Cirugía en horario extendido: una visión de los actores involucrados / Extended hours surgery: a vision of the actors involved

Introducción. Las listas de espera para cirugía de alta prevalencia son producto de una limitada oferta ante una elevada demanda de jornadas quirúrgicas. Tienen un impacto sobre las condiciones médicas de los pacientes y la consulta por urgencias. Como respuesta, se han incorporado los espacios quirúrgicos adicionales en horarios no convencionales. Su creciente implementación, aunque controversial, se reconoce cada vez más como una nueva normalidad en cirugía. Hay una limitada documentación de la efectividad de la medida, debido a la complejidad e intereses de los participantes. Métodos. Se analizó desde una posición crítica y reflexiva la perspectiva de los actores involucrados en un programa de cirugía en horario extendido, estableciendo las posibles barreras y los elementos facilitadores de una política enfocada a procedimientos en horario no convencional. Asimismo, se describen posibles oportunidades de investigación en el tema. Discusión. Los programas quirúrgicos en horarios no convencionales implican un análisis de los determinantes de su factibilidad y éxito para establecer la pertinencia de su implementación. La disponibilidad de las salas de cirugía, una estandarización de los procedimientos y una cultura de seguridad institucional implementada por la normativa vigente, favorecen estas acciones operacionales. Los aspectos económicos del prestador y del asegurador inciden en la planeación y ejecución de esta modalidad de trabajo. Conclusión. La realización segura y el éxito de un programa de cirugía en horario no convencional dependen de la posibilidad de alinear los intereses de los actores participantes en el proceso

Introduction. Waiting lists for high-prevalence surgeries are the product of limited supply due to a high demand for surgical days. They have an impact on patients' medical conditions and emergency consultation. In response, additional surgical spaces have been incorporated at unconventional times. Its growing implementation, although controversial, is increasingly recognized as a new normal in surgery. There is limited documentation of the effectiveness of the measure due to the complexity and interests of the participants. Methods. The perspective of the actors involved in an extended hours surgery program was analyzed from a critical and reflective position, establishing the possible barriers, and facilitating elements of a policy focused on procedures during unconventional hours. Possible research opportunities on the topic are also described. Discussion. Surgical programs at unconventional times involve an analysis of the determinants of their feasibility and success to establish the relevance of implementation. The availability of operating rooms, a standardization of procedures and a culture of institutional security implemented by current regulations, favor these operational actions. The economic aspects of the provider and the insurer affect the planning and execution of this type of work. Conclusion. The safe realization and success of a surgical program in unconventional hours depend on the possibility of aligning the interests of the actors involved in the process

Classificação de pacientes e dimensionamento de pessoal de enfermagem em unidade de internação pediátrica / Patient classification and nursing staff dimensioning in a pediatric inpatient unit / Clasificación de pacientes y dimensionamiento del personal de enfermería en una unidad de hospitalización pediátrica

RESUMO Objetivo: descrever a implantação do Sistema de Classificação de Pacientes e o dimensionamento do pessoal de enfermagem em unidade de internação pediátrica. Método: estudo descritivo, transversal e retrospectivo, realizado em um hospital universitário do Centro-Oeste do Brasil. Depois da implantação do Sistema de Classificação de Pacientes pediátricos, compilaram-se dados das classificações do nível de complexidade assistencial (N=4.639) entre pacientes (n=608) internados de janeiro a dezembro de 2019. Empregou-se análise estatística descritiva, incluindo metodologia própria para dimensionamento de pessoal. Resultados: houve prevalência de pacientes de cuidados intermediários. Pelo dimensionamento do pessoal, constatou-se superávit (+10) de trabalhadores de nível médio, e o quantitativo de enfermeiros projetado (seis) era compatível com o disponível. Conclusão: a implantação/emprego estratégico do Sistema de Classificação de Pacientes foi indispensável para a previsão de pessoal de enfermagem pediátrica, considerando que o superávit de pessoal constatado deve ser apreciado com cautela.

