emergency ability" were found significantly improved.The following items concerning maternal breastfeeding were mostly improved after the implementation. It included the correct rate access posture (84.31%vs96.83%x2=4.06, P<0.05);the correct rate of breast feeding (64.81%vs88.24%x2=9.58, P<0.01); unused bottle nipple (85.19%vs98.53%x2=6.01, P<0.05); duration of sucking after cesarean section(15.39+7.11vs22.22+14.62, t=2.067, P <0.05);the incidence of breast tenderness (27.78%vs11.76%, x2=5.04, P<0.05); the incidence of chapped nipple (31.48%vs16.18%x2=3.98, P<0.05); the nipple illusion incidence(3.70%vs1.47%x2=0.04, P>0.05); the rates of exclusive breastfeeding(68.67%vs85.19%x2=12.09, P<0.01).Conclusions:The management of nurse ladder in maternal wards can improve satisfaciton of nurses in"praise and recognition^"control and responsibility"and"balance of family and work"; improve maternal satisfaction on nursing service; improve the doctors’satisfaction on the dimension of "cooperation with nurses" and" emergency capability";improve the patient’s knowledge and ability of breast breeding so that reducing the incidence of breastfeeding problems and raising breast-feeding rate. |
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