Investigation On The Allocation Status Of Perinatal Nursing Human Resources In China’s Economically Developed Areas

BackgroundHealth human resources are the first part of health resources, and nursing human resources are a crucial part of health human resources. The working experience, training, and distribution of perinatal nurses is widely recognized as a crucial determinant of both health system performance and maternal and child health outcomes. Currently, the world faces a serious shortage of perinatal nurses, particularly the United States, Australia, and Britain. Each day about1000mothers die from pregnancy or childbirth-related complications secondary to inadequate nursing resources, and lack of appropriate perinatal care also affects child mortality, contributing to2million newborn deaths each day. After economic and policy reform over the past three decades, there have been remarkable improvements in China’s healthcare workforce, particularly with respect to employees’talent, education, and personal efficiency. China’s health personnel are growing younger and education qualifications are developing to higher and multiple levels. But with the deepening health system reforms and fierce international competition for talent, China also faces shortages of perinatal nurses (especially midwives) and unbalanced distribution. This study was sponsored by a multicenter research fund of Chinese Medical Association (CMA, No.2012A1003).This study took a large scale investigation and analysis on the allocation of perinatal nursing human resources and the midwives’working scope in China’s economically developed areas from January to April in2013by judgment sampling (seven provinces) and multi-stage stratified sampling (466Grade III and Grade II hospitals with perinatal nursing service) to explore reasonable allocation standards and the rational midwives’working scope, and provide a scientific basis for administrative departments of public health to make policies on allocation and development of perinatal nursing human resources.Objectives1To understand the status of the perinatal nursing human resources stock, the population and geographical distribution, and the development trend during2005-2011in China’s economically developed areas.2To analyze the internal structure of perinatal nursing human resources in China’s economically developed areas.3To discover and analyze the existing problems and reasons of the perinatal nursing human resources allocation situation and the midwives’working scope in China’s economically developed areas, and put forward reasonable suggestions.Significance1This study analyzed the existing problems and reasons of the perinatal nursing human resources allocation situation in China’s economically developed areas. It could offer basic data and method reference for establishing a national perinatal nursing human resources database which has not been set up in China, offer local data for study about perinatal nursing human resources in the whole country, provide an important reference for the health administration department of China to make reasonable development plan and practical polices in perinatal nursing human resources field, and to make the national perinatal nursing professional talent training plans and polices of the talent training mode reform, etc. 2The results of this study is helpful to determine the reasonable midwifery working scope suitable for China, so as to further define the midwife professional competence, in order to provide foundation to establish a set of scientific, standardized, reasonable midwife professional competency evaluation index system and offer scientific decision basis for the health administrative department of China to make rational polices of perinatal nursing human resources development.Methods1Second-hand data analysis1.1Data resourcesThe2006-2012health statistical year-books in China was mainly used in the analysis on macro level:the overall changing trend of the national nursing human resources during2005-2011; the population distribution, the geographical area distribution, and the overall situation of nursing human resources distribution among the31provinces and municipalities in China’s economically developed areas.1.2Statistic methodsThe constituent ratio was used to reflect the endemic distribution of perinatal nursing human resources in China’s economically developed areas; the Lorenz curve and Gini coefficient to evaluate the equity of the population and geographic distributions of China’s economically developed areas’s perinatal nursing workforce in7provinces.2Cross-sectional studyThe questionnaire of perinatal nursing human resources status in China’s economically developed areas was used to investigate466GradeⅢ and Grade Ⅱ hospitals with perinatal services and the data about five aspects including general data of hospitals, the allocation status of obstetrical nursing human resources, the allocation status of neonatology nursing human resources, the cognitive data of nursing management personnel on perinatal human resources configuration, and the working scope of midwives in China’s economically developed areas. This study analyzed human resource data from China’s economically developed areas to better understand current perinatal nursing allocation and how to best optimize available resources.2.1Sampling and ascertainment methodsChina mainland had24provinces with more than one trillion Chinese Yuan (CNY) as the2012GDP. These24provinces were in China’s economically developed areas. Using judgment sampling, we extracted7provinces (Guangdong, Beijing, Hainan, Jilin, Jiangsu, Shandong and Zhejiang) among the24provinces. There were6provinces with more than one trillion CNY as2012GDP in the selected7provinces in our study. Therefore, the extracted research objects could fully represent the current allocation of perinatal nursing human resources in China’s economically developed areas and the problems we identified could be extrapolated to the general Chinese population. The questionnaire validity was assessed by one epidemiologist, one health management expert, one biostatistician, and seven senior nursing management experts, with a Cronbach’s a index of0.92and a content validity index of0.85. There were468pieces of questionnaires distributed to selected hospitals in an official letter and466recovered. The effective recovery rate was99.57%.2.2Statistic methodsThis study analyzed data by SPSS13.0statistical analysis software, used the goodness of fit test to evaluate