ABSTRACT Objective: to describe the implementation of the Patient Classification System and the dimensioning of the nursing staff in a pediatric inpatient unit. Method: a descriptive, cross-sectional, and retrospective study, carried out at a university hospital in the Midwest of Brazil. After the implementation of the Pediatric Patient Classification System, we compiled data from the classifications of the level of care complexity (N=4,639) among patients (n=608) admitted from January to December 2019. Descriptive statistical analysis was employed, including proprietary methodology for staff sizing. Results: there was a prevalence of intermediate care patients. According to the staff dimensioning, there was a surplus (+10) of mid-level workers, and the projected number of nurses (six) was compatible with the available number. Conclusion: the strategic implementation/employment of the Patient Classification System was indispensable for the pediatric nursing staffing forecast, considering that the staffing surplus found should be appreciated with caution.

RESUMEN Objetivo: describir la implantación del Sistema de Clasificación de Pacientes y el dimensionamiento del personal de enfermería en una unidad de hospitalización pediátrica. Método: estudio descriptivo, transversal, retrospectivo, realizado en un hospital universitario del Centro-Oeste de Brasil. Tras la implantación del Sistema de Clasificación de Pacientes Pediátricos, se recopilaron los datos de las clasificaciones del nivel de complejidad asistencial (N=4.639) entre los pacientes (n=608) ingresados de enero a diciembre de 2019. Se utilizó el análisis estadístico descriptivo, incluida nuestra propia metodología de dimensionamiento del personal. Resultados: prevalencia de pacientes de cuidados intermedios. En cuanto a la dimensión del personal, se constató un superávit (+10) de trabajadores de nivel medio, y el número de enfermeros proyectado (seis) era compatible con el disponible. Conclusión: la implementación/empleo estratégico del Sistema de Clasificación de Pacientes fue indispensable para la previsión del personal de enfermería pediátrica, considerando que el excedente de personal encontrado debe ser apreciado con cautela.

Research and practice of hospital security human resource allocation / 中华医院管理杂志

A complete hospital security system is essential for the life and property safety of medical workers, patients and their families alike. The successful operation of the system depends on a reasonable staffing of the security department.From 2019, a tertiary hospital has explored and practiced the staffing management of security guards based on the actual needs of the hospital. The first job was to classify its security posts setup, and determine the staffing requirements of front-line security posts based on such indicators as scale, risk and people flow. The management range theory was called into play, to set the staffing coefficient of front-line security posts and their corresponding frontline administrators as 7∶1, and set that each management post needs one middle manager. The next job was to calculate the number of security guards per workload/post. The calculations estimated that the number of guards required for the four front-line security posts, namely, gate keeper post, public area patrol post, security and fire control post, and emergency response unit post, was 37, 46, 26 and 26 respectively. The corresponding management posts, namely, the office of the security department, the security management team, the fire management team, and the order maintenance team, required 7, 8, 5 and 5 management personnel respectively, totaling 160. Based on the calculations, the hospital optimized its staffing, and increased its total security personnel from 150 to 160, including the number of gate keeper posts were reduced by 17, and the number of emergency response unit posts was increased by 22. This optimization has effectively empowered the security department in dealing with medical disputes and emergencies, as well as identifying fire hazards, which serves a reference for the rational staffing of hospital security human resources.

The role, responsibility and staffing of nuclear medicine physicists / 中华放射医学与防护杂志

Nuclear medicine physicists play an important role in nuclear medicine, and they are also a significant part of medical physicists. This study investigated the regulations and requirements of international organizations such as International Atomic Energy Agency (IAEA) and International Organization Medical Physics (IOMP)for medical physicists in nuclear medicine, and discussed the necessity, role, responsibilities and the quantity requirements of nuclear medicine physicists staffing in hospitals according to the demand for nuclear medicine physicists and the present situation of nuclear medicine physicists in China, so as to provide a reference for the work of nuclear medicine physicists in China.

