北京市三级甲等医院急诊科护士配置现状的横断面研究

摘要

目的：调查北京市三级甲等医院急诊科护士配置现状,为人力资源优化配置提供参考依据。方法采用分层抽样法,选取19家北京市三级甲等医院为受试单位,对急诊科设置、急诊护士基线数据、急诊护士配置状况、离职护士和原因等内容进行横断面调查。结果年急诊量>10万人次的医院占84.21％,实际急诊科护士数与医院总床位数之比为(3.97~10.40)∶100,急诊科各区域床护比依次为：ICU区(0.6±0.3)∶1、抢救区(0.7±0.3)∶1、留观区(1.9±0.7)∶1、输液区(15.7±14.6)∶1和分诊区(49.0±21.0)∶1；急诊科护士人员构成中男护士占总护士数的7.50％,35岁以下护士占总护士数的79.30％,临床工作年限3年以下占26.12％、各层级职称护士比例,初级职称、中级职称、高级职称比例为1∶0.15∶0.01；护士离职危险因素包括工作负荷、人身威胁,保护因素包括福利待遇、职业归属感(P<0.05)。结论急诊量的超负荷是导致护理人力资源不足、床护比超标的主要原因；当前急诊护士配置存在的主要问题是男护士比例缺乏、护理队伍普遍年轻、资质有待提高；造成急诊护士离职的主要原因是工作负荷重、人身安全受到威胁,福利待遇低和缺乏职业归属感。%Objective To investigate the present situation of nurses allocation in emergency department in Beijing tertiary hospitals, and provide reference for the optimization of human resources allocation. Methods The cluster sampling method was used and 19 hospitals were selected as the test units. We conducted a cross-sectional study about the emergency department setting, the baseline data and allocation situation of emergency nurses, the reason of nurses for leaving, etc. Results The hospitals with emergency visits >100 thousand/year accounted for 84.21%. The ratio of the number of nurses in emergency and the total hospital beds was (3.97-10.40) ∶100, while the ratios of the number of nurses and beds in emergency department were:intensive care unit (ICU):(0.6±0.3), rescue area:(0.7±0.3)∶1, observation area:(1.9±0.7)∶1, infusion area:(15.7±14.6)∶1 and triage area:(49.0±21.0)∶1. Male nurses accounted for 7.50% of the total number of the nurses, nurses under 35 years old accounted for 79. 30% and nurses with working time below 3 years accounted for 26.12%. The ratio of the primary, secondary and senior nurse was 1∶0.15∶0.01. The risk factors of nurses′quit were working load and personal threats, and the protection factors included the low welfare benefits and lack of professional sense of belonging (P<0.05). Conclusions As a result of overload in emergency department, the nursing human resource is in shortage, and the ratio of nurses and beds is higher than the standard ratio. The current main problems of nurses allocation in emergency department are: lack of male nurses, younger in age of the nursing team, and unqualified. The reasons of nurses′ quit are working load, personal threats, low welfare benefits and lack of professional sense of belonging.