sample quality, and used x2to test perinatal nursing staff’s demographic data (age, working years, education qualifications, titles, and employment, etc.). Using Independent Sample t Test, we compared bed nurse ratio and doctor nurse ratio in hospitals of four grades and four types with data from2005, standards issued by China’s Ministry of Health, and2011international horizontal data. Finally, we compared the whole distributions of allocation structure indicators (age, working years, education qualifications and titles) between four types and four grades hospitals using Kruskal-Wallis H Test.Results1The average annual national population growth rate of China in2005-2011was0.75%. The number of nurses and physicians increased by13.71%and5.67%, respectively, corresponding to an increase in the number of provider per thousand persons of12.97%for nurses and4.91%for physicians.2Four provinces (Guangdong, Zhejiang, Jiangsu and Beijing29.4%,23%,18.6%and23%, respectively) accounted for81.1%of perinatal nursing human resources, suggesting a misdistribution of China’s perinatal nursing providers. In terms of obstetrical nursing human resources distribution equity, two Gini coefficients of geographical and population distribution were both less than0.35and near zero, which indicated relatively perfect equity. The population distribution equity was superior to geographic distribution (Gini coefficients:0<0.039<0.075). In terms of neonatology nursing human resources distribution equity, two Gini coefficients of geographical and population distribution were also both less than0.35and near zero, which indicated relatively perfect equity. The population distribution equity was also superior to geographic distribution (Gini coefficients:0<0.028<0.064).3In2012, both the bed nurse ratio (1:0.51) and doctor nurse ratio (1:1.93) in obstetrics department failed to meet the Health Ministry’s standards (1:0.8-0.85and1:2) respectively (P<0.05). In2012, the bed nurse ratio (1:0.79) met the Health Ministry’s standards (1:0.8-0.85) and the doctor nurse ratio (1:1.22) failed to meet the Health Ministry’s standards (1:2) in neonatology department respectively (P<0.05).4Age distribution of obstetrical nursing staff showed25-34-year old. Midwives and obstetrical nurses accounted for42%and47%respectively. More midwives, had amassed more than10years of work experience (43%). Midwives and obstetrical nurses with junior college degree as the main body took up50%and51%respectively, and with primary title as the main body took up51%and68%respectively. Age distribution of neonatology nursing staff showed25-34-year old (55%).The distribution of working experience was average. Nurses with junior college degree as the main body took up48%, with primary title as the main body66%, and without establishment40%.The perinatal nursing personnel with young ages, senior skilled, higher education, and advanced technical titles were relatively concentrated in Grade Ⅲ-A hospitals and Public hospitals of women and children.5Midwives, obstetrical nurses and neonatology nurses were employed by44.1%,73.3%, and60.3%of hospitals, respectively. Although, obstetrical nurses and neonatology nurses earned salaries (3000-5000CNY per month) similar to other hospital employees and the majority of hospitals had policies in place to guarantee nurses’welfare,75.1%of midwives,73.5%of obstetrical nurses and86.88%neonatology nurses remained unsatisfied with their compensation.6The drain rates of midwives, obstetrical nurses and neonatology nurses were5.2%,4.7%and6.7%respectively. The employed nursing staff occupied larger proportions in the loss of nursing staff (55.8%,72.8%and76.3%respectively). The age of drain nursing staff concentrated in25to35years-old, the education qualifications concentrated in technical secondary school levels, and the titles focused on primary or no title. The first one cause of drain nursing staff was large labor intensity, big working risk and too much working stress. The second one was low welfare treatment. Then was lack of social recognition.768.2%of obstetric nursing managers were not satisfied with the midwives’title system, and48.4%thought that midwives in China should set up independent title promotion system on the basis of referring to foreign midwife title system.92.5%of obstetric nursing managers held the very recognition attitude of the midwife-led continuity midwifery service mode. In terms of the fitness between working situation with their own career planning,72%of midwives,70.5%of obstetric nurses and56.1%of neonatology nurses were not satisfied.8The independent working scope of midwives in China was smaller than international standard, among which medical records management, cooperation with the prenatal screening and diagnosis, eugenic counseling, the identification of high-risk pregnancy and referral, and midwives counseling clinic. All of above needed qualifications to be carried out. In the surveyed466hospitals, only27%carried out the midwife consultation clinic. The average cesarean delivery rate of466health agencies in China’s economically developed areas was45.05%, and natural birth rate was only52.5%.89.2%of health facilities adopt lithotomy position as regular delivery position and it accounted for more than95%of all delivery positions.Conclusions1The stock and per capitas (including bed nurse ratio, doctor nurse ratio, the number of nurses per one thousand persons, and the annual national economical growth rate) of China’s economically developed areas’s perinatal nursing human resources proved insufficient. And there still exsisted a gap in the geographical distribution equity of perinatal nursing human resources in China’s economically developed areas.2The nursing workforce of China’s economically developed areas was distributed unevenly among different types and grades of hospitals.3The allocation structure of China’s economically developed areas’s perinatal nursing human resources failed to meet needs of nursing disciplinary development. The perinatal nursing personnel with young ages, senior skilled, higher education, and advanced technical titles were insufficient and relatively concentrated in GradeⅢ-A hospitals and Public hospitals of women and children. The employed nurse had become an important part of nursing team in our country, and was also the main part of perinatal nursing drain.4The midwives’registration and examination system, the professional title system, working scope, and service mode had some gaps with the international standards.