Nurse staffing during the SARS, MERS, and Ebola epidemics: A narrative review

Background@#The COVID-19 pandemic has put an immense strain on health systems worldwide. Nurses at the front line are prone to experience several staffing issues facing ever-increasing stresses to the health care system by a pandemic situation. The staffing experiences of nurses in this context can have a significant impact on current nursing practice and existing policies.@*Objective@#To carry out a synthesis of the scientific evidence available on the staffing experiences of nurses during the SARS, MERS, and Ebola epidemics.@*Method@# A narrative review was conducted. A literature search was carried out in PubMed, Scopus, and CINAHL databases. All studies describing nurses' experiences were included regardless of methodology. Atotal of 16 articles was included in the review.@*Results@#Narrative synthesis revealed ten themes from the results of the articles: training, staffing ratios and models, shifting models, volunteer staffing, skill mix, planning staffing needs, hospital preparedness, communication, effects of workload, and structured workflow processes.@*Conclusions@#Nurses are pivotal to the healthcare response to infectious disease pandemics and epidemics. The results of this review should provide a basis for nurse managers and administrators on how they can actively engage in supporting the staffing concerns and issues of nurses during the COVID-19 pandemic.

Determining Nurse Staffing By Classifying Patients Based on their Nursing Care Needs / 간호행정학회지

Measuring Health Clinics’ Workload Pressure in Kelantan Using the Workload Indicator of Staffing Needs

@#Introduction: Proper distribution of human resources is an important factor ensuring high-quality performance and sustained service quality. The aim of this study was determining the workload pressure among medical officers in health clinics (HCs) in Kelantan. Method: A record review survey was conducted between January and April 2019 using human resources data for 2018 involving HCs in Kelantan. It included all the HCs in Kelantan and excluded community clinics. Workload pressure was determined using a tool known as Workload Indicator of Staffing Needs, developed by World Health Organization. A high workload pressure was defined as a ratio between required and acquired medical officers of less than 1. The data were presented descriptively using as frequencies and percentages. Results: All 85 HCs in Kelantan were involved in the study; 90% (9/10) of the Kelantan districts recorded high workload pressure. Moreover, 68.2% (58/85) HCs had high workload pressure. Tanah Merah, Tumpat, Pasir Mas, and Kota Bharu had the most HCs with high workload pressure, and most such HCs were found in areas with a high-density population, requiring huge coverage. Conclusion: The Kelantan State Health Department should develop better human resource distribution strategies to ensure the sustainability of quality care in HCs.

Dimensionamento de pessoal para cuidados paliativos em uma instituição complexa de oncologia / Staff design for palliative care in a complex oncology institution

O presente estudo trata do dimensionamento de recursos humanos para cuidados paliativos oncológicos. As justificativas estão assentadas em argumentos como a transição epidemiológica do câncer associada ao envelhecimento da população e as estimativas mundiais de escassez de profissionais para a saúde. O principal objetivo deste trabalho foi contribuir para o dimensionamento dos recursos humanos de saúde no âmbito dos cuidados paliativos em oncologia. Os objetivos específicos foram revisar metodologias de dimensionamento de recursos humanos utilizadas para cuidados paliativos; analisar a carga de trabalho dos recursos humanos de saúde em uma unidade complexa de cuidados paliativos oncológicos e elaborar recomendações de dimensionamento e padrões de atividades no processo de trabalho de cuidados paliativos em oncologia. Foi realizada uma investigação quanti-qualitativa, descritiva e exploratória ancorada na perspectiva funcionalista, com base na pesquisa bibliográfica com uso de revisão integrativa e estudo documental. Acresceu-se ao processo investigativo estudo de caso com utilização de entrevista semiestruturada se utilizando de análise temática de conteúdo e aplicação da ferramenta WISN com utilização de software. Os resultados evidenciaram que há carência de literatura específica para dimensionamento de pessoal em cuidados paliativos oncológicos; que os papéis e atribuições definidos para profissionais desta área são genéricos e não traduzem a complexidade do cotidiano; que não há um padrão de atividades estipulado por categoria; e que a mensuração da carga de trabalho pode auxiliar o planejamento dos serviços. O produto da pesquisa foi uma definição de atividades-padrão para cada grupo profissional, análise e comparação das atividades por categorias, por setores, por turnos de trabalho e recomendações para incluir os recursos humanos como parte fundamental de uma política nacional de cuidados paliativos. Concluiu-se que a ferramenta WISN é aplicável para o planejamento de recursos humanos em instituições oncológicas de cuidados paliativos e permite vários desdobramentos para análise que podem ser utilizados com outros métodos consagrados na literatura.

The present study deals with the dimensioning of human resources for palliative oncology care. The justifications are based on arguments such as the epidemiological transition of cancer associated with the aging of the population and worldwide estimates of the shortage of health professionals. The main objective of this work was to contribute to the dimensioning of human health resources within the scope of palliative care in oncology. The specific objectives were to review methodologies for dimensioning human resources used for palliative care; analyze the workload of human health resources in a complex oncology palliative care unit and develop recommendations for sizing and patterns of activities in the palliative care work process in oncology. A quantitative-qualitative, descriptive and exploratory investigation was carried out, anchored in the functionalist perspective, based on bibliographic research using an integrative review and documentary study. A case study was added to the investigative process using semi-structured interviews using thematic content analysis and application of the WISN tool using software. The results showed that there is a lack of specific literature for dimensioning personnel in oncology palliative care; that the roles and duties defined for professionals in this area are generic and do not reflect the complexity of everyday life; that there is no standard of activity stipulated by category; and that measuring workload can assist with service planning. The product of the research was a definition of standard activities for each professional group, analysis and comparison of activities by categories, sectors, work shifts and recommendations to include human resources as a fundamental part of a national palliative care policy. It was concluded that the WISN tool is applicable for the planning of human resources in oncological palliative care institutions and allows several developments for analysis that can be used with other methods established in the literature

Variations in the number of births by day of the week, and morbidity and mortality in very-low-birth-weight infants / Variações no número de partos por dia da semana e morbidez e mortalidade em neonatos com muito baixo peso ao nascer

Abstract Objective: To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. Methods: This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. Results: Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p < 0.001), but differences were no longer significant after adjusting for confounding factors. Conclusions: The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.

Resumo Objetivo: Conhecer a distribuição dos partos de neonatos com muito baixo peso ao nascer durante a semana e se essa distribuição afeta a morbidez e a mortalidade nesse grupo de pacientes. Método: Esta é uma análise retrospectiva de dados coletados prospectivamente na rede espanhola SEN1500 (2002-2011). Foram excluídos neonatos nascidos em outro local, pacientes com grandes anomalias congênitas e pacientes falecidos na sala de parto. Os partos foram agrupados em "Dias úteis" e "Final de semana". Foi realizada uma análise de regressão logística multivariada para avaliar o efeito independente do parto sobre os resultados e uma regressão de Cox para avaliar a sobrevida. Resultados: Do total de 27.205 neonatos com muito baixo peso ao nascer nascidos e/ou internados nos centros participantes, 22.961 (84,4%) atenderam aos critérios de inclusão. Houve uma redução de 24% no número de partos no "Final de semana" em comparação com os "Dias úteis". Na análise bruta, os pacientes nascidos em finais de semana apresentaram maior morbidez e mortalidade (Taxa de mortalidade: 14,2% em comparação a 16,5%, p < 0,001), porém as diferenças não eram mais significativas após o ajuste aos fatores de confusão. Conclusões: Nossos resultados sugerem que as práticas atuais de atendimento reduzem a proporção de partos em finais de semana e tendem a agrupar alguns partos de alto risco nesse período, aumentando a morbidez e mortalidade brutas. Contudo, após o ajuste aos fatores de risco, as diferenças desaparecem, sugerindo que a cobertura de atendimento geral em nossos centros é adequada.

Adequacy of Nurse Staffing Level in Integrated Nursing Care / 간호행정학회지

PURPOSE: This study was done to evaluate the adequacy of nurse staffing in integrated nursing care. METHODS: Statistical data on integrated nursing care from the National Health Insurance Corporation was used in this study. We extracted hospital data and patient data related to patient needs for nursing care. We analyzed the differences in patient needs by staffing level of each type of medical institution. RESULTS: Approximately 70% of medical institutions provided nursing care by the mid level of nurse staffing, which was 1:6, 1:10 and 1:12 in the tertiary hospital, general hospital and semi-hospital, respectively. The patients' characteristics were significantly different by hospital type. Especially, the distribution of the main diagnosis was completely different between the tertiary hospital and semi-hospital. In the tertiary hospital, the patient needs measured by severity and activities of daily living dependency were higher at higher staffing level than at lower staffing level. However, the nurse staffing was less relevant to the patient needs in the general hospital and semi-hospital. CONCLUSION: To provide high-quality nursing care, accurate workload forecasting is required at the start, and then the standard nurse staffing level can established based on workload forecasting.

Effect of Crowding and Nurse Staffing on Time to Antibiotic Administration for Patients with Pneumonia in an Emergency Department / 간호행정학회지

PURPOSE: This study was conducted to identify the effect of crowding and nurse staffing on time to antibiotic administration for pneumonia patients in an emergency department (ED). METHODS: The sample included pneumonia patients visiting an ED from November 1, 2014 to February 28, 2015. Crowding was measured using ED occupancy rate, nurse staffing was measured as total length of stay per nurse and number of patients per nurse and the time duration was measured for the following processes: from patient arrival to prescription, from prescription to blood culture and antibiotic administration, and from blood culture to antibiotic administration. Data collected from the electronic medical records were analyzed using multivariate analyses. RESULTS: The mean times from arrival to antibiotics administration, from prescription to antibiotic administration, and from blood culture to antibiotic administration were 128.31, 47.29, and 15.60 minutes, respectively. Crowding, nurse staffing, work experience of the nurse and severity of the patient influenced the time duration of each process from patient arrival to antibiotic administration. CONCLUSION: The results reveal that crowding and nurse staffing affect length of time to antibiotic administration in pneumonia patients. Guidelines for safe nurse staffing in ED are required to improve patient outcomes.

National Survey on Clinical Pharmacy Services of Tertiary Hospitals in China: Part 2. Staffing of Clinical Pharmacist Team / 中国药学杂志

OBJECTIVE: To obtain data related to staffing of clinical pharmacist team of tertiary hospitals, find problems in staffing of the team, based on which provide advice on policy formulation. METHODS: A face-to-face interview survey was conducted to collect data on tertiary hospital clinical pharmacists' higher education background, standardized training and employment status which were analyzed with descriptive statistics tools. RESULTS: Respondents' highest degrees are mainly bachelor degree (36.9%) and master degree (54.6%); pharmacy occupies the largest proportion (60.2%) of the undergraduate majors, and medical /pharmaceutical majors beside clinical pharmacy, pharmacy and clinical medicine occupy the largest proportions of master (58.9%) and doctorate (100.0%) majors; the clinical pharmacists' highest standardized training certification are mainly national specialist clinical pharmacist (63.3%), and the type of certification are mainly granted by China's Ministry of Health; professional title of the respondents are mainly primary titles and intermediate title; most respondents' work seniority are shorter than 5 years. CONCLUSION: Educational background, certification of standardized training and clinical experience of clinical pharmacists of tertiary hospitals in China require further improvement.

Considerations and Discussions of Abolishing the Staffing of Government Affiliated Institutions in Public Hospitals / 中国医院管理

Through analysis of current state of personnel management of staffing of government affiliated institutions in public hospitals,in-depth exploration into certain aspects that are involved in abolishing staffing of government affiliated institutions,such as hospitals with different functions,regional health planning,hospitals' essential property as public interest,cultivation of human talents in medical treatment,matched welfare policies for the aged and financial investment is done.It is recomended that under the influence of many factors,public hospitals and governments should improve both the internal and external conditions for the multi-perspective influential factors in the early stage of reform.

A survey of family doctors′staffing and service capability in Changning district ,Shanghai / 中华医院管理杂志

Objective To evaluate the present family doctors staffing and service capacity building in Changning under the linkage reform of contracting service and health insurance payment . Methods The staffing data of family doctors were collected from the 2013-2015 annual reports ,while the data on their qualifications ,training ,job stress and competence were collected from two follow-up investigations. These data were analyzed with descriptive statistics .Results in 2016 ,the number of family doctors totaled 27000 ,up to 2.75 doctors per 10000 people.Over 97％ of the family doctors were qualification certificated.More than half of the family doctors participated in the standardized training .68.80％ (97/141)of the family doctors complained overwork.More than 80％ of the family doctors have encountered technical problems with medical services .Conclusions The number and quality of family doctors in Changning have been greatly improved to satisfy contracting services of the residents to a minimal extent. However ,more family doctors are needed ,as they still face much work stress. The family doctors call for standardized training ,better payroll and incentive mechanism ,better career development and coordinated support mechanism ,as well as better team building for greater performance .

Medical Radiation: Status and Availability in The Bahamas / Radiación Médica: Estatus y Disponibilidad en las Bahamas

ABSTRACT Introduction: The Bahamas became a member state of the International Atomic Energy Agency (IAEA) on January 7, 2014 (1). The purpose of this paper is to inform the reader on The Bahamas' ability to provide services that utilize radiation. Method: A study was conducted on various clinics across The Bahamas, New Providence in particular (primary sample area), Grand Bahama, Abaco and Exuma. Twenty per cent of the staff members of the respective locations were given questionnaires and the chief personnel were interviewed. Staff members were advised that their responses would remain anonymous and were welcomed to participate, thereafter. Microsoft Excel was used for data input and processing. Original surveys were checked against the dataset for potential errors. Results: Thirty-one clinics were approached to participate in the survey, of which 25 participated resulting in an 81% response rate. Fifty questionnaires were completed in total. Two clinics had multiple locations; therefore, 27 clinics (23 private, 4 public) participated in total. The included map illustrates the sample area of the survey, with New Providence being the primary sample area. The number of modalities, patients treated and frequency of quality assurance checks were also evaluated. Conclusion: Most of the examined clinics outsourced technicians and physicists to perform quality checks. This suggests that there is a need for qualified local technical support. Further studies are needed to understand the full extent of the country's needs regarding medical radiation and figuring out the steps necessary for approaching this subject.

RESUMEN Introducción: Las Bahamas se convirtieron en un Estado Miembro de la Agencia Internacional de Energía Atómica (AIEA) el 7 de enero de 2014 (1). El propósito de este trabajo es informar al lector sobre la capacidad de las Bahamas para prestar servicios que utilizan radiación. Método: Se realizó un estudio en varias clínicas a través de las Bahamas, Nueva Providencia en particular (área de muestra primaria), Gran Bahama, Abaco y Exuma. El veinte por ciento de los miembros del personal de las respectivas locaciones recibieron cuestionarios y el personal dirigente fueron entrevistados. A los miembros del personal se les informó que sus respuestas permanecerían anónimas, y se les dio la bienvenida por su participación. Para la entrada y el procesamiento de datos se usó Microsoft Excel. Las encuestas originales se chequearon contra el conjunto de datos para a fin de detectar posibles errores. Resultados: Treinta y una clínicas fueron abordadas para participar en la encuesta, de las cuales 25 participaron, para una tasa de respuesta de 81%. En total se completaron 50 cuestionarios. Dos clínicas tenían múltiples localidades. Por lo tanto, 27 clínicas (23 privadas, 4 públicas) participaron en total. El mapa incluido ilustra el área de la muestra de la encuesta, en la que Nueva Providencia es el área de la muestra primaria. El número de modalidades, los pacientes tratados, y la frecuencia de los controles de garantía de calidad, también fueron evaluados. Conclusión: La mayor parte de las clínicas examinadas subcontrataron técnicos y físicos para realizar chequeos de la calidad. Esto sugiere que hay necesidad de apoyo técnico local calificado. Se necesitan estudios adicionales para entender el alcance completo de las necesidades del país en relación con la radiación médica y los pasos necesarios para abordar este asunto.

Changes in Nurse Staffing Grades in General Wards and Adult and Neonatal Intensive Care Units / 임상간호연구

PURPOSE: This study aimed to explore the distributions of nurse staffing grades and to report changes in staffing grades in general wards and adult and neonatal intensive care units(ICUs) by hospital type and location. METHODS: Data collected from the Health Insurance Review and Assessment Service were analyzed. Nurse staffing was categorized from grades 1 to 6 or 7 for general wards, 1 to 9 for adult ICUs, and 1 to 4 for neonatal ICUs based on the nurse-to-bed ratio. RESULTS: The staffing grade for the general wards improved during 2008-2016 in 69.8% of the tertiary hospitals, 58.5% of the general hospitals, and 31.7% of the non-general hospitals. The adult ICUs at tertiary hospitals exhibited a greater improvement in staffing grades (48.8%) than did those of general hospitals (44.2%) during 2008-2015. Tertiary hospitals in non-capital regions showed a greater improvement than those in the capital region. The majority of neonatal ICUs (67.1%) had no change in the staffing grade during 2008-2015. CONCLUSION: Improvements in nurse staffing differed by hospital type and location. Government policies to improve nurse staffing in non-tertiary hospitals and those in non-capital regions are required to reduce variations in nurse staffing.

Estimation of Nurse Staffing Based on Nursing Workload with Reference to a Patient Classification System for a Intensive Care Unit / 중환자간호학회지

PURPOSE: This study aimed to estimate the appropriate nurse staffing ratio in intensive care units (ICUs) by measuring nursing workload based on patient's severity and needs, using the Korean Patient Classification System for critical care nurses.METHODS: The data were collected from January 18 to February 29, 2016 using a standardized checklist by observation or self-report. During the study period, 723 patients were included to be categorized from I to IV using the patient classification system. Measurement of total nursing workload on a shift was calculated in terms of hours based on the time and motion method by using tools for surveying nursing activities. The nursing activities were categorized as direct nursing care, indirect nursing care, and personal time. Total of 127 cases were included in measuring direct nursing time and 18 nurses participated in measuring indirect and personal time. Data were analyzed using descriptive statistics.RESULTS: Two patients were classified into Class I (11.1%), 5 into Class II (27.8%), 9 into Class III (50%), and two into Class IV (11.1%). The amount of direct nursing care required for Class IV (513.7 min) was significantly more than that required for Class I (135.4 min). Direct and indirect nursing care was provided more often during the day shift as compared to the evening or night shifts. These findings provided the rationale for determining the appropriate ratio for nursing staff per shift based on the nursing workload in each shift.CONCLUSIONS: An appropriate ratio of nurse staffing should be ensured in ICUs to re-arrange the workload of nurses to help them provide essential direct care for patients.

Development of Staffing Levels for Nursing Personnel to Provide Inpatients with Integrated Nursing Care / 간호행정학회지

PURPOSE: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. METHODS: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. RESULTS: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. CONCLUSION: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.

Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications

PURPOSE: This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. METHODS: Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. RESULTS: An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). CONCLUSION: To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future.

Policy Issues and New Direction for Comprehensive Nursing Service in the National Health Insurance / 간호행정학회지

PURPOSE: This study was done to identify issues surrounding comprehensive nursing care within the national health insurance, analyze results and problems within national health insurance and to suggest new policy directions for stability. METHODS: A literature search was performed using RISS, KISS, PUBMED databases. Eighteen studies were analyzed. RESULTS: For implementation of comprehensive nursing care, there was improvement in nursing and in facilities. By improvement of structure, this new system showed positive outcomes in term of patient satisfaction and indicators related to patient safety. However, issues related to overload, job stress and evaluation of the system remain. In order to establish this system, staffing levels for nurses and nurse aids need to be adjusted to appropriate levels that reflect requirements for nursing. In addition, range of work needs to be determined clearly. Lastly, regular and systematic evaluation is needed to provide safe quality services to patients and to prevent waste of financial resources. CONCLUSION: Comprehensive nursing care needs to be implemented in ways that patients can be provided with safe and high quality service. There is a need to resolve several issues to allow this new system to function.